scholarly journals The influence of the infusion of ephedrine and phenylephrine on the hemodynamic stability after subarachnoid anesthesia in senior adults - a controlled randomized trial

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Miodrag Žunić ◽  
Nevenka Krčevski Škvarč ◽  
Mirt Kamenik
Keyword(s):  
Blood Pressure ◽  
Final Analysis ◽  
Controlled Study ◽  
Senior Adults ◽  
Hemodynamic Changes ◽  
Hemodynamic Stability ◽  
Double Blind ◽  
Registration Number ◽  
Phenylephrine Infusion ◽  
Orthopedic Patients

Abstract Background We studied the influence of ephedrine or phenylephrine infusion administered immediately after spinal anesthesia (SA) on hemodynamics in elderly orthopedic patients. Methods A prospective, randomized, double-blind, placebo-controlled study. After a subarachnoid injection of 15 mg of levobupivacaine, the participants received an infusion of either ephedrine 20 mg (E group), phenylephrine 250 mcg (P group) or saline (C group) within 30 min. We measured blood pressure, cardiac index (CI) and heart rate (HR) from 15 min before to 30 min after SA. Results Seventy patients were included in the final analysis. At the end of measurements, mean arterial pressure (MAP) decreased significantly after SA in comparison to the baseline value in the C group but was maintained in the P and E group, with no significant differences between the groups. CI decreased after SA in the C group, was maintained in the P group, and increased significantly in the E group with significant differences between the C and E group (p = 0.049) also between the P and E (p = 0.01) group at the end of measurements. HR decreased significantly after SA in the C and P group but was maintained in the E group, with significant differences between the P and E group (p = 0.033) at the end of measurements. Conclusions Hemodynamic changes after SA in elderly orthopedic patients can be prevented by an immediate infusion of phenylephrine or ephedrine. In addition to maintaining blood pressure, the ephedrine infusion also maintains HR and increases CI after SA. Trial registration ISRCTN registry with registration number ISRCTN44377602, retrospectively registered on 15 June 2017.

scholarly journals The Influence Of The Infusion Of Ephedrine And Phenylephrine On The Hemodynamic Stability After Subarachnoid Anesthesia In Senior Adults - A Controlled Randomized Trial

2019 ◽  
Author(s):  
Miodrag Vojislav Žunić ◽  
Nevenka Krčevski Škvarč ◽  
Mirt Kamenik
Keyword(s):  
Blood Pressure ◽  
Spinal Anesthesia ◽  
Final Analysis ◽  
Controlled Study ◽  
Hemodynamic Stability ◽  
Double Blind ◽  
Study Objective ◽  
Phenylephrine Infusion ◽  
Orthopedic Patients ◽  
Study Intervention

Abstract ABSTRACT Study objective: We studied the influence of ephedrine or phenylephrine infusion given immediately after spinal anesthesia (SA) on hemodynamics in elderly orthopedic patients. Design: A prospective, randomized, double-blind, placebo-controlled study. Intervention: After subarachnoid injection of 15 mg of levobupivacaine the participants received either an infusion of ephedrine 20 mg (E group), phenylephrine 250 mcg (P group) or saline (C group) within 30 minutes. For 15 minutes before and and 30 minutes after SA we measured blood pressure, cardiac index (CI) and heart rate (HR). Results 70 patients were included in the final analysis. At the end of measurements mean arterial pressure decreased significantly after SA in comparison to baseline in the C group but was maintained in the P and the E group, with no significant differences between the groups. CI decreased after SA in the C group was maintained in the P group and increased significantly in the E group, with significant differences between the C and the E group (p=0.049) and between the P and the E (p=0.01) group at the end of measurements. HR decreased significantly after SA in the C and the P group and was maintained in the E group, with significant differences between the P and the E group (p=0.033) at the end of measurements. Conclusions Hemodynamic changes after SA in elderly orthopedic patients can be prevented by an immediate infusion of phenylephrine or ephedrine. In addition to maintaining blood pressure the ephedrine infusion also maintains HR and increases CI after spinal anaesthesia. Key words: spinal anesthesia, hemodynamic stability, phenylephrine, ephedrine Trial registration: ISRCTN registry ISRCTN44377602. Registered on 15 June 2017.

