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

Fentanyl was used in 100 abdominal surgical interventions, combined with droperidol or with diazepan, always with good results as far as analgesia was concerned. Tensional variations that occurred during the induction were quite small and disappeared during the filling up. In the course of the intervention, tensional variations were only met with subjects suffering from high blood pressure. The respiratory depression that went with analgesia did not constitute an obstacle but made it necessary to use artificial ventilation for the intervetion. The awakening was always quick, smooth, without any vomiting and was influenced neither by the time taken up by the intervention nor by the condition of the patient. No residual respiratory depression requiring the use of an anti-morphinic was noted. At the end of the study, fentanyl appears as a powerful analgesic, easy to use and successful in all the cases of abdominal surgery. Its effect does not last, a drawback that can be avoided by the use of an intravenous drip.
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PMID:[Value of moderate fentanyl dosage during anesthesis in abdominal surgery. Apropos of 100 cases]. 0 82

The effects of continuous lumbar epidural analgesia for labor and delivery were studied in 20 women with gestational hypertension. Maternal hemodynamics, renal function, acid-base, and blood gas findings were examined together with newborn APgar scores and umbilical vessel blood gas and acid-base values. Minimal change occurred in maternal renal function and hemodynamics. Maternal and bewborn aicd-base and blood gas findings were comparable to those of normotensive control subjects also receiving epidural analgesia. Apgar scores in both groups of subjects wer good. Continuous epidural analgesia is recommended as a useful form of therapy in the management of labor and delivery in women with gestational hypertension.
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PMID:Maternal and fetal effects of lumbar epidural analgesia for labor and delivery in patients with gestational hypertension. 0 86

The study includes 54 unselected coronary patients. Fifty underwent one or several aortocoronary bypass associated with left ventricular resection (3 times), mitral valve replacement (twice), aortic valve replacement (twice). Four patients underwent left ventricular resection alone. The operations were performed under analgesic anesthesia with sufentanil (SF) or fentanyl (F) with a double blind protocol. The ratio of concentrations of the two analgesics was SF/F = 1/10. Flunitrazepam induced and maintained sleep. After having reached by increments the total dose of 1.5 mg F/M2 or 0.15 mg SF/M2, droperidol was then added in small amounts of 3.75 mg/M2, alternating with the analgesic both being given as needed to maintain blood pressure between 100 and 120 mm Hg, in order to potentiate the level of analgesia reached and prevent vasoconstriction. Under this setting tachycardia (heart rate greater than 100 beats/min. and less than 120 beaths/min.) was observed before ECC in only 7.4% of cases with both analgesics and brief episodes of hypertension (mean maximum systolic blood pressure 140.7 +/- 20.3 mm Hg seen with SF exclusively). There was neither postoperative hypertension (except with 6 out of the 7 known hypertensive patients) nor low cardiac output, nor arbythmia. No patients remained in intensive care unit more than 24 hour. No difference attribuable to the used analgesic was detectable in the early and late follow-up in both series. On an average, the patients were discharged on postoperative day 10 in a valid condition.
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PMID:Analgesic anesthesia with fentanyl (F) and sufentanil (SF) in coronary surgery. A double blind study. 31 16

Experiences with the anaesthetic management of 248 patients undergoing total hip replacement are presented. Blood loss does not appear to be influenced by hypertension, the method of venting or the type of anaesthetic, with the exception of neurolept-analgesia. The importance of oxygen therapy in the treatment of the pulmonary embolic syndrome is stressed and the prevention of deep venous thrombosis is discussed. Mortality and morbidity figures are given.
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PMID:Clinical considerations in anaesthesia for hip arthroplasty. 71 19

Fetal heart rate (FHR) was recorded and maternal blood pressure measured in 104 patients in whom lumbar epidural analgesia was induced in labour. Fifty-one patients received an intravenous load of 11 of Hartmann's solution immediately before the epidural injection. This infusion significantly reduced the incidence of abnormalities of FHR from 34% to 12% and of maternal hypotension from 28% to 2%. We did not study mothers with pre-eclampsia and hypertension, but we conclude that there is a strong case for preloading all other mothers in whom lumbar epidural analgesia is induced in labour.
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PMID:Fluid loading to reduce abnormalities of fetal heart rate and maternal hypotension during epidural analgesia in labour. 71 63

With improving standards of antenatal care, severe pre-eclampsia dn eclampsia are becoming less common and experience in the management of these conditions is lessening. Co-ordinated plans for the care of patients should be established by obstetricians and anaesthetists working as a team. A suitable regime for drug therapy in severe pre-eclampsia or eclampsia is the following: Initial management Diazepam 10 mg slowly i.v. Pethidine 100-150 mg i.m. or i.v. in incremental dosage, or extradural blocks, if analgesia is also required. Hydrallazine 20 mg i.v. initially, followed by 5 mg at intervals of 20 min until the diastolic pressure is less than 110 mm Hg. Then, preferably by syringe pump in a concentration of 2 mg/ml, at a rate of 2-20 mg/h. If vomiting occurs this can be controlled by administration of atropine. Subsequent management Sedation and anticonvulsant therapy. Continue diazepam and, in severe cases, institute chlormethiazole infusion. Continue analgesia with pethidine or extradural block. Control of hypertension by adjusting the dose of hydrallazine. If tachycardia exceeds 120 beat/min give propanolol 2-4 mg i.v. Plasma protein depletion with groww oedema is treated by administration of salt-free albumin or plasma protein fraction. Diuretic therapy is indicated if there is gross oedema or signs suggestive of acute renal failure. Oliguria associated with increased blood urea may be a result of renal failure or dehydration. The latter should be evident from the patient's condition and central venous pressure, but i.v. fluids and frusemide 20-40 mg can be used as a therapeutic test. Mannitol reduces cerebral oedema and may be given if diuresis has been first produced with frusemide. Potassium chloride is given if the plasma potassium decreases to less than 3 mmol/litre. Heparin therapy is considered if there is clinical evidence of disseminated intravascular coagulation.
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PMID:The management of severe pre-eclampsia and eclampsia. 83 44

