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

Osmotherapy with sorbitol 40% during intracranial surgery using neurolept analgesia usually produced acute decreases in arterial blood pressure. Haemodynamical measurements during intraoperative infusions of sorbitol in 97 patients showed a rapid decrease of arterial mean pressure from 91 to 72 mm Hg. In 22 of these patients cardiac output measurements were performed. Increases of cardiac index from 2.5 to 4.3 l/min x m2 could be found. The hypotensive side effect can be used for treatment of reactive arterial hypertension in neurosurgical patients during surgery where this therapy is advantageous per se because of its cerebral dehydrating effects. The decrease of blood pressure is obviously caused by peripheral vasodilatation. Cardiac disturbances were not observed. Other side effects, especially the danger of hereditary fructose intolerance are discussed.
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PMID:[Acute lowering of blood pressure by infusion of hyperosmolal sorbitol solution in brain operations. Dangerous adverse effect or favorable side effect?]. 339 7

The epidemiology and etiology, pathophysiology, diagnosis, clinical presentation, complications, and treatment of acute myocardial infarction (AMI) are reviewed. Major risk factors for AMI include age, sex (men greater than women), family history, race, hyperlipidemia, hypertension, cigarette smoking, diabetes mellitus, and diet. AMI occurs when there is a prolonged decrease in oxygen supply to the myocardium caused by coronary thrombosis or coronary vascular spasm. Traditional drug treatment of uncomplicated AMI includes oxygen, laxatives, and analgesics. For analgesia, narcotic agonists are generally preferred, although intravenous nitroglycerin is of value for both reducing infarct size and relieving pain. Fibrinolytic therapy is also indicated in these patients. Low-dose heparin should be initiated on admission to the hospital. Beta-adrenergic blocking agents have proven useful in reducing the incidence of ventricular fibrillation and sudden death. Antiplatelet agents may also be used to decrease long-term mortality. Recent studies have focused on reduction of infarct size using agents such as beta blockers, calcium-channel blockers, nitroglycerin, and thrombolytics. Revascularization procedures are required in some patients to re-establish adequate coronary perfusion. Most patients who survive AMI initially have a relatively uncomplicated clinical course. An increasing number of therapeutic interventions are available for acute and chronic treatment of AMI.
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PMID:Current concepts in clinical therapeutics: acute myocardial infarction. 352 26

In general surgical wards postoperative epidural analgesia was performed in 286 patients consecutively. Epidural catheters were kept in place 8.3 days in the average with a minimum of 24 h and a maximum of 45 d. Bupivacain was applied as a 0.25% solution with an average daily dose of 75-250 mg and single doses of 12.5-50.0 mg. An uncomplicated course was noticed in 250 cases, 19 cases showed haemodynamic, 7 cases neurologic and 10 cases technical complications. Severe decrease of systolic blood pressure more than 30% of the control value was due to postoperative haemorrhage, to anaemia with Hgb-concentration lower than 11 g/dl or to untreated chronical hypertension. On the basis of these observations a list of conditions has been drawn up which should be adhered to when epidural catheters are used for postoperative pain relief in normal wards.
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PMID:[Risks in postoperative pain therapy using a peridural catheter in a normal general ward]. 372 90

A 51 year old woman patient with undiagnosed hypertension and established diabetes mellitus was to undergo hysterectomy. The induced neurolept-analgesia was interrupted because of sudden increase in the heart rate. Plasma adrenaline and noradrenaline values showed an approximately 12-fold increase. With signs of an extreme peripheral vasoconstriction, the patient died about 11 h after the start of anaesthesia. The post-mortem revealed an apricotsized, hormonally active pheochromocytoma of the left suprarenal body. Following investigation of the pathophysiological and pharmacological process, the case is analyzed from the medico-legal view, the non-clarification of the hypertension as objective failure to exercise due care is put up for discussion, and the question of causality and imputation discussed. Anesthesia in the presence of an undetected pheochromocytoma may be so rare that the criterion of adequacy, i.e. the objective predictability, cannot be applied. None the less the case demonstrates once again the physician's special duty to exercise due care. A precondition for any responsible choice of therapy must be accurate and comprehensive compilation of the findings.
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PMID:[Pheochromocytoma as an unexpected anesthesia complication]. 378 91

