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

A patient with a ganglioneuroblastoma secreting both noradrenaline and vasoactive intestinal peptide is described. Their vasoactive effects are antagonistic and pre-operatively the patient was normotensive. Manipulation of the tumour provoked hypertension and after excision marked hypotension occurred which responded to the administration of metaraminol and blood. This case emphasises the need for thorough investigation of patients with amine or peptide-secreting tumours which have atypical features.
Anaesthesia
PMID:Adrenal tumour secreting vasoactive intestinal peptide and noradrenaline. 59 87

In 330 consecutive anesthetics administered over a period of 24 months, an improved method of upper extremity intravenous regional anesthesia, entitled "the second wrap technique," included wrapping the extremity a second time with a Martin rubber bandage after the extremity was prepared and draped. In addition, a Penrose drain tourniquet often was applied during injection of the 0.5% lidocaine. No complications occurred. The technique provides a nearly bloodless operative field, improves the anesthesia, diminishes tourniquet pain, lessens the contraindications, and requires no premedication. The only contraindications are allergy to lidocaine, infection, operating time over 2 hours, and severe hypertension.
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PMID:Improved intravenous regional anesthesia for surgery of the hand, wrist, and forearm. The second wrap technique. 63 52

The intravenous injection of purified scorpion toxin (tityustoxin, TsTX) into unanesthetized rats induces a severe systemic hypertension followed by a hemorrhagic edema of the lungs. The edema is focal or diffuse, whereas the hemorrhage is always focal and less prominent than the edema. Anesthesia of the rats prevents the appearance of pulmonary edema. It seems likely that this protective action of the anesthesia is due, at least in part, to an interference with the hypertension induced by TsTX. The pulmonary edema is prevented by bilateral adrenalectomy, guanethidine or phenoxybenzamine. It is suggested that the edema depends on a sympathetic-adrenal discharge and that catecholamines released by TsTX act on alpha adrenergic receptors. The mean kininogen content of the rat plasma, 1 h after TsTX injection, is not significantly different from that found in the control animals. The possible role played by kinins and other mediators in the early phases of the pulmonary edema induced by TsTX is under investigation.
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PMID:Mechanism of the pulmonary edema induced by intravenous injection of scorpion toxin in the rat. 63 35

Experimental data on the effect of cordarone (10 mg/kg) upon blood circulation in animals under general anesthesia and in free behavior are presented. It was established that under general anesthesia cordarone induced in animals hypotension (16 +/- 2%), bradycardia (19 +/- 1.82%), heart contractility inhibition (29 +/- 6.10%). In animals under conditions of free behavior cordarone causes hypertension (9 +/- 3.1%), tachycardia (11 +/- 1.3%) and potentiates cardiac contractility. Practolole, a selective beta1-adrenoblocking agent, potentiates the effect of cordarone on the myocardium and also obliterates the difference between the effects of the drug in animals under general anesthesia and in free behavior. These data point to the drug exerting a direct inhibitory effect on the myocardium. It is suggested that the difference in the effects of cordarone in animals under general anesthesia and in conditions of free behavior is due to a lesser degree of activation produced by the drug in anesthetized animals.
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PMID:[Effect of cordarone on blood circulation under general anesthesia and in free behavior]. 65 77

During the years 1974 and 1975 at our institution, 587 patients who had suffered previous myocardial infarctions underwent anesthesia and surgery. Thirty-six (6.1%) had a reinfarction and 25 (69%) died. Patients operated on within three months of the previous infarction had a 27% reinfarction rate. This decreased to 11% if the infarct had occurred three to six months previously and stabilized at 4% to 5% if the interval was more than six months. Risk factors associated with significantly increased reinfarction rates included preoperative hypertension, intraoperative hypotensive episodes, and noncardiac thoracic or upper abdominal operations of more than three hours' duration. Time under anesthesia was strikingly correlated with reinfarction rates in the entire group. Postoperative intensive care unit admission did not significantly affect the reinfarction rate, nor did diabetes, angina, patient age or sex, or site of the previous myocardial infarction.
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PMID:Myocardial reinfarction after anesthesia and surgery. 66 Jul 89

