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2.
Rev. bras. ter. intensiva ; 30(1): 121-126, jan.-mar. 2018. tab, graf
Article in Portuguese | LILACS | ID: biblio-899567

ABSTRACT

RESUMO A nicotina é uma substância perigosa, extraída das folhas de fumo. Quando absorvida em quantidade excessiva, ela pode levar à insuficiência respiratória e à parada cardíaca. A comercialização de cigarros eletrônicos (e-cigarros) permite que os usuários manuseiem diretamente o líquido, com consequente aumento do risco de exposição à nicotina líquida. Descrevemos nossa experiência no tratamento do caso de um paciente que ingeriu elevada concentração de nicotina líquida contida em líquido para e-cigarros. O paciente apresentava bradicardia e hipotensão, que são sintomas de estimulação parassimpática, além de comprometimento da consciência. O paciente teve recuperação após tratamento com atropina e vasopressor.


ABSTRACT Nicotine is a dangerous substance extracted from tobacco leaves. When nicotine is absorbed in excessive amounts, it can lead to respiratory failure and cardiac arrest. The commercialization of electronic cigarettes (e-cigarettes) has allowed users to directly handle e-cigarette liquid. Consequently, the risk of liquid nicotine exposure has increased. We describe our experience of managing the case of a patient who orally ingested a high concentration of liquid nicotine from e-cigarette liquid. The patient presented with bradycardia and hypotension, which are symptoms of parasympathetic stimulation, together with impaired consciousness. He recovered following treatment with atropine and a vasopressor.


Subject(s)
Humans , Male , Bradycardia/etiology , Electronic Nicotine Delivery Systems , Nicotine/poisoning , Atropine/therapeutic use , Vasoconstrictor Agents/therapeutic use , Bradycardia/drug therapy , Hypotension/etiology , Hypotension/drug therapy , Middle Aged
4.
Arq. bras. cardiol ; 99(3): 848-856, set. 2012. ilus, graf, tab
Article in Portuguese | LILACS | ID: lil-649264

ABSTRACT

FUNDAMENTO: A hipertensão pulmonar é associada ao pior prognóstico no pós-transplante cardíaco. O teste de reatividade pulmonar com Nitroprussiato de Sódio (NPS) está associado a elevados índices de hipotensão arterial sistêmica, disfunção ventricular do enxerto transplantado e elevadas taxas de desqualificação para o transplante. OBJETIVO: Neste estudo, objetivou-se comparar os efeitos do Sildenafil (SIL) e NPS sobre variáveis hemodinâmicas, neuro-hormonais e ecocardiográficas durante teste de reatividade pulmonar. MÉTODOS: Os pacientes foram submetidos, simultaneamente, ao cateterismo cardíaco direito, ao ecocardiograma e à dosagem de BNP e gasometria venosa, antes e após administração de NPS (1 - 2 µg/Kg/min) ou SIL (100 mg, dose única). RESULTADOS: Ambos reduziram a hipertensão pulmonar, porém o nitrato promoveu hipotensão sistêmica significativa (Pressão Arterial Média - PAM: 85,2 vs. 69,8 mmHg, p < 0,001). Ambos reduziram as dimensões cardíacas e melhoraram a função cardíaca esquerda (NPS: 23,5 vs. 24,8 %, p = 0,02; SIL: 23,8 vs. 26 %, p < 0,001) e direita (SIL: 6,57 ± 2,08 vs. 8,11 ± 1,81 cm/s, p = 0,002; NPS: 6,64 ± 1,51 vs. 7,72 ± 1,44 cm/s, p = 0,003), medidas pela fração de ejeção ventricular esquerda e Doppler tecidual, respectivamente. O SIL, ao contrário do NPS, apresentou melhora no índice de saturação venosa de oxigênio, medido pela gasometria venosa. CONCLUSÃO: Sildenafil e NPS são vasodilatadores que reduzem, de forma significativa, a hipertensão pulmonar e a geometria cardíaca, além de melhorar a função biventricular. O NPS, ao contrário do SIL, esteve associado a hipotensão arterial sistêmica e piora da saturação venosa de oxigênio.


