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HUA Q, FAN L, WANG ZW, LI J. 2023 Guideline for the management of hypertension in the elderly population in China. J Geriatr Cardiol 2024; 21:589-630. [PMID: 38973827 PMCID: PMC11224653 DOI: 10.26599/1671-5411.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Affiliation(s)
| | - Qi HUA
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Li FAN
- Chinese PLA General Hospital, Beijing, China
| | - Zeng-Wu WANG
- Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing LI
- Xuanwu Hospital, Capital Medical University, Beijing, China
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Cao Q, Fan C, Fei Y, Zhang S, Shen T, Meng H. Waist-to-height ratio is a better predictor of hypertension in women during recovery from anesthesia compared to BMI, waist-to-hip ratio, and waist circumference. Heliyon 2024; 10:e28297. [PMID: 38533001 PMCID: PMC10963644 DOI: 10.1016/j.heliyon.2024.e28297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 03/28/2024] Open
Abstract
This was an observational study of patients with benign breast tumors intended to investigate and compare the predictive value of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) for hypertension in the recovery room. Logistic regression analysis was used to determine the association between these body fat anthropometric indices and hypertension. Receiver operating characteristic curve (ROC) analysis was performed to assess the comparative predictive ability. A total of 689 women were evaluated. Patients with BMI ≥28 (kg/m2), WC > 85 cm, WHR ≥0.82, and WHtR ≥0.5 had a significantly higher probability of increased systolic blood pressure (SBP) and diastolic blood pressure (DBP) than patients with less than threshold values (all P < 0.05). The areas under the ROC curve (AUC) of BMI, WC, and WHtR where all modestly significant (all AUC ≥0.65) and nearly identical at 0.6592, 0.65, and 0.6724, respectively. Conclusion: body fat anthropometric indices are useful predicting hypertension during recovery from general anesthesia in patients with benign breast tumors undergoing day surgery; WHtR outperformed the other indices and nearly identical.
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Affiliation(s)
- Qinqin Cao
- Department of Anesthesiology, Affiliated Hospital of Jining Medical University, China
| | - Chengjuan Fan
- Department of Nephrology, Affiliated Hospital of Jining Medical University, China
| | - Yufen Fei
- Department of Anesthesiology, Affiliated Hospital of Jining Medical University, China
| | - Shouxin Zhang
- Department of Anesthesiology, Affiliated Hospital of Jining Medical University, China
| | - Tong Shen
- Department of Anesthesiology, Affiliated Hospital of Jining Medical University, China
| | - Haihong Meng
- Department of Anesthesiology, Affiliated Hospital of Jining Medical University, China
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Zhang B, Zhu Q, Ji ZP. Nomogram for predicting early complications after distal gastrectomy. World J Gastrointest Surg 2023; 15:2500-2512. [PMID: 38111768 PMCID: PMC10725534 DOI: 10.4240/wjgs.v15.i11.2500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/04/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Reducing or preventing postoperative morbidity in patients with gastric cancer (GC) is particularly important in perioperative treatment plans. AIM To identify risk factors for early postoperative complications of GC post-distal gastrectomy and to establish a nomogram prediction model. METHODS This retrospective study included 131 patients with GC who underwent distal gastrectomy at the Second Hospital of Shandong University between January 2019 and February 2023. The factors influencing the development of complications after distal gastrectomy in these patients were evaluated using univariate and multivariate logistic regression analysis. Based on the results obtained, a predictive nomogram was established. The nomogram was validated using internal and external (n = 45) datasets. Its sensitivity and specificity were established by receiver operating characteristic curve analysis. Decision curve (DCA) analysis was used to determine its clinical benefit and ten-fold overfitting was used to establish its accuracy and stability. RESULTS Multivariate logistic regression analysis showed that hypertension, diabetes, history of abdominal surgery, and perioperative blood transfusion were independent predictors of postoperative complications of distal gastrectomy. The modeling and validation sets showed that the area under the curve was 0.843 [95% confidence interval (CI): 0.746-0.940] and 0.877 (95%CI: 0.719-1.000), the sensitivity was 0.762 and 0.778, respectively, and the specificity was 0.809 and 0.944, respectively, indicating that the model had good sensitivity and specificity. The C-indexes of the modeling and validation datasets were 0.843 (95%CI: 0.746-0.940) and 0.877 (95%CI: 0.719-1.000), respectively. The calibration curve (Hosmer Lemeshow test: χ2 = 7.33) showed that the model had good consistency. The results of the DCA analysis indicated that this model offered good clinical benefits. The accuracy of 10-fold cross-validation was 0.878, indicating that the model had good accuracy and stability. CONCLUSION The nomogram prediction model based on independent risk factors related to postoperative complications of distal gastrectomy can facilitate perioperative intervention for high-risk populations and reduce the incidence of postoperative complications.
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Affiliation(s)
- Biao Zhang
- Department of Gastrointestinal Surgery, Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
| | - Qing Zhu
- Department of Gastrointestinal Surgery, Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
| | - Zhi-Peng Ji
- Department of Gastrointestinal Surgery, Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
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Khanna AK, O'Connell NS, Ahuja S, Saha AK, Harris L, Cusson BD, Faris A, Huffman CS, Vallabhajosyula S, Clark CJ, Segal S, Wells BJ, Kirkendall ES, Sessler DI. Incidence, severity and detection of blood pressure and heart rate perturbations in postoperative ward patients after noncardiac surgery. J Clin Anesth 2023; 89:111159. [PMID: 37295123 DOI: 10.1016/j.jclinane.2023.111159] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/22/2023] [Accepted: 05/28/2023] [Indexed: 06/12/2023]
Abstract
STUDY OBJECTIVE We sought to determine changes in continuous mean and systolic blood pressure and heart rate in a cohort of non-cardiac surgical patients recovering on the postoperative ward. Furthermore, we estimated the proportion of vital signs changes that would remain undetected with intermittent vital signs checks. DESIGN Retrospective cohort. SETTING Post-operative general ward. PATIENTS 14,623 adults recovering from non-cardiac surgical procedures. INTERVENTIONS & MEASUREMENTS Using a wireless, noninvasive monitor, we recorded postoperative blood pressure and heart rate at 15-s intervals and encouraged nursing intervention as clinically indicated. MAIN RESULTS 7% of our cohort of 14,623 patients spent >15 sustained minutes with a MAP <65 mmHg, and 23% had MAP <75 mmHg for 15 sustained minutes. Hypertension was more common, with 67% of patients spending at least 60 sustained minutes with MAP >110 mmHg. Systolic pressures <90 mmHg were present for 15 sustained minutes in about a fifth of all patients, and 40% of patients had pressures >160 mmHg sustained for 30 min. 40% of patients were tachycardic with heart rates >100 beats/min for at least continuous 15 min and 15% of patients were bradycardic at a threshold of <50 beats/min for 5 sustained minutes. Conventional vital sign assessments at 4-h intervals would have missed 54% of mean pressure episodes <65 mmHg sustained >15 min, 20% of episodes of mean pressures >130 mmHg sustained >30 min, 36% of episodes of heart rate > 120 beats/min sustained <10 min, and 68% of episodes of heart rate sustained <40 beats per minute for >3 min. CONCLUSIONS Substantial hemodynamic disturbances persisted despite implementing continuous portable ward monitoring coupled with nursing alarms and interventions. A significant proportion of these changes would have gone undetected using traditional intermittent monitoring. Better understanding of effective responses to alarms and appropriate interventions on hospital wards remains necessary.
