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Antihypertensive Mechanism of Ketanserin in Postoperative Hypertension After Cardiopulmonary Bypass

The effect of ketanserin (0.15 mg/kg followed by an infusion at 6 mg/hr) was studied in 13 patients who developed hypertension (blood pressure > 150/90 mm Hg) after cardiopulmonary bypass (CPB) for coronary artery bypass grafting. Eleven patients responded to ketanserin with a decrease of arterial pressure from 159 ± 15/83 ± 10 mm Hg to 131 ± 9/70 ± 12 mm Hg (P < 0.01), which was sustained during the subsequent infusion of ketanserin. Mean plasma ketanserin concentrations were maintained at 187 /μg/L (range 118–525). No significant changes in plasma levels of 5-hydroxyindoles or in platelet 5-hydroxytryptamine content were observed during or after CPB, or after administration of ketanserin. Plasma epinephrine (398 ± 124 pg/ml) and norepinephrine (1161 ± 673 pg/ml) concentrations were markedly increased during the hypertensive period after CPB. Plasma epincphrine concentrations decreased (P < 0.01) during ketanserin infusion to 213 ± 101 pg/ml, whereas plasma norepinephrine concentrations did not change. The pressor response to three graded doses of phenylephrine was decreased during CPB (P < 0.01), and a further decrease (P < 0.05) occurred during infusion of ketanserin. The hypotensive effect of ketanserin after CPB may be attributable to alpha1,-adrenoceptor blockade rather than to its antiserotoninergic effect. Serotonin does not appear to be involved in the short-term disturbances of arterial pressure during or after CPB.