BACKGROUND: Pulmonary hypertension is associated with a worse prognosis after cardiac transplantation. The pulmonary hypertension reversibility test with sodium nitroprusside (SNP) is associated with a high rate of systemic arterial hypotension, ventricular dysfunction of the transplanted graft and high rates of disqualification from transplantation. OBJECTIVE: This study was aimed at comparing the effects of sildenafil (SIL) and SNP on hemodynamic, neurohormonal and echocardiographic variables during the pulmonary reversibility test. METHODS: The patients underwent simultaneously right cardiac catheterization, echocardiography, BNP measurement, and venous blood gas analysis before and after receiving either SNP (1 - 2 µg/kg/min) or SIL (100 mg, single dose). RESULTS: Both drugs reduced pulmonary hypertension, but SNP caused a significant systemic hypotension (mean blood pressure - MBP: 85.2 vs. 69.8 mm Hg; p < 0.001). Both drugs reduced cardiac dimensions and improved left cardiac function (SNP: 23.5 vs. 24.8%, p = 0.02; SIL: 23.8 vs. 26%, p < 0.001) and right cardiac function (SIL: 6.57 ± 2.08 vs. 8.11 ± 1.81 cm/s, p = 0.002; SNP: 6.64 ± 1.51 vs. 7.72 ± 1.44 cm/s, p = 0.003), measured through left ventricular ejection fraction and tissue Doppler, respectively. Sildenafil, contrary to SNP, improved venous oxygen saturation, measured on venous blood gas analysis. CONCLUSION: Sildenafil and SNP are vasodilators that significantly reduce pulmonary hypertension and cardiac geometry, in addition to improving biventricular function. Sodium nitroprusside, contrary to SIL, was associated with systemic arterial hypotension and worsening of venous oxygen saturation.


Subject(s)
Female , Humans , Male , Middle Aged , Hemodynamics/drug effects , Hypertension, Pulmonary/drug therapy , Hypotension/chemically induced , Nitroprusside/therapeutic use , Piperazines/therapeutic use , Sulfones/therapeutic use , Vasodilator Agents/therapeutic use , Blood Pressure/drug effects , Blood Pressure/radiation effects , Hemodynamics/physiology , Hypertension, Pulmonary/physiopathology , Hypotension/drug therapy , Nitroprusside/adverse effects , Preoperative Care , Purines/therapeutic use , Vascular Resistance/drug effects , Vascular Resistance/physiology , Vasodilator Agents/adverse effects , Ventricular Function/drug effects
5.
Tunisie Medicale [La]. 2012; 90 (4): 291-299
in French | IMEMR | ID: emr-131474

ABSTRACT

Hypotension and shocks are frequently observed in patients requiring admission in ICU. However, the optimal adrenergic support in shock is controversial. To perform a descriptive approach of the current use of catecholamine in a medico-surgical ICU in patients with schoks. Our study is prospective over 3 month period. Were included all patients admitted in our ICU during the study period's. We compared the populations with and without catecholamine, we analysed the catecholamine selected in various clinical settings and we studied the impact of the use of catecholamine on the patient outcomes. During the study's period, 226 patients were hospitalized in our service and were the subject of this study. The median age [ +/- SD] was of 47 +/- 24 years. During their hospitalization in the ICU, 132 patients [58.4%] presented a shock. The cardiogenic shock and the hypovolemic shock were the most observed [37.8% and 35.6% respectively]. Hundred thirty patients [57.5%] received catecholamines during their stay in ICU. Eighty four patients [64.6% of the patients having received catecholamines] had received dopamine. Sixty two patients [47.7% of the patients having received catecholamines] had received dobutamine, 63 patients [48.5%] had received epinephrine and 22 patients [16.9%] had received norepinephrine. The mean's period of catecholamines use was 5 +/- 4 days. Among drugs proposed in order to manage patients with cardiogenic shock, dobutamine was chosen as the first choice agent in 62% of the cases. Among drugs proposed in order to manage patients with septic shock, Dopamine was chosen as the first choice agent in 85.7% of the cases. In our study the patients of the class C or D in the Knauss classification are significantly predisposed to receive catecholamines during their ICU stay [OR: 5.3 ; IC 95%: 1.7 - 5.7].Moreover, the needing of catecholamine use is strongly associated with high mortality [OR: 16,8; IC 95%: 16.4 - 49.2]. The choice of catecholamines is a matter of debate for critically ill patients. The use of catecholamines is a clinical marker of severity and provider of mortality


Subject(s)
Humans , Male , Female , Hypotension/drug therapy , Hypovolemia/drug therapy , Prospective Studies , Shock/drug therapy , Intensive Care Units , Shock, Cardiogenic/drug therapy , Shock, Septic/drug therapy , Dobutamine , Dopamine , Treatment Outcome
6.
Rev. méd. Minas Gerais ; 19(4,supl.1): S13-S20, out.-dez. 2009.
Article in Portuguese | LILACS | ID: lil-563438