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Affiliation(s)
- Ashish K Khanna
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA; Outcomes Research Consortium, Cleveland, OH, USA.
| | - Nathaniel S O'Connell
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Sanchit Ahuja
- Outcomes Research Consortium, Cleveland, OH, USA; Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH and Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
| | - Amit K Saha
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA.
| | - Lynnette Harris
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA.
| | - Bruce D Cusson
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Ann Faris
- Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA; Center for Nursing Research, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA.
| | - Carolyn S Huffman
- Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA; Center for Nursing Research, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA.
| | - Saraschandra Vallabhajosyula
- Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA; Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Clancy J Clark
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Scott Segal
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA.
| | - Brian J Wells
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Center for Biomedical Informatics, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Eric S Kirkendall
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Daniel I Sessler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
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Zhou Y, Luo D, Shao L, Yue Z, Shi M, Zhang J, Hui K, Xiong J, Duan M. Risk factors for acute postoperative hypertension in non-cardiac major surgery: a case control study. BMC Anesthesiol 2023; 23:167. [PMID: 37193947 DOI: 10.1186/s12871-023-02121-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 04/30/2023] [Indexed: 05/18/2023] Open
Abstract
PURPOSE Acute postoperative hypertension (APH) is a common complication during the anesthesia recovery period that can lead to adverse outcomes, including cardiovascular and cerebrovascular accidents. Identification of risk factors for APH will allow for preoperative optimization and appropriate perioperative management. This study aimed to identify risk factors for APH. PATIENTS AND METHODS In this retrospective single-center study, 1,178 cases were included. Data was entered by two investigators, and consistency analysis was performed by another. Patients were divided into APH and non-APH groups. A predictive model was built by multivariate stepwise logistic regression. The predictive ability of the logistic regression model was tested by drawing the receiver operating characteristic (ROC) curve and calculating the area under the curve (AUC). Hosmer and Lemeshow goodness-of-fit (GOF) test was performed to reflect the goodness of fit of the model. Calibration curve was created to represent the relationship between predicted risk and observed frequency. Sensitivity analysis was performed to evaluate the robustness of the results. RESULTS Multivariate logistic regression analysis showed that age over 65 years (OR = 3.07, 95% CI: 2.14 ~ 4.42, P < 0.001), female patients (OR = 1.37, 95% CI: 1.02 ~ 1.84, P = 0.034), presence of intraoperative hypertension (OR = 2.15, 95% CI: 1.57 ~ 2.95, P < 0.001), and use of propofol in PACU (OR = 2.14, 95% CI: 1.49 ~ 3.06, P < 0.001) were risk factors for APH. Intraoperative use of dexmedetomidine (OR = 0.66, 95% CI: 0.49 ~ 0.89, P = 0.007) was a protective factor. Higher baseline SBP (OR = 0.90, 95% CI: 0.89 ~ 0.92, P < 0.001) also showed some correlation with APH. CONCLUSIONS The risk of acute postoperative hypertension increased with age over 65 years, female patients, intraoperative hypertension and restlessness during anesthesia recovery. Intraoperative use of dexmedetomidine was a protective factor for APH.
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Affiliation(s)
- Yaqing Zhou
- Department of Anesthesiology, Nanjing BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210019, China
- College of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Dongxue Luo
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Luyi Shao
- Department of Anesthesiology, Nanjing BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210019, China
- College of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Zichuan Yue
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Min Shi
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Jie Zhang
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Kangli Hui
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Jingwei Xiong
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Manlin Duan
- Department of Anesthesiology, Nanjing BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210019, China.
- College of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China.
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China.
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Waters CM, Pelczar K, Adlesic EC, Schwartz PJ, Giovannitti JA. ACE-Inhibitor or ARB-Induced Refractory Hypotension Treated With Vasopressin in Patients Undergoing General Anesthesia for Dentistry: Two Case Reports. Anesth Prog 2022; 69:30-35. [PMID: 36223194 PMCID: PMC9552622 DOI: 10.2344/anpr-69-02-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/15/2022] [Indexed: 11/06/2022] Open
Abstract
Two case reports present the use of vasopressin for treating refractory hypotension associated with continued angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) therapy prior to general anesthesia for oral surgery. Both patients were treated in an ambulatory dental surgery clinic and took either their ACEI or ARB medication for hypertension within 24 hours prior to undergoing an intubated general anesthetic. Persistent profound hypotension was encountered intraoperatively that was refractory to treatment with traditional methods. However, the ACEI- or ARB-induced refractory hypotension was successfully managed with the administration of vasopressin.