scholarly journals The Influence Of The Infusion Of Ephedrine And Phenylephrine On The Hemodynamic Stability After Subarachnoid Anesthesia In Senior Adults - A Controlled Randomized Trial

2019 ◽  
Author(s):  
Miodrag Vojislav Žunić ◽  
Nevenka Krčevski Škvarč ◽  
Mirt Kamenik
Keyword(s):  
Blood Pressure ◽  
Spinal Anesthesia ◽  
Final Analysis ◽  
Controlled Study ◽  
Hemodynamic Stability ◽  
Double Blind ◽  
Study Objective ◽  
Phenylephrine Infusion ◽  
Orthopedic Patients ◽  
Study Intervention

Abstract ABSTRACT Study objective: We studied the influence of ephedrine or phenylephrine infusion given immediately after spinal anesthesia (SA) on hemodynamics in elderly orthopedic patients. Design: A prospective, randomized, double-blind, placebo-controlled study. Intervention: After subarachnoid injection of 15 mg of levobupivacaine the participants received either an infusion of ephedrine 20 mg (E group), phenylephrine 250 mcg (P group) or saline (C group) within 30 minutes. For 15 minutes before and and 30 minutes after SA we measured blood pressure, cardiac index (CI) and heart rate (HR). Results 70 patients were included in the final analysis. At the end of measurements mean arterial pressure decreased significantly after SA in comparison to baseline in the C group but was maintained in the P and the E group, with no significant differences between the groups. CI decreased after SA in the C group was maintained in the P group and increased significantly in the E group, with significant differences between the C and the E group (p=0.049) and between the P and the E (p=0.01) group at the end of measurements. HR decreased significantly after SA in the C and the P group and was maintained in the E group, with significant differences between the P and the E group (p=0.033) at the end of measurements. Conclusions Hemodynamic changes after SA in elderly orthopedic patients can be prevented by an immediate infusion of phenylephrine or ephedrine. In addition to maintaining blood pressure the ephedrine infusion also maintains HR and increases CI after spinal anaesthesia. Key words: spinal anesthesia, hemodynamic stability, phenylephrine, ephedrine Trial registration: ISRCTN registry ISRCTN44377602. Registered on 15 June 2017.

scholarly journals The Influence Of The Infusion Of Ephedrine And Phenylephrine On The Hemodynamic Stability After Subarachnoid Anesthesia In Senior Adults - A Controlled Randomized Study

2019 ◽  
Author(s):  
Miodrag Vojislav Žunić ◽  
Nevenka Krčevski Škvarč ◽  
Mirt Kamenik
Keyword(s):  
Blood Pressure ◽  
Spinal Anesthesia ◽  
Randomized Study ◽  
Final Analysis ◽  
Controlled Study ◽  
Hemodynamic Stability ◽  
Double Blind ◽  
Study Objective ◽  
Phenylephrine Infusion ◽  
Orthopedic Patients

Abstract ABSTRACT Study objective: We studied the influence of ephedrine or phenylephrine infusion given immediately after spinal anesthesia (SA) on hemodynamics in elderly orthopedic patients. Design: A prospective, randomized, double-blind, placebo-controlled study. Intervention: After subarachnoid injection of 15 mg of levobupivacaine the participants received either an infusion of ephedrine 20 mg (E group), phenylephrine 250 mcg (P group) or saline (C group) within 30 minutes. For 15 minutes before and and 30 minutes after SA we measured blood pressure, cardiac index (CI) and heart rate (HR). Results 70 patients were included in the final analysis. At the end of measurements mean arterial pressure decreased significantly after SA in comparison to baseline in the C group but was maintained in the P and the E group, with no significant differences between the groups. CI decreased after SA in the C group was maintained in the P group and increased significantly in the E group, with significant differences between the C and the E group (p=0.049) and between the P and the E (p=0.01) group at the end of measurements. HR decreased significantly after SA in the C and the P group and was maintained in the E group, with significant differences between the P and the E group (p=0.033) at the end of measurements. Conclusions Hemodynamic changes after SA in elderly orthopedic patients can be prevented by an immediate infusion of phenylephrine or ephedrine. In addition to maintaining blood pressure the ephedrine infusion also maintains HR and increases CI after spinal anaesthesia. Key words: spinal anesthesia, hemodynamic stability, phenylephrine, ephedrine Trial registration: ISRCTN registry ISRCTN44377602. Registered on 15 June 2017.

