scholarly journals Controlled arterial hypotension during resection of cerebral arteriovenous malformations

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Katharina Riedel ◽  
Marcus Thudium ◽  
Azize Boström ◽  
Johannes Schramm ◽  
Martin Soehle
Keyword(s):  
Blood Pressure ◽  
Blood Loss ◽  
Arterial Blood Pressure ◽  
Arteriovenous Malformations ◽  
Neurological Deficits ◽  
Arterial Hypotension ◽  
Control Group ◽  
Cerebral Arteriovenous Malformations ◽  
Arterial Blood ◽  
Duration Of Surgery

Abstract Background Resection of cerebral arteriovenous malformations (AVM) is technically demanding because of size, eloquent location or diffuse nidus. Controlled arterial hypotension (CAH) could facilitate haemostasis. We performed a study to characterize the duration and degree of CAH and to investigate its association with blood loss and outcome. Methods We retrospectively analysed intraoperative arterial blood pressure of 56 patients that underwent AVM-resection performed by the same neurosurgeon between 2003 and 2012. Degree of CAH, AVM size, grading and neurological outcome were studied. Patients were divided into two groups, depending on whether CAH was performed (hypotension group) or not (control group). Results The hypotension group consisted of 28 patients, which presented with riskier to treat AVMs and a higher Spetzler-Martin grading. CAH was achieved by application of urapidil, increasing anaesthetic depth or a combination thereof. Systolic and mean arterial blood pressure were lowered to 82 ± 7 and 57 ± 7 mmHg, respectively, for a median duration of 58 min [25% percentile: 26 min.; 75% percentile: 107 min]. In the hypotension group, duration of surgery (4.4 ± 1.3 h) was significantly (p <  0.001) longer, and median blood loss (500 ml) was significantly (p = 0.002) higher than in the control group (3.3 ± 0.9 h and 200 ml, respectively). No case fatalities occurred. CAH was associated with a higher amount of postoperative neurological deficits. Conclusions Whether CAH caused neurological deficits or prevented worse outcomes could be clarified by a prospective randomised study, which is regarded as ethically problematic in the context of bleeding. CAH should only be used after strict indication and should be applied as mild and short as possible.

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 &lt; 0.001). Nonresponse to treatment (defined as three boluses of terlipressin or three changes in norepinephrine infusion) occurred in zero and eight cases (P &lt; 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.

scholarly journals Prospective Randomized Controlled Study to assess the Role of Dexmedetomidine on Perioperative Hemodynamics in Patients with Supratentorial Tumor undergoing Surgery

2017 ◽  
Vol 2 (1) ◽  
pp. 14-17
Author(s):  
Sachin Vaishnav ◽  
Anita Shetty ◽  
Manjula Sarkar
Keyword(s):  
Blood Pressure ◽  
Placebo Group ◽  
Arterial Blood Pressure ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Randomized Controlled ◽  
Arterial Blood ◽  
Supratentorial Tumor ◽  
Duration Of Surgery

ABSTRACT The stress response to an intense painful surgical stimulus is characterized by activation of the sympathetic nervous system and an increased secretion of the stress hormones. The ability of the alpha agonist dexmedetomidine (DEX) to decrease heart rate (HR) and arterial blood pressure in perioperative period was tested. One hundred and thirty two patients undergoing craniotomy for supratentorial tumor were randomly distributed to receive either saline (B group) or DEX (A group). The placebo group received saline, whereas the treatment group (A group) received a single bolus dose of DEX (1μg/kg) intravenously over 10 minutes before induction of anesthesia. Hemodynamic parameters, such as HR and arterial blood pressure were measured. Both the groups were comparable with respect to age, sex, American Society for Anesthesiologist grade, and duration of surgery. The arterial blood pressure and HR were found to be lower in the DEX group when compared with the placebo group. How to cite this article Vaishnav S, Shetty A, Sarkar M. Prospective Randomized Controlled Study to assess the Role of Dexmedetomidine on Perioperative Hemodynamics in Patients with Supratentorial Tumor undergoing Surgery. Res Inno in Anesth 2017;2(1):14-17.

