Sharp systolic blood pressure elevation at extubation is a risk factor for symptomatic epidural hematoma after spine surgery

Study design: The present study is a single-center retrospective cohort study. Objective: The objective of the study is to verify the hypothesis that sharp elevation of systolic blood pressure at extubation is a risk factor for development of symptomatic epidural hematoma after spinal surgery. Summary of background data: Postoperative symptomatic epidural hematoma (she) after spine surgery is a rare but potentially serious complication that may result in paralysis unless removed at an early stage. Methods: The subjects were 2611 patients treated with decompression and decompression/fusion of the cervical, thoracic, and lumbar vertebrae at our hospital. Twelve of these patients developed postoperative SEH and removal of hematoma was performed. To investigate the risk factors in these patients, data were analyzed for age at the time of surgery, sex, preoperative complications, medical history, body mass index, preoperative platelet count, surgical procedure, microscope use, operative time, blood loss, surgical site, systolic blood pressure (SBP) at extubation, difference between resting and extubation SBP, ratio of SBP at extubation to that at rest, blood pressure at discharge from the operating room, and use of a drain. Results: There was a significantly higher rate of SBP ratio (extubation/rest) ≥1.3 in patients with SEH ( p = 0.021, Fisher’s exact test). Among the preoperative complications and medical histories, the frequency of cerebrovascular disorder tended to be higher in SEH cases than in non-SEH cases ( p = 0.073). There was no significant difference for all other parameters listed above. In multivariate logistic analysis, the odds ratios were 3.98 ( p = 0.018) for an SBP ratio (extubation/rest) ≥1.3 and 4.75 ( p = 0.055) for cerebrovascular disorder, suggesting effects of these two items. With simultaneous input into a multivariate model, SBP ratio ≥1.3 had a significant independent association with postoperative SEH ( p = 0.021) and cerebrovascular disorder showed a tendency for this association ( p = 0.072). Conclusion: The risk for symptomatic epidural hematoma is significant in patients with SBP at extubation that is more than 1.3 times that of SBP at rest.

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Abstract 15385: A Tapered BP Cuff More Accurately Measures Systolic Blood Pressure Than Does a Standard Rectangular BP Cuff Over a Range of Arm Circumferences

Circulation ◽

10.1161/circ.142.suppl_3.15385 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Sean T Gloth ◽

Daniel I Ambinder ◽

Glenn Whitman ◽

Steven P Schulman ◽

Jeffrey A Brinker ◽

...

Keyword(s):

Blood Pressure ◽

Risk Factor ◽

Systolic Blood Pressure ◽

Radial Artery ◽

Mean Difference ◽

Non Invasive ◽

Arm Circumference ◽

Significant Difference ◽

Two Measures ◽

Continuous Range

Introduction: Systolic blood pressure (BP) is an important risk factor for cardiovascular outcomes. However, non-invasive measures obtained using a standard rectangular cuff (RC) are accurate only when the width of the cuff is ~40% of the arm circumference (AC). This ideal Ratio (IR) is met for the medium standard rectangular cuff at an AC of 30 cm. Hypothesis: A tapered cuff (TC) designed to maintain the IR over a range of ACs more accurately measures systolic BP than does a standard rectangular cuff. Methods: Twenty-two measures of BP using the RC and the TC were compared in seven patients with ACs of 30 cm. In addition, twenty-seven measures of SBP using the RC and the TC were compared with radial artery pressures in 12 patients with clinically placed arterial lines and arm circumferences ranging from 24 cm to 38 cm. Results: When ACs were 30 cm, there was no significant difference between the RC and SC systolic pressures (mean ± SD difference of 1.3 mmHg ± 0.8, p=.78) and they correlated with one another, R 2 of 0.99. However, over a range of ACs, the RC systolic pressures significantly differed from the arterial pressures (mean difference ± SD of 11 ± 4 mmHg, p=.005), and did not correlate with the arterial readings (Panel A) , whereas the TC systolic pressures did not differ from the arterial pressures (mean difference ± SD of 2 ± 1.3 mmHg, p=.18) and did correlate with the arterial readings (Panel B). Conclusion: Systolic BPs obtained with a TC which maintains the IR over a continuous range of arm circumferences are more accurate than are those obtained with a RC.