ABSTRACT

Justificativa e objetivos: Os fármacos vasopressores sempre apresentaram um lugar de destaque no controle da hipotensão arterial relacionada aos bloqueios do neuroeixo em anestesia obstétrica. Este artigo tem o objetivo de discutir os diversos fármacos utilizados na prática clínica e as inúmeras estratégias descritas na literatura para a prevenção e tratamento da hipotensão arterial pós-raquianestesia para cesariana. Conteúdo: Com a popularização da raquianestesia como técnica mais utilizada em anestesia para cesariana, os vasopressores tornaram-se pedra angular para a melhoria dos resultados maternos e fetais. Várias mudanças de paradigmas se apresentam nos dias atuais, destacando-se a segurança na utilização de fármacos alfa-agonistas, particularmente a fenilefrina. A efedrina já não tem sido mais considerada a primeira escolha em anestesia obstétrica, pois pode causar redução no pH fetal. Conclusões: A administração pro-filática e/ou terapêutica de agonistas alfa-adrenérgicos mostra-se segura e eficaz para o controle da hipotensão arterial pós-raquianestesia, otimizando os resultados maternos e fetais. Portanto, sugere-se revisão de conceitos.


Justification and objectives: vasopressor drugs have always been highlighted for the control of hypotension related to neuraxial blockade in obstetrical anesthesia. This article purpose is arguing the several drugs used in the clinical practice and the countless strategies described in the literature for the prevention and treatment of arterial hypotension after spinal anesthesia for caesarian section. Content: With the popularization of spinal anesthesia as the technique most used in anesthesia for caesarian section, vasopressors became the angular stone for the improvement of the maternal and fetal outcomes. Several changes of paradigms are introduced currently, highlighting the safe use of alpha-agonist drugs, particularly phenylephrine. Ephedrine has no longer been considered the unique first choice in obstetrical anesthesia, because it may cause reduction in fetal pH. Conclusions: The alpha adrenergic prophylactic and/or therapeutic administration proved to be a safe and effective option for the hypotension control after spinal anesthesia, optimizing the maternal and fetal outcomes. Therefore, that is the time for reviewing old concepts.


Subject(s)
Humans , Female , Pregnancy , Anesthesia, Obstetrical , Cesarean Section , Hypotension/drug therapy , Vasoconstrictor Agents/therapeutic use , Ephedrine/therapeutic use , Etilefrine/therapeutic use , Phenylephrine/therapeutic use , Metaraminol/therapeutic use
7.
Rev. argent. anestesiol ; 66(2): 134-142, jun. 2008. tab
Article in Spanish | LILACS | ID: lil-534259

ABSTRACT

Antecedentes: La anestesia espinal es utilizada en cirugías ortopédicas, pero produce hipotensión arterial en 10-40 por ciento de los pacientes. El uso de fenilefrina en infusión profiláctica ha permitido mantener la presión arterial durante el parto, pero no hay estudios en cirugías de reemplazo de rodilla. Objetivos: Evaluar el efecto de la infusión continua profiláctica de fenilefrina sobre la presión arterial sistólica (PaS), media (PaM) y diastólica (PaD), y la frecuencia cardíaca (FC) en cirugía de implante protésico de rodilla, comparado con placebo. También se evaluaron: la reposición de fluidos, los episodios de hipotensión y bradicardia, y los requerimientos de efedrina. Lugar de realización: Servicio de Anestesiología del Hospital Italiano de Buenos Aires. Diseño: Ensayo clínico, aleatorizado, controlado con placebo, doble ciego. Población: Se incluyeron 30 pacientes sometidos a reemplazo protésico de rodilla. Métodos: Se aleatorizaron al grupo F (bomba con infusión profiláctica con fenilefrina, n = 15) o al grupo P (solución fisiológica, n = 15). Se realizo bloqueo femoral y anestesia espinal. Las variables hemodinámicas se evaluaron en hora basal, inicio de infusión y a los 3, 6, 15, 30, 45 y 60 minutos posbloqueo. Resultados: No se encontró diferencia significativa entre los grupos en cuanto a PaS, PaM, PaD y FC. Tampoco en relación con el número de episodios de hipotensión, bradicardia, administración de efedrina, ni en los requerimientos de fluidos administrados. Conclusiones: En pacientes con anestesia espinal, la infusión profiláctica de fenilefrina no disminuyó la magnitud de la hipotensión posbloqueo, en comparación con placebo, durante la cirugía de implante protésico de rodilla.


