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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thirty patients (ASA physical status II-III) with a history of arterial hypertension, whose blood pressure (BP) control varied from normotension to moderate hypertension (diastolic BP less than 110 mmHg), scheduled for elective surgery under general anesthesia, were randomly assigned to two groups. Group 1 was premedicated 90-120 min prior to induction with diazepam 0.15 mg X kg-1 po; group 2, in addition, received clonidine 5 micrograms X kg-1 po. Anesthetic depth was assessed by on-line aperiodic analysis of the electroencephalogram. Following lidocaine 1 mg X kg-1 and fentanyl 2 micrograms X kg-1 (group 1 only), anesthesia was induced with thiopental 3-4 mg X kg-1 and vecuronium 0.1 mg X kg-1 was used to facilitate endotracheal intubation. Anesthesia was maintained with isoflurane in N2O/O2 and supplemented by fentanyl. In group 2, clonidine produced a rapid preoperative control of systolic and diastolic BP from 166 +/- 32/95 +/- 14 to 136 +/- 80 +/- 11 (P less than 0.01), was more effective in blunting the reflex tachycardia associated with laryngoscopy and endotracheal intubation than lidocaine-fentanyl pretreatment. It significantly reduced the intraoperative lability (coefficient of variation) of systolic (P less than 0.01) and diastolic BP and heart rate (HR) (P less than 0.05), and resulted in significantly slower HR during recovery (P less than 0.01). Anesthetic requirements for isoflurane were reduced 40% (P less than 0.01) in group 2; narcotic supplementation was also significantly reduced (P less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Anesthesia and hypertension: the effect of clonidine on perioperative hemodynamics and isoflurane requirements. 360 32

The hemodynamic effects of two types of anesthesia on aortofemoral bypass surgery were studied in a randomised prospective trial. Epidural anesthesia supplemented with nitrous oxide (group I) and total intravenous anesthesia combining fentanyl and a continuous infusion of etomidate (group II) were compared. A high incidence of preoperative disease was found and all 18 patients were classified in ASA classes III-IV. It is concluded that epidural anesthesia provides excellent anesthetic and hemodynamic stability provided that an optimal filling pressure is maintained. Total intravenous anesthesia resulted in significant hypertensive reactions during surgery, which were not specifically related to crossclamping. Decreasing the high SVRI with vasodilatory treatment was necessary to treat hypertension in all those patients with preoperative hypertensive disease. No problems were seen in the intravenous group patients without preoperative hypertension. Cardiac work was higher in the intravenous group due to the high impedance of the cardiovascular system provoked by the absence of vasodilatory properties with this type of intravenous anesthesia. Monitoring of PWP and CI by Swan-Ganz catheter is shown to be very useful for optimalization of hemodynamics and fluid management especially during crossclamping, when normal Frank-Starling relationships might not be valid anymore. The effect of vasodilatory treatment, crossclamping and declamping could be carefully evaluated.
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PMID:A hemodynamic study of epidural versus intravenous anesthesia for aortofemoral bypass surgery. 409 93

The effect on blood pressure and heart rate, following administration of the same intracerebroventricular (ivt) and intravenous (iv) doses of captopril, was compared in freely moving DOCA-salt hypertensive rats, with chronically implanted ivt, iv and intraarterial cannulae. Ivt captopril (500 micrograms) in DOCA-salt rats showed an initial pressor response followed by a long lasting hypotensive effect. The ivt effect was greater than that following iv administration. No effect was observed in normotensive controls either ivt or iv. ASA or naloxone pretreatments significantly lowered the captopril hypotensive effect, thus suggesting an involvement of prostaglandin and opioid systems in blood pressure elevation in "non renin dependent" hypertension.
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PMID:Cardiovascular responses of conscious DOCA-salt hypertensive rats to acute intracerebroventricular and intravenous administration of captopril. 634 5