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Affiliation(s)
- Caitlin M. Waters
- Department of Dental Anesthesiology, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania
| | - Kristen Pelczar
- Department of Dental Anesthesiology, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania
| | - Edward C. Adlesic
- Department of Dental Anesthesiology, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania
,Department of Oral and Maxillofacial Surgery, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania
| | - Paul J. Schwartz
- Department of Dental Anesthesiology, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania
,Department of Oral and Maxillofacial Surgery, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania
| | - Joseph A. Giovannitti
- Department of Dental Anesthesiology, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania
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Colomy VV, Reinaker TS. Comparative Study of Clevidipine to Nicardipine for Perioperative Hypertension in Patients Undergoing Cardiac Surgery. J Pharm Pract 2021; 36:501-507. [PMID: 34693825 DOI: 10.1177/08971900211053291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The primary objective of this study was to compare the efficacy of clevidipine to nicardipine in the treatment of perioperative acute hypertension in patients undergoing cardiac surgery. METHODS This was a single-center retrospective study which included patients who received either clevidipine or nicardipine. Patients were followed for the duration of study drug infusion or for a maximum of 48 hours. Outcomes assessed included the percent of time spent within patient specific goal blood pressure, incidence of hypertensive events per patient, safety outcomes, and cost of medication treatment. RESULTS There were 201 cardiac surgeries performed between August 2018-January 2019 and July 2019-February 2020. Sixty-seven patients met our inclusion criteria of receiving either clevidipine (n = 29) or nicardipine (n = 38). The median percent of time spent within goal blood pressure range for clevidipine was 55.2% compared to 36.4% for nicardipine treatment (P = .036). The median number of hypertensive episodes per patient was 3 for clevidipine and 2 for nicardipine (P = .211). There were no identified differences in safety outcomes such as hypotension, vasopressor use, serum creatinine elevation, tachycardia, and atrial fibrillation. The median cost of treatment required for the observed 48-hour period with clevidipine was $128.58 compared to $55.74 for nicardipine (P < .001). CONCLUSION Our findings suggest that patients undergoing cardiac surgery on clevidipine had better perioperative blood pressure control compared to nicardipine, with a negligible increase in cost, and no observed difference in safety.
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Affiliation(s)
- Veronika V Colomy
- Department of Pharmacy, 21798Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Travis S Reinaker
- Department of Pharmacy, 6566Einstein Medical Center Philadelphia, Philadelphia, PA, USA
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Galmén K, Jakobsson JG, Freedman J, Harbut P. Post-operative hypertension during early recovery following liver tumour ablation: A retrospective study. Acta Anaesthesiol Scand 2021; 65:1248-1253. [PMID: 34028010 DOI: 10.1111/aas.13930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND High-frequency jet ventilation is necessary to reduce organ movements during stereotactic liver ablation. However, post-operative hypertensive episodes especially following irreversible electroporation ablation compared with microwave ablation initiated this study. The hypothesis was that hypertensive episodes could be related to ventilation or ablation method. METHODS The aim of this retrospective study was to assess the proportion of patients with hypertensive events during recovery following liver ablation under general anaesthesia and to analyse the relation to ventilation and ablation technique. A medical chart review of 134 patients undergoing either high-frequency jet ventilation and microwave ablation (n = 45), high-frequency jet ventilation and irreversible electroporation (n = 44), or conventional ventilation and microwave ablation (n = 45) was performed. The proportion of patients with at least one episode of systolic arterial pressure 140-160, 160-180 or >180 mmHg during early recovery and the impact of ventilation method was studied. RESULTS Out of 134 patients, 100, 75 and 34 patients had at least one episode of mild, moderate and severe hypertension. Microwave ablation, as well as high frequency jet ventilation, was associated with an increased odds ratio for post-operative hypertension. The proportion of patients with at least one severe hypertensive event was 18/45, 9/44 and 7/45, respectively. CONCLUSION Both ventilation and ablation technique had an impact on post-operative hypertensive episodes. The microwave ablation/high-frequency jet ventilation combination increased the risk as compared with irreversible electroporation/high-frequency jet ventilation and microwave ablation/conventional ventilation.
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Affiliation(s)
- Karolina Galmén
- All at the Institution for Clinical Sciences Karolinska InstituteDanderyd University Hospital Stockholm Sweden
| | - Jan G. Jakobsson
- All at the Institution for Clinical Sciences Karolinska InstituteDanderyd University Hospital Stockholm Sweden
| | - Jacob Freedman
- All at the Institution for Clinical Sciences Karolinska InstituteDanderyd University Hospital Stockholm Sweden
| | - Piotr Harbut
- All at the Institution for Clinical Sciences Karolinska InstituteDanderyd University Hospital Stockholm Sweden
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Tobias JD, Naguib A, Simsic J, Krawczeski CD. Pharmacologic Control of Blood Pressure in Infants and Children. Pediatr Cardiol 2020; 41:1301-1318. [PMID: 32915293 DOI: 10.1007/s00246-020-02448-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/30/2020] [Indexed: 01/04/2023]
Abstract
Alterations in blood pressure are common during the perioperative period in infants and children. Perioperative hypertension may be the result of renal failure, volume overload, or activation of the sympathetic nervous system. Concerns regarding end-organ effects or postoperative bleeding may mandate regulation of blood pressure. During the perioperative period, various pharmacologic agents have been used for blood pressure control including sodium nitroprusside, nitroglycerin, β-adrenergic antagonists, fenoldopam, and calcium channel antagonists. The following manuscript outlines the commonly used pharmacologic agents for perioperative BP including dosing regimens and adverse effect profiles. Previously published clinical trials are discussed and efficacy in the perioperative period reviewed.
