Local Anesthetic -Bupiv Acaine Increases the Peritoneal Transport of Solutes. Part I: In Vivo Study

1984 ◽  
Vol 4 (4) ◽  
pp. 221-223 ◽  
Author(s):  
Andrzej Breborowicz ◽  
Jan Knapowski
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Local Anesthetic ◽  
Vascular System ◽  
Dialysis Fluid ◽  
The Past ◽  
The Mean ◽  
Long Acting ◽  
Solute Clearance

A local anesthetic -bupivacaine was used in concentration 0.25 mmol/l in the dialysis fluid during peritoneal dialysis in rabbits. Bupivacaine increased the mean peritoneal clearance of urea by 33% and of inulin by 53%. The effect of the anesthetic persisted during next exchanges, performed without the drug. Bupivacaine given intraperitoneally, did not decrease blood pressure. Peritoneal dialysis is used widely for treatment of renal failure (1). During the last few years, many attempts have been made to find a substance, which would increase the efficiency of peritoneal dialysis (2, 4). In the past we observed that procaine added to the fluid augments peritoneal solute clearance (5). Local anesthetics in the peritoneal cavity influence both the mesothelium and the vascular system. In the present study we used bupivacaine a long-acting, tissue-bound local anesthetic as the adjunct during peritoneal dialysis in rabbits.

Minoxidil Selectivel Y Improves Peritoneal Ul Trafiltration

1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 91-94 ◽  
Author(s):  
Assem K. El-Sherif ◽  
Nader H. Rizkalla ◽  
Mohamed H. Essawy ◽  
Ahmed M. El-Gohary
Keyword(s):  
Peritoneal Dialysis ◽  
Chronic Hemodialysis ◽  
Dialysis Session ◽  
Dialysis Fluid ◽  
Endstage Renal Disease ◽  
Urea Nitrogen ◽  
Fluid Removal ◽  
The Mean ◽  
To Receive ◽  
Solute Clearance

This cross-over randomized clinical trial was car-ried out to evaluate the effects of intraperitoneal (IP) administration of minoxidil on fluid removal and solute clearance during peritoneal dialysis. Twenty-one patients with endstage renal disease, awaiting enrollment in chronic hemodialysis therapy, were randomly allocated to receive IP minoxidil either in the first or the last nine cycles of a 24-cycle peritoneal dialysis session. Cycle-to-cycle data on fluid balance, blood pressure, and adverse effects of the drug were obtained. The dialysis fluid recovered in cycles 3,6,9, 18,21, and 24 was analyzed, together with plasma, for creatinine, urea nitrogen, and protein content. The mean excess fluid volume collected in minoxidil cycles was 1123.8±1119 mL versus 145.2±743.6 mL in the minoxidil-free cycles (p = 0.004). The mean creatinine clearance, urea nitrogen clearance, and protein losses were comparable in minoxidil cycles and the minoxidilfree cycles. Six patients developed hypotension during the minoxidil cycles, corrected by normal saline, but no other important side effects were noted. It is concluded that IP minoxidil selectively increases ultrafiltration without influencing solute clearance in peritoneal dialysis.

Risk Factors for Early Mortality in U.S. Peritoneal Dialysis Patients: Impact of Residual Renal Function

2002 ◽  
Vol 22 (3) ◽  
pp. 371-379 ◽  
Author(s):  
◽  
Michael V. Rocco ◽  
Diane L. Frankenfield ◽  
Barbara Prowant ◽  
Pamela Frederick ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Renal Function ◽  
Peritoneal Dialysis ◽  
Serum Albumin ◽  
Creatinine Clearance ◽  
Residual Renal Function ◽  
Chronic Peritoneal Dialysis ◽  
Dialysis Patients ◽  
The Mean

