Arterial Hypotension and Hypertension

2019 ◽  
pp. 293-296
Author(s):  
Kirstin M. Erickson ◽  
Daniel J. Cole
Keyword(s):  
Arterial Hypotension

Terlipressin Versus  Norepinephrine to Correct Refractory Arterial Hypotension after General Anesthesia in Patients Chronically Treated with Renin-Angiotensin System Inhibitors

2003 ◽  
Vol 98 (6) ◽  
pp. 1338-1344 ◽  
Author(s):  
Gilles Boccara ◽  
Alexandre Ouattara ◽  
Gilles Godet ◽  
Eric Dufresne ◽  
Michèle Bertrand ◽  
...  
Keyword(s):  
Blood Pressure ◽  
General Anesthesia ◽  
Arterial Blood Pressure ◽  
Renin Angiotensin System ◽  
Arterial Hypotension ◽  
Angiotensin System ◽  
Renin Angiotensin ◽  
Arterial Blood ◽  
Long Term Treatment ◽  
Systolic Arterial Blood Pressure

Background Terlipressin, a precursor that is metabolized to lysine-vasopressin, has been proposed as a drug for treatment of intraoperative arterial hypotension refractory to ephedrine in patients who have received long-term treatment with renin-angiotensin system inhibitors. The authors compared the effectiveness of terlipressin and norepinephrine to correct hypotension in these patients. Methods Among 42 patients scheduled for elective carotid endarterectomy, 20 had arterial hypotension following general anesthesia that was refractory to ephedrine. These patients were the basis of the study. After randomization, they received either 1 mg intravenous terlipressin (n = 10) or norepinephrine infusion (n = 10). Beat-by-beat recordings of systolic arterial blood pressure and heart rate were stored on a computer. The intraoperative maximum and minimum values of blood pressure and heart rate, and the time spent with systolic arterial blood pressure below 90 mmHg and above 160 mmHg, were used as indices of hemodynamic stability. Data are expressed as median (95% confidence interval). Results Terlipressin and norepinephrine corrected arterial hypotension in all cases. However, time spent with systolic arterial blood pressure below 90 mmHg was less in the terlipressin group (0 s [0-120 s] vs. 510 s [120-1011 s]; P < 0.001). Nonresponse to treatment (defined as three boluses of terlipressin or three changes in norepinephrine infusion) occurred in zero and eight cases (P < 0.05), respectively. Conclusions In patients who received long-term treatment with renin-angiotensin system inhibitors, intraoperative refractory arterial hypotension was corrected with both terlipressin and norepinephrine. However, terlipressin was more rapidly effective for maintaining normal systolic arterial blood pressure during general anesthesia.

Renal and pressor effects of aminoguanidine in cirrhotic rats with ascites.

1996 ◽  
Vol 7 (12) ◽  
pp. 2694-2699
Author(s):  
M C Ortíz ◽  
L A Fortepiani ◽  
C Martínez ◽  
N M Atucha ◽  
J García-Estañ
Keyword(s):  
Nitric Oxide ◽  
Blood Pressure ◽  
Liver Cirrhosis ◽  
Experimental Model ◽  
Systemic Blood Pressure ◽  
Arterial Hypotension ◽  
Control Group ◽  
No Production ◽  
Water Excretion ◽  
Excretory Function

Recent work indicates that nitric oxide (NO) plays an important role in the systemic and renal alterations of liver cirrhosis. This study used aminoguanidine (AG), a preferential inhibitor of inducible nitric oxide synthase (iNOS), to evaluate the role of this NOS isoform in the systemic and renal alterations of an experimental model of liver cirrhosis with ascites (carbon tetrachloride/ phenobarbital). Experiments have been performed in anesthetized cirrhotic rats and their respective control rats prepared for clearance studies. Administration of AG (10 to 100 mg/kg, iv) elevated dose-dependent mean arterial pressure (MAP, in mm Hg) in the cirrhotic rats from a basal level of 79.3 +/- 3.6 to 115.0 +/- 4.7, whereas in the control animals, MAP increased only with the highest dose of the inhibitor (from 121.8 +/- 3.6 to 133.3 +/- 1.4). In the cirrhotic group, AG also significantly increased sodium and water excretion, whereas these effects were very modest in the control group. Plasma concentration of nitrates+nitrites, measured as an index of NO production, were significantly increased in the cirrhotic animals in the basal period and decreased with AG to levels not significantly different from the control animals. Similar experiments performed with the nonspecific NOS inhibitor N omega-nitro-L-arginine (NNA) also demonstrated an increased pressor sensitivity of the cirrhotic rats, but the arterial hypotension was completely corrected. These results, in an experimental model of liver cirrhosis with ascites, show that AG exerts a beneficial effect as a result of inhibition of NO production, increasing blood pressure and improving the reduced excretory function. Because NNA, but not AG, completely normalized the arterial hypotension, it is suggested that the constitutive NOS isoform is also contributing in an important degree. It is concluded that the activation of both inducible and constitutive NOS isoforms plays an important role in the lower systemic blood pressure and associated abnormalities that characterize liver cirrhosis.

