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

Umbilical artery flow velocity waveforms were obtained using continuous-wave Doppler ultrasound to examine the effect of epidural analgesia on peak systolic/least diastolic ratio (A/B ratio) in 38 women in uncomplicated labour, and 12 women with pregnancy-induced hypertension (PIH). In the uncomplicated group there was no significant change in A/B ratio after epidural analgesia, but in the PIH group there was significant correlation between the fall in mean blood pressure and the fall in A/B ratio at 30 min after induction of epidural analgesia (r = 0.85, p less than 0.001). This suggests that epidural analgesia in PIH is associated with a reduction in placental resistance and may be beneficial to the fetus.
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PMID:Epidural analgesia and its effect on umbilical artery flow velocity waveform patterns in uncomplicated labour and labour complicated by pregnancy-induced hypertension. 236 27

A six point concentration: response curved of the contractile effect of angiotensin II (AII) on helically-cut strips of human chorionic plate artery strips were established at final concentrations of between 10(-14) to 10(-9) M. The tissues were obtained from the placentae of primigravid patients who had normal pregnancy, and also from those with pregnancy induced hypertension (PIH). The tissue response were then related to mode of delivery, obstetric analgesia, and anaesthesia. A total of 36 chorionic plate arteries from 12 primigravid patients were studied. i) The overall initial EC50s of the tissues ranged from 8.0 x 10(-13) M and 4.5 x 10(-13) M. The tissues from PIH patients were significantly more sensitive to AII, when compared with tissues from the normotensive subjects (P greater than or equal to 0.01 less than or equal to 0.05). ii) The tissues from epidural vaginal deliveries were also significantly more sensitive to AII, than those from both normal vaginal deliveries and caesarean deliveries respectively. The median gradients of the semi-log transformed concentration response curved were 2.4 +/- 0.18; 1.27 +/- 0.37, and 1.5 +/- 0.49, for epidural, Caeserean and normal vaginal deliveries respectively. iii) It is suggested that whilst Lumbar epidural analgesia may be of great value in pain relief in labour and in the control of intrapartum hypertension in pre-eclampsia, this procedure may be associated with hypersensitivity and perhaps vasospasm of the placental vasculature to vasoactive agents invivo.
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PMID:The influence of mode of delivery, obstetric analgesia and anaesthesia on the response of isolated human chorionic plate arteries to angiotensin II. 248 65

This article summarized the effects of combined acupuncture-epidural anaesthesia (n = 37) and epidural anaesthesia (n = 37) for operations of patients being in a critical, old, weak or special condition. And, the effects were compared between the two different anaesthetic methods in a similar clinical condition. The patients studied were almost complicated with coronary arteriosclerotic heart disease, hypertension or other types of disease excepting the surgical condition. There were different degrees of functional disturbance in their important visceral organs. The states of the body were all belong to critical or weak condition. This might be a difficulty of considerably great for anaesthesia and operation. By using combined acupuncture-epidural anaesthesia, the advantages of acupuncture anaesthesia and epidural anaesthesia were brought into fully play, and, the defect of incomplete analgesia as well as inadequate muscle relaxation was remedied. By acupuncture for 30 to 40 minutes, the EGGs that were originally abnormal had shown some improvement in parts of case and recovered to normal in individual patient. Even though the EGGs had not shown improvement in some cases, but, took no further steps to deteriorate, although undergoing harmful effects in operative process, such as exploration, hemorrhage or others. In some cases, the circulative function showed stabilization exceeding one's expectations. The result showed that acupuncture has a regulative role on the cardiovascular system, thus enhancing the safety in anaesthetic process.
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PMID:[A summary on effects of combined acupuncture anaesthesia for critical, old, week, special patients]. 251

