Canadian Journal of Anesthesia, Vol 25, 198-203, Copyright © 1978 by Canadian Anesthesiologists' Society

Serum Epinephrine and Norepinephrine During Valve Replacement and Aorta-Coronary Bypass

¹ Department of Anesthesiology, Loyola University Stritch School of Medicine, 2160 South First Avenue, Maywood, Illinois
² Department of Surgery, Loyola University Stritch School of Medicine, 2160 South First Avenue, Maywood, Illinois

A comparison of the levels of serum epine-phrine, norepinephrine and blood pressure was made in 25 patients undergoing aorta-coronary bypass or valve replacement who were anaesthetized with a nitrous oxide-narcotic technique. Serum epinephrine and norepinephrine were measured in arterial samples drawn pre-induction, post-induction, before cardiopulmonary bypass, two and eight minutes after initiation of cardiopulmonary bypass, 20 minutes before termination and after termination of cardiopulmonary bypass. In both patient groups significant increases in epinephrine and norepine-phrine occurred before cardiopulmonary bypass, with accompanying increase of blood pressure in the valve replacement patients. During cardiopulmonary bypass an initial hypotensive response (p < 0.001) was recorded, followed by a significant increase in blood pressure and epinephrine in both groups. After cardiopulmonary bypass, aorta-coronary bypass patients had epinephrine, norepinephrine and blood pressure equal to levels before cardiopulmonary bypass. In contrast, serum epinephrine continued to rise in the valve replacement patients, with a gradual recovery of blood pressure to pre-bypass levels. These findings demonstrate significant differences in blood pressure and catecholamine response in patients with valvular disease from patients with coronary artery disease.