In an attempt to assess cardiac risk in non-cardiac surgery, 1001 patients over 40 years of age who underwent major operative procedures were examined preoperatively, observed through surgery, studied with at least one postoperative electrocardiogram, and followed until hospital discharge or death. Documented postoperative myocardial infarction occurred in only 18 patients; though most of these patients had some pre-existing heart disease, there were few preoperative factors which were statistically correlated with postoperative infarction. Postoperative pulmonary edema was strongly correlated with preoperative heart failure, but 21 of the 36 patients who developed pulmonary edema did not have any prior history of heart failure. Nearly all of these 21 patients were elderly, had abnormal preoperative electrocardiograms, and had intraabdominal or intrathoracic surgery. In the absence of an acute infarction, bifascicular conduction defects, with or without PR interval prolongation, never progressed to complete heart block. Spinal anesthesia protected against postoperative heart failure but not against other cardiac complication. By multivariate regression analysis, postoperative cardiac death was significantly correlated with (a) myocardial infarction in the previous 6 months; (b) third heart sound or jugular venous distention immediately preoperatively; (c) more than five premature ventricular contractions per minute documented at any time preoperatively; (d) rhythm other than sinus, or premature atrial contractions on preoperative electrocardiogram; (e) age over 70 years; (f) significant valvular aortic stenosis; (g) emergency operation; (h) a 33% or greater fall in systolic blood pressure for more than 10 minutes intraoperatively. Notably unimportant factors included smoking, glucose intolerance, hyperlipidemia, hypertension, peripheral atherosclerotic vascular disease, angina, and distant myocardial infarction.
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PMID:Cardiac risk factors and complications in non-cardiac surgery. 66 58

A continuous infusion of ketamine, following an initial dose of 1 mg/kg, has been used as sole anaesthetic in over 200 adult patients. The pre-operative use of 4 mg lorazepam has made this acceptable with respect to emergence sequelae and dreams. The technique can be used with neuromuscular blocking drugs and controlled ventilation with air, but here pancuronium is best avoided because of excessive tachycardia and hypertension. Hypertonus was the main problem encountered in the non-relaxant cases. The amount of ketamine required for anaesthesia has been analysed in detail and recommendations on dosage are given. The cardiovascular effects have also been analysed in detail. There is a need for a similar investigation to be carried out in circumstances where inhalation agents are not available and where there is a shortage of anaesthetists.
Anaesthesia 1978 Apr
PMID:Ketamine infusions. Observations on technique, dosage and cardiovascular effects. 66 50

Cardiovascular collapse associated with pneumoencephalography (PNE) has been reported but there has been no prospective study of its nature and cause. We have recorded prospectively the e.c.g. of 82 unselected patients, with no cardiovascular or metabolic disease, undergoing PNE under general anaesthesia. The frequency of arrhythmia following air injection was 60%; bradycardia 22%; ventricular ectopic beats 26%; nodal rhythm or sinus tachycardia 11%. Cardiovascular collapse occurred in three patients; two with "torsades de pointes" and one with bigeminy and q.r.s. block. Arrhythmia was more frequent in patients with a pituitary tumour and intracranial hypertension (91%). Eight postoperative control PNE examinations were uneventful. Three of four patients with frontal lobe tumours and four of seven with posterior fossa tumours exhibited arrhythmia.
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PMID:Cardiac arrhythmia induced by pneumoencephalography. 67 72

