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Vasopressor and Anesthesia

M Clerc, J Prothet, T Rimmelé
Composite tissue allotransplantation (CTA) is a complex procedure requiring a multidisciplinary collaboration between surgeons, anesthetists, and transplantation specialists. We will describe the perioperative management of a bilateral forearm allograft performed at our facility. A 40-year-old man who lost both forearms was registered on the transplant waiting list; a suitable graft was available 11months later. Anesthesia required planning for vascular access, hemodynamic monitoring, fluid therapy management and prevention of deep vein thrombosis...
June 2016: Hand Surgery and Rehabilitation
M C Vallejo, A F Attaallah, O M Elzamzamy, D T Cifarelli, A L Phelps, G R Hobbs, R E Shapiro, P Ranganathan
BACKGROUND: During spinal anesthesia for cesarean delivery phenylephrine is the vasopressor of choice but can cause bradycardia. Norepinephrine has both β- and α-adrenergic activity suitable for maintaining blood pressure with less bradycardia. We hypothesized that norepinephrine would be superior to phenylephrine, requiring fewer rescue bolus interventions to maintain blood pressure. METHODS: Eighty-five parturients having spinal anesthesia for elective cesarean delivery were randomized to Group P (phenylephrine 0...
August 28, 2016: International Journal of Obstetric Anesthesia
Meredith Degnan, Jessica Brodt, Yiliam Rodriguez-Blanco
AIM: The aim of this study was to describe our institutional experience, primarily with general anesthesiologists consulting with cardiac anesthesiologists, caring for left ventricular assist device (LVAD) patients undergoing noncardiac surgery. MATERIALS AND METHODS: This is a retrospective review of the population of patients with LVADs at a single institution undergoing noncardiac procedures between 2009 and 2014. Demographic, perioperative, and procedural data collected included the type of procedure performed, anesthetic technique, vasopressor requirements, invasive monitors used, anesthesia provider type, blood product management, need for postoperative intubation, postoperative disposition and length of stay, and perioperative complications including mortality...
October 2016: Annals of Cardiac Anaesthesia
Xiangdi Yu, Fangxiang Zhang
BACKGROUND: Pain during cesarean delivery is one of the more common reasons for a successful medicolegal claim. However, creating an extensive block area can result in hypotension, so determining the precise dose of local anesthetic is critical. OBJECTIVES: Investigate effects of parturient height on the median effective dose (ED50) of intrathecally-administered ropivacaine. DESIGN: Prospective cross-sectional analytic study. SETTING: Anesthesiology department in a provinicial hospital in China...
September 2016: Annals of Saudi Medicine
Kajal Jain, Jeetinder Kaur Makkar, Siva Subramani Vp, Shalini Gander, Praveen Kumar
BACKGROUND: Previous evidence showed that use of phenylephrine was associated with higher umbilical artery pH (UA pH) than ephedrine after elective cesarean delivery (CD). However, the best choice of vasopressor and its effect on funic gases in cases of acute fetal compromise require additional studies. METHODS: Ninety parturients showing acute fetal compromise during intrapartum period and taken up for CD (category II) under spinal anesthesia were randomized to receive prophylactic infusion of ephedrine 2...
November 2016: Journal of Clinical Anesthesia
Michael K Essandoh, Andrew J Otey, Mahmoud Abdel-Rasoul, Erica J Stein, Katja R Turner, Nicholas C Joseph, Emile G Daoud
BACKGROUND: To date, general anesthesia has been suggested as the preferred approach for implantation of a subcutaneous implantable cardioverter-defibrillator (S-ICD). The purpose of this study was to assess the use of monitored anesthesia care (MAC) for S-ICD implantation. The goals were to assess adequate sedation and analgesia (efficacy endpoints) and major perioperative airway or hemodynamic compromise (safety endpoints). The authors hypothesized that MAC may provide adequate sedation and analgesia and no major perioperative airway or hemodynamic compromise during S-ICD implantation and multiple defibrillation threshold (DFT) testing...
October 2016: Journal of Cardiothoracic and Vascular Anesthesia
Lucy Mwaura, Vitalis Mung'ayi, Jimmie Kabugi, Samina Mir
BACKGROUND: Spinal anaesthesia is the standard of care for elective caesarean delivery. It has advantages over general anaesthesia. However the sympathetic blockade induced by spinal anaesthesia results in an 80 percent incidence of hypotension without prophylactic management. Current evidence supports co-loading with intravenous fluids in conjunction with the use of vasopressors as the most effective way to prevent and treat the hypotension. Phenylephrine is the accepted vasopressor of choice in the parturient...
