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Vasopressor and Anesthesia

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https://www.readbyqxmd.com/read/28804498/feasibility-of-cervical-epidural-anesthesia-for-breast-cancer-surgery
#1
Manuel Wenk, Christina Massoth, Daniel M Pöpping, Michael Möllmann
BACKGROUND: Effects of perioperative cervical level neuraxial blocks on the dissemination of cancer metastases have become a matter of substantial interest. However, experience with these catheters has been limited and data on feasibility and efficacy is sparse. METHODS: Data from 39 patients scheduled to undergo breast cancer surgery while awake with a cervical epidural alone was retrospectively analyzed. RESULTS: In 26 patients (66,7%, 95% CI 51,7-81,7) the cervical epidural catheter was sufficient for surgery...
2017: Anesthesiology Research and Practice
https://www.readbyqxmd.com/read/28759487/aortocaval-compression-syndrome-time-to-revisit-certain-dogmas
#2
Allison J Lee, Ruth Landau
More than 70 years ago, the phenomenon of "postural shock" in the supine position was described in healthy women in late pregnancy. Since then, avoidance of the supine position has become a key component of clinical practice. Indeed, performing pelvic tilt in mothers at term to avoid aortocaval compression is a universally adopted measure, particularly during cesarean delivery. The studies on which this practice is based are largely nonrandomized, utilized a mix of anesthetic techniques, and were conducted decades ago in the setting of avoidance of vasopressors...
July 27, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28738447/comparison-of-local-versus-general-anesthesia-in-patients-undergoing-transcatheter-aortic-valve-replacement-a-meta-analysis
#3
Pedro A Villablanca, Divyanshu Mohananey, Katarina Nikolic, Sripal Bangalore, David P Slovut, Verghese Mathew, Vinod H Thourani, Josep Rode's-Cabau, Iván J Núñez-Gil, Tina Shah, Tanush Gupta, David F Briceno, Mario J Garcia, Jacob T Gutsche, John G Augoustides, Harish Ramakrishna
BACKGROUND: Transcatheter aortic valve replacement (TAVR) is typically performed under general anesthesia (GA). However, there is increasing data supporting the safety of performing TAVR under local anesthesia/conscious sedation (LA). We performed a meta-analysis to gain better understanding of the safety and efficacy of LA versus GA in patients with severe aortic stenosis undergoing TAVR. METHODS AND RESULTS: We comprehensively searched EMBASE, PubMed, and Web of Science...
July 24, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28713516/sequential-compression-pump-effect-on-hypotension-due-to-spinal-anesthesia-for-cesarean-section-a-double-blind-clinical-trial
#4
Fatemeh Javaherforoosh Zadeh, Mostafa Alqozat, Reza Akhond Zadeh
BACKGROUND: Spinal anesthesia (SA) is a standard technique for cesarean section. Hypotension presents an incident of 80-85% after SA in pregnant women. OBJECTIVE: To determine the effect of intermittent pneumatic compression of lower limbs on declining spinal anesthesia induced hypotension during cesarean section. METHODS: This double-blind clinical prospective study was conducted on 76 non-laboring parturient patients, aged 18-45 years, with the American Society of Anesthesiologist physical status I or II who were scheduled for elective cesarean section at Razi Hospital, Ahvaz, Iran from December 21, 2015 to January 20, 2016...
May 2017: Electronic Physician
https://www.readbyqxmd.com/read/28707996/effect-of-the-degree-of-head-elevation-on-the-incidence-and-severity-of-venous-air-embolism-in-cranial-neurosurgical-procedures-with-patients-in-the-semisitting-position
#5
Hatice Türe, M Volkan Harput, Nural Bekiroğlu, Özgül Keskin, Özge Köner, Uğur Türe
OBJECTIVE The semisitting position of a patient confers numerous advantages in various neurosurgical procedures, but venous air embolism is one of the associated complications of this position. To date, no prospective studies of the relationship between the degree of head elevation and the rate and severity of venous air embolism for patients undergoing a procedure in this position have been performed. In this study, the authors compared changes in the severity of venous air embolism according to the degree of head elevation (30° or 45°) in patients undergoing an elective cranial neurosurgical procedure in the semisitting position...