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Affiliation(s)
- Joseph D Tobias
- Departments of Anesthesiology & Pain Medicine, Nationwide Children's Hospital and The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Aymen Naguib
- Departments of Anesthesiology & Pain Medicine, Nationwide Children's Hospital and The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Janet Simsic
- Department of Pediatrics and Division of Pediatric Cardiology, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Catherine D Krawczeski
- Department of Pediatrics and Division of Pediatric Cardiology, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
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Vilela-Martin JF, Yugar-Toledo JC, Rodrigues MDC, Barroso WKS, Carvalho LCBS, González FJT, Amodeo C, Dias VMMP, Pinto FCM, Martins LFR, Malachias MVB, Jardim PCV, Souza DDSMD, Passarelli Júnior O, Barbosa ECD, Polonia JJ, Póvoa RMDS. Luso-Brazilian Position Statement on Hypertensive Emergencies - 2020. Arq Bras Cardiol 2020; 114:736-751. [PMID: 32491016 DOI: 10.36660/abc.20190731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
| | | | - Manuel de Carvalho Rodrigues
- Centro Hospitalar Universitário Cova da Beira, Covilhã, Portugal.,Liga de Hipertensão Arterial, Universidade Federal de Goiás, Goiânia, GO, Brasil
| | | | | | | | - Celso Amodeo
- Centro Hospitalar de Vila Nova Gaia, Espinho, Portugal
| | | | | | | | | | - Paulo Cesar Veiga Jardim
- Faculdade de Medicina, Universidade Federal do Pará, Belém, PA, Brasil.,Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brasil
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McEvoy MD, Gupta R, Koepke EJ, Feldheiser A, Michard F, Levett D, Thacker JK, Hamilton M, Grocott MP, Mythen MG, Miller TE, Edwards MR, Miller TE, Mythen MG, Grocott MPW, Edwards MR, Ackland GL, Brudney CS, Cecconi M, Ince C, Irwin MG, Lacey J, Pinsky MR, Sanders R, Hughes F, Bader A, Thompson A, Hoeft A, Williams D, Shaw AD, Sessler DI, Aronson S, Berry C, Gan TJ, Kellum J, Plumb J, Bloomstone J, McEvoy MD, Thacker JK, Gupta R, Koepke E, Feldheiser A, Levett D, Michard F, Hamilton M. Perioperative Quality Initiative consensus statement on postoperative blood pressure, risk and outcomes for elective surgery. Br J Anaesth 2019; 122:575-586. [DOI: 10.1016/j.bja.2019.01.019] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 12/08/2018] [Accepted: 01/03/2019] [Indexed: 12/17/2022] Open
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Incidence, Severity, and Detection of Blood Pressure Perturbations after Abdominal Surgery. Anesthesiology 2019; 130:550-559. [DOI: 10.1097/aln.0000000000002626] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Editor’s Perspective
What We Already Know about This Topic
What This Article Tells Us That Is New
Background
Intraoperative and postoperative hypotension are associated with myocardial and kidney injury and 30-day mortality. Intraoperative blood pressure is measured frequently, but blood pressure on surgical wards is usually measured only every 4 to 6 h, leaving long intervals during which hypotension and hypertension may be undetected. This study evaluated the incidence and severity of postoperative hypotension and hypertension in adults recovering from abdominal surgery and the extent to which serious perturbations were missed by routine vital-sign assessments.
Methods
Blood pressure was recorded at 1-min intervals during the initial 48 h in adults recovering from abdominal surgery using a continuous noninvasive monitor. Caregivers were blinded to these measurements and depended on routine vital-sign assessments. Hypotension and hypertension were characterized as time under and above various mean arterial pressure thresholds.
Results
Of 502 available patients, 312 patients with high-quality records were analyzed, with a median measurement time of 48 [interquartile range: 41, 48] postoperative hours. Nearly a quarter experienced an episode of mean arterial pressure of less than 70 mm Hg lasting at least 30 min (24%; 95% CI, 20%, 29%), and 18% had an episode of mean arterial pressure of less than 65 mm Hg lasting at least 15 min. Nearly half the patients who had mean arterial pressure of less than 65 mm Hg for at least 15 min (47%; 95% CI, 34%, 61%) were undetected by routine vital-sign assessments. Episodes of mean arterial pressure greater than 110 mm Hg lasting at least 30 min were observed in 42% (95% CI, 37%, 48%) of patients; 7% had mean arterial pressure greater than 130 mm Hg for at least 30 min, 96% of which were missed by routine assessments. Episodes of mean arterial pressure less than 65 mm Hg and mean arterial pressure greater than 110 mm Hg captured by routine vital-sign assessments but not by continuous monitoring occurred in 34 and 8 patients, respectively.
Conclusions
Postoperative hypotension and hypertension were common, prolonged, profound, and largely undetected by routine vital-sign assessments in a cohort of adults recovering from abdominal surgery. Frequent or continuous blood pressure monitoring may detect hemodynamic perturbations more effectively and potentially facilitate treatment.
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2018 Chinese Guidelines for Prevention and Treatment of Hypertension-A report of the Revision Committee of Chinese Guidelines for Prevention and Treatment of Hypertension. J Geriatr Cardiol 2019; 16:182-241. [PMID: 31080465 PMCID: PMC6500570 DOI: 10.11909/j.issn.1671-5411.2019.03.014] [Citation(s) in RCA: 242] [Impact Index Per Article: 48.4] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Simultaneous Quantitation of a Novel α₁/β₁-Blocker TJ0711 and Its Two Metabolites in Dog Plasma Using LC-MS/MS and Its Application to a Pharmacokinetic Study after Intravenous Infusion. Pharmaceutics 2019; 11:pharmaceutics11010038. [PMID: 30669292 PMCID: PMC6359546 DOI: 10.3390/pharmaceutics11010038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 01/12/2019] [Accepted: 01/14/2019] [Indexed: 11/17/2022] Open
Abstract
TJ0711∙HCl, which is a novel α1/β1 adrenoceptor blocking agent with a ratio of 1:1 for α1/β1, is designed to treat and prevent perioperative hypertension. M1 and M3 were identified as important metabolites in vitro for either antihypertension activity or the major metabolite production. In order to obtain a pharmacokinetic profile of both TJ0711 and its metabolites, a rapid, selective, and reliable LC-MS/MS method was developed and validated for simultaneous determination of TJ0711 and two metabolites in beagle dog plasma via efficiently separating two interferential metabolites M16 and M4 from M1 and M3, respectively. Chromatographic separation was achieved on a Waters CORTECS C18+ column (2.1 × 100 mm, 2.7 μm). The mass spectrometric detection was carried out in positive ion MRM mode with ESI+ source. Protein precipitation was used in sample preparation and provided good recovery without a matrix effect. Good linearity was observed at the ranges of 0.5–100 ng/mL for TJ0711 and M3, 0.1–20 ng/mL for M1. Additional validation results were within the acceptance limits followed U.S. FDA guidelines for bioanalytical method validation. This method was successfully applied to an intravenous infusion pharmacokinetic study of TJ0711 at dosing rates of 3, 6, and 12 µg/kg/min in anesthetized beagle dogs for the first time. TJ0711 and its two metabolites exhibited effective proportionality in the dosage of 3 to 12 µg/kg/min. Neither TJ0711 nor its metabolites showed significant differences in pharmacokinetic parameters such as t1/2, CL, and Vss among three dose groups.
