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Rev. med. Risaralda ; 27(1): 64-69, ene.-jun. 2021. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1280494


Resumen Introducción: El shock hemorrágico es una de las causas más comunes de muerte en pacientes con trauma debido a que pone en marcha un círculo vicioso de mecanismos que incluyen hipotermia, acidosis y coagulopatía. Para mitigar estos efectos, se han propuesto estrategias de control de daños, incluido el aporte controlado de líquidos con hipotensión permisiva contemplando metas en la presión arterial sistólica para mantener una adecuada perfusión de los tejidos. Objetivo: Conocer información actualizada acerca del manejo de la hipotensión permisiva en pacientes con trauma. Metodología: Se buscó información en las bases de datos Web-of-Science y Scopus de los últimos cinco años. El resultado arrojó un total de 118 artículos de los cuales se tomaron 30, según los criterios de inclusión y exclusión. Resultados: Todos los artículos consideran el uso de la hipotensión permisiva como una buena opción para el manejo de los pacientes con trauma e hipotensión, sin embargo, difieren en qué momento es adecuado utilizarlo y en qué condiciones se debe realizar. Conclusiones: Si bien la hipotensión permisiva se ha convertido en uno de los pilares fundamentales en el manejo prehospitalario del paciente con trauma, se requieren estudios investigativos en humanos para soportar cuándo y cómo debe utilizarse.

Abstract Introduction: Hemorrhagic shock is one of the most common causes of death in trauma patients, because it sets in motion a vicious cycle of mechanisms, including hypothermia, acidosis, and coagulopathy. To mitigate these effects, damage control strategies have been proposed, including the controlled intake of fluids with permissive hypotension, contemplating goals in systolic blood pressure, and thus, maintaining adequate tissue perfusion. Objective: The present research aimed to review the literature in search of updated information about the management of permissive hypotension in patients with trauma. Methodology: Information was searched in the Web-of-Science and Scopus databases in the last five years. The result yielded a total of 118 articles, of which 30 were taken according to the inclusion and exclusion criteria. Results: All the articles consider the use of permissive hypotension as a good option for the management of patients with trauma and hypotension, however, they differ when it is appropriate to use it and under what conditions it should be performed. Conclusions: Although permissive hypotension has become one of the fundamental pillars in the prehospital management of the patient with trauma, research studies in humans are required to support when and how it should be used.

Humans , Shock, Hemorrhagic , Wounds and Injuries , Hypotension , Hypothermia , Tissues , Acidosis , Blood Pressure , Cause of Death , Health Strategies , Alkalies , Arterial Pressure
Chinese Medical Journal ; (24): 1043-1051, 2021.
Article in English | WPRIM | ID: wpr-878147


BACKGROUND@#Hypotension is a common complication caused by spinal anesthesia (SA), which may have adverse impacts on the condition of the parturient and fetus. Liquid infusion was found to be relatively effective for reducing the incidence of hypotension. However, the question of whether colloid preload can optimize hemodynamic variables in the cesarean section remains controversial. This study aims to determine the effects of colloid preload on the incidence of hypotension induced by SA in elective cesarean section.@*METHODS@#Related keywords were searched on PubMed, EMBASE, and Cochrane Library from inception dates to May 2020. Studies included were evaluated for eligibility and quality. The primary outcome was the intra-operative incidence of hypotension and severe hypotension. The secondary outcomes included the lowest intra-operative systolic blood pressure, the maximal intra-operative heart rate, the intra-operative needs of ephedrine and phenylephrine, the incidence of maternal nausea and/or vomiting, and neonatal outcomes (umbilical artery pH and Apgar scores). Apart from the above, RevMan 5.3 was used for the data analysis.@*RESULTS@#Altogether nine randomized controlled trials were included in the meta-analysis. There were no significant differences in the incidence of intra-operative hypotension, severe hypotension, or neonatal outcomes between the colloid preload group and control group, except for the umbilical artery pH.@*CONCLUSION@#This meta-analysis suggests that colloid preload does not significantly reduce the incidence of hypotension associated with SA in elective cesarean section.

Anesthesia, Spinal/adverse effects , Cesarean Section/adverse effects , Colloids , Female , Humans , Hypotension/etiology , Incidence , Infant, Newborn , Pregnancy , Vasoconstrictor Agents/therapeutic use
Chinese Medical Journal ; (24): 792-799, 2021.
Article in English | WPRIM | ID: wpr-878087


