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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

Total intravenous anesthesia was performed with continuous infusion of midazolam and bolus injection of fentanyl. A bolus injection of midazolam 0.3 mg.kg-1 was followed by an infusion regimen with an initial infusion rate of 0.68 mg.kg-1.hr-1 for 15 min followed by a maintenance infusion of 0.125 mg.kg-1.hr-1 and infusion was stopped at about 30 min before the end of operation. Fentanyl and pancuronium were injected as required. Nicardipine was given for intraoperative hypertension. Plasma concentrations of epinephrine and norepinephrine decreased significantly at 10 min after induction, but increased significantly during operation. Therefore, this anesthetic method was considered not to be so deep. Plasma concentrations of midazolam were higher than 200 ng.ml-1 during operation. After discontinuation of midazolam infusion, its concentration decreased quickly, and the elimination half life of midazolam was 1.675 +/- 0.2807 hr. The value was not so large as we had anticipated. Total intravenous anesthesia with continuous infusion of midazolam and bolus injection of fentanyl is thought to produce light anesthesia. Plasma concentration of midazolam decreased quickly.
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PMID:[Total intravenous anesthesia with continuous infusion of midazolam--study on plasma levels of midazolam and catecholamines]. 225 46

We studied the cardiovascular effects of intravenously administered fentanyl in normotensive rats anesthetized with pentobarbital and artificially ventilated. Fentanyl induced an immediate and short-lasting fall in blood pressure and heart rate by an action on opiate receptors localized at vagal nerve endings. Bilateral vagotomy suppressed these effects. The bradycardia, suppressed by bilateral vagotomy and reduced by previous administration of atropine, seemed to be due to a vagovagal reflex. Inhibition of the sympathetic outflow may also occur, because in pithed rats fentanyl failed to lower blood pressure. This masks a direct central stimulation of sympathetic outflow, because in bilaterally vagotomized rats fentanyl induced an alpha-adrenoceptor-blocking drug-sensitive hypertension which was insensitive to adrenalectomy. In addition, stimulation of cardiac opiate receptors by high doses of fentanyl lead to bradycardia in pithed rats. We conclude that in the rat, fentanyl administered intravenously can act at three different levels on cardiovascular regulation: the vagal nerve endings, the brain, and the heart.
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PMID:Multiple sites for the cardiovascular actions of fentanyl in rats. 241 Jul 3

The hypertensive response to anesthetic induction with endotracheal intubation may be harmful in patients with cardiovascular disease, increased intracranial pressure, or anomalies of the cerebral vessels. Recommendations for attenuating the reflex hypertension and tachycardia elicited by upper airway irritation are therefore manifold. Besides minimizing the cardiovascular response, anesthesia induction for patients at risk must also satisfy the following requirements: it must be applicable regardless of patient collaboration, prevent impairment of cerebral blood flow, and avoid arousal of the patient; it should neither be time-consuming nor affect the duration or modality of the ensuing anesthesia. Among the recommended procedures, intravenous lidocaine or fentanyl appear to best fulfill the above mentioned criteria. However, our own equivocal observations and controversial results in the literature concerning the efficacy of intravenous lidocaine prompted us to reinvestigate the issue in two well-defined patient groups. In 46 patients with intracranial vessel malformations and 78 patients with brain tumors, blood pressure responses to endotracheal intubation were studied under anesthesia induction with 1.5 mg/kg lidocaine or 6 micrograms/kg fentanyl i.v. 30 s before thiopental injection or 2-3 min before intubation. The two equally simple induction procedures were compared to anesthesia induction with thiopental alone. In both patient groups no significant effect of lidocaine on the pressure response could be observed. Fentanyl lowered the pressure response slightly though significantly in brain-tumor patients only (p less than 0.05), but showed a significant pressure-lowering action persisting over the whole observation period in all patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Suppression of blood pressure increases during intubation: lidocaine or fentanyl?]. 338 93