The cardiopulmonary effects resulting from the combination of xylazine and ketamine hydrochloride were evaluated in the adult horse. Xylazine (1.1 mg mg/kg) administered intravenously prior to or simultaneously with ketamine hydrochloride (2.2 mg/kg; intravenous) provided excellent analgesia and light anesthesia in all horses. Cardiac output, arterial blood pressure, pulmonary arterial pressure, central venous pressure, and pulmonary arterial wedge pressure remained within normal limits for the adult horse. Evidence of respiratory acidosis developed with time during the anesthetic period. Induction and recovery from anesthesia appeared smooth and excitement-free. In the horse, larger dosages of ketamine hydrochloride (6.6 mg/kg) following sedation with xylazine (1.1 mg/kg; intravenous) were accompanied by muscular tremor and rigidity, mydriasis, oculogyric movements, sweating, hypertension, tachycardia, and increased rectal temperature during recovery from anesthesia. Providing there is good sedation from xylazine, the combination of xylazine and ketamine hydrochloride as a short-term intravenous anesthetic technique in the horse appears safe and acceptable providing reasonably stable cardiopulmonary function. If the sedative properties of xylazine are not apparent or if excessive dosages of ketamine hydrochloride are used, the drug combination results in serious side effects precluding its use for anesthesia in the horse.
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PMID:Evaluation of xylazine and ketamine hydrochloride for anesthesia in horses. 84 17

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

Prostaglandins participate in the regulation of blood pressure in normotensive and hypertensive subjects; vascular tone is subject to the continuous relaxing influence of endogenous vasodilating prostaglandins. Prostaglandin I2 (PGI2; prostacyclin), probably the most important physiological modulator of vascular tone, decreases blood pressure together with a concomitant increase in cardiac output and a reduction in systemic vascular resistance secondary to peripheral vasodilation. In addition, vasodilation within the splanchnic, pulmonary and coronary vascular beds has been observed, with increased blood flow through the mesenteric, renal and coronary vascular beds. These changes in regional blood flow have been associated with the inhibition, by PGI2, of the vasoconstrictor response to sympathetic nervous stimulation and pressor hormones [noradrenaline (norepinephrine), angiotensin II]. However, other prostaglandins, such as prostaglandin E2 (PGE2) and prostaglandin F2 alpha (PGF2 alpha), induce coronary vasoconstriction and have different effects on pulmonary artery blood pressure because of their effect on pulmonary vascular resistance. Nonsteroidal anti-inflammatory drugs (NSAIDs; e.g. indomethacin) have been reported to induce hypertension parallel to a fall in cardiac output, suggesting that the underlying mechanism is an increase in systemic vascular resistance. In animal models these agents reduced regional blood flow in the ischaemic myocardium, with a corresponding increase in infarct size. Ibuprofen, which inhibits prostaglandin synthesis to a lesser extent than indomethacin, did not exert systemic or coronary haemodynamic effects. NSAIDs also provide protection in shock models but may exacerbate haemodynamic derangements and decrease survival in acute hypovolaemic hypotension. To what extent do NSAIDs and opioids influence cardiovascular status during the postoperative course and analgesic therapy? Continuous infusion of NSAIDs for analgesia had no major haemodynamic effects. Also, there were insignificant changes in indices of left heart function (cardiac output, stroke volume) and the systemic circulation (mean arterial pressure, systemic vascular resistance) following intravenous ketorolac injections, whereas cardiac output and mean arterial pressure decreased after administration of morphine. The pulmonary circulation was unaffected by ketorolac administration, whereas morphine administration induced an increase in pulmonary vascular resistance. Indices of right and left cardiac work were decreased by morphine. Thus, ketorolac produces fewer haemodynamic effects than morphine, although it is possible that some of the effects of morphine may result from morphine-induced histamine release. NSAIDs may be seen as a worthwhile gain with respect to morphine in clinical situations when hypotension is disadvantageous or when reduction in afterload is not a specific therapeutic aim.
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PMID:Cardiovascular risks and benefits of perioperative nonsteroidal anti-inflammatory drug treatment. 128 61

A questionnaire on the use of adrenaline in obstetric analgesia was completed by 87 obstetric anaesthetists: 71% of consultants in teaching hospitals were prepared to use adrenaline mixed with local anaesthetics compared with 33% of consultants in district hospitals; they had a similar duration of obstetric anaesthetic experience. Test doses containing adrenaline were not commonly used in labour, but were more often used prior to elective Caesarean section. Adrenaline was used with either lignocaine or bupivacaine; few consultants used both solutions. Contraindications to the use of adrenaline in the nonuser group were in decreasing order of rank: neurological damage, pregnancy-induced hypertension, stenotic valvular heart disease, sickle cell disease or trait of fetal distress. Overall, the contraindications related to the systemic absorption of adrenaline were most common.
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PMID:Use of adrenaline in obstetric analgesia. 146 45


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