June 2016: African Health Sciences
Shamsuddin Akhtar, Joseph Heng, Feng Dai, Robert B Schonberger, Mathew M Burg
BACKGROUND/OBJECTIVES: Despite guidelines suggesting a 25-50 % reduction in induction doses of intravenous anesthetic agents in the elderly (≥65 years), we hypothesized that practitioners were not sufficiently correcting drug administration for age, contributing to an increased incidence of hypotension in older patients undergoing general anesthesia. STUDY DESIGN: We conducted a retrospective, observational study in a tertiary-care academic hospital. The study included 768 female patients undergoing gynecologic surgeries who received propofol-based induction of general anesthesia...
August 31, 2016: Drugs & Aging
Reese W Randle, Courtney J Balentine, Susan C Pitt, David F Schneider, Rebecca S Sippel
BACKGROUND: The optimal preoperative α-blockade strategy is debated for patients undergoing laparoscopic adrenalectomy for pheochromocytomas. We evaluated the impact of selective versus non-selective α-blockade on intraoperative hemodynamics and postoperative outcomes. METHODS: We identified patients having laparoscopic adrenalectomy for pheochromocytomas from 2001 to 2015. As a marker of overall intraoperative hemodynamics, we combined systolic blood pressure (SBP) > 200, SBP < 80, SBP < 80 and >200, pulse > 120, vasopressor infusion, and vasodilator infusion into a single variable...
August 25, 2016: Annals of Surgical Oncology
Joana B Goic, Amy M Koenigshof, Lindsey D McGuire, Anthony C Klinger, Matthew W Beal
OBJECTIVE: To evaluate a population of dogs for evidence of contrast-induced nephropathy (CIN). DESIGN: A retrospective case review between 2006 and 2012. SETTING: A university teaching hospital. ANIMALS: A total of 1,217 client-owned dogs that were administered intravenous iodinated contrast agents were reviewed for evidence of CIN. Inclusion required a measured serum creatinine within 1 week prior as well as within 1 week following administration of contrast...
September 2016: Journal of Veterinary Emergency and Critical Care
Jean-Luc Hanouz, Anne-Lise Fiant, Jean-Louis Gérard
OBJECTIVES: The goal of the present study was to examine changes of middle cerebral artery (VMCA) blood flow velocity in patients scheduled for shoulder surgery in beach chair position. DESIGN: Prospective observational study. SETTING: Operating room, shoulder surgery. PATIENTS: Fifty-three consecutive patients scheduled for shoulder surgery in beach chair position. INTERVENTIONS: Transcranial Doppler performed after induction of general anesthesia (baseline), after beach chair positioning (BC1), during surgery 20minutes (BC2), and after back to supine position before stopping anesthesia (supine)...
September 2016: Journal of Clinical Anesthesia
Shaun Patel, Krystal L Weierstahl, Sonalee Shah, Christina W Fidkowski
The maternal mortality rate for parturients with severe pulmonary hypertension is 30% to 50%. General, epidural, and combined low-dose spinal-epidural anesthesia have been used successfully for cesarean deliveries in patients with pulmonary hypertension. We describe a cesarean delivery performed using an intrathecal catheter in a 25-year-old morbidly obese (body mass index, 82 kg/m) woman (gravida 3, para 2 at 32 weeks of gestation) who had severe pulmonary hypertension, right ventricular failure, pulmonary emboli, and obstructive sleep apnea...
October 1, 2016: A & A Case Reports
V Perilli, P Aceto, T Sacco, C Modesti, P Ciocchetti, F Vitale, A Russo, G Fasano, A Dottorelli, L Sollazzi
Graft and patients survival are the main goal of anesthesiological management in patients undergoing liver transplantation (LT). Even if anesthesiological practice sustained major developments over time, some evidence-based intraoperative strategies have not yet been widely applied. The aim of this review was to summarize intraoperative anesthesiological strategies which could have the potential to improve LT graft and/or recipient survival. Monitoring must be as accurate as possible in order to manage intraoperative hemodynamic changes...
July 2016: European Review for Medical and Pharmacological Sciences
Philip M Jones, Daniel Bainbridge, Michael W A Chu, Philip S Fernandes, Stephanie A Fox, Ivan Iglesias, Bob Kiaii, Ronit Lavi, John M Murkin
PURPOSE: Volatile anesthetics possess cardioprotective properties, but it is unknown if the cardioprotective effects extend equally to all members of the class. Although sevoflurane is a relatively newer anesthetic than isoflurane, its introduction into practice was not preceded by a head-to-head comparison with isoflurane in a trial focusing on clinically important outcomes. Our objective was to determine whether sevoflurane was non-inferior to isoflurane on a clinically important primary outcome in a heterogeneous group of adults undergoing cardiac surgery...