BACKGROUND@#Norepinephrine infusion decreases hypotension after spinal anesthesia during cesarean section. This study aimed to compare the efficacy of norepinephrine infusion and ephedrine bolus against post-spinal hypotension in parturients.@*METHODS@#In this double-blinded, randomized controlled clinical trial, parturients scheduled for elective cesarean section were randomly allocated to receive norepinephrine infusion (0.05 μg·kg-1·min-1) just before spinal anesthesia continuing for 30 min or ephedrine bolus (0.15 mg/kg) just before spinal anesthesia. A rescue bolus (5 μg norepinephrine for the norepinephrine group, and 5 mg ephedrine for the ephedrine group) was administered whenever hypotension occurred. Our primary outcome was the incidence of hypotension within 30 min of spinal anesthesia administration. Secondary outcomes included maternal and neonatal outcomes 30 min after spinal block, and neonatal cerebral oxygenation 10 min after birth.@*RESULTS@#In total, 190 patients were enrolled; of these patients, 177 were included in the final analysis. Fewer patients suffered hypotension in the norepinephrine group than in the ephedrine group (29.5% vs. 44.9%, odds ratio [OR]: 0.51, 95% confidence interval [CI]: 0.28-0.95, P = 0.034). Moreover, the tachycardia frequency was lower in the norepinephrine group than in the ephedrine group (OR: 0.22, 95% CI: 0.11-0.44, P < 0.001), and patients suffered less nausea and vomiting (OR: 0.28, 95% CI: 0.11-0.70, P = 0.004). There was no difference in Apgar scores and umbilical arterial blood gas analysis between the two groups. However, neonatal cerebral regional saturations were significantly higher after birth in the norepinephrine group than in the ephedrine group (mean difference: 2.0%, 95% CI: 0.55%-3.45%, P = 0.008).@*CONCLUSION@#In patients undergoing elective cesarean section with spinal anesthesia, norepinephrine infusion compared to ephedrine bolus resulted in less hypotension and tachycardia, and exhibited potential neonatal benefits.@*TRIAL, NCT02542748;

Anesthesia, Spinal/adverse effects , Cesarean Section/adverse effects , Double-Blind Method , Female , Humans , Hypotension/prevention & control , Infant, Newborn , Phenylephrine , Pregnancy , Randomized Controlled Trials as Topic , Vasoconstrictor Agents/therapeutic use
Article in English | WPRIM | ID: wpr-880626


With the advancement of disease treatments, the number of patients undergoing surgery worldwide is increasing. However, many patients still experience severe perioperative complications. Perioperative hypotension is one of the common side effects during surgery. Physiologically, perioperative hypotension can lead to insufficient perfusion of important organs and result in acute and chronic irreversible organ injury, which cause serious consequences for the patient's postoperative hospitalization and even the long-term outcome. Therefore, in order to optimize perioperative circulation management and improve the quality of life for patients after surgery, it is of great importance to investigate the relationship between perioperative hypotension and postoperative myocardial injury, ischemic stroke, postoperative delirium, acute kidney injury, and postoperative mortality. Individualized circulation management and reasonable application of vasoactive drugs may be the key point to early prevention and correct treatment of perioperative hypotension, which is of great significance for reducing perioperative related morbidity and mortality and improving the prognosis for the surgical patients.

Acute Kidney Injury/etiology , Humans , Hypotension/etiology , Postoperative Complications/etiology , Quality of Life
Rev. colomb. anestesiol ; 48(4): e400, Oct.-Dec. 2020. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1144318


Abstract Introduction Laparoscopic adrenalectomy is the treatment of choice of pheochromocytoma. During the first surgical phase (pneumoperitoneum insufflation, tumor and veins handling), there is a risk of hypertensive crisis due to catecholamine release. After tumor excision, patients can suffer relative vasodilation and the residual effect of antihypertensive drugs, which results in arterial hypotension. For that reason, antihypertensive drugs used in the first phase should have a rapid onset of action, short half-life and no residual effect. Methods We report a series of three cases of patients with pheochromocytoma who were treated with laparoscopic adrenalectomy. They all received clevidipine infusion from the beginning of the surgery, before they had presented hypertension, to treat and try to minimize hypertensive peaks. Results In all patients, hypertensive peaks were controlled in a few minutes. After tumor resection, clevidipine infusion was stopped in all cases, and any patient required infusion of vasopressors. Discussion Clevidipine could be a first choice antihypertensive drug in pheochromocytoma surgery. Starting the infusion of clevidipine before the hypertensive peaks could help to make them less pronounced.

Resumen Introducción La adrenalectomía laparoscópica es el tratamiento de elección del feocromocitoma. Durante la primera fase quirúrgica (insuflación de neumoperitoneo, manipulación del tumor y de las venas implicadas), existe el riesgo de que se desencadenen crisis hipertensivas debido a la liberación de catecolaminas. Después de la extirpación del tumor, los pacientes pueden sufrir una vasodilatación relativa y el efecto residual de los fármacos antihipertensivos usados previamente, lo que resulta en hipotensión arterial. Por esa razón, los fármacos antihipertensivos utilizados en la primera fase quirúrgica deben tener rápido inicio de acción, vida media corta y mínimo efecto residual. Métodos Se describe una serie de casos de tres pacientes con feocromocitoma que fueron tratados con adrenalectomía laparoscópica. Todos recibieron infusión de clevidipino desde el comienzo de la cirugía, antes de presentar hipertensión arterial, para así intentar minimizar y tratar rápidamente los posibles picos hipertensivos. Resultados En todos los pacientes los picos hipertensivos se controlaron en pocos minutos. Después de la resección del tumor, la infusión de clevidipino se detuvo en todos los casos y ningún paciente requirió perfusión de vasopresores. Discusión El clevidipino podría ser un fármaco antihipertensivo de primera elección en la cirugía de feocromocitoma. Iniciarlo antes de que ocurran los picos hipertensivos podría ayudar a que sean más leves.