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Sage AM, Keating SC, Lascola KM, Schaeffer DJ, Clark-Price SC. Cardiopulmonary effects and recovery characteristics of horses anesthetized with xylazine-ketamine with midazolam or propofol. Vet Anaesth Analg 2018; 45:772-781. [PMID: 30262441 DOI: 10.1016/j.vaa.2018.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate cardiopulmonary and recovery characteristics of horses administered total intravenous anesthesia (TIVA) with xylazine and ketamine combined with midazolam or propofol. STUDY DESIGN Randomized crossover study. ANIMALS A group of eight adult horses, aged 7-22 years, weighing 493-740 kg. METHODS Horses were administered xylazine (1 mg kg-1) intravenously (IV), and anesthesia was induced with ketamine (2.2 mg kg-1) IV. Anesthesia was maintained for 45 minutes via IV infusion of xylazine (0.016 mg kg-1 minute-1) and ketamine (0.03 mg kg-1 minute-1) combined with midazolam at 0.002 mg kg-1 minute-1 (MKX), propofol at 0.05 mg kg-1 minute-1 (PKXlow) or propofol at 0.1 mg kg-1 minute-1 (PKXhigh). Additional ketamine was administered if a horse moved spontaneously. Cardiopulmonary variables, blood gases, lactate concentration, packed cell volume and total solids were recorded before sedation (baseline), at 10, 20, 30 and 45 minutes during TIVA and 10 minutes after standing. Recovery variables and quantitative recovery scores were compared. Significance was set at p < 0.05. RESULTS Additional ketamine was required for 50% of MKX horses. Systolic arterial pressure was elevated in MKX at 20 minutes compared with baseline (p = 0.043), at 10 and 20 minutes compared with PKXhigh (p = 0.007, p = 0.024) and at 20 and 30 minutes compared with PKXlow (p = 0.009, p = 0.02). MKX horses (5/8) were hypertensive compared with PKXlow (1/8; p = 0.017). All horses became hypoxemic (PaO2 ≤80 mmHg; 10.7 kPa) during TIVA. Recovery variables did not differ among treatments. CONCLUSIONS AND CLINICAL RELEVANCE PKXlow and PKXhigh had similar cardiopulmonary and recovery performance compared with MKX. PKX combinations provided superior quality of anesthesia to that of MKX. A combination of propofol, ketamine and xylazine administered as TIVA can be used in horses to provide anesthesia for short procedures. Supplemental oxygen is recommended.
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Affiliation(s)
- Adrianna M Sage
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, IL, USA
| | - Stephanie Cj Keating
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, IL, USA.
| | - Kara M Lascola
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
| | - David J Schaeffer
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, IL, USA
| | - Stuart C Clark-Price
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
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Alshami A, Romero C, Avila A, Varon J. Management of hypertensive crises in the elderly. J Geriatr Cardiol 2018; 15:504-512. [PMID: 30364798 PMCID: PMC6198269 DOI: 10.11909/j.issn.1671-5411.2018.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 05/30/2018] [Accepted: 05/30/2018] [Indexed: 11/21/2022] Open
Abstract
Hypertensive crises are elevations of blood pressure higher than 180/120 mmHg. These can be urgent or emergent, depending on the presence of end organ damage. The clinical presentation of hypertensive crises is quite variable in elderly patients, and clinicians must be suspicious of non-specific symptoms. Managing hypertensive crises in elderly patients needs meticulous knowledge of the pathophysiological changes in them, pharmacological options, pharmacokinetics of the medications used, their side effects, and their interactions with other medications. Clevidipine, nicardipine, labetalol, esmolol, and fenoldopam are among the preferred choices in the elderly due to their efficacy and tolerability. Nitroprusside, hydralazine, and nifedipine should be avoided, unless there are no other options available, due to the high risk of complications and unpredictable responses.
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Affiliation(s)
- Abbas Alshami
- Dorrington Medical Associates, Houston, Texas, USA
- University of Baghdad/College of Medicine, Baghdad, Iraq
| | - Carlos Romero
- Dorrington Medical Associates, Houston, Texas, USA
- Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - America Avila
- Dorrington Medical Associates, Houston, Texas, USA
- Universidad Durango Santander, Hermosillo, Sonora, México
| | - Joseph Varon
- The University of Texas Health Science Center at Houston, USA
- The University of Texas Medical Branch at Galveston, USA
- Critical Care Services, United Memorial Medical Center / United General Hospital, Houston, Texas, USA
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Effects of fenoldopam on renal blood flow in hypertensive chronic kidney disease. J Nephrol 2018; 32:75-81. [PMID: 29766465 DOI: 10.1007/s40620-018-0496-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/06/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIM The synthetic drug fenoldopam mesylate (FM) may have a renoprotective role, and a "renal dose" of 0.1 µg/kg/min intravenous (IV) infusion of FM has been reported as able to increase renal blood flow without affecting systemic blood pressure. But conclusive data are still lacking. We aimed to investigate by color-Doppler ultrasonography the effects of IV administration of FM at this dosage in hypertensive chronic kidney disease (CKD) patients, and verify whether it may induce any systemic hemodynamic alteration. METHODS In 60 hypertensive CKD patients, we measured by duplex Doppler ultrasonography, at baseline and during infusion of 0.1 µg/kg/min of FM, the systolic and diastolic flow velocity (sampled at the renal hilum, intermediate section and origin of both renal arteries) and the intra-parenchymal renal resistive index (RRI) sampled on interlobular arteries of both kidneys. Patients were divided into four subgroups (I-IV) according to classification of National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF-DOQI). RESULTS Infusion of 0.1 µg/kg/min FM significantly decreased the RRI (0.73 ± 0.05 vs. 0.65 ± 0.06; p < 0.0001) and increased the systolic and diastolic flow velocities in all renal artery tracts examined. No single episode of systemic hypotension was observed. CONCLUSIONS Very low-dose FM may significantly increase renal blood flow and exert a renal protective effect in hypertensive CKD patients. Infusion of FM at such low dosage appears also to be quite safe, even in CKD and hypertensive patients.
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Zhang ZM, Liu Z, Liu LM, Zhang C, Yu HW, Wan BJ, Deng H, Zhu MW, Liu ZX, Wei WP, Song MM, Zhao Y. Therapeutic experience of 289 elderly patients with biliary diseases. World J Gastroenterol 2017; 23:2424-2434. [PMID: 28428722 PMCID: PMC5385409 DOI: 10.3748/wjg.v23.i13.2424] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 01/14/2017] [Accepted: 02/17/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To present clinical characteristics, diagnosis and treatment strategies in elderly patients with biliary diseases.
METHODS A total of 289 elderly patients with biliary diseases were enrolled in this study. The clinical data relating to these patients were collected in our hospital from June 2013 to May 2016. Patient age, disease type, coexisting diseases, laboratory examinations, surgical methods, postoperative complications and therapeutic outcomes were analyzed.