One of the arguments used in favour of epidural analgesia for hypertensive patients in labour is its effect on mean arterial blood pressure, although the fetal and maternal risk from hypertension is more closely linked to maximum recorded levels. We have therefore assessed the effect of epidural analgesia on maximum blood pressure. There was no change in the maximum systolic or diastolic blood pressure after epidural analgesia when compared to baseline values or levels in untreated hypertensive controls. We conclude that this form of analgesia should be offered to hypertensive patients purely for its analgesic effect and not as a method for blood pressure control.
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PMID:Effect of epidural analgesia on maximum and minimum blood pressures during the first stage of labour in primigravidae with mild/moderate gestational hypertension. 396 1

Professor Brosens and colleagues (April 27, p.808) questions the safety of prostaglandins (PGs) for the induction of labor when pregnancy is complicated by hypertensive states, especially preeclampsia. Objections are based on the possibility that the uteroplacental bloodflow, which may already be compromised in these situations, could be further reduced by vasoconstrictive effects of the PGs on uterine, placental, and umbilical vessels. We have been using PGs extensively in this department and for the past year have been carrying out a double-blind trial of PGE2 and oxytocin by intravenous infusion after amniotomy for induction of labor in primigravidae. In 23 of the patients included thus far, labor was induced between 36 and 38 weeks because of moderate or severe preeclampsia. Of these, 12 have received oxytocin and 11 PGE2. In all cases, elective epidural analgesia has been employed and continuous fetal heartrate and intrauterine pressure recordings performed throughout. 1 patient in the group required an emergency cesarean section because of fetal distress; 2 others (1 from each group) were delivered by cesarean section because of failure to progress in labor. The remainder delivered vaginally with no evidence of increased incidence of fetal distress in the PG group. No perinatal deaths occurred. In an additional 18 primigravidae labor was induced at 36-38 weeks because of hypertensive complications of pregnancy by local PGE2 administration as previously described. These patients were assessed as clinically unfavorable for induction. 2 patients developed fetal distress and required cesarean sections; the others delivered vaginally. Experience with PGF2alpha is much less extensive but there is no reason to believe that this compound would behave differently, except with regard to maternal side effects. Thus it seems beneficial to use PGs for inducing labor in pregnancies complicated by hypertension and preeclampsia; no evidence of the suggested theoretical hazards has been seen. The suggested dangers may be questioned on 2 bases. It seems premature, based on existing knowledge, to infer that spiral arteries in hypertensive pregnancies are adversely affected by vasoconstrictor substances. Also, it is probable that high concentrations of PGs occur naturally in reproductive tissues and a rapid increase of PG in amniotic fluid occurs in spontaneous labors as well as those induced with oxytocin or PGs. Due caution must be exercised in using PGs where placental function may be impaired. The results-to-date which have been obtained with careful monitoring of the fetal heartrate and intrauterine pressure, show no evidence of adverse effects on the fetus as a result of PG use in preeclampsia and suggest they represent a valuable therapeutic agent in the management of this condition.
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PMID:Letter: Prostaglandins and pre-eclampsia. 413 36

Hypertension and coronary heart disease occupy a decisive position among the cardiovascular concomitant diseases. The article presents the pathophysiological interlinks between these two diseased conditions. It is evident that the left ventricle is in danger of being exposed to ischaemia, which must be considered a major risk factor in anaesthesia and surgery. Pretreatment with beta-blockers and digitalis is discussed. To the present day, no generally valid recommendation can be given for a definite method of anaesthesia. It is of decisive importance to protect the patient against sympathetic stimulation by providing for satisfactory analgesia and sedation. The therapeutical concept in case of undesirable intraoperative states of hypertension is explained.
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PMID:[Anesthesia in patients with concomitant cardiovascular diseases]. 612 41