Background Potential risk factors for 1-year mortality, including the peritoneal component of dialysis dose, residual renal function, demographic data, hematocrit, serum albumin, dialysate-to-plasma creatinine ratio, and blood pressure, were examined in a national cohort of peritoneal dialysis patients randomly selected for the Centers for Medicare and Medicaid Services End-Stage Renal Disease (ESRD) Core Indicators Project. Methods The study involved retrospective analysis of a cohort of 1219 patients receiving chronic peritoneal dialysis who were alive on December 31, 1996. Results During the 1-year follow-up period, 275 patients were censored and 200 non censored patients died. Among the 763 patients who had at least one calculable adequacy measure, the mean [± standard deviation (SD)] weekly Kt/V urea was 2.16 ± 0.61 and the mean weekly creatinine clearance was 66.1 ± 24.4 L/1.73 m2. Excluding the 365 patients who were anuric, the mean (±SD) urinary weekly Kt/V urea was 0.64 ± 0.52 (median: 0.51) and the mean (±SD) urinary weekly creatinine clearance was 31.0 ± 23.3 L/1.73 m2 (median: 26.3 L/1.73 m2). By Cox proportional hazard modeling, lower quartiles of renal Kt/V urea were predictive of 1-year mortality; lower quartiles of renal creatinine clearance were of borderline significance for predicting 1-year mortality. The dialysate component of neither the weekly creatinine clearance nor the weekly Kt/V urea were predictive of 1-year mortality. Other predictors of 1-year mortality ( p < 0.01) included lower serum albumin level, older age, and the presence of diabetes mellitus as the cause of ESRD, and, for the creatinine clearance model only, lower diastolic blood pressure. Conclusion Residual renal function is an important predictor of 1-year mortality in chronic peritoneal dialysis patients.

Abstract P279: Human Angiotensin Receptor Gene Variations, Hypertension & Reno-Vascular Complications

Hypertension ◽  
2016 ◽  
Vol 68 (suppl_1) ◽  
Author(s):  
Sudhir Jain ◽  
Natalie Sirianni ◽  
Nitin Puri ◽  
Ahmed A Khudhair ◽  
Ashok Kumar
Keyword(s):  
Blood Pressure ◽  
Transcriptional Regulation ◽  
Gene Expression Regulation ◽  
Vascular System ◽  
Receptor Gene ◽  
Vascular Complications ◽  
Renin Angiotensin System ◽  
Organ Damage ◽  
Angiotensin Receptor

Angiotensin receptor type 1 (AT1R), a G-protein coupled receptor mediates the effect of angiotensin-II and contributes to the pathophysiological consequences of reno-vascular system. AT1R-signaling promotes renal sodium retention, vascular remodeling, hypertension, and end organ damage. Genetic variations that increase AT1R can cause pathological outcomes associated with renin angiotensin system overactivity. However, genetically variable, transcriptional regulation of the human AT1R gene is poorly understood. In this regard, the human AT1R gene has a haplotype block of four SNPs: T/A at -810, T/G at -713, A/C at -214, and A/G at -153 in its promoter. Variants -810T, -713T, -214A, and -153A always occur together (named haplotype-I or Hap-I) and variants -810A, -713G, -214C, and -153G always occur together (haplotype-II or Hap-II). We have found that hap-I is associated with hypertension in Caucasians. Thus, we generated transgenic (TG) mice with hap-II and I of the hAT1R gene to study its transcriptional regulation in vivo . TG mice with hap-I have higher baseline expression of hAT1R (3.9 folds) in the kidney with increased blood pressure (Hap-I, 126±3 vs. Hap II, 115±4). Since, diet-induced obesity is accompanied by systemic inflammation and redox imbalance that, in turn, alter the cellular transcriptional milieu, we gave Western diet (WD) treatment to our TG mice. Preliminary studies show that transcription factors like USF1, GR and STAT3 binds strongly (2.1; 2.3; 1.7 folds respectively Vs Hap-II) to increase hAT1R expression (5.8 folds) and resulting blood pressure (136±2 vs. 120±3 in Hap II) in TG-mice with hap-I, as compared to hap-II. Complementary experiments show increased inflammatory and redox markers in renal tissues of Hap-I mice, when compared to Hap-II, after WD; including, IL6 (5.9 fold), NOX1 (5.2 fold), CRP (9.8 fold), and TNFα (6.3 fold). Also, histochemical analysis of kidneys show an elevated pathology in Hap-I TG mice. Thus, haplotype-dependent transcriptional regulation of the hAT1R gene causes increased hAT1R expression and blood pressure, in Hap-I TG mice. Importantly, WD exacerbates this differential gene- expression regulation, further increasing hAT1R and promoting a pro-oxidant/inflammatory milieu in mice with Hap-I.