Humans , Male , Female , Middle Aged , Aged , Antihypertensive Agents , Pheochromocytoma , Catecholamines , Adrenalectomy , Hypotension
Rev. bras. cir. cardiovasc ; 35(5): 824-830, Sept.-Oct. 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1137319


Abstract Objective: To investigate the cardiovascular effects produced by transthoracic application of low-intensity pulsed ultrasound therapy (LIPUST). Methods: Three-month-old male Wistar rats (± 300 g, N=16) were randomly allocated in two groups, namely SHAM (control group, faked procedures) and UST (animals treated with LIPUST). These animals, under anesthesia, were instrumented (femoral artery and vein catheterization) for hemodynamic recordings (mean blood pressure [MBP], heart rate [HR]) and blood biochemical profile (lipids, creatine kinase-myocardial band [CK-MB]). Then, LIPUST (spatial average-temporal average [ISATA] 1-MHz, power 0.1 to 1.2 W/cm2, pulsed 2:8 ms, cycle at 30%, for three minutes) was applied to animals from the UST group, externally to their thorax. SHAM animals were equally manipulated, but without application of ultrasound energy. After the hemodynamic and biochemical measurements, animals were sacrificed, and their hearts were mounted in a Langendorff apparatus for coronary reactivity evaluation. Standard histology techniques were employed to analyze the hearts. Results: LIPUST application caused statistically significant reductions in MBP (92±4 vs. 106±1 mmHg) and HR (345±14 vs. 380±17 rpm) when compared with SHAM procedures. UST rats exhibited higher CK-MB levels (318±55 vs. 198±26 U/dL) and lower plasma triglycerides levels (38±7 vs. 70±10 mg/dL) than SHAM animals. Coronary reactivity was not significantly changed by LIPUST. Cardiac histopathology showed an increase in capillary permeability in treated animals when compared with SHAM animals. Conclusion: Noninvasive LIPUST induces significant metabolic and hemodynamic changes, including intensity-dependent bradycardia and hypotension, indicating a possible therapeutic effect for cardiac events.

Animals , Male , Rats , Bradycardia/therapy , Hypotension , Myocardium , Rats, Wistar , Ultrasonic Waves , Heart , Hemodynamics
Rev. cuba. med. mil ; 49(3): e331, jul.-set. 2020. fig
Article in Spanish | LILACS, CUMED | ID: biblio-1144488


Introducción: El lupus eritematoso sistémico tiene múltiples formas de presentarse. La afectación del pericardio es la manifestación cardíaca más frecuente. El taponamiento cardíaco es muy raro, pero se presenta como un síndrome clínico hemodinámico potencialmente mortal. Objetivo: Mostrar una forma muy rara de presentación del lupus eritematoso sistémico; el taponamiento cardíaco. Caso clínico: Paciente blanca de 47 años con anasarca, disnea, palpitaciones, polipnea, ortopnea, tiraje intercostal, dolor torácico intenso, punzante, toma del estado general, ansiedad, fiebre, artralgia, artritis, lesiones dermatológicas, acrocianosis, ingurgitación yugular e hipotensión marcada. Comentarios: El paciente con taponamiento cardíaco debe ser asumido por un equipo multidisciplinario que defina el diagnóstico preciso y la conducta, sobre todo cuando se trata del debut del lupus eritematoso sistémico, que con los fenómenos autoinmunitarios, afecta a todos los órganos y sistemas(AU)

Introduction: Systemic lupus erythematosus has multiple ways of presentation. Pericardium involvement is the most frequent cardiac manifestation. Cardiac tamponade is very rare, but it presents as a life-threatening clinical hemodynamic syndrome. Objective: To show a very rare form of presentation of systemic lupus erythematosus; cardiac tamponade. Clinical case: 47-year-old white patient with anasarca, dyspnea, palpitations, polypnea, orthopnea, intercostal retraction, throbbing severe chest pain, bad general condition, anxiety, fever, arthralgia, arthritis, dermatological lesions, acrocyanosis, jugular engorgement and severe hypotension. Comments: Cardiac tamponade patient must be assumed by a multidisciplinary team that defines the precise diagnosis and behavior, especially when it comes to the debut of systemic lupus erythematosus, which with its autoimmune phenomena, affects all organs and systems(AU)