Eight-five carotid endarterectomies were performed in 77 patients, under regional anaesthesia using 2 different techniques: cervical epidural anaesthesia (35 cases) and cervical plexus block (50 cases). The patients' mean age was 71 years; 80 per cent had arterial hypertension and 41 per cent coronary disease. Transoperative cerebral ischaemia was detected by a 5-minute carotid clamping test, the occurrence of a neurological event indicating that shunting was required. In 62 patients this test was combined with measurement of carotid back pressure. None of the patients needed general anaesthesia. Intraoperative neurological events occurred more frequently (P less than 0.01) when the carotid back pressure was 25 mmHg or less, and 12 temporary shunts were installed for that reason (14.1 per cent). Three neurological events occurred at the end of endarterectomy: no shunt was installed and complete recovery was observed immediately after declamping. No complications ascribable to the anesthetic techniques were recorded. Mortality was nil, and the only neurological morbidity was a brachio-facial deficit which left few sequelae. The frequency of intra- or postoperative arterial hypertension was similar in both groups. Intraoperative hypotension, frequent under epidural anaesthesia, was observed in only one patient who had brachial plexus block (P less than 0.01). The analgesia obtained was equally good with both anaesthetic techniques, but cervical plexus block anaesthesia is easier to perform, had less haemodynamic repercussions and therefore tends to be preferred to cervical epidural anaesthesia. The lack of mortality, low morbidity and absence of systemic complications in this series despite the high number of patients at risk are in favour of this type of anaesthesia, notably for such patients. Moreover, because vigilance is preserved attention can be paid to the quality rather than the rapidity of endarterectomy, which is the best way of preventing embolism.
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PMID:[Carotid surgery under locoregional anesthesia]. 253 1

The pharmacological properties of centrally acting alpha2-receptor agonists such as clonidine suggest a potentially important role as ideal adjuvants for anesthesia since they produce sedation, analgesia anxiolysis, xerostomia and cardiovascular stability without respiratory depression, development of tolerance or addiction liability. Further clinical experience with this exciting development will undoubtedly establish the ultimate role and optimal use of alpha2 -receptor agonists in anesthetic practice. Beta-blockage can result in significant bradycardia, atrial ventricular conduction problems, bronchospasm and left ventricular contractile dysfunction. Thus, the use of long-acting beta-blockers is of limited value in the perioperative period. Esmolol, because of its ultrashort action, cardioselective properties and titratability, has been shown to be safe and effective for the treatment of tachycardia and hypertension. Doses from 50 to 300 micrograms/kg/min for up to 7 hours in the perioperative period have been shown to cause no apparent cumulative effect. It has been used in the treatment of asthmatic patients with tachycardia and hypertension without significant increases in airway resistance. Studies using esmolol during general anesthesia have demonstrated no significant interaction with several anesthetic regimens.
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PMID:Clinical pharmacology of alpha2-agonist and beta-adrenergic blocker. 257 80

Earlier studies from this laboratory had indicated that there is a selective increase in the density of brain kappa opioid receptors labeled with [3H]ethylketocyclazocine in spontaneously hypertensive (SHR) rats in comparison to normotensive Wistar-Kyoto rats. The binding of a mu-ligand, [3H]naltrexone, and a delta-ligand, [3H]Tyr-D-Ser-Gly-Phe-Leu-Thr, to brain membranes of hypertensive and normotensive rats did not differ. The present studies were undertaken to determine further the role of kappa opioid receptors in hypertension. The binding of [3H]ethylketocyclazocine to brain membranes of hypertensive rats was much greater than those of normotensive rats. The density of kappa receptors was significantly higher in hypothalamic membranes of hypertensive rats as compared to normotensive rats. In order to determine the functional significance of the increased density of brain kappa opioid receptors in SHR rats, the effect of the kappa receptor agonists, tifluadom, U-50,488H and bremazocine, on two known actions associated with kappa receptors, namely analgesia and diuresis, were determined in SHR and normotensive rats. All three kappa agonists produced dose-dependent analgesia as measured by the tail-flick test. The intensity of the analgesic responses at each dose of the drugs in SHR rats was much greater than in normotensive Wistar-Kyoto rats. The kappa drugs also produced dose-dependent diuretic effects when the rats were loaded with 5% saline intragastrically. The increases in the volumes of urine produced by kappa drugs were much greater in SHR rats in comparison to normotensive rats. The basal tail-flick reaction time or urinary output in the two strains did not differ.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Kappa opioid receptor activity in spontaneously hypertensive rats. 283 73