RESULTS The average age of the 289 patients with biliary diseases was 73.9 ± 8.5 years (range, 60-102 years). One hundred and thirty-one patients (45.3%) had one of 10 different biliary diseases, such as gallbladder stones, common bile duct stones, and cholangiocarcinoma. The remaining patients (54.7%) had two types of biliary diseases. One hundred and seventy-nine patients underwent 9 different surgical treatments, including pancreaticoduodenectomy, radical resection of hilar cholangiocarcinoma and laparoscopic cholecystectomy. Ten postoperative complications occurred with an incidence of 39.3% (68/173), and hypopotassemia showed the highest incidence (33.8%, 23/68). One hundred and sixteen patients underwent non-surgical treatments, including anti-infection, symptomatic and supportive treatments. The cure rate was 97.1% (168/173) in the surgical group and 87.1% (101/116) in the non-surgical group. The difference between these two groups was statistically significant (χ2 = 17.227, P < 0.05).
CONCLUSION Active treatment of coexisting diseases, management of indications and surgical opportunities, appropriate selection of surgical procedures, improvements in perioperative therapy, and timely management of postoperative complications are key factors in enhancing therapeutic efficacy in elderly patients with biliary diseases.
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Lou N, Wang D, Wang Z, Ye W, Liu X. Management of acute postoperative hypertension for reducing cardiovascular complications in cancer patients: when and how aggressively? Turk J Med Sci 2016; 46:1634-1640. [PMID: 28081339 DOI: 10.3906/sag-1412-33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 02/04/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM We sought to determine what factors cardiovascular complications (CVCs) correlate with in cancer patients with acute postoperative hypertension (APH) and to define when and how aggressively to treat this disorder in the present study. MATERIALS AND METHODS A retrospective observational study of cancer patients with postoperative hypertension at a single intensive care unit between July 2007 and June 2013 was conducted. The outcome of interest was the incidence of a CVC. RESULTS There were 1162 patients enrolled, of which 92 (7.9%) experienced one or more CVCs. Preexisting hypertension (OR 38.3, 95% CI 3.2-457.4, P = 0.004) and choice of vasodilator (OR 6.5, 95% CI 2.3-18.6, P = 0.000) were predictors of a CVC. Cardiovascular complications were less likely to occur if pain was relieved efficiently during the postoperative period (OR 15.9, 95% CI 1.9-130.1, P = 0.01). Furthermore, there were increased CVCs among patients with postoperative hypertensive crises compared to those with stage 1 or stage 2 hypertension with the treatment threshold for systolic blood pressure (OR 5.7, 95% CI 2.0-16.5, P = 0.001) or diastolic blood pressure (OR 6.0, 95% CI 1.8-20.3, P = 0.004). CONCLUSION To reduce CVCs, APH may be defined and managed as a hypertensive crisis in cancer patients.
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Affiliation(s)
- Ning Lou
- Department of Critical Care Medicine, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, P.R. China
| | - Daofeng Wang
- Department of Critical Care Medicine, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, P.R. China
| | - Zhi Wang
- Department of Critical Care Medicine, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, P.R. China
| | - Wenfeng Ye
- Department of Clinical Nutrition, Sun Yat-Sen University Cancer Center, Guangzhou, P.R. China
| | - Xiao Liu
- Department of Critical Care Medicine, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, P.R. China
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Dexmedetomidine versus labetalol infusions for controlling emergence hypertension in cranial surgeries for supratentorial tumors. EGYPTIAN JOURNAL OF ANAESTHESIA 2016. [DOI: 10.1016/j.egja.2016.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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22
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Varon J, Soto-Ruiz KM, Baumann BM, Borczuk P, Cannon CM, Chandra A, Cline DM, Diercks DB, Hiestand B, Hsu A, Jois-Bilowich P, Kaminski B, Levy P, Nowak RM, Schrock JW, Peacock WF. The management of acute hypertension in patients with renal dysfunction: labetalol or nicardipine? Postgrad Med 2014; 126:124-30. [PMID: 25141250 DOI: 10.3810/pgm.2014.07.2790] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
STUDY OBJECTIVES To compare the safety and efficacy of U.S. Food and Drug Administration (FDA)-recommended doses of labetalol and nicardipine for hypertension (HTN) management in a subset of patients with renal dysfunction (RD). DESIGN Randomized, open label, multicenter prospective clinical trial. SETTING Thirteen United States tertiary care emergency departments. PATIENTS OR PARTICIPANTS Subgroup analysis of the Evaluation of IV Cardene (Nicardipine) and Labetalol Use in the Emergency Department (CLUE) clinical trial. The subjects were 104 patients with RD (i.e., creatinine clearance < 75 mL/min) who presented to the emergency department with a systolic blood pressure (SBP) ≥ 180 mmHg on 2 consecutive readings and for whom the emergency physician felt intravenous antihypertensive therapy was desirable. INTERVENTIONS The FDA recommended doses of either labetalol or nicardipine for HTN management. MEASUREMENTS The number of patients achieving the physician's predefined target SBP range within 30 minutes of treatment. RESULTS Patients treated with nicardipine were within target range more often than those receiving labetalol (92% vs. 78%, P = 0.046). On 6 SBP measures, patients treated with nicardipine were more likely to achieve the target range on either 5 or all 6 readings than were patients treated with labetalol (46% vs. 25%, P = 0.024). Labetalol patients were more likely to require rescue medication (27% vs. 17%, P = 0.020). Adverse events thought to be related to either treatment group were not reported in the 30-minute active study period, and patients had slower heart rates at all time points after 5 minutes (P < 0.01). CONCLUSIONS In severe HTN with RD, nicardipine-treated patients are more likely to reach a target blood pressure range within 30 minutes than are patients receiving labetalol. CLINICAL IMPLICATIONS Within 30 minutes of administration, nicardipine is more efficacious than labetalol for acute blood pressure control in patients with RD.
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Affiliation(s)
- Joseph Varon
- Department of Emergency Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX.
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Martínez Ruiz A. [Capture of conscience: the precise control of the arterial pressure in the perioperative environment]. ACTA ACUST UNITED AC 2014; 61:537-40. [PMID: 25304430 DOI: 10.1016/j.redar.2014.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 09/04/2014] [Indexed: 11/16/2022]
Affiliation(s)
- A Martínez Ruiz
- Servicio de Anestesiología y Reanimación, Hospital de Cruces, Barakaldo, Bizkaia, España; Profesor Asociado Universidad del País Vasco, EHU, Leioa, Bizkaia, España.