Humans , Female , Middle Aged , Cardiac Tamponade/diagnostic imaging , Edema , Hypotension , Lupus Erythematosus, Systemic/complications , Dyspnea
Arch. argent. pediatr ; 118(3): e284-e287, jun. 2020. ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1116948


La miocarditis es una complicación grave de la infección por el virus de la varicela-zóster. Un varón de 15 años ingresó a la sala de emergencias debido a dolor torácico, taquicardia e hipotensión. En el electrocardiograma se observó taquicardia sinusal. Los biomarcadores cardíacos estaban elevados. En el ecocardiograma se notó hipocinesia apical, septal, e inferolateral del ventrículo izquierdo e insuficiencia mitral. Los anticuerpos IgM en suero para el virus de la varicela-zóster eran positivos. El paciente recibió el alta sin secuelas.

Myocarditis is a serious complication of varicella zoster virus infection. A 15 year-old boy was admitted to the Emergency Department for chest pain, tachycardia and hypotension. An electrocardiogram showed sinus tachyicardia. Cardiac biomarkers were elevated and echocardiography revealed left ventricular apical, inferolateral, septal hypokinesis, and mitral regurgitation. Varicella zoster virus serum immunoglobulin M antibody was positive. The patient was discharged without any sequelae.

Humans , Male , Adolescent , Varicella Zoster Virus Infection/diagnosis , Tachycardia , Hypotension , Myocarditis
Arq. bras. cardiol ; 114(2): 295-303, Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1088850


Abstract Background: Cigarette smoking is usually associated with hypertension and may modify vasoconstrictor response. Objective: The present study aimed to analyze and compare the interaction of passive cigarette smoking and hypertension on epinephrine and felypressin blood pressure effects after intravascular injection. Method: 45-day male Wistar rats had the main left renal artery partially constricted and the right kidney removed (1K1C model). Rats were placed in the chamber for exposition to passive cigarette smoking (10 cigarettes) during 10 min (6 days a week). Hypertensive rats received atenolol (90 mg/kg/day) by gavage for two weeks. Hypotensive and hypertensive response, response duration and heart rate were recorded from direct blood pressure values. The significance level was 5%. Results: Passive cigarette smoking increased maximal hypertensive response to epinephrine in normotensive and 1K1C-atenolol treated rats and to felypressin only in 1K1C-atenolol treated rats; it also reduced epinephrine hypotensive response. Epinephrine increased heart rate in normotensive and hypertensive passive smokers or non-smoker rats. Comparing the two vasoconstrictors, epinephrine showed greater hypertensive response in normotensive smokers, 1K1C-atenolol treated smokers and non-smokers. However, in normotensive-nonsmoker rats, felypressin showed a greater and longer hypertensive effect. Conclusions: Our results suggest that passive cigarette smoking may reduce epinephrine vasodilation and increase hypertensive response when compared to felypressin. Therefore, felypressin may be safe for hypertensive patients to avoid tachycardia and atenolol interaction, but for normotensive and non-smoker patients, epinephrine may be safer than felypressin.

Resumo Fundamento: O tabagismo geralmente está associado à hipertensão e pode modificar a resposta vasoconstritora. Objetivo: O presente estudo teve como objetivo analisar e comparar a interação do tabagismo passivo e hipertensão sobre os efeitos da epinefrina e felipressina na pressão arterial após injeção intravascular. Métodos: Ratos Wistar machos de 45 dias tiveram a artéria renal principal esquerda parcialmente obstruída e o rim direito removido (modelo 1K1C). Os ratos foram colocados na câmara para exposição ao tabagismo passivo (10 cigarros) durante 10 minutos (6 dias por semana). Ratos hipertensos receberam atenolol (90 mg/kg/dia) por gavagem durante duas semanas. A resposta hipotensora e hipertensiva, a duração da resposta e a frequência cardíaca foram registradas a partir da medida dos valores diretos da pressão arterial. O nível de significância foi de 5%. Resultados: O tabagismo passivo aumentou a resposta hipertensiva máxima à epinefrina em ratos normotensos e ratos 1K1C tratados com atenolol e à felipressina apenas em ratos 1K1C tratados com atenolol; também reduziu a resposta hipotensiva à epinefrina. A epinefrina aumentou a frequência cardíaca em ratos fumantes passivos ou não-fumantes, normotensos e hipertensos. Comparando os dois vasoconstritores, a epinefrina apresentou maior resposta hipertensiva em fumantes normotensos, ratos 1K1C fumantes e não fumantes tratados com atenolol. No entanto, em ratos normotensos e não fumantes, a felipressina apresentou um efeito hipertensivo maior e mais prolongado. Conclusões: Nossos resultados sugerem que o tabagismo passivo pode reduzir a vasodilatação da epinefrina e aumentar a resposta hipertensiva quando comparado à felipressina. Portanto, a felipressina pode ser segura para pacientes hipertensos, com o objetivo de evitar a interação entre taquicardia e atenolol, mas para pacientes normotensos e não-fumantes, a epinefrina pode ser mais segura que a felipressina.