Background: Spinal anesthesia is used in orthopedic surgery but it produces arterial hypotension in 10-40 per cent of patients. The use of prophylactic infusion of phenylephrine could maintain arterial pressure during cesarean delivery, but no tests were carried out during knee replacement surgery. Objective: Evaluation of the effect of prophylactic infusion of phenylephrine on systolic (SaP), diastolic (DaP), median (MaP) and cardiac rate (CR) during knee replacement surgery with spinal anesthesia, compared to with placebo. We also evaluated amount of fluids, hypotension and bradycardic episodes, and ephedrine requirements. Setting: Anesthesiology Service of Hospital Italiano de Buenos Aires. Design: clinical trial, randomized, placebo controlled, double blinded. Population: We included 30 patients scheduled for knee replacement surgery. Methods: Patients were randomized to group F (prophylactic infusion of phenylephrine, N = 15) or group P (placebo, n = 15). Hemodynamic variables were evaluated at basal, start of infusion and at 3, 6, 15, 30, 45 and 60 minutes from the blockade. Results: The differences in SaP, DaP, MaP and CR were not statistically different. Neither were the numbers of cases with hypotension, bradycardia, ephedrine requirements or fluids administered. Conclusions: In patients receiving spinal anesthesia for knee replacement surgery, a prophylactic infusion of phenylephrine did not decrease the magnitude of hypotension in comparison with placebo.


Antecedentes: A anestesia espinhal é utilizada em cirurgias ortopédicas, mas causa hipotensao arterial em 10-40 por cento dos pacientes. O uso da fenilefrina em infusao profilática permitiu manter a pressao arterial durante o parto; porém, nao se conhecem estudos sobre seu uso em cirurgias de substitução de joelho. Objetivos: Avaliar o efeito da infusao continua profilática de fenilefrina sobre a pressao arterial sistólica (PaS), média (PaM) e diastólica (PaD) e a freqüencia cardiaca (FC) em cirurgia de implante de prótese de joelho, comparado com placebo. Foram também avaliados: a reposição de fluídos, os episódios de hipotensao e bradicardia, e a necessidade de efedrina. Lugar de realização: Serviço de Anestesiologia do Hospital Italiano de Buenos Aires. Desenho: Estudo clínico, aleatorizado, controlado com placebo, duplo-cego. População: Trinta pacientes submetidos a substituiçao protésica de joelho. Métodos: Os pacientes foram aleatorizados ao grupo F (bomba de infusao profilática, fenilefrina, n = 15) ou ao grupo P (solução fisiológica, n = 15). Foi feito bloqueio 3 em 1 e anestesia espinhal. Avaliaram-se as variáveis hemodinamicas no momento basal, no inicio da infusao e aos 3, 6, 15, 30, 45 e 60 minutos pós-bloqueio. Resultados: Entre os grupos nao se encontrou diferença significativa no que diz respeito a PaS, PaM, PaO e FC, número de casos de hipotensao, de bradicardia, de administração de efedrina nem nas necessidades de fluidos administrados. Conclusoes: Em pacientes com anestesia espinhal, a infusao profilática de fenilefrina nao diminuiu a magnitude da hipotensao pós-bloqueio, em comparação com placebo, durante cirurgia de implante de prótese de joelho.


Subject(s)
Humans , Male , Female , Anesthesia, Spinal/adverse effects , Anesthesia, Spinal/methods , Phenylephrine/administration & dosage , Hemodynamics , Knee/surgery , Arthroplasty, Replacement, Knee , Anesthesia, Conduction/adverse effects , Anesthesia, Conduction/methods , Bradycardia/drug therapy , Ephedrine/administration & dosage , Hypotension/drug therapy , Informed Consent
8.
Indian Pediatr ; 2008 Apr; 45(4): 285-94
Article in English | IMSEAR | ID: sea-9826