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Clevidipine compared with nitroglycerin for blood pressure control in coronary artery bypass grafting: a randomized double-blind study. Can J Anaesth 2014; 61:398-406. [DOI: 10.1007/s12630-014-0131-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 02/17/2014] [Indexed: 11/26/2022] Open
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Urriola-Martínez M, Molina-Méndez F. [Anesthesia for coronary revascularization in patients with Kawasaki disease: case report]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2013; 83:267-72. [PMID: 24268888 DOI: 10.1016/j.acmx.2013.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 03/26/2013] [Accepted: 04/04/2013] [Indexed: 11/30/2022] Open
Abstract
Kawasaki disease is a self-limited vasculitis that occurs predominantly in infants and young children, that is characterized by coronary artery lesions (especially aneurysms). It is one of the leading causes of acquired heart disease in children. The etiology of Kawasaki disease still remains unknown. A hypothesis is that an infectious agent produces clinically apparent disease only in certain genetically predisposed individuals. It also is possible that the disease results from an immunologic response and is triggered by different microbial agents. For unknown reason it dominates in Asians. Treatment is directed to prevent coronary thrombosis and reduce inflammation; it is based on high-dose intravenous immunoglobulin and acetyl salicylic acid, which significantly reduce the risk of coronary artery aneurysms from 25 to 4%. In order to reduce myocardial ischemia, percutaneous coronary interventions and coronary artery bypass graft can be used. There is a lot of information about surgical techniques for coronary artery complications linked to Kawasaki disease, but minimal information about anesthetic techniques; for this reason, we describe the anesthetic management of a patient who required coronary artery bypass graft, and we present a literature review on the topic.
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Affiliation(s)
- Mónica Urriola-Martínez
- Servicio de Anestesiología Cardiovascular, Instituto Nacional de Cardiología Ignacio Chávez, México DF, México.
| | - Francisco Molina-Méndez
- Servicio de Anestesiología Cardiovascular, Instituto Nacional de Cardiología Ignacio Chávez, México DF, México
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Lonsdale DO, Baker EH. Understanding and managing medication in elderly people. Best Pract Res Clin Obstet Gynaecol 2013; 27:767-88. [PMID: 23850054 DOI: 10.1016/j.bpobgyn.2013.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 06/05/2013] [Indexed: 12/18/2022]
Abstract
Ageing alters drug handling by the body (pharmacokinetics) and response to medications (pharmacodynamics). Multiple comorbidities increase the risk of adverse drug reactions and medication burden, with increased potential for drug interactions. Elderly people are seldom included in clinical trials, so underestimation of benefits and overestimation of risk may lead to under-treatment. Cognitive and functional changes associated with ageing may make it difficult for elderly people to adhere to treatment regimens. In this review, we consider these issues, with particular reference to drugs prescribed for gynaecology patients (the 'gynaecology formulary'). It will focus on key areas of gynaecological practice, including prescribing anticholinergic drugs, hormone treatments and anticancer drugs, and perioperative issues relating to anaesthesia, analgesia and anticoagulation. Implications of common comorbidities, including osteoporosis, diabetes mellitus and cardiovascular disease, for prescribing in gynaecological patients will also be considered.
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Affiliation(s)
- Dagan O Lonsdale
- Clinical Pharmacology Unit, Division of Biomedical Sciences, St George's University of London, Mailpoint J1A, Cranmer Terrace, London SW17 0RE, UK
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Salgado DR, Silva E, Vincent JL. Control of hypertension in the critically ill: a pathophysiological approach. Ann Intensive Care 2013; 3:17. [PMID: 23806076 PMCID: PMC3704960 DOI: 10.1186/2110-5820-3-17] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 05/14/2013] [Indexed: 01/21/2023] Open
Abstract
Severe acute arterial hypertension can be associated with significant morbidity and mortality. After excluding a reversible etiology, choice of therapeutic intervention should be based on evaluation of a number of factors, such as age, comorbidities, and other ongoing therapies. A rational pathophysiological approach should then be applied that integrates the effects of the drug on blood volume, vascular tone, and other determinants of cardiac output. Vasodilators, calcium channel blockers, and beta-blocking agents can all decrease arterial pressure but by totally different modes of action, which may be appropriate or contraindicated in individual patients. There is no preferred agent for all situations, although some drugs may have a more attractive profile than others, with rapid onset action, short half-life, and fewer adverse reactions. In this review, we focus on the main mechanisms underlying severe hypertension in the critically ill and how using a pathophysiological approach can help the intensivist decide on treatment options.
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Affiliation(s)
- Diamantino Ribeiro Salgado
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, route de Lennik 808, Brussels 1070, Belgium
- Dept of Internal Medicine, Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255 Sala 4A, Rio de Janeiro 12-21941-913, Brazil
| | - Eliezer Silva
- Intensive Care Unit, Albert Einstein Hospital, Sao Paulo, Brazil
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, route de Lennik 808, Brussels 1070, Belgium
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Adlesic EC. Cardiovascular anesthetic complications and treatment in oral surgery. Oral Maxillofac Surg Clin North Am 2013; 25:487-506, vii. [PMID: 23684368 DOI: 10.1016/j.coms.2013.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Perioperative hypertension is a common problem. If hypertension is left untreated in patients at risk, infarctions and stroke are possible. There are limited choices of antihypertensive agents for the office. Aggressive antihypertensive therapy is not indicated because most of the episodes seen in the office are hypertensive urgencies and not emergencies. Hypotension is usually managed by decreasing the depth of anesthesia, intravenous fluids, and then vasopressors, typically ephedrine or phenylephrine. Consider treatment of hypotension whenever the mean arterial pressure decreases less than 60 mm Hg.
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Lien SF, Bisognano JD. Perioperative hypertension: defining at-risk patients and their management. Curr Hypertens Rep 2013; 14:432-41. [PMID: 22864917 DOI: 10.1007/s11906-012-0287-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Hypertension is an extremely pervasive condition that affects a large percentage of the world population. Although guidelines exist for the treatment of the patient with elevated blood pressure, there remains a paucity of literature and accepted guidelines for the perioperative evaluation and care of the patient with hypertension who undergoes either cardiac or noncardiac surgery. Of particular importance is defining the patients most vulnerable to complications and the indications for immediate and rapid antihypertensive treatment and/or cancellation of surgery to reduce these risks in each of the three perioperative settings: preoperative, intraoperative, and postoperative. This review also examines the parenteral antihypertensive medications most commonly administered in the perioperative setting.