Animals , Male , Atenolol/pharmacology , Tobacco Smoke Pollution/adverse effects , Blood Pressure/drug effects , Epinephrine/pharmacology , Felypressin/pharmacology , Antihypertensive Agents/pharmacology , Time Factors , Vasoconstrictor Agents/pharmacology , Vasodilation/drug effects , Rats, Wistar , Dose-Response Relationship, Drug , Drug Interactions , Heart Rate/drug effects , Hypertension/drug therapy , Hypotension
Article in English | WPRIM | ID: wpr-876354


@#Introduction: Balanced general anesthesia technique is a popular choice for induction because it can minimize potential side effects from individual drugs when otherwise used alone. However, hypotension is still a common occurrence during induction. Perfusion Index (PI) has been used as a measure of systemic vascular resistance and has shown to predict hypotension after regional anesthesia and propofol induction. This study aimed to determine whether baseline PI can predict hypotension following balanced general anesthesia induction and determine a cut-off value where hypotension is expected to occur. Methods: Thirty-five ASA I/II adults for elective surgery under general anesthesia were enrolled. Heart rate, blood pressure and PI were measured every minute from baseline to 5 minutes following induction and 10 minutes after endotracheal intubation. Hypotension was defined as fall in systolic BP (SBP) by >30% of baseline and/or mean arterial pressure (MAP) to <60 mmHg. Severe hypotension (MAP of <55 mm Hg) was treated. Results: No hypotension was observed in the first 5 minutes. Within 10 minutes, hypotension occurred in 8.6% by SBP criterion and 2.6% by MAP criterion. Within 15 minutes, hypotension was seen in 5.7% by SBP and MAP criterion, respectively. PI showed very low (r < 0.2) to low (r = 0.2 to 0.39), negative to positive and insignificant correlation (p > 0.05) with hypotension whether using SBP or MAP criterion and whether observed at 10 or 15 minutes of anesthesia induction. The Area under the ROC curve is 0.397, 95% CI [0 .126, 0.667], p = 0.431. Conclusion: This study lends inconclusive evidence on the usefulness of Innovo Deluxe Fingertip Pulse Oximeter with Plethysmograph and Perfusion Index to predict intraoperative hypotension following balanced general anesthesia induction for this sample of patients. However, there was a positive, moderate (r=0.538, 0.501 and 0.469) and significant (p<0.05) correlation between perfusion index and SBP, Diastolic BP and MAP, respectively.

Oximetry , Hypotension , Anesthesia, General , Arterial Pressure , Blood Pressure , Perfusion Index
Yonsei Medical Journal ; : 243-250, 2020.
Article in English | WPRIM | ID: wpr-811471


PURPOSE: We aimed to analyze the surveillance reports of adverse events (AEs) due to different types of pneumococcal vaccines, in addition to detecting and validating signals of pneumococcal vaccines by comparing AEs with labels.MATERIALS AND METHODS: We analyzed the percentages of AEs according to vaccine type [pneumococcal polysaccharide vaccines (PPSVs) and pneumococcal conjugate vaccines (PCVs)] in children and adults using data from the Korea Adverse Event Reporting System (KAERS) database from 2005 to 2016. A signal was defined as an AE that met all three indices of data mining: proportional reporting ratio (PRR), reporting odds ratio (ROR), and information component (IC). We validated the detected signals by calculating sensitivity, specificity, as well as positive and negative predictive values of the signals against label information.RESULTS: Of the 39933 AE reports on vaccination, 5718 (7.0%) were related to pneumococcal vaccine. The most frequent AE after vaccination with PPSV was fever (23.9%) in children and injection-site reaction in adults. The most frequent AE after vaccination with PCV in children was pharyngitis (26.2%). In total, 13 AEs met all three indices for signal detection. Among these, hypotension, apathy, sepsis, and increased serum glutamic oxaloacetic transaminase level were not listed on vaccine labels. In validation analysis, PRR and ROR performed slightly better than IC for adults who were vaccinated with PPSVs.CONCLUSION: Overall, 13 new signals of PPSVs, including four signals not listed on the labels, were detected. Further research based on additional AE reports is required to confirm the validity of these signals for children.