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Systolic Blood Pressure Elevation in Children with Obstructive Sleep Apnea Is Improved with Positive Airway Pressure Use

The Journal of Pediatrics ◽

10.1016/j.jpeds.2017.11.043 ◽

2018 ◽

Vol 195 ◽

pp. 102-107.e1 ◽

Cited By ~ 13

Author(s):

Lourdes M. DelRosso ◽

Janet King ◽

Raffaele Ferri

Keyword(s):

Blood Pressure ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Systolic Blood Pressure ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Blood Pressure Elevation ◽

Pressure Elevation ◽

Obstructive Sleep

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Dental anxiety in patients undergoing oral surgery and its effects on blood pressure and heart rate

Research Society and Development ◽

10.33448/rsd-v9i8.5536 ◽

2020 ◽

Vol 9 (8) ◽

pp. e316985536

Author(s):

Jaqueline Oliveira Barreto ◽

Julliana Cariry Palhano Freire ◽

Arthur Willian de Lima Brasil ◽

Cristian Statkievicz ◽

Francisley Ávila Souza ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Systolic Blood Pressure ◽

Oral Surgery ◽

Dental Anxiety ◽

Waiting Room ◽

Demographic Questionnaire ◽

Significant Difference ◽

Before And After ◽

Evaluation Anxiety

Objective: To assess dental anxiety in patients undergoing oral surgery, as well as its impact on blood pressure and heart rate. Material and Methods: A total of 233 patients answered a socio-demographic questionnaire and another one based on the Corah dental anxiety scale. Blood pressure and heart rate were assessed at three moments while: patients were in the waiting room, immediately before and after the procedure. Results: This study revealed a prevalence of anxiety of 77.3%. There was a statistically significant difference in mean systolic blood pressure and heart rate at the three moments of the evaluation. Anxiety was prevalent in the sample and was observed from the time in the waiting room until the time when local anesthesia was performed, causing variations in systolic blood pressure and heart rate, anxiety levels decreased after the end of the service. In conclusion, we observed that oral surgery is directly related to increased anxiety, and anxiety is mainly related to the change in heart rate.

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Home Blood Pressure Measurement in the Morning Related to Cancer in Patients with Type 2 Diabetes Mellitus: 10 Years-Term Results of a Longitudinal Study and Cancer

The Open Hypertension Journal ◽

10.2174/1876526201507010001 ◽

2015 ◽

Vol 7 (1) ◽

pp. 1-6

Author(s):

Kyuzi Kamoi

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Risk Factor ◽

Cause Of Death ◽

Japanese Patients ◽

Pressure Measurements ◽

Significant Difference

Previous longitudinal studies have demonstrated that blood pressure measurements at home (HBP) in the wakening- up display stronger predictive power for death, and vascular complications in patients with type 2 diabetes mellitus (T2DM) than clinic blood pressure measurements (CBP). The leading cause of death was cancer. Patients with T2DM have associated with cancer, and high CBP is a risk factor for cancer. Therefore, this study investigated whether HBP or CBP is related to cancer event in patients with T2DM for 10 years. At baseline, 400 Japanese patients with T2DM were classified as hypertensive (HT) or normotensive (NT) based on HBP and CBP. Mean (± SD) duration was 95 ± 35 months. Primary and secondary endpoints were death and cancer, respectively. Differences in outcome between HT and NT were analyzed using survival curves from Kaplan-Meier analysis and log-rank testing. Associated risk factors were assessed using Cox proportional hazards. On basis of HBP, death and event of cancer were significantly higher in HT than in NT. The leading cause of death was cancer. On basis of CBP, there was no significant difference in the incidence of death and event of cancer between patients with HT and NT at baseline. Associated risk factor for cancer was T2DM. Home morning HT may be reflected more keenly state of cancer than clinic HT, which may be superior to clinic NT. When we meet with such patients, it is important that cancer may be one of many causes for morning HT in Japanese patients with T2DM.