July 14, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28704246/the-effect-of-glycopyrrolate-on-the-incidence-of-hypotension-and-vasopressor-requirement-during-spinal-anesthesia-for-cesarean-delivery-a-meta-analysis
#6
Selina D Patel, Ashraf S Habib, Sioned Phillips, Brendan Carvalho, Pervez Sultan
BACKGROUND: The objective of this meta-analysis was to determine the efficacy of glycopyrrolate at reducing spinal hypotension during cesarean delivery. METHODS: A literature search was performed to identify randomized controlled trials investigating the effect of glycopyrrolate on spinal-induced hypotension during cesarean delivery. Primary outcomes were intraoperative hypotension and vasopressor requirement (phenylephrine equivalents). Secondary outcomes included heart rate (HR), nausea and vomiting, dry mouth, and Apgar scores...
July 10, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28689624/neonatal-effects-after-vasopressor-during-spinal-anesthesia-for-cesarean-section-a-multicenter-randomized-controlled-trial
#7
K Uerpairojkit, R Anusorntanawat, A Sirisabya, M Chaichalothorn, S Charuluxananan
BACKGROUND: Placental transfer of ephedrine causes fetal effects when compared with phenylephrine. This study compared their drug effects on neonatal parameters after cesarean delivery under spinal anesthesia. METHODS: Three-hundred-and-fifty-four women undergoing elective cesarean delivery who needed intravenous vasopressor following spinal anesthesia were randomized into two groups. Group E received boluses of ephedrine 6mg, and Group P phenylephrine 100µg, titrated to maintain systolic blood pressure near baseline values...
July 6, 2017: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/28678073/prophylactic-norepinephrine-infusion-for-preventing-hypotension-during-spinal-anesthesia-for-cesarean-delivery
#8
Warwick D Ngan Kee, Shara W Y Lee, Floria F Ng, Kim S Khaw
BACKGROUND: The use of norepinephrine for maintaining blood pressure (BP) during spinal anesthesia for cesarean delivery has been described recently. However, its administration by titrated manually controlled infusion in this context has not been evaluated. METHODS: In a double-blinded, randomized controlled trial, 110 healthy women having spinal anesthesia for elective cesarean delivery were randomly allocated to 1 of 2 groups. In group 1, patients received an infusion of 5 μg/mL norepinephrine that was started at 30 mL/h (2...
July 1, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28669885/evaluation-of-gastric-microcirculation-by-laser-speckle-contrast-imaging-during-esophagectomy
#9
Rikard Ambrus, Michael P Achiam, Niels H Secher, Morten Bs Svendsen, Kim Rünitz, Mette Siemsen, Lars B Svendsen
BACKGROUND: Thoracic epidural anesthesia (TEA) may provoke hypotension, and that, as well as the use of vasopressors and the surgical technique, could affect splanchnic microcirculation, of which the surgical target organ is of particular interest. This study used laser speckle contrast imaging (LSCI) to monitor gastric microcirculation during esophagectomy. STUDY DESIGN: Forty-five patients undergoing open esophagectomy were randomized to primary activation (EA; 25 patients) or no intraoperative activation (LA; 20 patients) of TEA...
June 29, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28663637/evaluation-of-leg-wrapping-for-the-prevention-of-postspinal-hypotension-in-cesarean-section-under-spinal-anesthesia
#10
Aparna Abhijit Bagle, Adithya Vishnu, Anil Kumar, Amit Malik, Vinit Garg, Gayatri Khanvilkar
BACKGROUND: Spinal blockade provides excellent anesthesia for patients undergoing cesarean section. However, hypotension after spinal anesthesia is a common adverse effect that is commonly experienced in patients undergoing cesarean section. The aim of our study was to analyze if a simple technique like leg wrapping with elastic crepe bandage would be effective in controlling postspinal hypotension. MATERIALS AND METHODS: Sixty full-term pregnant patients who were posted for cesarean section belonging to American Society of Anesthesiologists I and II were divided into two groups...