ABSTRACT

PURPOSE: Hypotension is a frequent occurrence in sick preterm neonates. It is important to appropriately recognise and treat hypotension in preterm infants due to the possible association with short and long term adverse outcomes. SEARCH STRATEGY: An extensive search for relevant articles was carried out on PubMed, Embase and Cochrane database of systematic reviews. Cross references were hand searched. CONCLUSIONS: The pathophysiology hypotension in preterm infants is multifactorial. Hypovolemia plays only a minor role in the absence of overt fluid losses. Cardiac dysfunction seems to be a factor in some neonates. Assessment of hypotension should be based on an overall clinical condition. Overzealous fluid administration seems to be associated with adverse outcomes and should be avoided in the absence of obvious fluid losses. Inotropes should be used if fluid boluses fail to correct hypotension. Dopamine is the most effective inotrope. Dobutamine can be used as add on therapy or as first line if cardiac dysfunction is an obvious cause. Evidence points to hypocortisolism in at least some hypotensive infants. Steroids have been used successfully in inotrope-resistant hypotension in some infants. Steroids should be used judiciously since there have been concerns about adverse neurological outcome in preterm infants who received steroids in the neonatal period.


Subject(s)
Adrenergic beta-Agonists/therapeutic use , Blood Pressure , Cardiac Output/drug effects , Cardiotonic Agents/therapeutic use , Dobutamine/therapeutic use , Dopamine/therapeutic use , United Kingdom/epidemiology , Humans , Hypotension/drug therapy , Infant, Newborn , Infant, Premature , Risk Factors , Sympathomimetics/therapeutic use , Time Factors
10.
Rev. cuba. farm ; 38(3)sept.-dic. 2004. tab
Article in Spanish | LILACS | ID: lil-403356

ABSTRACT

Se desarrolló una formulación de clorhidrato de fenilefrina inyectable para el tratamiento de la hipotensión arterial y la cirugía oftalmológica, para lo cual se diseñaron y estudiaron 3 formulaciones; se selecció la más factible para la continuidad del estudio. El ensayo de estabilidad del producto a diferentes temperaturas durante 222 días y en estante por un período de 24 meses, se realizó mediante la aplicación del análisis de cromatografía líquida de alta resolución. La formulación obtenida se comparó desde el punto de vista farmacológico y toxicológico con un producto comercial. Los resultados demostraron que la formulación desarrollada cumple con los ensayos de estabilidad y tiene una potencia farmacológica en relación con el comercial del 113 por ciento; no existieron diferencias entre la actividad de los 2 productos comparados. El comercial resultó más tóxico que la formulación desarrollada al tener una DL50 superior. El producto logrado con el desarrollo tecnológico empleado cumple con las especificaciones de calidad de la USP 26


Subject(s)
Humans , Cataract Extraction , Chromatography, High Pressure Liquid/methods , Drug Stability , Hypotension/drug therapy , Phenylephrine , Technology, Pharmaceutical
11.
Assiut Medical Journal. 2004; 28 (3): 47-62
in English | IMEMR | ID: emr-65410

ABSTRACT

In this study, 40 women undergoing elective cesarean surgery [CS] at term were allocated randomly to receive either a preload of 20 ml/kg of normal saline over 10-15 min immediately before spinal anesthesia [fluid group] or prophylactic ephedrine 50 mg in 10 min before spinal anesthesia [ephedrine group]. The two techniques were compared for their maternal and neonatal effects. Moderate hypotension was defined as >20% reduction in systolic blood pressure [SAP] and severe hypotension as >30% reduction in SAP. The study concluded that ephedrine e 50 mg given intramuscularly ten minutes before induction of spinal anesthesia reduced the incidence of hypotension and the total dose of rescue ephedrine therapy than preloading with 20 ml/kg crystalloid during spinal anesthesia for CS. The incidence of nausea and vomiting was also reduced and the fetal outcome was improved. However, this dose of ephedrine did not completely eliminate hypotension, nausea and vomiting


Subject(s)
Humans , Female , Cesarean Section , Ephedrine , Hypotension/drug therapy , Injections, Intramuscular , Saline Solution, Hypertonic
12.
Rev. méd. Chile ; 130(9): 1009-1013, sept. 2002. tab, graf
Article in Spanish | LILACS | ID: lil-323234