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Early Achievement of Blood Pressure Lowering and Hematoma Growth in Acute Intracerebral Hemorrhage: Stroke Acute Management with Urgent Risk-Factor Assessment and Improvement-Intracerebral Hemorrhage Study

Cerebrovascular Diseases ◽

10.1159/000492728 ◽

2018 ◽

Vol 46 (3-4) ◽

pp. 116-122

Author(s):

Yoshitaka Yamaguchi ◽

Masatoshi Koga ◽

Shoichiro Sato ◽

Hiroshi Yamagami ◽

Kenichi Todo ◽

...

Keyword(s):

Blood Pressure ◽

Risk Factor ◽

Intracerebral Hemorrhage ◽

Acute Management ◽

Acute Hypertension ◽

Risk Factor Assessment ◽

Significant Difference ◽

Pressure Lowering ◽

Hematoma Growth ◽

Multicenter Prospective Observational Study

Background: Previous studies have revealed that hematoma growth mainly occurs during the first 6 h after the onset of spontaneous intracerebral hemorrhage (ICH). Early lowering of blood pressure (BP) may be beneficial for preventing hematoma growth. However, relationships between timing of BP lowering and hematoma growth in ICH remain unclear. We investigated associations between timing of BP lowering and hematoma growth for ICH. Methods: The Stroke Acute Management with Urgent Risk-factor Assessment and Improvement (SAMURAI)-ICH Study was a multicenter, prospective, observational study investigating the safety and feasibility of early (within 3 h from onset) reduction of systolic BP (SBP) to < 160 mm Hg with intravenous nicardipine for acute hypertension in cases of spontaneous ICH. The present study was a post hoc analysis of the SAMURAI-ICH study. We examined relationships between time from onset, imaging, and initiation of treatment to target SBP achievement and hematoma growth (absolute growth ≥6 mL) in ICH patients. Target SBP achievement was defined as the time at which SBP first became < 160 mm Hg. Results: Among 211 patients, hematoma growth was seen in 31 patients (14.7%). The time from imaging to target SBP and time from treatment to target SBP were significantly shorter in patients without hematoma growth than in those with (p = 0.043 and p = 0.032 respectively), whereas no significant difference was seen in time from onset to SBP < 160 mm Hg between groups (p = 0.177). Patients in the lower quartiles of time from imaging to target SBP and time from treatment to target SBP showed lower incidences of hematoma growth (p trend = 0.023 and 0.037 respectively). The lowest quartile of time from imaging to target SBP (< 38 min) was negatively associated with hematoma growth on multivariable logistic regression (OR 0.182; 95% CI 0.038–0.867; p = 0.032). Conclusions: Early achievement of target SBP < 160 mm Hg is associated with a lower risk of hematoma growth in ICH.

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Abstract P011: Cardiovascular Risk Factors and Longevity

Circulation ◽

10.1161/circ.137.suppl_1.p011 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Michelle C Odden ◽

Andreea Rawlings ◽

Alice Arnold ◽

Mary Cushman ◽

Mary Lou Biggs ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Risk Factor ◽