scholarly journals EFFECT OF DIFFERENT OCCLUSION PRESSURE ON PECULIARITIES OF MUSCLE BLOOD FLOW

2018 ◽  
Vol 1 (108) ◽  
pp. 2-8
Author(s):  
Kęstutis Bunevičius ◽  
Albinas Grunovas ◽  
Jonas Poderys
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Arterial Blood Pressure ◽  
Arterial Blood Flow ◽  
Control Group ◽  
Reactive Hyperaemia ◽  
Occlusion Pressure ◽  
Arterial Blood ◽  
Flow Intensity ◽  
Blood Flow Intensity

Background. Occlusion pressure intensity influences the blood flow intensity. Immediately after the cuff pressure is released, reactive hyperaemia occurs. Increased blood flow and nutritive delivery are critical for an anabolic stimulus, such as insulin. The aim of study was to find which occlusion pressure was optimal to increase the highest level of post occlusion reactive hyperaemia. Methods. Participants were randomly assigned into one of the four conditions (n = 12 per group): control group without blood flow restriction, experimental groups with 120; 200 or 300 mmHg occlusion pressure. We used venous occlusion plethysmography and arterial blood pressure measurements. Results. After the onset of 120 and 200 mm Hg pressure occlusion, the blood flow intensity significantly decreased. Occlusion induced hyperaemia increased arterial blood flow intensity 134 ± 11.2% (p < .05) in the group with 120 mmHg, in the group with 200 mmHg it increased 267 ± 10.5% (p < .05), in the group with 300 mmHg it increased 233 ± 10.9% (p < .05). Applied 300 mmHg occlusion from the 12 minute diastolic and systolic arterial blood pressure decreased statistically significantly. Conclusions. Occlusion manoeuvre impacted the vascular vasodilatation, but the peak blood flow registered after occlusion did not relate to applied occlusion pressure. The pressure of 200 mmHg is optimal to impact the high level of vasodilatation. Longer than 12 min 300 mmHg could not be recommended due to the steep decrease of systolic and diastolic blood pressures.

Responses of cerebral arterioles to increased venous pressure

1982 ◽  
Vol 243 (3) ◽  
pp. H442-H447 ◽  
Author(s):  
E. P. Wei ◽  
H. A. Kontos
Keyword(s):  
Blood Pressure ◽  
Intracranial Pressure ◽  
Arterial Blood Pressure ◽  
Venous Pressure ◽  
Venous Hypertension ◽  
Arterial Hypotension ◽  
Arterial Blood ◽  
Pial Arterioles ◽  
Cerebral Arterioles ◽  
Arteriolar Vasodilation

The responses of pial arterioles to increased venous pressure were studied in anesthetized cats equipped with cranial windows for the observation of the pial microcirculation. Stable increases in venous pressure consistently induced arteriolar vasodilation, which averaged 6-12% of the control diameter. The vasodilation occurred when arterial blood pressure was normal and during arterial hypotension induced by bleeding; it also occurred irrespective of whether intracranial pressure was kept constant or was allowed to increase venous hypertension. The results are consistent with the view that autoregulatory adjustments in caliber of pial arterioles are mediated predominantly by metabolic rather than myogenic mechanisms.

scholarly journals The COMPARISON BETWEEN HYPERBARIC BUPIVACAINE PLUS FENTANYL AND HYPERBARIC BUPIVACAINE ALONE IN SPINAL ANESTHESIA FOR CAESAREAN SECTION

2021 ◽  
Vol 71 (3) ◽  
pp. 1033-36
Author(s):  
Fatima Iqbal ◽  
Manzoor Ahmed Faridi ◽  
Aisha Saeed ◽  
Inamullah Shah
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Caesarean Section ◽  
Arterial Blood Pressure ◽  
Mean Arterial Blood Pressure ◽  
Control Group ◽  
Study Group ◽  
Hyperbaric Bupivacaine ◽  
Arterial Blood ◽  
The Mean