The effects of clonidine, a centrally acting alpha 2-adrenergic receptor agonist, on depth of fentanyl anesthesia and on cardiovascular response to laryngoscopy and intubation were studied. Twenty-four patients undergoing aortocoronary bypass surgery (ACBS) with a history of arterial hypertension, coronary artery disease (NYHA class 3-4), and well-preserved left ventricular function were assigned randomly to either Group 1 (n = 12), who received standard premedication, or Group 2 (n = 12), who received clonidine 5 micrograms X kg-1 po in addition to standard premedication 90 min before estimated induction time. Depth of anesthesia was assessed by on-line aperiodic computerized analysis of the electroencephalogram (Lifescan EEG Monitor). Fentanyl was administered in 250-micrograms increments to shift the EEG to the 0.5-3-Hz frequency range (delta activity) in all subjects. In both groups, the anesthetic regimen effectively prevented hyperdynamic cardiovascular responses to laryngoscopy and intubation. No significant differences in measured or derived hemodynamic variables were observed between the two groups during the awake control period, except for stroke volume index (SVI), which was significantly greater in Group 1, 44 +/- 9 ml X beat-1 X m-2 compared with Group 2, 35 +/- 3.3 ml X beat-1 X m-2 (P less than 0.05). By contrast, fentanyl requirements in Group 2 were significantly reduced by 45% when compared with Group 1, i.e., from 110 +/- 23 to 61 +/- 19 micrograms X kg-1 (P less than 0.001). The authors conclude that at a similar anesthetic depth, as assessed by the EEG shift into the lower frequency range (0.5-3 Hz), a markedly reduced fentanyl dose effectively prevented the hyperdynamic cardiovascular response to laryngoscopy and intubation in the group of patients premedicated with clonidine. This is likely explained by the known synergistic inhibitory action of opiates and alpha 2-adrenoceptor agonists on central sympathetic outflow.
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PMID:Effects of clonidine on narcotic requirements and hemodynamic response during induction of fentanyl anesthesia and endotracheal intubation. 394 35

Fentanyl in doses of 50-60 microgram/kg has been reported to produce anesthesia with remarkable hemodynamic stability in patients with coronary artery disease (CAD). Because the authors had observed hypertension and tachycardia in response to noxious stimulation during aortocoronary bypass (ACB) operations in patients so anesthetized, they studied the hemodynamic changes and anesthetic conditions produced by fentanyl/O2/relaxant anesthesia in patients undergoing elective ACB. Twelve patients with left ventricular (LV) ejection fractions greater than 0.4 were maintained on propranolol until 10 hours before operation and were premedicated with fentanyl, diazepam, and scopolamine. Cannulae were inserted before the study commenced for measurement of intravascular pressures, arterial blood gases, and thermodilution cardiac output. The patients breathed 100 per cent oxygen throughout the study. Controlled ventilation aided by succinylcholine to reduce truncal rigidity maintained PaCO2 at 30-45 torr. Measurements were made after each of the following: breathing oxygen (control), 10 microgram/kg fentanyl, 50 microgram/kg fentanyl, and 0.1 mg/kg pancuronium, tracheal intubation, skin incision, and sternotomy. Fentanyl alone produced no significant hemodynamic changes. Fentanyl and pancuronium in combination produced increased heart rate and reduced stroke volume. Significant and progressively greater increases in mean arterial pressure and systemic vascular resistance followed intubation, skin incision, and sternotomy. Chest rigidity occurred in every patient at a lower fentanyl dose than did unresponsiveness. While fentanyl, 62.4 +/- 2.9 microgram/kg (SE), produced minor hemodynamic changes, it failed to block hemodynamic responses to noxious stimulation. Such changes resulted in increased cardiac work, and could have affected myocardial oxygen balance unfavorably. In eight of the 12 patients, following the last set of measurements, supplementary anesthetic agents were required to maintain hemodynamic stability during the surgical procedure. The authors suggest that this fentanyl/O2/relaxant technique should be modified for patients with severe CAD and reasonably good LV function.
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PMID:Hemodynamic changes during fentanyl--oxygen anesthesia for aortocoronary bypass operation. 697 39

An anaesthetic technique using high-dose fentanyl for coronary artery surgery is described. Fentanyl 60 or 70 micrograms kg-1 was used as the sole anaesthetic agent, and patients were ventilated with air/O2 (fentanyl 70 micrograms kg-1) or N2O/O2 (fentanyl 60 micrograms kg-1). Cardiovascular data from 30 patients are presented. Fentanyl caused no significant cardiovascular depression. The only statistically significant changes in cardiovascular parameters were seen in the patients who received fentanyl 60 micrograms kg-1. Five minutes after skin incision there was an increase in peripheral resistance. Diastolic pressure was increased following sternotomy. Problems associated with this technique of anaesthesia are a 50% incidence of hypertension following sternotomy (requiring treatment with sodium nitroprusside) and prolonged respiratory depression. The lack of cardiovascular depression produced by fentanyl and the ability of fentanyl to reduce hormonal and metabolic responses to surgery make it a satisfactory technique for cardiac anaesthesia.
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PMID:Cardiovascular effects of high-dose fentanyl anaesthesia. 712 5