scholarly journals The Influence Of The Infusion Of Ephedrine And Phenylephrine On The Hemodynamic Stability After Subarachnoid Anesthesia In Senior Adults - A Contolled Randomized Trial

2019 ◽  
Author(s):  
Miodrag Vojislav Žunić ◽  
Nevenka Krčevski Škvarč ◽  
Mirt Kamenik
Keyword(s):  
Blood Pressure ◽  
Spinal Anesthesia ◽  
Final Analysis ◽  
Controlled Study ◽  
Hemodynamic Stability ◽  
Double Blind ◽  
Study Objective ◽  
Phenylephrine Infusion ◽  
Orthopedic Patients ◽  
Study Intervention

Abstract ABSTRACT Study objective: We studied the influence of ephedrine or phenylephrine infusion given immediately after spinal anesthesia (SA) on hemodynamics in elderly orthopedic patients. Design: A prospective, randomized, double-blind, placebo-controlled study. Intervention: After subarachnoid injection of 15 mg of levobupivacaine the participants received either an infusion of ephedrine 20 mg (E group), phenylephrine 250 mcg (P group) or saline (C group) within 30 minutes. For 15 minutes before and and 30 minutes after SA we measured blood pressure, cardiac index (CI) and heart rate (HR). Results 70 patients were included in the final analysis. At the end of measurements mean arterial pressure decreased significantly after SA in comparison to baseline in the C group but was maintained in the P and the E group, with no significant differences between the groups. CI decreased after SA in the C group was maintained in the P group and increased significantly in the E group, with significant differences between the C and the E group (p=0.049) and between the P and the E (p=0.01) group at the end of measurements. HR decreased significantly after SA in the C and the P group and was maintained in the E group, with significant differences between the P and the E group (p=0.033) at the end of measurements. Conclusions Hemodynamic changes after SA in elderly orthopedic patients can be prevented by an immediate infusion of phenylephrine or ephedrine. In addition to maintaining blood pressure the ephedrine infusion also maintains HR and increases CI after spinal anaesthesia. Key words: spinal anesthesia, hemodynamic stability, phenylephrine, ephedrine Trial registration: ISRCTN registry ISRCTN44377602. Registered on 15 June 2017.

scholarly journals Dexmedetomidine decreased the post‐thyroidectomy bleeding by reducing cough and emergence agitation – a randomized, double‐blind, controlled study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sang Hun Kim ◽  
Yoo Seok Kim ◽  
Seongcheol Kim ◽  
Ki Tae Jung
Keyword(s):  
Postoperative Bleeding ◽  
Postoperative Hemorrhage ◽  
Controlled Study ◽  
Emergence Agitation ◽  
Double Blind ◽  
Extubation Time ◽  
Registration Number ◽  
Recovery From Anesthesia ◽  
Postanesthetic Care Unit ◽  
Group D