Objective: To compare the result of the combination of hyperbaric bupivacaine plus fentanyl with hyperbaric bupivacaine alone in patients undergoing caesarean section in spinal anaesthesia. Study Design: Comparative, cross-sectional study. Place and Duration of Study: Department of Anesthesia, Fauji Foundation Hospital, Rawalpindi Pakistan, from Dec 2017 to Jun 2018. Methodology: After consulting the institutional ethical review committees a total of 60 females between ages 18-40 years were enrolled for caesarean section delivery. They were divided into two groups. The study group (n=30) received a subarachnoid injection of 0.5% hyperbaric bupivacaine (10mg) 2ml with 25ug of fentanyl 0.5ml and control group (n=30) was injected 0.5% hyperbaric bupivacaine 12.5mg (2.5 ml) only. Pain experienced during the procedure was assessed by using 10-point visual analogue scoring method. The mean duration of analgesia, mean arterial blood pressure and heart rate after surgery were compared between two groups. Results: The mean duration of analgesia was 206.5/min ± 6.4 in the study group and it was 163.6min ± 7.2 in the control group (p=0.001). Mean arterial BP after surgery was 92.3mmHg ± 3.8 in the study group and 88.7mmHg ± 4.1 in the control group (p=0.001). The mean heart rate recorded after surgery was 75.2/min ± 5.2 in the study group and it was 70.4/min ± 6.1 in the control group (p=0.001). Conclusions: The mean duration of analgesia was significantly longer in the study group when compared with the control group with better mean arterial blood pressure and heart rate response after Caesarean section.

The Role of Several Angiogenesis Peptides Markers in the Management of Hypertensive Pregnant Women

2018 ◽  
Vol 69 (6) ◽  
pp. 1509-1514
Author(s):  
Elena Mihalceanu ◽  
Daniela Cristina Dimitriu ◽  
Ioan Tudor Lazar ◽  
Brindusa Alina Petre ◽  
Gabriel Constantinescu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Serum Creatinine ◽  
Pregnant Women ◽  
Arterial Blood Pressure ◽  
Angiogenic Factors ◽  
Control Group ◽  
Serum Samples ◽  
Biochemical Tests ◽  
Arterial Blood ◽  
Plgf Ratio

The objectives of the research herein are to detect if the modifications of sFlt-1 and PlGF can be correlated with the clinical and biochemical status of the hypertensive pregnant woman and if the sFlt-1/PlGF ratio is a good predictor for preeclampsia in case of the investigated patients. In the study herein, 100 pregnant women were evaluated; they were distributed in the following groups: The group of pregnant women diagnosed with HTN at the time of hospital admission � including 50 pregnant women, of which 16 pregnant women presented medium and severe forms of preeclampsia and 34 pregnant women with pregnancy-induced hypertension and 50 pregnant women with normal pregnancy evolution as control group. We have performed hematological and biochemical tests, using serum samples from all analyzed patients and measured the serum concentrations of sFlt-1 and PlGF angiogenic factors. We found a significant correlation between the value of the arterial blood pressure, the proteinuria, the serum creatinine and the AST, on one hand, and the sFlt-1/PlGF ratio, on the other hand. The ROC curve has emphasized the fact that the proteinuria (AUC = 0.849), the AST (AUC = 0.664), the value of the arterial blood pressure SBP/DBP (AUC = 0.683/0.631), the serum creatinine (AUC = 0.674) and the sFlt-1/PlGF ratio, at a cut off value = 200, are effective preeclampsia predictors. Similarly, statistically significant increase (p = 0.001) of the sFlt-1 serum concentration in case of the pregnant women from the PE group (14365�6464 pg/mL) and from the PIH group (9892�8443 pg/mL), compared to the control group (3278�1444 pg/mL) and, respectively, a significant decrease (p = 0.003) of the PlGF pro-angiogenic marker for the group of pregnant women suffering from preeclampsia (119.30�56.63 pg/mL) and from PIH (129.12�21.41 pg/mL), compared to the control group (327.57�59.62 pg/mL). The results obtained within this research show that sFlt-1/PlGF ratio represents an effective preeclampsia predictor, confirming the fact that the study of the angiogenic factors may help to analyze the stratification of the risk degree in HTN pregnant women.