This study determined the cardiovascular effects of percutaneous radiofrequency coagulation of the Gasserian ganglion, performed under neuroleptanalgesia and intermittent ultrashort-acting barbiturate anaesthesia. Twelve ASA physical status class II patients were studied. Highly significant increases in mean heart rate and arterial blood pressure followed the insertion of the cannula electrode into the Gasserian ganglion (p less than 0.001). In six randomly assigned patients severe tachycardia and hypertension also accompanied the progress of the thermal lesion (p less than 0.0001). Three patients developed premature ventricular contractions, and two developed significant ST segment depression. Intravenous nitroglycerin, used during current generation, successfully controlled the hypertensive response in the other six patients. In percutaneous thermocoagulation of the Gasserian ganglion the patient's co-operation is essential. In addition to providing suitable operating conditions for both surgeons and patient, we should also be able to maintain normal and stable cardiovascular haemodynamics. Intravenous nitroglycerin used as an adjunct to light general anaesthesia safely maintained intraoperative normotension. It is also suggested that patients with coronary artery disease be adequately monitored and protected during the procedure.
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PMID:Anaesthetic considerations in percutaneous radiofrequency coagulation of the Gasserian ganglion. 642 54

In 1975 a check list was introduced for the pre-operative evaluation of the surgical risks. In contrast to assessing the general condition of the patient according to the ASA nomenclature, the check list is largely based on objective criteria with a point system for evaluation. The number of points determines the magnitude of risk. 140,250 anaesthesias are avaluated with regard to the frequency of cardiovascular complications. The incidence of complications increases steadily in the presence of hypertension and arrhythmia in four consecutive risk groups and in the presence of hypotension and asystole in all five groups.
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PMID:[Objective criteria for the pre-operative evaluation of the surgical risks (author's transl)]. 741 46

The effects of clonidine, alpha 2-adrenergic receptor agonist, on perioperative hemodynamics and anesthetic requirements were studied in randomized 20 elderly patients without hypertension (ASA I-II) scheduled for elective abdominal surgery under general anesthesia. The control group (n = 10) was premedicated with oral diazepam 0.1 mg.kg-1 90 min prior to arrival in the operating room. The clonidine group (n = 10), in addition, received clonidine approximately 2.5 micrograms.kg-1 orally at the same time. Anesthesia was induced with fentanyl 2 micrograms.kg-1 and thiamylal 4 mg.kg-1. Vecuronium 0.15 mg.kg-1 following 0.01 mg.kg-1 priming dose was used to facilitate endotracheal intubation. Anesthesia was maintained with isoflurane in 50% nitrous oxide-oxygen and supplementary fentanyl. Clonidine effectively attenuated the cardiovascular response associated with laryngoscopy and tracheal intubation. Intraoperative variability of heart rate was significantly lower in patients receiving clonidine compared with controls. No significant differences in the requirements of either isoflurane or narcotic supplementation were observed between the two groups. We conclude that a low dose clonidine is a useful adjunct in the management of elderly patients without producing side effects.
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PMID:[The effects of low dose clonidine on perioperative hemodynamics and anesthetic requirements in elderly patients]. 760 94

Lower extremity vascular grafts, either vein or synthetic, fail for diverse reasons. Technical defects or poor surgical judgment doom a graft beyond any benefit pharmacotherapy can offer. Graft failure due to spontaneous thrombosis particularly affects prosthetic conduits, and use of antiplatelet agents (dextran, ASA) or anticoagulants (heparin, warfarin) is probably useful in this setting. An effective way to inhibit vein graft or anastomotic intimal hyperplasia remains elusive. Perhaps the most permanent and longstanding influence on lower extremity graft survival can be made through risk factor intervention aimed at arresting the progression of atherosclerosis. Aggressive treatment of hyperlipidemia, hypertension, smoking, and other known risk factors should be routinely and aggressively pursued in patients with lower extremity grafts, either autogenous or prosthetic. Lower extremity graft patency is optimally ensured by technically adept insertion of a proper autologous conduit in a well-selected patient. Pharmacotherapy may have a significant adjunctive role in the maintenance of graft patency, especially in high-risk settings such as limb salvage with associated poor outflow, a marginal vein graft, or the obligatory use of prosthetic material.
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PMID:Pharmacologic intervention to prevent graft failure. 763 20