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Affiliation(s)
- Susan F Lien
- Division of Cardiology, University of Rochester Medical Center, Rochester, NY, USA.
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Clevidipine for perioperative blood pressure control in infants and children. Pharmaceuticals (Basel) 2013; 6:70-84. [PMID: 24275788 PMCID: PMC3816677 DOI: 10.3390/ph6010070] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 12/28/2012] [Accepted: 01/11/2013] [Indexed: 11/29/2022] Open
Abstract
Various pharmacologic agents have been used for perioperative BP control in pediatric patients, including sodium nitroprusside, nitroglycerin, β-adrenergic antagonists, fenoldopam, and calcium channel antagonists. Of the calcium antagonists, the majority of the clinical experience remains with the dihydropyridine nicardipine. Clevidipine is a short-acting, intravenous calcium channel antagonist of the dihydropyridine class. It undergoes rapid metabolism by non-specific blood and tissue esterases with a half-life of less than 1 minute. As a dihydropyridine, its cellular and end-organ effects parallel those of nicardipine. The clevidipine trials in the adult population have demonstrated efficacy in rapidly controlling BP in various clinical scenarios with a favorable adverse effect profile similar to nicardipine. Data from large clinical trials regarding the safety and efficacy of clevidipine in children is lacking. This manuscript aims to review the commonly used pharmacologic agents for perioperative BP control in children, discuss the role of calcium channel antagonists such as nicardipine, and outline the preliminary data regarding clevidipine in the pediatric population.
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Plante A, Ro E, Rowbottom JR. Hemodynamic and related challenges: monitoring and regulation in the postoperative period. Anesthesiol Clin 2012; 30:527-554. [PMID: 22989593 DOI: 10.1016/j.anclin.2012.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The clinician caring for patients in the immediate postoperative period must maintain a high index of suspicion for the development of complications. Evolving illness manifests itself throughout the continuum of care and must be recognized and aggressively managed to ensure optimal outcome. This article discusses common hemodynamic problems encountered in the postanesthesia care unit. These problems are presented in a clinical framework that is familiar to experienced practitioners and recognizable to trainees. This article reviews of these common problems including relevant physiologic principles; effects on hemodynamics; and a logical approach to evaluation, monitoring, and management of a complex postoperative patient.
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Affiliation(s)
- Andrew Plante
- Department of Anesthesiology & Perioperative Medicine, University Hospitals, Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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Zuleta J, Canseco AP. Ophthalmic Surgery. Perioper Med (Lond) 2012. [DOI: 10.1002/9781118375372.ch26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Greene NH, Lee LA. Modern and Evolving Understanding of Cerebral Perfusion and Autoregulation. Adv Anesth 2012; 30:97-129. [PMID: 28275288 DOI: 10.1016/j.aan.2012.08.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Nathaniel H Greene
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA 98195-6540, USA
| | - Lorri A Lee
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA 98195-6540, USA; Department of Neurological Surgery, University of Washington, Seattle, WA 98195-6540, USA
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Atasever B, Boer C, van der Kuil M, Lust E, Beishuizen A, Speekenbrink R, Seyffert J, de Mol B, Ince C. Quantitative Imaging of Microcirculatory Response During Nitroglycerin-Induced Hypotension. J Cardiothorac Vasc Anesth 2011; 25:140-4. [DOI: 10.1053/j.jvca.2009.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Indexed: 11/11/2022]
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Tobias JD, Schechter WS, Phillips A, Weinstein S, Michler R, Berkenbosch JW, Montoya C. Clevidipine for Perioperative Blood Pressure Control in Infants and Children Undergoing Cardiac Surgery for Congenital Heart Disease. J Pediatr Pharmacol Ther 2011. [DOI: 10.5863/1551-6776-16.1.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
ABSTRACT
OBJECTIVE
To determine the efficacy and adverse effect profile of clevidipine when used for perioperative blood pressure (BP) control during surgery for congenital heart disease (CHD).
METHODS
We retrospectively reviewed our experience with the perioperative use of clevidipine in pediatric-aged patients undergoing surgery for CHD.
RESULTS
The study cohort included 14 patients ranging from 11 months to 15 years (7.4 ± 4.6 years) and weighing from 5 to 41 kg (21.8 ± 11.1 kg). Clevidipine was administered as a continuous infusion for control of either postoperative BP or intraoperative mean arterial pressure (MAP) during cooling and cardiopulmonary bypass (CPB). It was administered as a bolus for BP control during emergence from anesthesia following cardiac surgery. The continuous infusion was started at 1 mcg/kg/min and increased in increments of 0.5 to 1 mcg/kg/min as needed. For postoperative BP control, dosing requirements varied from 1 to 7 mcg/kg/min (mean = 2.0 ± 1.2 mcg/kg/min). The target BP was achieved within 5 minutes in all patients. Two patients were treated with intravenous or oral propranolol for an increase in heart rate (HR) while receiving clevidipine. Despite doses up to 10 mcg/kg/min, effective control of MAP could not be achieved during CPB and cooling (core body temperature 28°C to 32°C). Bolus doses of clevidipine (10 to 15 mcg/kg) controlled BP during emergence from anesthesia with a decrease of the MAP from 97 ± 6 mm Hg to 71 ± 5 mm Hg (p<0.01).
CONCLUSIONS
Clevidipine is effective for perioperative BP control in infants and children with CHD; however, it does not appear effective in controlling MAP during cooling and CPB.
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Affiliation(s)
- Joseph D. Tobias
- Departments of Anesthesiology and Pediatrics, Nationwide Children's Hospital and the Ohio State University, Columbus, Ohio
| | - William S. Schechter
- Departments of Anesthesiology and Pediatrics, Columbia University, New York, New York
| | - Alistair Phillips
- Department of Cardiothoracic Surgery, The Heart Center, Nationwide Children's Hospital, Columbus, Ohio
| | - Samuel Weinstein
- Department of Cardiac Surgery, Montefiore Hospital, New York, New York
| | - Robert Michler
- Department of Cardiac Surgery, Montefiore Hospital, New York, New York
| | | | - Carlos Montoya
- Pediatric Cardiology, Winthrop University, New York, New York
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