April 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/28625306/spinal-induced-hypotension-incidence-mechanisms-prophylaxis-and-management-summarizing-20-years-of-research
#11
REVIEW
Jennifer E Lee, Ronald B George, Ashraf S Habib
Hypotension commonly occurs in parturients undergoing cesarean delivery under spinal anesthesia. This leads to maternal and neonatal adverse outcomes, including maternal nausea and vomiting and fetal acidosis, and might even lead to cardiovascular collapse if not treated. Arterial dilatation and reduction in systemic vascular resistance are the major contributors to spinal-induced hypotension. Therefore, strategies aimed at expanding the intravascular volume with fluid loading or increasing venous return with lower extremities mechanical compression and lateral tilt have had limited effectiveness in the management of spinal-induced hypotension...
March 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/28603701/a-comparison-of-intravenous-ephedrine-or-phenylephrine-for-prevention-of-postspinal-hypotension-during-elective-lower-abdominal-surgery-a-randomized-double-blind-case-control-study
#12
Khosrou Naghibi, Mojtaba Rahimi, Zahra Mashayekhi
BACKGROUND: In this randomized, double-blinded case-control study, we investigated the intravenous effects of ephedrine or phenylephrine on prevention of post-spinal hypotension in elective lower abdominal surgery under spinal anesthesia. MATERIALS AND METHODS: One hundred and thirty-five patients, American Society of Anesthesiologists physical status I or II candidate for elective lower abdominal surgery under spinal anesthesia were randomized to three groups (45 each)...
2017: Advanced Biomedical Research
https://www.readbyqxmd.com/read/28598913/xenon-as-an-adjuvant-to-propofol-anesthesia-in-patients-undergoing-off-pump-coronary-artery-bypass-graft-surgery-a-pragmatic-randomized-controlled-clinical-trial
#13
Layth Al Tmimi, Sarah Devroe, Geertrui Dewinter, Marc Van de Velde, Gert Poortmans, Bart Meyns, Bart Meuris, Mark Coburn, Steffen Rex
BACKGROUND: Xenon was shown to cause less hemodynamic instability and reduce vasopressor needs during off-pump coronary artery bypass (OPCAB) surgery when compared with conventionally used anesthetics. As xenon exerts its organ protective properties even in subanesthetic concentrations, we hypothesized that in patients undergoing OPCAB surgery, 30% xenon added to general anesthesia with propofol results in superior hemodynamic stability when compared to anesthesia with propofol alone...
June 8, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28543052/norepinephrine-reduces-arterial-compliance-less-than-phenylephrine-when-treating-general-anesthesia-induced-arterial-hypotension
#14
F Vallée, O Passouant, A Le Gall, J Joachim, J Mateo, A Mebazaa, E Gayat
INTRODUCTION: During general anesthesia, arterial hypotension is frequent and may be an important contributor to perioperative morbidity. We assessed the effect of a 5 μg bolus of Norepinephrine (NA) when compared with 50 μg bolus of Phenylephrine (PE) administered to treat hypotension during maintenance anesthesia, on MAP, derived cardiac output and arterial stiffness parameters. METHODS: Patients scheduled for a neurosurgical procedure under general anesthesia were prospectively included...
July 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/28489683/intraoperative-use-of-vasopressors-does-not-increase-the-risk-of-free-flap-compromise-and-failure-in-cancer-patients
#15
Lin Fang, Jun Liu, Cuicui Yu, Matthew M Hanasono, Gang Zheng, Peirong Yu
OBJECTIVE: To examine the effects of vasopressors on free flap outcomes. BACKGROUND: Most micro-surgeons avoid the use of vasopressors during free flap surgery due to concerns of vasoconstriction, which could potentially lead to vascular thrombosis and flap failure. Previous studies lack the statistical power to draw meaningful conclusions. METHODS: All free flaps between 2004 and 2014 from a single institution were reviewed retrospectively...