Seven groups of patients with and without hypertension or with ischaemic heart disease, treated with different beta blockers were investigated to study the circulatory effects of neurolept anaesthesia alone or combined with thoracic epidural analgesia from T4 to T12/L2 during abdominal surgery. The combination of thoracic epidural analgesia and neurolept anaesthesia in hypertensive subjects treated with non-cardioselective beta blockers induced slightly lower blood pressure than measured in similar patients on cardioselective beta blockers with neurolept anaesthesia only. Patients on non-selective beta blockers with intrinsic stimulatory activity (ISA) had higher blood pressure and heart rate after neurolept anaesthesia induction than patients on cardioselective blockers. During surgery, heart rate remained at a higher level in the patients treated with ISA blockers, whereas blood pressure increased to the same level as in patients with cardioselective blockers. Cardiovascular stability was, however, best maintained in the epidural group, where myocardial energy expenditure during maximal surgical stress was comparable to that in a group of healthy subjects with the same format of anaesthesia and significantly lower than in healthy subjects with neurolept anaesthesia alone. No circulatory side effects of the combination of thoracic epidural analgesia and beta blockade were seen. In patients with ischaemic heart disease, with or without non-selective beta blockade, similar haemodynamic changes were recorded following neurolept anaesthesia. During maximal surgical stress, unmasking of alpha adrenergic activity with marked rise in blood pressure was seen in the beta-blocked patients. Despite the more accelerated haemodynamic changes in the blocked patients, a lower increase in myocardial oxygen consumption was recorded compared with the non-blocked patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Beta-blockers and thoracic epidural analgesia. Cardioprotective and synergistic effects. 615 83

Polypeptides are endogenous agents, involved in the regulation of many physiologic functions and the pathogenesis of several diseases. Polypeptide antagonists form a group of new chemical entities which may provide valid therapeutic agents. Some polypeptides (angiotensin, kinins) are released through the action of proteolytic enzymes (renin, kallikreins) and act as hormones or autacoids; others (substance P, neurotensin) are synthetized by nervous cells to serve as neurotransmitters or neuromodulators. The main homeostatic role of the renin-angiotensin system is to uphold high systemic arterial blood pressure. Overproduction of renin and insufficient checking of renin secretion are among the most common causes of arterial hypertension. Several forms of arterial hypertension (neurovascular, idiopathic) benefit from a reduction in renin-angiotensin system activity. This is achieved either through decreasing renin secretion, by inhibiting conversion of angiotensin I into angiotensin II, or through blocking the peripheral actions (at the receptor sites) of angiotensin II. Renin secretion is very significantly reduced by beta-blocking agents (propranolol); conversion of angiotensin I into angiotensin II is inhibited by teprotide, captopril and their derivatives; peripheral actions of angiotensin II are blocked by saralasin. Bradykinin and related agents produce vasodilation, increase vascular permeability and stimulate pain fibers. Kinins thus reproduce the cardinal features of inflammation and are held to be mediators of the inflammatory reaction. The substance P neuropeptide is found in the brain and bowel; it may act as a transmitter of the sensation of pain at the spinal cord and central nervous system sites. Among other effects outside of the brain, substance P is a potent vasodilator and inhibits renin secretion. Neurotensin is a neuropeptide which produces hypothermia, muscular relaxation and analgesia. Outside of the brain, this peptide is involved in the regulation of gastric secretion, intestinal motility and insulin and glucagon secretion. The vasoactive intestinal peptide, found in certain cholinergic nerve endings, is a large peptide which inhibits gastric secretion, intestinal motility and vascular tone.
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PMID:[Polypeptides and antagonists]. 620 6

A patient with Down's syndrome and Eisenmenger's complex presented for orthopaedic surgery on the elbow under general anaesthesia. During pre-oxygenation, in order to prevent a subsequent fall in systemic vascular resistance, metaraminol 1 mg was administered intravenously. The patient immediately developed bradycardia, mild hypertension and became deeply cyanosed. His condition rapidly improved after atropine 0.6 mg was given intravenously. Following induction of anaesthesia with thiopentone and tracheal intubation facilitated by suxamethonium, anaesthesia was maintained by mechanical ventilation of the lungs with nitrous oxide and oxygen (40%) with intravenous increments of fentanyl for analgesia and pancuronium for muscle relaxation; residual neuromuscular blockade was reversed with neostigmine. The patient made an eventful recovery. Although general anaesthesia is tolerated by patients with Eisenmenger's complex, powerful vasoactive drugs should not be administered unless specifically indicated.
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PMID:Anaesthesia for a patient with Down's syndrome and Eisenmenger's complex. 623 22


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