EFFECT OF USING FENTANYL AS AN ADDITIVE WITH THE LOCAL ANAESTHESTIC MIXTURE IN PERIBULBAR BLOCK FOR CATARACT SURGERIESA PROSPECTIVE RANDOMIZED CONTROL STUDY

2021 ◽  
pp. 5-7
Author(s):  
M.Selvi Annie Geeta ◽  
Lakshmi K.Nair
Keyword(s):  
Blood Pressure ◽  
Cataract Surgery ◽  
Respiratory Rate ◽  
Pulse Rate ◽  
Local Anesthetic ◽  
Sensory Blockade ◽  
Vas Score ◽  
Department Of Ophthalmology ◽  
Peribulbar Block ◽  
The Mean

INTRODUCTION: Cataract surgery is one of the most commonly performed surgery in the elderly patients. Regional anesthesia is safe, reliable, provide adequate akinesia and analgesia of the eye, a good postoperative pain relief and a shorter hospital stay. The various regional anesthetic techniques used in ophthalmic surgeries are peribulbar block, retrobulbar block, sub tenon's block, subconjunctival block and topical corneo-conjunctival anesthesia. Due to its safer approach, the peribulbar block is most commonly. Addition of an opioid like fentanyl to the anesthetic preparation will provide a faster onset of lid and globe akinesia, faster onset of sensory blockade, increase the duration of analgesia and reduce the need for rescue analgesia postoperatively. AIM OF THE STUDY: To evaluate the effect of addition of fentanyl to the local anesthetic mixture in peribulbar block in cataract surgery. MATERIALS AND METHODS: This study was done in the Department of Anesthesiology in collaboration with the Department of Ophthalmology in Kanyakumari Government Medical College from January 2019 to December 2019. Patient posted for cataract surgery were allocated into two groups by randomization (30 each). Group S – 4ml of 2% lignocaine with adrenaline premixed with hyaluronidase + 1ml of 0.5% Bupivacaine + 0.5ml normal saline. Group F – 4ml of 2% lignocaine with adrenaline premixed with hyaluronidase + 1ml of 0.5% Bupivacaine + 25 mcg Fentanyl (0.5 ml). The Parameters related to the study such as Onset of lid akinesia, Onset of globe akinesia, Onset of sensory blockade, Duration of analgesia by VAS score, Level of sedation by Ramsay sedation score, vital parameters – SpO , pulse rate, respiratory rate, blood pressure and any 2 Complications were recorded. RESULTS: We found that the demographic parameters were comparable and statistically insignicant. The preoperative hemodynamic parameters like the systolic and diastolic blood pressure, pulse rate, SpO2, respiratory rate were statistically insignicant and comparable. The mean onset of lid akinesia was 5.8 ± 1.76 mins and 3.13 ± 1.25 mins in Group S and Group F respectively. The mean onset of globe akinesia was found to be 7.46 ± 2.22 mins and 4.2 ± 1.60 mins in Group S and Group F respectively. The mean onset of sensory blockade was 6.8 ± 1.24 mins and 4.93 ± 1.63 mins in Group S and Groups F respectively. Thus the onset of globe and lid akinesia and the onset of sensory blockade was faster in Group F compared to Group S. The mean VAS scores were statistically signicant (P<0.001) between both the groups at 1 hour, 1.5 hour, 2 hour, 4 hour, 6 hour postoperatively and it was found that Group F has a lower VAS score when compared with Group S. The VAS score at 8 hour and 10 hours postoperatively were statistically insignicant (p>0.05) in both the groups. The mean duration of analgesia was 4.56 ± 1.65 hours in Group S and 7.63 ± 2.55 hours in Group F and was found to be statistically signicant(P<0.001). CONCLUSION: Based on this study, we can conclude that there is a faster onset in the lid akinesia, globe akinesia, in the onset of sensory blockade and a substantial increase in the duration of analgesia when fentanyl is used as an additive along with the local anesthetic mixture in peribulbar block for cataract surgery