A 24-year-old black female presented for repeat elective Caesarean section. The procedure was performed under epidural anaesthesia. Sufentanil 25 micrograms, intended for postoperative analgesia, was inadvertently diluted to 10 ml with 15 per cent potassium chloride (KCl) instead of preservative-free normal saline (0.9 per cent NaCl). This solution was then injected via an epidural catheter into the epidural space at the conclusion of surgery. Two hours after injection of the sufetanil-KCl mixture, the patient had a level of sensory blockade to T1 and diaphoresis above this level. Painful muscle spasms had also developed below T1. One hour later she developed hypertension which required hydralazine 10 mg and labetalol 25 mg IV for treatment. The patient was treated supportively with oxygen. Dexamethasone 10 mg was administered intravenously to reduce spinal cord oedema. Intravenous diazepam 10 mg and meperidine 75 mg were given for sedation and analgesia. Complete recovery occurred within 12 hours.
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PMID:Inadvertent epidural administration of potassium chloride. A case report. 297 23

Forty patients who had undergone coronary artery graft surgery and who required vasodilator therapy for postoperative hypertension were given infusions of either alfentanil or morphine together with bolus doses of midazolam for sedation and analgesia while ventilation was controlled artificially. Sodium nitroprusside (SNP) was administered to both groups using a computer-controlled closed loop system which adjusted the infusion rate to maintain a preset target arterial pressure. Target pressure +/- 5, 10, 15 and 20 mm Hg was maintained longer in the group receiving alfentanil. This group also required less SNP per hour. No difference was noted between the groups in the time taken to regain spontaneous ventilation and to extubation of the trachea, although the alfentanil group tended to be sedated more deeply during the infusion. The main advantage of alfentanil over morphine at doses used in this study was its superior ability to attenuate hypertensive responses to noxious stimuli, providing improved haemodynamic stability.
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PMID:Sedation following cardiac surgery: evaluation of alfentanil and morphine in the presence of a computerized closed loop arterial pressure controller. 314

The authors anesthetized 18 patients with good pulmonary and ventricular function for coronary artery bypass grafting with high doses of fentanyl. When the patients were arousable and their vital signs stable in the intensive care unit, the authors administered nalbuphine or placebo (randomly and double-blinded) until extubation criteria were met, and subsequently gave nalbuphine for analgesia. In one of ten placebo patients, tracheal extubation was accomplished without nalbuphine. This patient then retained CO2 and required nalbuphine; the other nine placebo patients could not be extubated after placebo trials and were given nalbuphine. In all other patients in both groups, tracheal extubation was successful following nalbuphine (median dose 60 micrograms/kg, range 30-180 micrograms/kg). One patient became renarcotized 4 h after tracheal extubation without an increase in plasma fentanyl concentration; he received an additional dose of nalbuphine and recovered without further incident. Nine patients required treatment with vasoactive agents or beta-blockers for hypertension or tachycardia associated with the administration of nalbuphine. Eight of 18 patients were not satisfied with nalbuphine analgesia, and required morphine for relief of their pain. Recurrent elevations of fentanyl concentrations in plasma were observed and appeared to be related to increasing motor activity. Nalbuphine is an effective opioid antagonist after fentanyl anesthesia, but its use is associated with side effects, and analgesia for the post-sternotomy patient may be unsatisfactory unless the dose is carefully titrated to the minimum required to antagonize respiratory depression.
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PMID:Nalbuphine antagonism of fentanyl-induced ventilatory depression: a randomized trial. 327 86

Carotid endarterectomy in 39 elderly patients was carried out under local anesthesia and neuroleptic analgesia. There were no deaths within 30 days. Two patients required an intraoperative shunt because of signs of ischemic changes (aphasia, motor changes) during two-minute test cross-clamping. In two patients, transient vocal cord paresis was observed, and seven patients (18%) experienced immediate postoperative hypertension. Our results support the contention that in awake elderly patients the need for an intraoperative shunt can be accurately assessed by simple neurological monitoring. Carotid surgery under local anesthesia and neuroleptic analgesia appears to be a safe procedure, and is especially recommended for elderly patients with hypertension, diabetes mellitus or ischemic heart disease.
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PMID:Carotid surgery under local anesthesia in the elderly. 337 34


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