Adult , Apathy , Aspartate Aminotransferases , Child , Data Mining , Fever , Humans , Hypotension , Korea , Odds Ratio , Pharyngitis , Pneumococcal Vaccines , Sensitivity and Specificity , Sepsis , Vaccination , Vaccines , Vaccines, Conjugate
Chonnam Medical Journal ; : 27-35, 2020.
Article in English | WPRIM | ID: wpr-787277


Intradialytic blood pressure abnormalities are associated with adverse outcomes in patients with end-stage renal disease on dialysis. Vascular calcification is a common complicating feature, but whether this complication results in intradialytic blood pressure abnormalities remains uncertain. Therefore, this study investigated the relationship between coronary artery calcium score and intradialytic blood pressure abnormalities in patients with end-stage renal disease on maintenance hemodialysis. Thirty-six patients who received nongated chest computed tomography scans were included. Intradialytic hypotension was defined as a minimum intradialytic systolic blood pressure of <100 mmHg or a pre-dialysis blood pressure – minimum intradialytic systolic blood pressure >30 mmHg. Intradialytic hypertension was defined as >10 mmHg increase in systolic blood pressure (pre- to post-dialysis). Patients were classified as 22 (61.1%) with coronary artery calcium score <400 and 14 (38.9%) with coronary artery calcium score ≥400. Median systolic and diastolic blood pressures were equivalent, but median pulse pressure was higher in patients with coronary artery calcium score ≥400 than in those with scores <400. Coronary artery calcium score was comparable according to both intradialytic hypotension and hypertension, and had no correlation with systolic blood pressure fall and nadir systolic blood pressure. Coronary artery calcium score predicted the occurrence of cardiovascular events and all-cause mortality (hazard ratio 1.001 and 1.001; p=0.058 and 0.010). Coronary vascular calcification could be irrelevant to intradialytic blood pressure abnormalities in patients with end-stage renal disease on dialysis.

Blood Pressure , Calcium , Coronary Vessels , Dialysis , Humans , Hypertension , Hypotension , Kidney Failure, Chronic , Mortality , Renal Dialysis , Thorax , Vascular Calcification
J. Phys. Educ. (Maringá) ; 31: e3108, 2020. tab, graf
Article in Portuguese | LILACS | ID: biblio-1134735


RESUMO O objetivo do presente estudo foi investigar o efeito hipotensivo induzido pela corrida aeróbica em jovens adultos. Trinta e um indivíduos (18 mulheres e 13 homens) foram submetidos a uma avaliação antropométrica e o protocolo de corrida proposto em uma esteira ergométrica durante 40 min entre 60 a 70% da frequência cardíaca de reserva. Realizaram-se medidas da pressão arterial sistólica (PAS) e pressão arterial diastólica (PAD) que posteriormente foram comparados antes e ao final do protocolo de corrida através do teste t de Student para as variáveis dependentes. Todos os testes foram assumidos com α = 0,05. Em comparação com a PAS antes (127,1 ± 11,5 mmHg) e após (119,9 ± 10,2 mmHg) a corrida, os resultados obtidos evidenciaram uma diminuição da pressão arterial sistólica, o qual resultou uma diferença média de -7,2 ± 6,2 mmHg, demonstrando uma diferença significativa (p = 0,00001). Entretanto, na PAD antes (73,6 ± 8,6 mmHg) e após (72,5 ± 7,8 mmHg) não demonstrou uma diferença significativa (p = 0,36) como efeito agudo na diminuição após a corrida. Portanto, conclui-se que a corrida em moderada intensidade e longa duração pode ser auxiliado no tratamento não farmacológico da hipertensão arterial e como melhoria na saúde cardiovascular.

ABSTRACT The aim of the present study was to investigate the acute effects of blood pressure induced by moderate intensity aerobic exercise in young adults. Thirty-one individuals (18 women and 13 men) were submitted an anthropometric evaluation and a 40-min running protocol between 60% and 70% of the reserve heart rate. Hemodynamic measurements, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were carried out before and after the running protocol through Student's t-test for the dependent variables. All tests assumed α = 0.05. Significant differences were recorded between SBP before (127.1 ± 11.5 mmHg) and after (119.9 ± 10.2 mmHg) the running protocol. The results showed a decrease in systolic blood pressure, which resulted in a mean difference of -7.2 ± 6.2 mmHg, demonstrating a significant difference (p = 0.00001). However, in the DBP before (73.6 ± 8.6 mmHg) and after (72.5 ± 7.8 mmHg) no showing a significant difference (p = 0.36) as an acute effect on the decrease the running protocol. In conclusion, that moderate intensity and long duration running exercise can be aided in the non-pharmacological treatment of arterial hypertension and as an improvement in cardiovascular health.

Humans , Male , Female , Adult , Arterial Pressure , Endurance Training/statistics & numerical data , Hypotension , Running/statistics & numerical data , Exercise , Exercise Test/statistics & numerical data , Heart Rate
J. bras. nefrol ; 41(4): 492-500, Out.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1056600