scholarly journals Comparison between Phentolamine and Nitroglycerin for Controlled Hypotension during Functional Endoscopic Sinus Surgery

2019 ◽  
Vol 4 (1) ◽  
Keyword(s):  
Blood Pressure ◽  
Blood Loss ◽  
Arterial Blood Pressure ◽  
Mean Arterial Blood Pressure ◽  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Controlled Hypotension ◽  
Operative Field ◽  
Arterial Blood

Background: Intraoperative bleeding is one of the most common complications in Functional endoscopic sinus surgery. Controlled hypotension is a method to minimize surgical blood loss and enhance the operative field visibility. The objective of this study was to compare the efficacy of controlled hypotensive anesthesia with intravenous infusion of phentolamine versus nitroglycerin as regarding intraoperative blood loss and hemodynamic stability. Methods: This current randomized study enrolled 30 patients candidate for Functional endoscopic sinus surgery at Beni-suef university hospital, in 2 equal groups receiving either 0.5 to 10 μg/kg/minute nitroglycerin or 0.1 to 2 mg/minute phentolamine to achieve a mean arterial blood pressure (MAP) of about 50 to 65 mmHg. Mean arterial blood pressure, amount of blood loss and the quality of surgical field using the 0-5 point bleeding scale were recorded. Results: Based on the current study findings, the two drugs produced the desired hypotension on the same time point; there were no significant differences between the study groups regarding the volume of bleeding and operative field visibility. Conclusions: Nitroglycerin and Phentolamine are safe, efficient and might be advisable option for deliberate hypotensive anesthesia throughout Functional endoscopic sinus surgery. Phentolamine can be a good alternative to Nitroglycerin in reduction of MAP during this procedure.

scholarly journals Ambulatory arterial blood pressure monitoring in patients before and after thyroidectomy

2008 ◽  
Vol 65 (2) ◽  
pp. 135-139
Author(s):  
Branislava Ivanovic ◽  
Ivan Paunovic ◽  
Djordje Nikcevic ◽  
Dane Cvijanovic ◽  
Nevena Kalezic ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Arterial Blood Pressure ◽  
Thyroid Surgery ◽  
De Novo ◽  
Blood Pressure Monitoring ◽  
Ambulatory Monitoring ◽  
Clinical Syndrome ◽  
Control Group ◽  
Arterial Blood

Bacground/Aim. Increased values of thyroid hormones in the clinical syndrome of hyperthyreosis affect blood pressure values and its circadial variation. The aim of this study was to define the influence of hyperthyreosis on the values and circadial variations of arterial blood pressure, as well as to investigate the effect of thyroid surgery on blood pressure values. Methods. We compared the 24-hour averages of systolic and diastolic blood pressure, their variations and their reduction during the night between 20 female patients with hyperthyroidism and hypertension de novo and 20 healthy females. We compared the values of 24-hour ambulatory monitoring performed before the surgery with the values gathered two weeks after the surgery. Results. The 24-hour average systolic and diastolic blood pressure values were higher in the patients with hyperthyroidism than in the control group (p < 0.001). In the group of patients, the variations in blood pressure were significantly higher than they were in the group of healthy people (p < 0.001). The amplitude of the nocturnal reduction of blood pressure was also significantly lower in the patients with hyperthyroid status and hypertension, in comparison to the healthy persons (p < 0.001). Two weeks after the surgery, a significant reduction of blood pressure values (both for systolic and diastolic) appeared. Conclusion. The patients with hyperthyroidism- caused hypertension had higher systolic and diastolic blood pressure, higher variations in blood pressure and lower nocturnal reduction of blood pressure than healthy subjects. Thyroid surgery, as a control of thyroid function, optimised blood pressure very rapidly.

Sign in / Sign up

Export Citation Format

Share Document