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

1,4-Dihydro-2,6-dimethyl-4(3-nitrophenyl)-3,5-pyridine carboxylic acid, 3-ethyl-5-methyl ester (nitrendipine, Bay e 5009) is a new vasodilatory calcium antagonist with pronounced hypertensive efficacy. Doses of 0.3-31.5 mg/kg p.o. lower the blood pressure of rats with spontaneous, renal and desoxycorticosterone acetate (DOCA)-hypertension. Doses of 0.03-10.0 mg/kg p.o. lower the blood pressure of dogs with renal hypertension. The hypotensive effect is about 10 times less in normotensive rats. No increase in tolerance occurred during therapeutic studies lasting 5 weeks in hypertensive rats and several days in hypertensive dogs. There were no signs either of acquired tolerance developing during these studies. Dogs in fentanyl analgesia respond to i.v. administration of 0.001-0.03 mg/kg with a reduction in peripheral vascular resistance and an increase in cardiac output and heart rate. The stroke volume remains unchanged. The vasodilatory effect occurs at different degrees in different vascular beds. The most pronounced increases in vascular flow were measured in the muscular vessels of the hind quarters and in the coronary vessels. The mesenterical, skin and brain blood flows were much less affected.
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PMID:Pharmacological studies of the antihypertensive effect of nitrendipine. 719 97

Lumbar epidural anaesthesia was used as an anticonvulsant in a series of 1 106 patients with hypertension in labour, including 7 patients with eclampsia. Six of the 1 074 patients in whom epidural analgesia was successful subsequently had convulsions. Of these 4 had convulsions after delivery, which took place at least 2 1/2 hours after the last dose of local anaesthetic, and the 2 others within 5 minutes of receiving the first dose of bupivacaine. We conclude that before it wears off epidural anaesthesia is an effective way of preventing eclampsia and that other anticonvulsant therapy is not required, although the latter may be necessary before the procedure. The possible mechanism of the anticonvulsant action is discussed.
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PMID:Epidural anaesthesia as an anticonvulsant in the management of hypertensive and eclamptic patients in labour. 743 21

The anaesthetic and surgical problems associated with Caesarean section in eight grossly obese patients (weight 150-204 kg) are described. In addition to an increase in the frequency and severity of the complications of obesity, those weighing more than 150 kg present a panniculus which may weigh 70 kg. Extradural analgesia was used for three patients and general anaesthesia for five (two because of fetal distress). One fetus died in utero after serious and prolonged arterial hypotension in the mother caused by powerful cephalad retraction of the panniculus (extradural analgesia). General anaesthesia was associated with severe episodes of hypertension in two patients.
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PMID:Caesarean section associated with gross obesity. 743 30

The author present a patient who developed an acute intracranial subdural hematoma approximately 35 hours after an uncomplicated delivery under saddle block analgesia. The proposed mechanism is that of cerebrospinal fluid efflux through the lumbar puncture site during uterine contractions and straining; shift of the intracranial structures, especially veins; venous hypertension; venous rupture; and subdural hematoma formation.
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PMID:Postpartum acute subdural hematoma; a probable complication of saddle block analgesia. 744 83

A case is presented of a woman who, for six years, had been treated for depression with 45 mg daily of the monoamine oxidase inhibitor (MAOI), phenelzine, and who continued taking the drug throughout her pregnancy and labour. Well-documented and potentially fatal interactions between MAOIs and opioids, notably meperidine, meant that her labour analgesia needed careful planning. Opioid- and epinephrine-free epidural bupivacaine analgesia was instituted early with small increments of bupivacaine 0.25% to produce a T10 block, after which an infusion of 8 ml.hr-1 bupivacaine 0.125% was used to maintain analgesia. After 14 hr labour, the epidural was extended uneventfully to allow Caesarean section to be performed for failure to progress. Pressor agents were avoided as indirect-acting drugs can produce severe hypertension. The child appeared normal and the mother had an uncomplicated postoperative course. Epidural analgesia contributed to the safe conduct of labour and Caesarean delivery.
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PMID:Anaesthetic management of labour and delivery in a woman taking long-term MAOI. 755

Epidural analgesia is a frequently used method to reduce the pain of child-bearing. Concerns regarding the safety and potential hazards still persist in the medical community. This review intends to examine how epidural analgesia determines the various factors of fetal and neonatal well-being. Placental drug transfer of opiates like morphine, pethidine and fentanyl is rapid and can lead to neonatal depression. Sufentanil seems to be the safest opiate to administer epidurally. Local anaesthetics are transferred to the fetus in substantial amounts, but the reported effects are subtle and are probably inconsequential. Utero- and fetoplacental blood flow seems to be improved by epidural analgesia with local anaesthetics. Even when using stronger solutions for more extensive blockade in patients for caesarean section, no adverse effects could be demonstrated using pulsed Doppler technique as long as prolonged hypotension (> 2 min) is avoided. Hypotension is best prevented with 20-25 ml/kg crystalloid preload and prompt treatment with ephedrine or etilephrine. Addition of adrenaline to local anaesthetics is considered to be safe for the healthy mother and fetus but it should best be avoided in mothers with pregnancy induced hypertension. Fetal and neonatal acid-base balance and gas-exchange are not adversely affected by epidural analgesia. Many studies show that epidural analgesia can indeed protect the fetus if hypotension is prevented. Neonatal well-being evaluated by APGAR, BRAZELTON, SCANLON and NACS scores is not significantly influenced by local anaesthetics. Neonatal depression can occur however with epidural use of morphine, fentanyl and alfentanil. Sufentanil, again in doses up to 30 micrograms in association with bupivacaine seems to be devoid of depressive effects on the neonate. In summary, the anaesthetist has good arguments to reassure his obstetrical colleagues that providing epidural analgesia for pregnant women in labour is a justifiable intervention to support the natural process of child-bearing.
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PMID:Influence of epidural analgesia on fetal and neonatal well-being. 755 18