Reporting our experience with etomidate infusion in 37 cases of endoscopic examinations of the larynx, we recommend a method of general anesthesia ensuring easy examination conditions and rapid recovery. After premedication with atropine, IV Thalamonal is administered till obtention of somnolence. A dose of 0.25 mg/kg of etomidate is used for induction and an infusion at a rate of 25 mcg/kg/min for maintenance of anesthesia. Succinylcholine is used for intubation and whenever complementary muscular relaxation is required. Ventilation is ensured by the jet mixing technique with a manual injector. Fentanyl is given when reactions of tachycardia or arterial hypertension due to nociceptive stimuli are observed. The method described is safe, provides good conditions of anesthesia with complete amnesia and rapid recovery.
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PMID:Etomidate infusion for laryngoscopy. 730 19

Sixty patients, ASA I-III, presenting for elective colonic surgery were studied to assess the stability of blood pressure and heart rate during anaesthesia with three equally potent anaesthetic techniques. Patients in group I (n = 20) received thiopentone induction, isoflurane and nitrous oxide; patients in group II (n = 20) received total intravenous anaesthesia with propofol; and patients in group III (n = 20) received intravenous propofol supplemented with nitrous oxide. Fentanyl and vecuronium were used in all three groups. The depth of anaesthesia was judged on clinical signs of adequate anaesthesia. Episodes of bradycardia (heart rate < 50 beats min-1), tachycardia (heart rate > 90 beats min-1), hypotension (mean arterial pressure > or = 30% below pre-operative blood pressure) or hypertension (mean arterial pressure > 30%, or systolic blood pressure > 15 mmHg, above pre-operative value) were recorded when lasting > 5 min. Any use of ephedrine or glycopyrrolate given to correct hypotension or bradycardia was documented: In group II, significantly more patients were given ephedrine (P < 0.01) to treat hypotension. The drug was administered after intubation but before skin incision in the majority of cases (9/11). Glycopyrrolate was given to significantly more patients in group III (P < 0.025) to treat bradycardia, and in 21 of a total of 34 patients given glycopyrrolate it was administered before surgery. With the use of these additional drugs, there were no differences in the number of patients with 5 min episodes of hypotension, hypertension, tachycardia or bradycardia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A comparison of propofol and isoflurane anaesthesia: the need for ephedrine and glycopyrrolate. 764 20

Activation of the sympathetic nervous system occurs in response to desflurane, causing tachycardia and hypertension. Fentanyl partially blunts the hemodynamic effects of desflurane but fails to attenuate the sympathetic response. This study determined the clinical effectiveness and dose response of alfentanil on the neurocirculatory responses to desflurane. Twenty-five healthy, male volunteers were randomized into one of three groups to receive either placebo (n = 9), 10 micrograms/kg intravenous (IV) bolus alfentanil (n = 9), or 20 micrograms/kg IV bolus alfentanil (n = 7) in conjunction with anesthetic induction by propofol, 2.5 mg/kg. Mean arterial pressure (MAP, radial artery), heart rate (HR), and efferent muscle sympathetic nerve activity (SNA, peroneal nerve) were recorded. After conscious baseline measurements, anesthesia was induced by propofol and alfentanil/placebo. One minute later, the desflurane vaporizer was activated at 11%. Neurocirculatory measurements were recorded for 11 min. There were no differences between the groups at conscious baseline. Induction of anesthesia was associated with significantly decreased MAP in the placebo and the 10 micrograms/kg alfentanil groups and increased HR in all groups with little change in SNA. In placebo subjects, desflurane administration increased HR and MAP above baseline. In both alfentanil groups, during desflurane administration HR and MAP never increased significantly above baseline. However, SNA was significantly increased in both groups. Alfentanil effectively blunts the hemodynamic changes but not the sympathetic responses associated with rapid increases in the inspired concentration of desflurane.
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PMID:Alfentanil modifies the neurocirculatory responses to desflurane. 871 95


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