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

Blood loss and the incidence of emetic sequelae were assessed in 148 patients undergoing midcavity forceps delivery under continuous lumbar extradural analgesia. Five units of oxytocin i.v. was found to be as effective as ergometrine 0.5 mg i.v. in reducing blood loss at delivery. Nausea, retching or vomiting occurred in 35 (46%) of the mothers who received ergometrine and in none of those who received i.v. oxytocin. The cardiovascular side-effects of ergometrine and oxytocin are reviewed and compared with special reference to patients with hypertension and heart disease. It is suggested that 5 units of oxytocin i.v. should be preferred in these high-risk patients. Because of the absence of an emetic action, i.v. oxytocin is preferable to i.v. ergometrine for patients receiving extradural analgesia.
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PMID:Ergometrine, oxytocin and extradural analgesia. 95 92

During transesophageal echocardiography probe passage, airway reflexes are usually obtunded with topical local anesthetics. This technique meets with varying degrees of success. Even partially intact airway reflexes result in coughing, retching, and withdrawal, which may prevent transesophageal echocardiography examination or predispose to life-threatening tachycardia and hypertension. Proper preparation of the patient enhances comfort and helps protect against tachycardia and hypertension as well as reducing the time required for examination. This article outlines specific monitoring issues and offers precautions that are critical to transesophageal echocardiography probe passage. It suggests a premedication regimen and describes methods of sedation. Furthermore, it outlines the afferent innervation of the upper airway and specific techniques of temporary reflex interruption.
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PMID:Sensory blockade for difficult passage of transesophageal echocardiography probes. 151 Aug 53

1. In the unanaesthetized monkey (Macaca cyclopis), heating the spinal cord or the medulla oblongata from 38 to 42-43 degrees C produced subcutaneous vasodilatation, respiratory acceleration (frequently interrupted with a period of apnoea in the medullary experiment), bradycardia and hypotension. The animal became drowsy and had a slight decrease of body temperature. Heating the medulla oblongata often induced retching and/or emesis.2. Cooling the spinal cord or medulla oblongata from 38 to 32-33 degrees C produced subcutaneous vasoconstriction, slower respiration, tachycardia and hypertension. The animal became restless and had a slight increase of body temperature. Cooling the spinal cord induced shivering of the four limbs, while cooling the medulla oblongata induced only shivering of the jaws.3. The effects of heating or cooling of the spinal cord or the medulla oblongata were antagonized by simultaneous application of temperature displacement of the opposite nature in the same areas or vice versa.4. The data suggest that some thermosensitive elements possibly responsible for thermoregulation reside in the spinal cord and the medulla oblongata.
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PMID:Effects of heating and cooling the spinal cord and medulla oblongata on thermoregulation in monkeys. 462 23

Postoperative nausea and vomiting (PONV) are the most common side effects following anesthesia. It is unpleasant for the patients and has significant impact on postoperative well-being. After ophthalmic surgery arterial hypertension caused by retching and vomiting can cause intraocular bleeding with detrimental effects on the result of surgery. It is possible to identify risk patients who are likely to develop PONV. In these patients antiemetic prophylaxis is indicated, but the extreme age of patients (geriatric patients with relevant comorbidity and children) undergoing (ambulatory) ophthalmic procedures must be considered. Furthermore, antiemetics should be free from side effects, especially sedating effects, since these procedures are often performed on an outpatient basis. Regional or local anesthesia is the method of choice. However, when general anesthesia is necessary avoidance of volatile anesthetics, nitrous oxide, and administration of 5-HT(3) antagonists is recommended. Also, dexamethasone is a potent antiemetic drug that can favorably be combined with the 5-HT(3) antagonists. Dimenhydrinate is well accepted and an effective antiemetic for pediatric patients. By combining these antiemetic measures PONV can be lowered to a clinically satisfying level even in high-risk patients.
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PMID:[Prophylaxis and treatment of nausea and vomiting after outpatient ophthalmic surgery]. 1499 16

Postoperative nausea and vomiting (PONV) are the most frequent side-effects in the postoperative period, impairing subjective well-being and having economic impact due to delayed discharge. However, emetic symptoms can also cause major medical complications, and post-craniotomy patients may be at an increased risk. A review and critical appraisal of the existing literature on PONV in post-craniotomy patients, and a comparison of these findings with the current knowledge on PONV in the general surgical population, leads to the following conclusions: (1) Despite the lack of a documented case of harm caused by retching or vomiting in a post-craniotomy patient, the potential risk caused by arterial hypertension and high intra-abdominal/intra-thoracic pressure leading to high intracranial pressure, forces to avoid PONV in these patients. (2) There is unclarity about a specifically increased (or decreased) risk for PONV in post-craniotomy patients compared with other surgical procedures. (3) The decision whether or not to administer an antiemetic should not be based primarily on risk scores for PONV but on the likelihood for potential catastrophic consequences of PONV. If such a risk cannot be ruled out, a multimodal antiemetic approach should be considered regardless of the individual risk. (4) Randomized controlled trials with antiemetics in post-craniotomy patients are limited with respect to sample size and methodological quality. This also impacts upon the meaning of meta-analyses performed with trials that showed marked heterogeneity and inconclusive results. (5) No studies on the treatment of established PONV are available. This highlights the need to transfer knowledge about PONV treatment from other surgical procedures. (6) Despite the possibility that PONV in post-craniotomy patients can be triggered by specific conditions (e.g. surgery near the area postrema at the floor of the fourth ventricle with the vomiting centre located nearby), recommendations based on trials in post-craniotomy patients may be flawed. Thus, general knowledge on prevention and treatment of PONV must adopted for craniotomy settings.
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PMID:Prevention and control of postoperative nausea and vomiting in post-craniotomy patients. 1828 38

Serotonin syndrome is an unexpected fatal adverse event related to serotonergic medication. This case report is the first report describing the possible treatment effect of famotidine on serotonin syndrome. Furthermore, this is the first case report of serotonin syndrome induced by meperidine alone in a patient with no previous history suggesting a susceptibility to serotonin syndrome. A 70-year-old male with no recent history of serotonergic drug use presented with severe serotonin syndrome following ureteroscopy, possibly due to postoperative meperidine administration. The patient's symptoms included hypertension, tachycardia, tachypnea, hyperthermia, myoclonus, diaphoresis, retching, nausea, agitation, and semicoma mentality with no pupillary light reflex. Symptoms began to subside immediately after the administration of intravenous famotidine for prevention of aspiration pneumonia, with mental and neurological symptoms showing improvement initially, followed by autonomic symptoms. This case report suggests that the histamine type 2 receptor antagonist famotidine may be an effective emergency treatment for serotonin syndrome.
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PMID:Famotidine-induced reversal of meperidine-related serotonin syndrome: a case report. 2836 96