Abstract Background Bleeding after thyroidectomy occurs due to violent coughing during emergence. Dexmedetomidine is helpful for the smooth emergence and suppression of cough. The purpose of the present study was to compare the effects of dexmedetomidine on postoperative bleeding after thyroidectomy. Methods Randomized, double-blind, controlled trials were conducted in female patients (ASA I–II, aged 20 to 60 years). The patients were randomly allocated into two groups. Approximately 15 min before the end of the surgery, dexmedetomidine was administered (0.6 µg/kg/h) without a loading dose in group D (n = 69), and normal saline was administered in group S (n = 70) at the same infusion rate. Hemodynamic data, coughing reflex, extubation time, Ramsay sedation scale (RSS), and recovery time were assessed during the administration of the study drugs and recovery from anesthesia. The amount of postoperative hemorrhage was measured for 3 days. Results Data from a total of 139 patients were analyzed. The incidence of severe cough was significantly lower in group D than in group S (4.3 % vs. 11.5 %, P = 0.022). The emergence agitation in the postanesthetic care unit was significantly lower in group D than in group S (P = 0.01). Postoperative bleeding was significantly lower in group D than in group S until the second postoperative day (P = 0.015). Conclusions Dexmedetomidine can be helpful in decreasing bleeding after thyroidectomy by reducing coughing and emergence agitation. Trial registration This study was registered at http://clinicaltrials.gov (registration number NCT02412150, 09/04/2015).

Abstract WP245: Hyperacute Blood Pressure Variability is Associated with Early Neurological Deterioration

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Joseph Kim ◽  
Jeffrey L Saver ◽  
David S Liebeskind ◽  
Sidney Starkman ◽  
Scott Hamilton ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Cerebral Ischemia ◽  
Acute Stroke ◽  
Symptom Onset ◽  
Blood Pressure Variability ◽  
Final Diagnosis ◽  
Controlled Study ◽  
Double Blind ◽  
Neurologic Deterioration

Background: Increased blood pressure variability (BPV) has been associated with worse outcomes in acute stroke. The effect of hyperacute (<4 hours) BPV on early neurologic deterioration (END) has not been described. Objective: To investigate whether BPV in the first hours after stroke onset is associated with END from prehospital evaluation to presentation at the emergency department Methods: All patients enrolled in the NIH Field Administration of Stroke Therapy-Magnesium (FAST-MAG) phase 3 trial were included. FAST-MAG was a multicenter, randomized, double-blind, placebo-controlled study looking at whether initiation of magnesium sulfate (20 grams/24 hours) in the prehospital setting of acute stroke would reduce disability. Study agent was initiated prior to hospital arrival < 2 hours from symptom onset. BPV was defined as the standard deviation of systolic blood pressure of all readings obtained by 4 hours after initiation of study agent. END was diagnosed as Glasgow Coma Scale (GCS) decrease by ≥ 2 points between the prehospital evaluation and post-emergency department arrival assessment by a study nurse. Results: There were 1,700 cases evaluated by paramedics 24 minutes (15-45 IQR), and by study nurses 150 minutes (120-180) after symptom onset with a median of 6 (IQR 5-6) BP readings. The mean (±SD) age was 69±13 years, 42.6% were women, and the median prehospital GCS was 15 (IQR 14-15). The final diagnosis was cerebral ischemia in 73.3% of patients, intracranial hemorrhage in 22.8%, and a stroke-mimicking condition in 3.9%. END was seen in 202 (12%) of subjects, with higher rates noted in those with intracerebral hemorrhage (ICH) compared to cerebral ischemia (31% vs 6%). Overall, there was greater BPV in patients with END (23mmHg vs 15mmHg, p<0.001). Blood pressure variability was greater in cases of cerebral ischemia with END (N=1,245, 18mmHg vs 15mmHg, p=0.004) and in ICH cases with END (N=387, 23mmHg vs 15mmHg, p<0.001). Conclusion: Greater blood pressure variability is associated with early neurologic deterioration in patients with cerebral ischemia and ICH evaluated <2 hours from symptom onset.

scholarly journals Rice Bran Supplement Containing A Functional Substance, the Novel Peptide Leu-Arg-Ala, has Anti-Hypertensive Effects: A Double-Blind, Randomized, Placebo-Controlled Study