Recently published information is changing the approach of anaesthetists to pulmonary aspiration prophylaxis, drug dosing, hypertension during general anaesthesia, hypotension during spinal and epidural anaesthesia, intraoperative hypothermia, and postoperative ileus in elderly patients. Routine aspiration prophylaxis is no longer recommended. Lower drug doses are required to achieve the same endpoints in the elderly as in younger patients. Greater use of antihypertensive drugs rather than additional doses of anaesthetic agents is recommended during general anaesthesia to avoid myocardial depression or prolonged emergence. Routine preoperative volume loading prior to spinal and epidural anaesthesia is being questioned. Tolerance of mean arterial pressures of 65 mmHg during spinal and epidural anaesthesia is encouraged even in patients with hypertension. The adverse effects of inadvertent intraoperative hypothermia are discussed, including the conversion of vecuronium from an intermediate to a long-acting neuromuscular blocking agent. Spinal or epidural local anaesthetics with or without spinal or epidural opioids and ketorolac are associated with less postoperative ileus than postoperative analgesia based on opioids administered intravenously or intramuscularly. Finally, improving postoperative care will reduce perioperatively mortality to a greater extent than reducing intraoperative anaesthesia-related complications.
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PMID:Clinical pearls in the anaesthetic management of elderly patients. 771 Feb 32

The authors analyze the efficacy of midazolam (dormicum, Egys, Hungary) used for induction anesthesia in 35 patients subjected to planned surgery for varicose disease of the lower limbs and on the abdominal organs and in 17 critical patients in intensive care units. To assess the hemodynamics, catheterization of the peripheral and pulmonary arteries was carried out, cardiac output, pressure in cardiac cavities, pulmonary capillary wedging pressure assessed, total peripheral and total pulmonary resistance, cardiac and stroke indexes estimated, gaseous composition of arterial and mixed venous blood analyzed. The drug had virtually no side effects on the function of vital systems of the body. Midazolam fully meets the requirements to drugs used for induction anesthesia and is compatible to such drugs as barbiturates, diazepam, ketamine. The drug can meet pharmacodynamic and pharmacokinetic requirements to sedative agents used in intensive care units, excepting analgesia. However, the need in analgesics and their doses are reduced during sedative therapy with midazolam. Midazolam effects on the lesser circulation hemodynamics permit its use as a sedative agent in patients with respiratory distress syndrome and pulmonary artery thromboembolism; it is also advisable for induction anesthesia in patients operated on for pulmonary artery thromboembolism and in other patients with lesser circulation hypertension.
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PMID:[Clinical experience in the use of dormicum (midazolam) in anesthesiology and intensive care]. 773 88

Consecutive obese (n = 53) and non-obese parturients (n = 609) were prospectively evaluated during labour to analyse the influence of maternal obesity on labour pain and outcome. Excessive pre-pregnancy weight was classified as a body mass index of 30 kg.m-2 or more. Pain intensity was measured using an 11 point visual scoring scale. Obese parturients had more complicated pregnancies (hypertension and diabetes) and their babies weighed significantly more (3865 g versus 3592 g, p < 0.001). These differences did not affect labour pain experience, or the duration or mode of delivery. Eighty-five percent of the obese parturients and 83% of the controls had high maximal pain scores during the first stage (> 7). Both groups received similar analgesia. More technical problems (p = 0.03) were experienced in establishing epidural analgesia for obese parturients, but this did not influence the success of pain treatment. After delivery, obese women were significantly more content with the pain relief received; only 12% vs 23% in the control group complained of poor pain control (p = 0.03). In this study, obesity and increased fetal size did not complicate labour or its outcome. Critical patient assessment should be emphasised, however, due to the physiological and medical problems present in obese parturients.
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PMID:The effect of maternal obesity on labour and labour pain. 774 49

Giving a definition of analgesia in ICU needs to answer several questions: Why sedation? Which drugs can we use? How can we deal with sedation? (monitoring, continuous administration, weaning...)? Two different types of sedation must be considered: treatment-sedation (status epilepticus, tetanus, intracranial hypertension...) and comfort-sedation in anxious and/or restless and/or painful patients and in those necessitating mechanical ventilation. Analgesic consumptions vary widely with diseases and their outcome, background diseases and ICU environment. Several studies have shown that pain and analgesia are frequently neglected in ICU. The authors review the different drugs in use, with their advantages and drawbacks. A particular place is reserved to regional techniques, often underused in ICU. Indications are then fully discussed, according to several specific pathological conditions. Monitoring and weaning of sedation are also discussed at the end of the review.
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PMID:[Role of analgesia for sedation in intensive care medicine]. 776 33


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