Cardiovascular Risk ◽

Systolic Blood Pressure ◽

Cardiovascular Risk Factors ◽

Old Age ◽

Repeated Measures ◽

Ldl Cholesterol ◽

Low Cardiovascular Risk

Introduction: Cardiovascular disease is the leading cause of mortality in old age, yet there is limited research on the patterns of cardiovascular risk factors that predict survival to 90 years. Hypothesis: The patterns of cardiovascular risk factors that portend longevity will differ from those that confer low cardiovascular risk. Methods: We examined repeated measures of blood pressure, LDL-cholesterol, and BMI from age 67 and survival to 90 years in the Cardiovascular Health Study (CHS). CHS is a prospective study of 5,888 black and white adults in two waves (1989-90 and 1992-93) from Medicare eligibility lists in four counties in the U.S. We restricted to participants aged 67 to 75 years at baseline to control for birth cohort effects and examined repeated measures of cardiovascular risk factors throughout the late-life course. We fit logistic regression models to predict survival to age 90 using generalized estimating equations, and modeled the risk factors as linear, a linear spline, and clinically relevant categories. Models were adjusted for demographics and medication use, and we also examined whether the association of each risk factor with longevity varied by the age of risk factor measurement. Best fit models are presented. Results: Among 3,645 participants in the birth cohort, 1,160 (31.8%) survived to 90 by June 16 th , 2015. Higher systolic blood pressure in early old age was associated with reduced odds for longevity, but there was an interaction with age such that the association crossed the null at 80 years. (Table) Among those with LDL-cholesterol <130 mg/dL, higher LDL-cholesterol was associated with greater longevity; at levels above 130 mg/dL there was no association between LDL-cholesterol and longevity. BMI had a u-shaped association with longevity. Conclusions: In summary, the patterns of risk factors that predict longevity differ from that considered to predict low cardiovascular risk. The risk of high systolic blood pressure appears to depend on the age of blood pressure measurement.

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The Initial Factors with Strong Predictive Value in Relation to Six-Month Outcome among Patients Operated due to Extra-Axial Hematomas

Diagnostics ◽

10.3390/diagnostics10030174 ◽

2020 ◽

Vol 10 (3) ◽

pp. 174 ◽

Cited By ~ 2

Author(s):

Bartłomiej Kulesza ◽

Jakub Litak ◽

Cezary Grochowski ◽

Adam Nogalski ◽

Radosław Rola

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Prognostic Value ◽

Epidural Hematoma ◽

Brain Injuries ◽

Demographic Data ◽

Traumatic Brain Injuries ◽

Factors Affecting ◽

Craniocerebral Injuries ◽

Gcs Score

Introduction: Traumatic brain injuries (TBI) are a real social problem, with an upward trend worldwide. The most frequent consequence of a traumatic brain injury is extra-axial hemorrhage, i.e., an acute subdural (SDH) and epidural hematoma (EDH). Most of the factors affecting the prognosis have been analyzed on a wide group of traumatic brain injuries. Nonetheless, there are few studies analyzing factors influencing the prognosis regarding patients undergoing surgery due to acute subdural and epidural hematoma. The aim of this study was to identify the factors which have the strongest prognostic value in relation to the 6-month outcome of the patients undergoing surgery for SDH and EDH. Patients and methods: The study included a group of 128 patients with isolated craniocerebral injuries. Twenty eight patients were operated upon due to EDH, and a group of 100 patients were operated upon due to SDH. The following factors from the groups were analyzed: demographic data, physiological factors, laboratory factors, computed tomography scan characteristics, and time between the trauma and the surgery. All of these factors were correlated in a multivariate analysis with the six-month outcome in the Glasgow outcome scale. Results: The factors with the strongest prognostic value are GCS score, respiration rate, saturation, glycaemia and systolic blood pressure. Conclusion: Initial GCS score, respiratory rate, saturation, glycaemia and systolic blood pressure were the factors with the strongest prognostic value.

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A comparison of CAT Doppler and oscillometric Memoprint machines for non-invasive blood pressure measurement in conscious cats

Journal of Feline Medicine and Surgery ◽

10.1016/j.jfms.2004.08.003 ◽

2005 ◽

Vol 7 (3) ◽

pp. 147-152 ◽

Cited By ~ 31

Author(s):

Rosanne E. Jepson ◽

Vivien Hartley ◽

Michael Mendl ◽

Sarah ME Caney ◽

David J Gould

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Blood Pressure Measurement ◽