ABSTRACT

Background: Hypotension occurs in 20 percent of hemodialysis procedures. Aim: To study the effects of midodrine on hypotension during hemodialysis. Patients and methods: Ten patients on chronic hemodialysis and with a history of hypotension during the procedure, were studied. They received midodrine 10 mg per os or placebo during 5 dialytic procedures each, in a double blind cross over design. Results: Blood pressure levels prior to dialysis were similar during the midodrine or placebo administration periods. During dialysis, systolic blood pressure fell 19.3ñ28 mmHg with midodrine and 23.4ñ28 mmHg with placebo. Diastolic blood pressure fell 7.3ñ11.5 mmHg with midodrine and 11.1ñ12 mmHg with placebo. The reduction in median arterial pressure was also less pronounced with midodrine. Conclusions: Midodrine lessens the fall in arterial pressure during hemodialysis, in patients with symptomatic hypotension


Subject(s)
Humans , Male , Female , Hypotension/drug therapy , Midodrine , Renal Insufficiency, Chronic/complications
14.
Zagazig University Medical Journal. 2002; 8 (1): 439-50
in English | IMEMR | ID: emr-61244

ABSTRACT

The study was designed to evaluate the efficacy of three different regimens for prophylactic treatment of hypotension during spinal anaesthesia for elective cesarean section. Thirty-six parturients, 21-32 years old, ASA I or II and term singleton pregnancy were randomized to one of three groups receiving, preload 1.5 L Ringer's lactate solution [Fluid group] [F group], ephedrine I.V infusion 2 mg/min. [Ephedrine group] [E group], or I.V infusion 2 mg/min ephedrine plus 10 micro g/min. phenylephrine [Ephedrine + phenylephrine group [E + P group]. Maternal systolic blood pressure and heart rate were measured at frequent intervals. Hypotension defined as systolic blood pressure decrease >/= 20% from baseline blood pressure. We found that hypotension occurred less frequently in [E + P] group than in [F or E] groups 35% versus 73% and 77% respectively, supplemental ephedrine requirement and nausea scores [0 - 3] were less in the [E + P] group. Neonatal venous and arterial pH values were significantly higher in [E + P] group. Apgar scores were similarly good in the three groups. On conclusion, the incidence of hypotension during spinal anaesthesia for elective caesarean section delivery was significantly lower in phenylephrine ephedrine combination than in ephedrine infusion alone or crystalloid preload


Subject(s)
Humans , Female , Cesarean Section , Drug Combinations , Hypotension/drug therapy , Phenylephrine , Ephedrine , Treatment Outcome
15.
Jordan Medical Journal. 2002; 36 (2): 146-149
in English | IMEMR | ID: emr-59607

ABSTRACT

Objectives to assess the maternal cardiovascular changes [i.e. hypotension] and neonatal status in healthy women who underwent elective C.S under epidural anaesthesia and to compare the effect of optimal doses of 3 different vasopressors on hypotension and acid-base status in mothers and neonates during spinal anaesthesia [SA] for caesarian section [CS]. the total number of pregnant women who underwent, spinal anaesthesia during c.s were 150 between Jan 1st till 31st Dec 1999 at Q.A.M.H., a total of 15 pregnant women were randomly selected into: group 1 received an infusion of ephedrine 1mg/min [at 60ml/hr]. Group 2 received an infusion of ephedrine 2mg/min [at 120ml/hr] and group 3 was given an infusion of phenylephrine 10 mcg/min [at 60ml/hr] there was no significant difference in maternal age, weight or systolic arterial pressure between the 3 groups. Similarly, there was no significant difference between the 3 groups in the volume of bupivacaine used, time taken for anaesthesia to reach T4, time from insertion of the spinal to delivery of fetus and uterine incision delivery time


Subject(s)
Humans , Female , Phenylephrine , Ephedrine , Phenylephrine/administration & dosage , Ephedrine/administration & dosage , Hypotension/drug therapy
16.
Rev. chil. med. intensiv ; 16(3): 154-161, sept. 2001. tab
Article in Spanish | LILACS | ID: lil-302048