Abstract Introduction: Intradialytic hypotension (IDH) is a major complication of hemodialysis, with a prevalence of about 25% during hemodialysis sessions, causing increased morbidity and mortality. Objective: To study the effects of sertraline to prevent IDH in hemodialysis patients. Methods: This was a double-blind, crossover clinical trial comparing the use of sertraline versus placebo to reduce intradialytic hypotension. Results: Sixteen patients completed the two phases of the study during a 12-week period. The IDH prevalence was 32%. A comparison between intradialytic interventions, intradialytic symptoms, and IDH episodes revealed no statistical difference in the reduction of IDH episodes (p = 0.207) between the two intervention groups. However, the risk of IDH interventions was 60% higher in the placebo group compared to the sertraline group, and the risk of IDH symptoms was 40% higher in the placebo group compared to the sertraline group. Survival analysis using Kaplan-Meier estimator supported the results of this study. Sertraline presented a number needed to treat (NNT) of 16.3 patients to prevent an episode from IDH intervention and 14.2 patients to prevent an episode from intradialytic symptoms. Conclusion: This study suggests that the use of sertraline may be beneficial to reduce the number of symptoms and ID interventions, although there was no statistically significant difference in the blood pressure levels.

Resumo Introdução: A hipotensão intradialítica (HID) é uma das principais complicações da hemodiálise, com uma prevalência de cerca de 25% durante as sessões de hemodiálise, causando aumento da morbimortalidade. Objetivo: Estudar os efeitos da sertralina na prevenção da HID em pacientes em hemodiálise. Métodos: Este foi um ensaio clínico duplo-cego, cruzado, comparando o uso de sertralina versus placebo para reduzir a hipotensão intradialítica. Resultados: Dezesseis pacientes completaram as duas fases do estudo durante um período de 12 semanas. A prevalência de HID foi de 32%. Uma comparação entre intervenções intradialíticas, sintomas intradialíticos (ID) e episódios de HID não revelou diferença estatística na redução dos episódios de HID (p = 0,207) entre os dois grupos de intervenção. No entanto, o risco de intervenções para HID foi 60% maior no grupo placebo em comparação com o grupo Sertralina, e o risco de sintomas ID foi 40% maior no grupo placebo em comparação com o grupo Sertralina. A análise de sobrevida utilizando o estimador de Kaplan-Meier corroborou os resultados deste estudo. A sertralina apresentou um número necessário para tratar (NNT) de 16,3 pacientes para prevenir um episódio de intervenção de HID e 14,2 pacientes para prevenir um episódio de sintomas intradialíticos. Conclusão: Este estudo sugere que o uso de sertralina pode ser benéfico para reduzir o número de sintomas e intervenções de HID, embora não tenha havido diferença estatisticamente significante nos níveis pressóricos.

Humans , Male , Female , Middle Aged , Aged , Renal Dialysis/adverse effects , Serotonin Uptake Inhibitors/therapeutic use , Sertraline/therapeutic use , Renal Insufficiency/therapy , Hypotension/physiopathology , Placebos/administration & dosage , Blood Pressure/drug effects , Blood Pressure/physiology , Double-Blind Method , Prevalence , Renal Dialysis/mortality , Cross-Over Studies , Renal Insufficiency/complications , Hypotension/prevention & control , Hypotension/epidemiology
Rev. SOBECC ; 24(4): 224-230, 30-12-2019.
Article in Portuguese | LILACS, BDENF | ID: biblio-1096095


Objetivo: Verificar as principais complicações da cirurgia de revascularização do miocárdio (RM) com circulação extracorpórea (CEC) e sua associação com os fatores de risco modificáveis e não modificáveis, diagnósticos de enfermagem, tempo de CEC e carga horária de enfermagem. Método: Coorte retrospectiva por meio da análise de 50 prontuários de pacientes adultos submetidos à RM com CEC, entre 2012 e 2017. Projeto aprovado pelo Comitê de Ética em Pesquisa parecer nº 1969823. Resultados: A amostra foi predominantemente masculina (70%), com idade média de 62,1 anos (desvio padrão ­ DP±9,98). O tempo médio de CEC foi de 124 minutos (DP±0,46). Complicações pós-operatórias ocorreram em 52% dos 50 pacientes analisados, sendo a mais frequente o sangramento (16%). O diagnóstico de enfermagem mais frequente foi risco de infecção (92%). Constatou-se que os cuidados pela equipe de enfermagem foram mais requeridos por pacientes que apresentaram hipotensão (p=0,003) e arritmia (p=0,000) no pós-operatório. Conclusão: O conhecimento das complicações pós-operatórias associadas ao perfil dos pacientes atendidos colabora para a elaboração de planos de cuidados mais adequados

Objective: To verify the main complications of myocardial revascularization (MR) with cardiopulmonary bypass (CPB) and its association with modifiable and non-modifiable risk factors, nursing diagnoses, CPB time and nursing workload. Method: Retrospective cohort through analysis of 50 medical records of adult patients undergoing MR with CPB between 2012 and 2017. Project approved by the Research Ethics Committee Report No. 1969823. Results: The sample was predominantly male (70%), with a mean age of 62.1 years (standard deviation - SD ± 9.98). The mean CPB time was 124 minutes (SD ± 0.46). Postoperative complications occurred in 52% of the 50 patients analyzed, with bleeding being the most frequent (16%). The most frequent nursing diagnosis was risk of infection (92%). It was found that nursing staff care was most needed by patients with postoperative hypotension (p = 0.003) and arrhythmia (p = 0.000). Conclusion: Knowledge of postoperative complications associated with the patients helps develop more appropriate care plans

