S-100beta protein levels do not correlate with stroke in patients undergoing carotid endarterectomy under general anesthesia.

To establish the S-100beta protein profile during carotid artery surgery to show a possible correlation between postoperative stroke and this biochemical marker. Prospective, nonrandomized study. Departments of anesthesiology, biochemistry, and vascular surgery in a single university hospital. One hundred patients consecutively scheduled for carotid endarterectomy. Postoperative neurologic complications were defined as major, occurrence of a postoperative permanent stroke, or minor, occurrence of a new postoperative transient ischemic attack lasting < 2 hours. Serum samples were obtained before induction, before carotid artery cross-clamping, after declamping, at the end of surgery, during recovery, and on the first postoperative day. Concentrations of S-100beta were analyzed using a commercially available kit (LIA-mat S300 analyzer, Byk-Sangtec Medical, Bromma, Sweden). Ninety-five patients awoke without a neurologic defect. Three patients experienced a permanent stroke, and 2 patients had a transient ischemic attack. S-100 basal values were unrelated to preoperative status, including hypertension, neurologic status, renal function, and degree of the carotid lesion. S-100 concentration increased slightly but significantly at the end of surgery and remained stable until the first postoperative day. S-100 profile during the procedure was independent of the duration of carotid artery cross-clamping and the need for a shunt. S-100 serum level was not significantly different in the patients with a postoperative ischemic event in comparison with the entire group. The S-100 profile was not increased in 2 of 3 patients with a permanent stroke and in 1 of 2 patients with a transient ischemic attack in comparison with the 95 patients with uneventful recovery. S-100 concentration slightly increased at the end of surgery and remained high until the first postoperative day in all patients. S-100 was not significantly different in the patients with postoperative stroke. S-100 did not serve as a marker for postoperative stroke after carotid artery surgery. This fact must be taken into account during further investigations of S-100

Terlipressin-ephedrine versus ephedrine to treat hypotension at the induction of anesthesia in patients chronically treated with angiotensin converting-enzyme inhibitors: a prospective, randomized, double-blinded, crossover study.

In patients chronically treated with angiotensin converting-enzyme inhibitors (ACEI), typically selected doses of ephedrine do not always restore arterial blood pressure when anesthesia-induced hypotension occurs. We postulated that the administration of terlipressin, an agonist of the vasopressin system, with ephedrine more effectively restores pressure in this setting than the administration of ephedrine alone. This prospective, randomized, cross-over, double-blinded study compared terlipressin combined with ephedrine (n = 19) with ephedrine alone (n = 21) in treating hypotension at the induction of anesthesia in 40 ACEI-treated patients undergoing hypotension (mean arterial blood pressure [MAP] <65 mm Hg or <30% of baseline value) after standardized anesthetic protocol (target-controlled IV anesthesia with propofol). Data are mean +/- SD. Patient characteristics, MAP, and heart rate before and after the induction of anesthesia during hypotensive episodes were not significantly different between the two groups. After the first bolus, MAP was significantly greater in the Terlipressin-Ephedrine group (72 +/- 12 mm Hg versus 65 +/- 8 mm Hg, P < 0.05). The occurrence of a second hypotensive episode (5% versus 71%, P < 0.001), the duration (2 +/- 1 min versus 3 +/- 1 min, P < 0.01) of hypotensive episodes, and the median dose of ephedrine (3 versus 6 mg, P < 0.05) were significantly less in the Terlipressin-Ephedrine group. In conclusion, terlipressin combined with ephedrine is more effective than ephedrine alone for treating anesthesia-induced hypotension in ACEI-treated patients. We conclude that this patient population with a partially blocked endogenous response to hypotension may be good candidates for successful use of a vasopressin analog to counteract intraoperative refractory hypotension. IMPLICATIONS: Vascular surgical patients chronically treated with drugs that inhibit the functioning of the renin-angiotensin system may experience hypotension unresponsive to conventional therapy. This double-blinded, cross-over study demonstrated that in these patients the use of a vasopressin analog, terlipressin given with ephedrine, was effective in reversing intraoperative systemic hypotension refractory to ephedrine