ABSTRACT

Se revisan los tipos de volumen y drogas vasoactivas utilizados en la reanimación de pacientes hipotensos o en shock. Se analizan sus características químicas, modos de acción, ventajas y efectos adversos. Se buscó información en revisiones previas, consensos y trabajos originales relevantes, publicados desde 1980 hasta ahora, realizando las búsquedas a través de bases de datos de Internet. En el uso de fluidos, no está demostrado una ventaja en la reanimación inicial en el uso de coloides, prefiriéndose los cristaloides por su bajo costo y nula toxicidad. En la reanimación tardía, se pueden preferir los coloides por su menor tendencia a provocar edema, en especial en pacientes con disfunción cardiaca. La albúmina es el coloide ideal por su buen poder oncótico y escasos efectos adversos. Los hidroxietilalmidones de peso molecular intermedio son una aceptable alternativa a la albúmina, de menor costo. En las drogas vasopresoras, destaca la creciente preferencia de la norepinefrina por sobre la dopamina en la primera línea del tratamiento del shock séptico, siendo un problema su mayor costo. En las drogas inótropas destaca la dobutamina, reservándose la milrinoma para pacientes con mayor tendencia a las arritmias, por ser de mucho mayor precio. En el caso de requerirse el uso de drogas vasopresoras o inótropas, se recomienda realizar monitoreo hemodinámico. En conclusión, existe una variada alternativa de fluidos y drogas vasoactivas para la reanimación de nuestros pacientes. La elección de una alternativa u otra, dependerá del buen juicio clínico y el adecuado uso de nuevas evidencias


Subject(s)
Humans , Hypotension/drug therapy , Shock , Vasoconstrictor Agents , Vasomotor System , Albumins , Anaphylaxis , Dextrans , Dobutamine , Epinephrine , Fluid Therapy , Milrinone , Norepinephrine , Nitric Oxide Synthase/antagonists & inhibitors , Phenylephrine , Shock, Cardiogenic/drug therapy , Vasoconstrictor Agents , Vasodilator Agents
17.
Zagazig University Medical Journal. 2001; 7 (1): 343-58
in English | IMEMR | ID: emr-58717

ABSTRACT

This study was performed to determine if preoperative intravenous dextrose in two different regimens affects the incidence degree and case of treatment of hypotension during spinal anaesthesia for cesarean section, Also we aimed at evaluating the blood flow velocity waveforms [FVWS] of the uterine and umbilical arteries and the neonatal outcome in such cases.Sixty healthy parturients undergoing elective caesarean section under spinal anaesthesia were allocated into three groups [20 parturients in each] to receive intravenously either normal saline [group A], dextrose 5%, in normal saline [group B], dextrose 10% in normal saline [group C] at 125 mL/hr for two hours prior to delivery, Following a bolus of 15 mL/kg normal saline iv spinal anaesthesia was induced with hyperbaric bubivacaine 0, 5% fentanyl and morphine, Hypotension [systolic blood pressure < 100 mmHg or > 20% decrease] was treated with fluids and/or vasopressor. Data collected: Maternal demographics blood glucose concentrations [fasting at time of spinal and at delivery], blood pressure [baseline and at one minute intervals from spinal to delivery] and uterine and umbilical arteries Doppler FVW before preloading and 5 minutes after spinal anesthesia, Neonatal demographics neonatal Apgar scores umbilical blood gas analysis at birth glucose and lactate concentrations at birth. I and 2 hours after birth, There was no difference between the three groups in the rate of hypotension [p=0, 283]. All parturients who experienced hypotension received fluids and there was also no difference between the groups in vasopressor requirement. S/D in the uterine arteries increased significantly after spinal anaesthesia while it didn't change in umbilical arteries. There was no significant difference between the three groups regarding S/D in the umbilical and uterine arteries either before preload or 5 minutes after injection of the anesthestic. Umbilical arterial and venous pH was significantly lower and lactate was higher in group C than group A [P<0.05], after birth neonatal capillary blood glucose was stable in group A. but decreased significantly in group C [P<0.05] and lactate decreased in group C at 2h. We concluded that administration of dextrose 5% at a rate of 5.22 g/h and 10% at a rate of 10.22g/h preoperatively does not affect the hypotension rate uterine or umbilical Doppler FVW. or make it easier to treat hypotension and was potentially harmful to the foetus with the large dose of 10.22 g/h


Subject(s)
Humans , Female , Cesarean Section , Glucose , Hypotension/drug therapy , Fetal Blood , Preanesthetic Medication , Treatment Outcome
18.
Neurol India ; 2000 Jun; 48(2): 126-31
Article in English | IMSEAR | ID: sea-121638