scholarly journals P1159MILD BLOOD PRESSURE VARIABILITY IS ASSOCIATED WITH BETTER SURVIVAL IN PATIENTS WITH END STAGE RENAL DISEASE AND PERITONEAL DIALYSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Hanri Afghahi ◽  
Salmir Nasic ◽  
Khaled Alhomsi ◽  
Henrik Hadimeri ◽  
Helena Rydell ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Renal Disease ◽  
Mortality Risk ◽  
End Stage Renal Disease ◽  
Laboratory Findings ◽  
Risk Of Mortality ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims Recently, variability in blood pressure (BP) has been recognized as a risk factor for mortality and cardiovascular events in the general population. However, most studies included patients with normal or near normal kidney function. Aim To study the association between BP variability and the risk of all-cause mortality in patients with end stage renal disease (ESRD) and peritoneal dialysis (PD) treatment. Method From 2008 until the end of 2017, 2329 patients with ESRD and at least three months of PD (mean age: 63.8 years, men: 67.5%) were followed for 16 months in median (interquartile range: 11-28 months). Data were extracted from the Swedish Renal Register (SNR). The coefficient variation (CV = the ratio of the standard deviation (SD) to the mean value) was defined as BP variability in terms of systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) [SBP(SD)/SBP(mean), DBP(SD)/ DBP(mean), and MAP(SD)/MAP(mean), respectively]. The relationships between BP variability and mortality were examined by time-dependent Cox models to estimate hazard ratios (HR) and 95% confidence intervals (CI) in univariate and multivariate analyses, with adjustment for demographics, laboratory findings and comorbidity. Results During the follow-up period, 1054 (45%) deaths occurred. The mean level of BP variability was CV=0.10± 0.1. The highest rate of mortality was observed in the patients with the highest variability in SBP (CV&gt;0.25; 64% of those patients died). In the multivariate model, for each of the BP variables, we compared the risk of mortality in the lowest variability group (CV≤ 0.05) with that in the CV=0.10-0.15 group (reference): SBP: (HR 1.74, 95% CI 1.44- 2.09; p&lt;0.001); DBP: (HR 1.91, 95% CI 1.59- 2.23; p&lt;0.001); and MAP: (HR 1.73, 95% CI 1.44- 2.06; p&lt;0.001). Thus, for all BP variables, the lowest variability was associated with increased mortality risk. We then compared the highest variability group (CV&gt;0.25) with the CV=0.10-0.15 group (reference): SBP: (HR 1.60, 95% CI 1.14- 2.25; p&lt;0.001); DPB: (HR 1.74, 95% CI 1.44- 2.09; p&lt;0.001); and MAP: (HR 1.98, 95% CI 1.21- 3.27; p&lt;0.001). Thus, for all BP variables, the highest variability was related to increased mortality risk. Conclusion In this study, the association between BP variability and the risk of mortality was U-shaped in patients with ESRD and PD. Thus, both very low and high levels of BP variability were related to higher risk of mortality. Mild BP variability was associated with the lowest risk of mortality, which could suggest that, non-intensive and long duration of ultrafiltration (UF) with PD was probably beneficial in terms of survival

scholarly journals Blood pressure and hypertension prevalence among oldest-old in China for 16 year: based on CLHLS

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jiajun Du ◽  
Guoning Zhu ◽  
Yanhong Yue ◽  
Miao Liu ◽  
Yao He
Keyword(s):  
Blood Pressure ◽  
Oldest Old ◽  
Specific Population ◽  
Hypertension Prevalence ◽  
The Past ◽  
Healthy Longevity ◽  
Hypertension Prevention ◽  
Lack Of Information ◽  
The Mean ◽  
Lower Education

Abstract Background There were little national data on hypertension based on the oldest-old, and lack of information on chronological changes. This study aimed to describe trends of blood pressure (BP) levels and hypertension prevalence for the past 16 years among the oldest-old in China. Methods All the oldest-old who had participated in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) 1998 to 2014 with information about BP levels and hypertension were included in the analysis. Results There was fluctuation over the past 16 years for both SBP and DBP levels. The mean SBP level decreased from 148.4 ± 24.4 mmHg in 1998 to 130.8 ± 18.7 mmHg in 2005, and then increased to 139.7 ± 22.0 mmHg in 2014. The mean DBP level decreased from 84.3 ± 13.4 mmHg in 1998 to 78.9 ± 11.7 mmHg in 2008, and then increased to 79.7 ± 11.8 mmHg in 2014. The hypertension prevalence increased from 43.1 to 56.5% for the 16 years. The prevalence of isolated systolic hypertension was lowest in 2002–2005 (14.3%), and then increased to 30.7% in 2014. Multivariate logistic regression showed that older age, lower education and economic level, without health insurance were associated with higher hypertension prevalence. Conclusions There was a significant increase in hypertension prevalence among the Chinese oldest-old from 1998 to 2014. Greater efforts are needed for hypertension prevention among this specific population.