Paroxysmal hypertension occurred during the first 8 hours after cardiac valve replacement in 15 of 186 consecutive patients. The clinical characteristics of this hypertension were similar to those of hypertension after myocardial revascularization, except that this complication occurred much less frequently after valve replacement (8.1%) than after myocardial revascularisation (33%) (P less than 0.001). Hypertension resulting from hypoxia, hypercapnia, shivering, or arousal from anaesthesia was excluded from consideration. The rise in systemic arterial pressure (average 34/35 mmHg +/- 4.9/4.3 SE) was usually associated with a reduction in central venous pressure (12/15 patients) and a mild increase (2 to 4 cm saline) in left atrial pressure. The incidence of hypertension was not related to the valve replaced (aortic or mitral), type of lesion (stenosis or regurgitation), preoperative level of blood pressure, or use of hypothermia during operation. However, none of the 18 patients who had double valve replacement showed significant rise in blood pressure after operation. It is suggested that these hypertensive episodes may be related to pressor reflexes from the heart and/or great vessels.
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PMID:Arterial hypertension in immediate postoperative period after valve replacement. 68 68

Earlier studies of renal transplantation and of sodium metabolism indicated that the cause of high blood pressure in the Milan strain of genetically hypertensive rats (MHS) was altered renal function. To pinpoint the active factors, we used micropuncture to study several indices of renal function in normal (NR) and MHS rats at three different ages: A) 26 to 30 days, before development of hypertension (pre-MHS); B) 35 to 40 days; and C) 75 to 90 days, after the development of hypertension. The indices studied and the important differences found between the two strains were: 1) Single nephron filtration rate (SNFR) and late proximal tubular fluid delivery to the distal nephron (LPF). In group A, the pre-MHS rats had significantly lower values than did the NR (SNFR = 6.3 +/- 0.8 nl/min [MHS] vs. 8.3 +/- 1.2 [NR], P less than 0.01; LPF = 3.14 +/- 0.25 nl/min [MHS] vs. 4.1 +/- 0.35 [NR], p less than 0.05). In group C, the values in the MHS rats were significantly higher than those of the NR (SNFR = 17.3 +/- 1.4 nl/min [MHS] vs. 12.1 +/- 0.8 [NR], P less than 0.05; LPF - 7.4 +/- 0.5 nl/min [MHS] vs. 5.3 +/- 0.3 [NR], P less than 0.01). 2) Number of glomeruli. In group C only, the MHS rats had significantly fewer than did the NR rats (MHS = 55, 253 +/- 2,821 vs. NR = 64,527 +/- 2,900, P less than 0.05). 3) Glomerular filtration rate (GFR) and SNFR as a function of the mean blood pressure (MAP). In group A, the GFR of the MHS rats was lower than that of the NR rats (GFR = 0.38 +/- 0.03 ml/min . 100 g of body wt [MHS], 0.50 +/- 0.03 [NR] P less than 0.05). In group C, there was no longer any significant difference. At equal MAP, SNFR was equal in all the groups, except group A, where SNFR was significantly lower in MHS. 4) Pressure differences: Glomerular capillary pressure (gP). GP was significantly higher in MHS rats than in NR rats (group A, + 5.2 mm Hg; group C, + 6.7 mm Hg). In the pre-MHS rats, anesthesia significantly increased (P less than 0.001) the blood pressure difference between the two strains. This effect was not seen in the adult MHS rats. This may increase the differences in GP between pre-MHS and NR. 5) Afferent effective filtration pressure (EFPA). EFPA values were also higher in MHS rats (+ 2.9 mm Hg in group A, + 6.8 mm Hg in group C), but once again the effects of anesthesia probably account for the differences in magnitude seen between pre-MHS and NR. Only 22% of the absolute differences in systemic arterial pressure in the adult MHS and NR rats was transmitted to the glomerular capillary, while 33% of the difference was transmitted in the younger rats. These values suggest a reduced glomerular hydraulic conductivity, even though other explanations could not be excluded, and they are consistent with the hypothesis that the primary cause of development of hypertension in the MHS rats may be a decrease in SNFR.
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PMID:Renal micropuncture study of normotensive and Milan hypertensive rats before and after development of hypertension. 71 81


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