Nutrients ◽  
2019 ◽  
Vol 11 (4) ◽  
pp. 726
Author(s):  
Ogawa ◽  
Shobako ◽  
Fukuhara ◽  
Satoh ◽  
Kobayashi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Placebo Group ◽  
Adverse Events ◽  
Rice Bran ◽  
Test Group ◽  
Normal Blood ◽  
Controlled Study ◽  
The Novel ◽  
Normal Blood Pressure ◽  
Double Blind

The anti-hypertensive effect of processed rice bran (PRB) was recently reported, for which the novel peptide Leu-Arg-Ala (LRA) was identified as the functional substance. The purpose of this study was to assess the anti-hypertensive effects of a rice bran supplement containing PRB in individuals with high-normal blood pressure (systolic blood pressure (SBP): 130–139 mmHg and/or diastolic blood pressure (DBP): 85–89 mmHg) or grade 1 hypertension (SBP: 140–159 mmHg and/or DBP: 90–99 mmHg). One hundred individuals with high-normal blood pressure or grade 1 hypertension were recruited to participate in this double-blind, randomized, placebo-controlled study. Participants were randomly allocated to the placebo group (n = 50) or the test group (n = 50). Each group took four test tablets (43 μg LRA/day) or four placebo tablets daily. The decrease in blood pressure in the test group compared with the placebo group was the primary outcome. Adverse events were recorded and hematological/urinary parameters measured to determine the safety of the supplement, which was the secondary outcome. In total, 87 participants completed the study. The SBP of the test group at 12 weeks was significantly lower than that of the placebo group (p = 0.0497). No serious adverse events were observed. Daily consumption of a rice bran supplement containing PRB can safely improve mildly elevated blood pressure.

scholarly journals Variable versus fixed-rate infusion of phenylephrine during cesarean delivery: a randomized controlled trial

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Ahmed Hasanin ◽  
Sara Habib ◽  
Yaser Abdelwahab ◽  
Mohamed Elsayad ◽  
Maha Mostafa ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Systolic Blood Pressure ◽  
Cesarean Delivery ◽  
Controlled Trial ◽  
Controlled Study ◽  
Lower Systolic Blood Pressure ◽  
Randomized Controlled ◽  
Phenylephrine Infusion ◽  
Infusion Regimen

Abstract Background Phenylephrine is the most commonly used vasopressor for prophylaxis against maternal hypotension during cesarean delivery; however, the best regimen for its administration is not well established. Although variable infusion protocols had been suggested for phenylephrine infusion, evidence-based evaluation of variable infusion regimens are lacking. The aim of this work is to compare variable infusion, fixed on-and-off infusion, and intermittent boluses of phenylephrine for prophylaxis against maternal hypotension during cesarean delivery. Methods A randomized controlled study was conducted, including full-term pregnant women scheduled for elective cesarean delivery. Participants were divided into three groups which received phenylephrine by either intermittent boluses (1.5 mcg/Kg phenylephrine), fixed on-and-off infusion (with a dose of 0.75 mcg/Kg/min), or variable infusion (with a starting dose of 0.75 mcg/Kg/min). The three groups were compared with regard to frequency of: maternal hypotension (primary outcome), second episode hypotension, reactive hypertension, and bradycardia. Other outcomes included heart rate, systolic blood pressure, physician interventions, and neonatal outcomes. Results Two-hundred and seventeen mothers were available for final analysis. The 2 infusion groups showed less incidence of maternal hypotension {26/70 (37%), 22/71 (31%), and (51/76 (67%)} and higher incidence of reactive hypertension compared to the intermittent boluses group without significant differences between the two former groups. The number of physician interventions was highest in the variable infusion group compared to the other two groups. The intermittent boluses group showed lower systolic blood pressure and higher heart rate compared to the two infusion groups; whilst the two later groups were comparable. Conclusion Both phenylephrine infusion regimens equally prevented maternal hypotension during cesarean delivery compared to intermittent boluses regimen. Due to higher number of physician interventions in the variable infusion regimen, the current recommendations which favor this regimen over fixed infusion regimen might need re-evaluation.

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