A Comparison of a Synthetic Prostaglandin and Xylometazolin Hydrochloride as Nasal Decongestants

1982 ◽  
Vol 90 (5) ◽  
pp. 595-597
Author(s):  
Richard T. Jackson ◽  
Jay E. Birnbaum
Keyword(s):  
Blood Pressure ◽  
Blood Vessel ◽  
Prostaglandin E ◽  
Synthetic Analog ◽  
Nasal Patency ◽  
Nasal Decongestant ◽  
Nasal Decongestants ◽  
Long Acting

A synthetic prostaglandin E2 analog was compared in the dog to xylometazoline hydrochloride and natural PGE1 and PGE2 for nasal decongestant activity. Using both in vivo nasal patency tests and in vitro nasal blood vessel contraction tests, the synthetic analog was more effective, was very long-acting, and did not change blood pressure at effective systemic or topical doses.

scholarly journals Ultrafiltration and Dialysis Adequacy with Various Daily Schedules of Dialysis Fluids

2012 ◽  
Vol 32 (5) ◽  
pp. 545-551 ◽  
Author(s):  
Ramón Paniagua ◽  
Malgorzata Debowska ◽  
María-De-Jesús Ventura ◽  
Marcela Ávila–Díaz ◽  
Carmen Prado–Uribe ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
High Glucose ◽  
Dialysis Fluid ◽  
Dialysis Adequacy ◽  
Mean Values ◽  
Fluid Removal ◽  
Glucose Exposure ◽  
The Mean ◽  
Dialysis Fluids ◽  
Small Solute

Dialysis regimens for continuous ambulatory peritoneal dialysis (CAPD) patients vary with the need for fluid removal, but also because of concerns about the local and systemic consequences of high glucose exposure. The implications of various regimens for dialysis adequacy—that is, fluid and small-solute removal—are not always clear. We therefore analyzed ultrafiltration (UF) and adequacy indices for 4 different combinations of dialysis fluid.Collections of 24-hour dialysate and urine were carried out in 99 patients on CAPD. On 4 separate occasions, each patient performed 4 exchanges in 24 hours, including 3 daily exchanges with 1.36% glucose and 1 night exchange with either 1.36% glucose (G1 schedule), 2.27% glucose (G2 schedule), 3.86% glucose (G3 schedule), or icodextrin (Ico schedule). Weekly, total, and dialysis Kt/V and KT were calculated for both urea and creatinine.The mean values of urea Kt/V and KT were significantly lower for the G1 schedule than for the G3 and Ico schedules. The adequacy indices for overnight application of 3.86% glucose and icodextrin were similar. Using dialysis fluids with 1.36% and 2.27% glucose overnight reduces glucose exposure, but those schedules may provide inadequate UF and small-solute removal in some patients (UF < 1 L daily, Kt/V < 1.7).

Computer Simulations of Continuous Flow Peritoneal Dialysis Using the 3-Pore Model—A First Experience

2019 ◽  
Vol 39 (3) ◽  
pp. 236-242 ◽  
Author(s):  
Carl M. Öberg ◽  
Giedre Martuseviciene
Keyword(s):  
Peritoneal Dialysis ◽  
Flow Rate ◽  
In Silico ◽  
Continuous Flow ◽  
High Volume ◽  
Dialysis Fluid ◽  
Pore Model ◽  
Dialysate Flow ◽  
Dialysate Flow Rate

Background Continuous flow peritoneal dialysis (CFPD) is performed using a continuous flux of dialysis fluid via double or dual-lumen PD catheters, allowing a higher dialysate flow rate (DFR) than conventional treatments. While small clinical studies have revealed greatly improved clearances using CFPD, the inability to predict ultrafiltration (UF) may confer a risk of potentially harmful overfill. Here we performed physiological studies of CFPD in silico using the extended 3-pore model. Method A 9-h CFPD session was simulated for: slow (dialysate to plasma creatinine [D/P crea] < 0.6), fast (D/P crea > 0.8) and average (0.6 < D/P crea < 0.8) transporters using 1.36%, 2.27%, or 3.86% glucose solutions. To avoid overfill, we applied a practical equation, based on the principle of mass-balance, to predict the UF rate during CFPD treatment. Results Increasing DFR > 100 mL/min evoked substantial increments in small- and middle-molecule clearances, being 2 - 5 times higher compared with a 4-h continuous ambulatory PD (CAPD) exchange, with improvements typically being smaller for average and slow transporters. Improved UF rates, exceeding 10 mL/min, were achieved for all transport types. The β2-microglobulin clearance was strongly dependent on the UF rate and increased between 60% and 130% as a function of DFR. Lastly, we tested novel intermittent-continuous regimes as an alternative strategy to prevent overfill, being effective for 1.36% and 2.27%, but not for 3.86% glucose. Conclusion While we find substantial increments in solute and water clearance with CFPD, previous studies have shown similar improvements using high-volume tidal automated PD (APD). Lastly, the current in silico results need confirmation by studies in vivo.

Sign in / Sign up

Export Citation Format

Share Document