May 9, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28428483/a-retrospective-study-of-anesthesia-for-subcutaneous-ureteral-bypass-placement-in-cats-27-cases
#16
Geneviève C Luca, Beatriz P Monteiro, Marilyn Dunn, Paulo V M Steagall
The goals of this retrospective clinical case series study were to describe the management of anesthesia, and to report perioperative complications in cats undergoing subcutaneous ureteral bypass (SUB) placement due to ureteral obstruction. Medical records of client-owned cats with ureteral obstruction and anesthetized for SUB placement between 2012 and 2015 in a veterinary teaching hospital were reviewed. Twenty-seven cases were identified. Duration of anesthesia and surgery (mean ± standard deviation) were 215 ± 42 min and 148 ± 36 min, respectively...
June 10, 2017: Journal of Veterinary Medical Science
https://www.readbyqxmd.com/read/28368937/physician-directed-versus-computerized-closed-loop-control-of-blood-pressure-using-phenylephrine-in-a-swine-model
#17
Nicole Ribeiro Marques, William E Whitehead, Upendar R Kallu, Michael P Kinsky, Joe S Funston, Taoufik Wassar, Muzna N Khan, Mindy Milosch, Daniel Jupiter, Karolos Grigoriadis, George C Kramer
BACKGROUND: Vasopressors provide a rapid and effective approach to correct hypotension in the perioperative setting. Our group developed a closed-loop control (CLC) system that titrates phenylephrine (PHP) based on the mean arterial pressure (MAP) during general anesthesia. As a means of evaluating system competence, we compared the performance of the automated CLC with physicians. We hypothesized that our CLC algorithm more effectively maintains blood pressure at a specified target with less blood pressure variability and reduces the dose of PHP required...
July 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28368936/closed-loop-feedback-computer-controlled-phenylephrine-for-maintenance-of-blood-pressure-during-spinal-anesthesia-for-cesarean-delivery-a-randomized-trial-comparing-automated-boluses-versus-infusion
#18
RANDOMIZED CONTROLLED TRIAL
Warwick D Ngan Kee, Yuk-Ho Tam, Kim S Khaw, Floria F Ng, Shara W Y Lee
BACKGROUND: We previously described the use of closed-loop feedback computer-controlled infusion of phenylephrine for maintaining blood pressure (BP) during spinal anesthesia for cesarean delivery. In this study, we report a modified system in which phenylephrine is delivered by intermittent boluses rather than infusion. We hypothesized that the use of computer-controlled boluses would result in more precise control of BP compared with infusions. METHODS: Two hundred fourteen healthy patients having spinal anesthesia for elective cesarean delivery were randomized to have their systolic BP maintained by phenylephrine administered by computer-controlled continuous infusion or computer-controlled intermittent boluses...
July 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28289667/laparoscopic-cholecystectomy-under-spinal-epidural-anesthesia-vs-general-anaesthesia-a-prospective-randomised-study
#19
Turgut Donmez, Vuslat Muslu Erdem, Sinan Uzman, Dogan Yildirim, Huseyin Avaroglu, Sina Ferahman, Oguzhan Sunamak
PURPOSE: Laparoscopic cholecystectomy (LC) is usually performed under the general anesthesia (GA). Aim of the study is to investigate the availability, safety and side effects of combined spinal/epidural anesthesia (CSEA) and comparison it with GA for LC. METHODS: Forty-nine patients who have a LC plan were included into the study. The patients were randomly divided into GA (n = 25) and CSEA (n = 24) groups. Intraoperative and postoperative adverse events, postoperative pain levels were compared between groups...
March 2017: Annals of Surgical Treatment and Research
https://www.readbyqxmd.com/read/28258299/vasopressors-induce-passive-pulmonary-hypertension-by-blood-redistribution-from-systemic-to-pulmonary-circulation
#20
Chunling Jiang, Hong Qian, Shuhua Luo, Jing Lin, Jerry Yu, Yajiao Li, Qi An, Nanfu Luo, Lei Du
Vasopressors are widely used in resuscitation, ventricular failure, and sepsis, and often induce pulmonary hypertension with undefined mechanisms. We hypothesize that vasopressor-induced pulmonary hypertension is caused by increased pulmonary blood volume and tested this hypothesis in dogs under general anesthesia. In normal hearts (model 1), phenylephrine (2.5 μg/kg/min) transiently increased right but decreased left cardiac output, associated with increased pulmonary blood volume (63% ± 11.8, P = 0...
May 2017: Basic Research in Cardiology
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