The Impact of Late Onset Arterial Hypotension on Respiratory Outcome in Extremely Premature Infants

Neonatology ◽  
2018 ◽  
Vol 115 (2) ◽  
pp. 164-168
Author(s):  
Waleed Kurtom ◽  
Deepak Jain ◽  
Meiying Quan ◽  
Silvia Vanbuskirk ◽  
Eduardo Bancalari ◽  
...  
Keyword(s):  
Premature Infants ◽  
Late Onset ◽  
Arterial Hypotension ◽  
Respiratory Outcome ◽  
The Impact

scholarly journals Systemic disorders and the prognosis of stroke in Congolese patients: a cross-sectional study

2020 ◽  
Vol 54 (4) ◽  
pp. 225-230
Author(s):  
Marc Tshilanda ◽  
Ulrick S. Kanmounye ◽  
Remy Kapongo ◽  
Michel Tshiasuma
Keyword(s):  
Stroke Patient ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Arterial Hypotension ◽  
Sectional Study ◽  
Stroke Event ◽  
Chi Square ◽  
Cross Sectional ◽  
Chi Square Test ◽  
The Mean

Objectives: Stroke is one of the leading causes of death, disability, and dementia in developing countries. Our study aimed to evaluate the systemic disorders associated with mortality in patients admitted within 72 hours of the initial stroke event. Setting: The study took place at a tertiary hospital in Kinshasa. Participants: Patients admitted within 72 hours of the initial stroke event. Interventions: This cross-sectional study consisted of a retrospective review of stroke patient records from January 2016 to December 2018. The Pearson-Chi square test and odds ratios were calculated with a threshold of significance of 0.05. Main outcome measures: Mortality Results: We recruited 114 cases. The mean age was 61.8 ± 2.4 years, and the sex ratio was 1.78 in favor of men. Hypertension (76.3%), dyslipidemia (71.1%), and diabetes mellitus (58.8%) were the most frequent comorbidities. Most patients had hypoxia (85.9%), hypertension (82.4%), hyperglycemia (57.8%), and fever (28.1%). We registered thirty-two deaths (28.1%): 20 (62.5%) from the ischemic strokes, and 12 (37.5%) from hemorrhagic strokes. Systemic disorders with the worst prognosis during were arterial hypotension (OR=3.87, p >0.001), and fever (OR = 1.56, p = 0.047). Conclusion: Arterial hypotension and fever adversely affect stroke patient outcomes, and strokes are responsible for high mortality in Congo

scholarly journals Preoperative management and features of induction of anaesthesia in acute bowel obstruction (clinical lecture)

2021 ◽  
Vol 16 (7-8) ◽  
pp. 18-32
Author(s):  
M.М. Pylypenko ◽  
M.V. Bondar
Keyword(s):  
General Anaesthesia ◽  
Bowel Obstruction ◽  
Rapid Sequence Induction ◽  
Arterial Hypotension ◽  
Infusion Therapy ◽  
Electrolyte Disturbances ◽  
Vital Functions ◽  
Rapid Sequence ◽  
Abdominal Hypertension ◽  
Induction Of Anaesthesia

This article presents the main approaches to the pre-operative preparation of patients with severe acute bowel obstruction and emphasizes that this preparation should be limited in time and don’t delay the surgery. In severe bowel obstruction, in addition to a thorough assessment of vital functions and determination of leading physiologic disorders, it is extremely important to examine patients using specific scales which allow determining the risks of major complications. General anaesthesia usually is the method of choice for acute bowel obstruction; however, it could be supplemented by regional anaesthesia to improve intra- and postoperative pain relief. While preparing for general anaesthesia, first of all, it is necessary to determine the risks of difficult airway and complicated intubation, as well as regurgitation and aspiration of gastric contents, which allows you to purposefully approach the choice of intubation techniques and prevent the occurrence of these formidable complications. Sellick’s manoeuvre is no longer required in these patients, and instead of it during intubation, bimanual laryngoscopy can be used. Arterial hypotension is a common complication during induction of anaesthesia in severe bowel obstruction, and such patients should always be treated with infusion therapy, and their fluid and electrolyte disturbances should be corrected. At the same time, to prevent intestinal oedema and the development of intra-abdominal hypertension, infusion therapy should be limited both in time and in volume. If hypovolemia cannot be completely corrected, vasopressors should be given prophylactically to reduce the risk of significant arterial hypotension during rapid sequence induction.

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