ABSTRACT

Twenty five patients with post operative ischaemic deficits, following clipping of intracranial aneurysms, were studied. Hypertensive-hypervolaemic-haemodilution (triple H) therapy was given to all patients using colloids and crystalloids. CVP was used to monitor the fluid therapy. Dopamine was needed in 22 patients to elevate the systemic blood pressure. Vasospasm was confirmed in 20 patients with transcranial doppler studies (TCD). 20 (80%) patients survived, 10 (40%) with good outcome, 7 (28%) with fair, 2 (8%) with poor outcome and 1 (4%) with vegetative state. There were 5 (20%) deaths, 4 of which occurred due to infarct. All these patients had poor Hunt and Hess grade at admission, high Fisher grade haemorrhages in the initial CT scan and/or required prolonged temporary clipping at surgery. One death occurred due to central venous line induced septicaemia. The duration of 'triple H therapy' amongst the survivors varied from 2-7 days with an average of 4.6 days. The complications of 'triple H therapy' included hypokalaemia (3 patients), haemorrhagic infarct (1 patient) and septicaemia (1 patient). It is concluded that 'triple H therapy' is useful in treating vasospasm induced ischaemic deficits. It worsens brain oedema in presence of acute infarcts and hence is contraindicated in such patients. A further study involving a larger number of patients with strict haemodynamic and ICP monitoring is suggested to determine the usefulness of individual components of 'triple H therapy'.


Subject(s)
Adolescent , Adult , Aged , Dopamine/therapeutic use , Female , Hemodilution , Humans , Hypotension/drug therapy , Hypovolemia/therapy , Intracranial Aneurysm/complications , Male , Middle Aged , Plasma Substitutes/therapeutic use , Postoperative Care , Postoperative Complications/drug therapy , Subarachnoid Hemorrhage/complications , Survival Analysis , Tomography, X-Ray Computed , Treatment Outcome , Vasospasm, Intracranial/etiology
19.
Scientific Journal of Al-Azhar Medical Faculty [Girls] [The]. 2000; 21 (2): 279-289
in English | IMEMR | ID: emr-55518

ABSTRACT

Forty patients ASA class I undergoing elective cesarean section under spinal anesthesia were randomly allocated to receive either 500 ml of hetastarch solution or 1000 ml of lactated ringer's solution prior to spinal anesthesia. Also, serial measurements of blood gases were done to the patients. An evaluation of the fetus using Apgar score at 1, 5 and 10 m was done. The incidence of hypotension was seven out of 20 patients in hetastarch solution group and 12 out of 20 patients in the lactated ringer's solution group; this difference was significant. Blood gases measurements showed insignificant changes in both groups compared with the basal values. The neonatal outcome as determined by Apgar score was good and similar in both groups. The total cost of the drugs used in hetastarch [H] group was more than the cost of the drugs used in lactated ringer's group


Subject(s)
Humans , Female , Cesarean Section , Hypotension/drug therapy , Lactates , Hydroxyethyl Starch Derivatives , Treatment Outcome
20.
Benha Medical Journal. 1998; 15 (3): 319-330
in English | IMEMR | ID: emr-47740

ABSTRACT

Two vasopressors were compared to reduce incidence of hypotension during spinal anaesthesia in elderly patients, methoxamine 10mg i.m. or ephedrine 10mg i.v. plus 20mg I.m, in terms of haemodynamic stability and requirement for additional vasopressors. Forty patients [aged 60-75yr] undergoing surgery of the lower body were allocated randomly into group M [n=20] and group E [n=20] the vasopressors were injected 10 min before induction of spinal anaesthesia. Rescue ephedrine 3-6 mg was given if systolic blood pressure [SAP] or mean arterial blood pressure [MAP] reduced more than 25% of the base line value. Patient and spinal characteristics were similar in the two groups. SAP and MAP increased initially form baseline until induction of spinal anaesthesia and then decreased for 25 min in both groups [not significant between groups]. Heart rate [HR] decreased from the baseline in group M [p<0.05] and was lower than in group E at all time form 4-70 min [p<0.01]. The incidence of hypotension of SAP and MAP was not significant between groups [SAP 25% vs 30% and MAP 20% vs 25%]. Requirements for rescue ephedrine [20% vs 25%] dose of rescue ephedrine given [4.8 vs 5.1mg] and time to onset of hypotension [9.8 vs 11.6 min] were similar in groups M and E. respectively. We conclude that methoxamine 10mg i.m. given 10 min before induction of spinal anaesthesia in normovolaemic elderly insignificantly reduce Incidence of subsequent SAP and MAP hypotension. requirements for rescue vasopressor therapy but has significant reduction of HR compared with ephedrine 10 mg i.v. plus 20mg i.m


Subject(s)
Humans , Male , Female , Hypotension/drug therapy , Aged , Ephedrine/administration & dosage , Methoxamine/administration & dosage , Vasoconstrictor Agents , Heart Rate , Blood Pressure
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