Sixty patients, ASA I-III, presenting for elective colonic surgery were studied to assess the stability of blood pressure and heart rate during anaesthesia with three equally potent anaesthetic techniques. Patients in group I (n = 20) received thiopentone induction, isoflurane and nitrous oxide; patients in group II (n = 20) received total intravenous anaesthesia with propofol; and patients in group III (n = 20) received intravenous propofol supplemented with nitrous oxide. Fentanyl and vecuronium were used in all three groups. The depth of anaesthesia was judged on clinical signs of adequate anaesthesia. Episodes of bradycardia (heart rate < 50 beats min-1), tachycardia (heart rate > 90 beats min-1), hypotension (mean arterial pressure > or = 30% below pre-operative blood pressure) or hypertension (mean arterial pressure > 30%, or systolic blood pressure > 15 mmHg, above pre-operative value) were recorded when lasting > 5 min. Any use of ephedrine or glycopyrrolate given to correct hypotension or bradycardia was documented: In group II, significantly more patients were given ephedrine (P < 0.01) to treat hypotension. The drug was administered after intubation but before skin incision in the majority of cases (9/11). Glycopyrrolate was given to significantly more patients in group III (P < 0.025) to treat bradycardia, and in 21 of a total of 34 patients given glycopyrrolate it was administered before surgery. With the use of these additional drugs, there were no differences in the number of patients with 5 min episodes of hypotension, hypertension, tachycardia or bradycardia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A comparison of propofol and isoflurane anaesthesia: the need for ephedrine and glycopyrrolate. 764 20

Total intravenous anesthesia (TIVA) can be an effective alternative to inhalational anesthesia. Various techniques of TIVA have been associated with significant cardiovascular alterations and prolonged wake up times. The purpose of this study was to determine if TIVA utilizing propofol, ketamine, and vecuronium would provide stable hemodynamics in normotensive ASA physical status I and II patients and allow rapid awakening upon completion of surgery. Anesthesia was induced with propofol 1.0 mg/kg intravenously (IV), followed immediately by ketamine 1.0 mg/kg IV and vecuronium 0.1 mg/kg IV. Anesthesia was maintained by constant infusion of propofol 100-200 micrograms/kg/min and ketamine 17-34 micrograms/kg/min. This combination maintained hemodynamic stability and provided a rapid wake up time in 80% of the 40 subjects. The remaining 20% experienced significant tachycardia and hypertension or premature ventricular contractions. The mean wake up time was 9.7 minutes from time of neuromuscular blocking reversal to time of extubation. TIVA can be accomplished with propofol, ketamine, and vecuronium; however, 20% of patients experienced side effects, which make this method less attractive compared to alternative anesthetic techniques.
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PMID:The effects of total intravenous anesthesia using propofol, ketamine, and vecuronium on cardiovascular response and wake up time. 772 66

Using ear densitography, consisting of photoelectric plethysomography and Holter electrocardiography, we measured systolic time intervals (STI) in 21 patients, ASA class 1 and 2, undergoing laparoscopic cholecystectomy using CO2 insufflation under general anesthesia (neuroleptanesthesia with isoflurane in air, FIO2 0.5). The patients were divided into two groups: Y-group (10 patients under 59 years of age) and O-group (11 patients over 60 years of age). We investigated the influence of age on cardiac pump function during pneumoperitoneum non-invasively. Y-group showed improvement of cardiac pump function (reduction of PEP/LVET) from 30 minutes after the beginning of insufflation and quick recovery of cardiac function immediately after deflation. O-group showed a tendency of increasing PaCO2 and arterial diastolic pressure, and delayed recovery of cardiac function (elongation of PEP at 60 minutes, and increase of PEP/LVET at 60 and 90 minutes, respectively, after insufflation). Hypertension and tachycardia were apparent immediately after pneumoperitoneum in the O-group. We conclude that special care and monitoring are mandatory for the aged patients with impaired cardiac or respiratory function during laparoscopic surgery.
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PMID:[Influence of age on cardiac pump function during laparoscopic cholecystectomy--measurements by ear densitography]. 781 1


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