Systemic Hypertension ◽

Pressure Measurements ◽

Non Invasive ◽

Measuring Devices ◽

Oscillometric Device ◽

Significant Difference

Indirect blood pressure measurements were compared in 28 conscious cats using Doppler and oscillometric blood pressure-measuring devices. Ten cats were used to compare Doppler measurements between two examiners and 18 cats were used to compare Doppler and oscillometric measurements. The Doppler machine obtained systolic and diastolic blood pressure readings in 100% and 51% of attempts, respectively. With the oscillometric machine, systolic and diastolic blood pressure readings were obtained in 52% of the attempts. With the Doppler, measures of mean systolic blood pressure between two examiners were positively correlated, but there was no correlation for diastolic blood pressure measures. When comparing the results obtained by Doppler and oscillometric machines there was no significant difference between mean systolic blood pressure readings, but the oscillometric machine produced significantly higher estimates of diastolic blood pressure. In both cases, the standard deviations for the oscillometric machine were considerably larger than those for the Doppler machine. The first reading of systolic blood pressure obtained with the Doppler machine was an excellent predictor of the mean of five readings, but this was not so for the oscillometric machine. It took less than 5 min to obtain five readings in 37.5% of cases with the Doppler machine but this was true for only 5% of cases with the oscillometric machine. Two cats with ophthalmological lesions consistent with systemic hypertension were identified. In these two patients, systolic blood pressure measurements were between 200 and 225 mmHg when measured by Doppler, and between 140 and 150 mmHg when measured by the oscillometric machine. This suggests that a lower reference range for normal systolic blood pressure values should be used for the oscillometric device.

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Renal and Cardiovascular Effects of Exogenous Insulin in Healthy Volunteers

Clinical Science ◽

10.1042/cs0800219 ◽

1991 ◽

Vol 80 (3) ◽

pp. 219-225 ◽

Cited By ~ 49

Author(s):

R. O. B. Gans ◽

L. v.d. Toorn ◽

H. J. G. Bilo ◽

J. J. P. Nauta ◽

R. J. Heine ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Analysis Of Variance ◽

Sodium Excretion ◽

Circadian Variation ◽

Cardiovascular Effects ◽

Insulin Dosage ◽

Angiotensin I ◽

Blood Pressure Elevation ◽

Fractional Sodium Excretion

1. Renal and cardiovascular effects of three dosages of insulin [50 (Ins I), 300 (Ins II) and 500 (Ins III) m-units h−1 kg−1] were investigated in healthy males by using a euglycaemic clamp technique. On separate days, control experiments were carried out to correct for any circadian variation in the variables studied. 2. All three insulin dosages resulted in a marked decline in fractional sodium excretion (actual experiments: basal, 0.95 ± 0.15%, Ins I, 0.79 ± 0.10%, Ins II, 0.80 ± 0.12%, Ins III, 0.84 ± 0.08%; control experiments: basal, 0.96 ± 0.10%, Ins I, 1.20 ± 0.12%, Ins II, 1.53 ± 0.15%, Ins III, 1.43 ± 0.10%; means ± sem, P < 0.005, analysis of variance). With the highest insulin dosage, the reduction in fractional sodium excretion tended to be less striking. This coincided with a rise in heart rate, pulse pressure and pulse rate-systolic blood pressure product (double product). Although blood pressure itself did not change, systolic blood pressure also tended to increase (actual experiments: basal, 133 ± 5 mmHg, Ins I, 132 ± 5 mmHg, Ins II, 139 ± 5 mmHg, Ins III, 143 ± 4 mmHg; control experiments: basal, 128 ± 3 mmHg, Ins I, 129 ± 3 mmHg, Ins II, 130 ± 3 mmHg, Ins III, 133 ± 3 mmHg; means ± sem, P = 0.09, analysis of variance). There was a positive correlation between the change in fractional sodium excretion and the change in systolic blood pressure over control values (r = 0.696, P < 0.028). At a rise in systolic blood pressure of 18 mmHg, the sodium-retaining effect of insulin appeared to be offset. A shift of the pressure-natriuresis relation to the right is suggested. 3. Plasma catecholamines did not change. Plasma renin activity increased from 1.11 ± 0.17 (basal) to 2.13 ± 0.31 (Ins III) pmol of angiotensin I h−1 ml−1; on the control day, a decline from 1.28 ± 0.24 (basal) to 0.81 ± 0.13 (Ins III) pmol of angiotensin I h−1 ml−1 was noted (P < 0.001). Despite this rise no concomitant rise in plasma aldosterone occurred. 4. Chronic hyperinsulinaemia may lead to blood pressure elevation in the long-term if it is postulated that resistance to the glucose-lowering effect of insulin is absent for the effects of insulin on the kidney and the cardiovascular system.

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