October 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Anitha Prashanth, Murali Chakravarthy, Antony George, Rohini Mayur, Rajathadri Hosur, Sumant Pargaonkar
Hypotension subsequent to spinal anesthesia occurs in a significant number of parturients undergoing lower segment caesarian section. Currently available methods to predict the incidence of hypotension, its severity and the outcome are sub-optimal. Many workers have used basal heart rate as one of the predictors. But using this method it is not possible to objectively analyze and predict the extent and severity of hypotension. We used an equipment measuring the level of sympatho-vagal balance, ANSiscope™, which derives these values from computed value of RR interval variability...
July 18, 2016: Journal of Clinical Monitoring and Computing
Maryam Y Naim, Robert M Sutton, Stuart H Friess, George Bratinov, Utpal Bhalala, Todd J Kilbaugh, Joshua W Lampe, Vinay M Nadkarni, Lance B Becker, Robert A Berg
OBJECTIVES: Treatment algorithms for cardiac arrest are rescuer centric and vary little from patient to patient. The objective of this study was to determine if cardiopulmonary resuscitation-targeted to arterial blood pressure and coronary perfusion pressure rather than optimal guideline care would improve 24-hour survival in a porcine model of ventricular fibrillation cardiac arrest. DATA SOURCES: Preclinical animal laboratory using female 3-month-old swine. STUDY SELECTION: A randomized interventional study...
July 13, 2016: Critical Care Medicine
Claus Z Simonsen, Leif H Sørensen, Niels Juul, Søren P Johnsen, Albert J Yoo, Grethe Andersen, Mads Rasmussen
RATIONALE: Endovascular therapy after acute ischemic stroke due to large vessel occlusion is now standard of care. There is equipoise as to what kind of anesthesia patients should receive during the procedure. Observational studies suggest that general anesthesia is associated with worse outcomes compared to conscious sedation. However, the findings may have been biased. Randomized clinical trials are needed to determine whether the choice of anesthesia may influence outcome. AIM AND HYPOTHESIS: The objective of GOLIATH (General or Local Anestesia in Intra Arterial Therapy) is to examine whether the choice of anesthetic regime during endovascular therapy for acute ischemic stroke influence patient outcome...
July 12, 2016: International Journal of Stroke: Official Journal of the International Stroke Society
Deepak Gupta, Vitaly Soskin, Milos Marjanovic, Hassan Amhaz, Ashish Mazumdar
BACKGROUND: Measuring non-invasive blood pressure (NIBP) in less than one minute intervals (STAT NIBP measurements) is not always feasible. Therefore, large number of undetectable hypotension episodes can only be recognized with continuous beat to beat monitoring of blood pressure, for example, by continuous non-invasive arterial pressure monitor (CNAP). OBJECTIVE: The purpose of the current study was to investigate whether CNAP correlates well with conventional intermittent oscillometric NIBP during elective cesarean sections under subarachnoid blockade (SAB) and whether CNAP based patient management results in improved immediate maternal vasopressor requirements and improved immediate fetal/neonatal outcomes compared with NIBP based patient management...
February 2016: Middle East Journal of Anesthesiology
Alma Soxhuku-Isufi, Vjollca Shpata, Hektor Sula
AIM: The aim of the study was to examine whether ephedrine and phenylephrine were different in their efficacy for managing maternal hypotension and their effect of adverse maternal and neonatal outcome. METHODS: A double-blind randomized controlled study in healthy pregnant women ASA physical status 2, which underwent elective caesarian delivery under spinal anesthesia. Patients were randomized to receive an intravenous bolus of either phenylephrine (Ph group) or ephedrine (E group) immediately after the episode of hypotension after spinal anesthesia...
March 15, 2016: Open Access Macedonian Journal of Medical Sciences
Elaina E Lin, Julie S Moldenhauer, Kha M Tran, David E Cohen, N Scott Adzick
The anesthetic management for open fetal surgery has been described, but many therapeutic tenets have not been supported with data. We present data on the anesthetic management and outcomes of 65 patients undergoing ex utero intrapartum therapy procedures at the Children's Hospital of Philadelphia between 1998 and 2011. Patients were identified, and medical records were retrospectively reviewed. Maternal general anesthesia combined with postoperative epidural analgesia was commonly used. High levels of volatile anesthetic were used for uterine relaxation...
August 2016: Anesthesia and Analgesia
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