Objetivo: Verificar las principales complicaciones de la cirugía de revascularización miocárdica (RM) con bypass cardiopulmonar (BCP) y su asociación con factores de riesgo modificables y no modificables, diagnósticos de enfermería, tiempo de BCP y carga de trabajo de enfermería. Método: Cohorte retrospectiva mediante el análisis de 50 registros médicos de pacientes adultos sometidos a RM con BCP entre 2012 y 2017. Proyecto aprobado por el Comité de Ética de Investigación Opinión 1969823. Resultados: La muestra fue predominantemente masculina (70%), con edad media de 62,1 años (DE±9,98). El tiempo medio de BCP fue de 124 minutos (DE±0,46). Las complicaciones postoperatorias ocurrieron en el 52% de los 50 pacientes analizados, siendo el sangrado el más frecuente (16%). El diagnóstico de enfermería más frecuente fue el riesgo de infección (92%). Se encontró que la atención por parte del personal de enfermería era más necesaria para los pacientes que presentaban hipotensión (p=0,003) y arritmia (p=0,000) después de la operación. Conclusión: El conocimiento de las complicaciones postoperatorias asociadas con el perfil de los pacientes ayudó en la elaboración de planes de atención más apropriados.

Humans , Postoperative Complications , Myocardial Revascularization , Myocardium , Arrhythmias, Cardiac , Cardiovascular Diseases , Extracorporeal Circulation , Hypotension
Rev. ecuat. pediatr ; 20(2): 43-46, diciembre 2019.
Article in Spanish | LILACS | ID: biblio-1116487


Los Inhibidores de la enzima convertidora de angiotensina II (IECAs) y antagonistas de los receptores de angiotensina II (ARA II) son drogas usadas comúnmente en el manejo de hipertensión arterial, sin embargo, su uso en el embarazo está asociado con toxicidad fetal.1, 2 La acción de la angiotensina II requiere su unión a dos receptores; AT1, involucrado en el control de la tensión arterial y AT2, probablemente encargado del crecimiento fetal. 2 La angiotensina II es esencial en la hemodinamia sistémica y la filtración glomerular fetal y neonatal. La disminución de la perfusión placentaria por efecto hipotensor en el bloqueo del sistema renina angiotensina aldosterona materno puede determinar hipotensión fetal sistémica, disminución de la filtración glomerular, oligoamnios e insuficiencia renal, anormalidades tubulares, hipoplasia craneal y alto riesgo de muerte perinatal. 2 Reportamos el caso de prematuro de 30 semanas con oligohidramnios severo y exposición materna a olmesartan. Al nacimiento presentó dificultad respiratoria; imposibilidad de mantener una adecuada tensión arterial a pesar de los esfuerzos para conseguir mejorar su tono vascular; anuria sin respuesta a diuréticos; alteraciones craneales; alteraciones metabólicas severas con consecuencias fatales. El tratamiento de hipertensión materna con inhibidores de la enzima convertidora de angiotensina II y los antagonistas de los receptores de angiotensina II está asociada con toxicidad fetal por lo que su uso debe ser evitado durante el embarazo.

Angiotensin II converting enzyme (ACE) inhibitors and angiotensin II receptor antagonists (ARBs) are drugs for general use in the management of arterial hypertension, however their use in gestational hypertension is related to the Fetal toxicity. 1, 2 The action of angiotensin II requires its binding to two receptors; AT1, involved in the control of blood pressure and AT2, probably responsible for fetal growth.2 Angiotensin II is essential in systemic hemodynamics and fetal and neonatal glomerular filtration. The decrease in placental perfusion due to hypotensive effect in the blockade of the maternal rennin angiotensin aldosterone system can determine systemic fetal hypotension, decreased glomerular filtration, oligohydramnios and renal insufficiency, tubular abnormalities, cranial hypoplasia and high risk of perinatal death. 2 We report the case of prematurity of 30 weeks with a history of severe oligohydramnios and maternal exposure to olmesartan. At birth the patient presented in particular respiratory distress; inability to maintain adequate blood pressure despite efforts to improve your vascular tone; anuria without response to diuretics; cranial alterations; metabolic alterations with fatal consequences. The treatment of maternal hypertension with inhibitors of the angiotensin II convective enzyme and angiotensin II receptor antagonists is associated with fetal toxicity and should therefore be avoided during pregnancy

Angiotensin-Converting Enzyme Inhibitors , Oligohydramnios , Premature Birth , Renal Insufficiency , Angiotensin II , Maternal Exposure , Hypertension, Pregnancy-Induced , Fetal Development , Toxicity , Hypotension