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Query: UMLS:C0034063 (pulmonary edema)
 10,665 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This paper reviews the principal aspects of the immediate management of patients suffering from spinal injury. An understanding of the pathophysiology of primary and secondary spinal cord injury enables appropriate initial care to be provided, thereby avoiding exacerbation and/or progressive deterioration of the lesion. It includes protective measures, restoration of vital functions to maintain adequate tissue perfusion and oxygenation, as well as pharmacological prevention of secondary injury. Protective measures include proper immobilisation of the spine with a semi-rigid collar and tape on a long backboard, or on vacuum mattress, taking great care to avoid deleterious in-line compression forces on the spinal column. The combination of cervical spine instability, a full stomach, unopposed vagal reflexes, hypoxia and hypercarbia makes airway management of these patients difficult. Tracheal intubation under fibroscopic control, with insertion of the tube only after topical anaesthesia of the airways under titrated intravenous sedation, offers safety and comfort to the patient. However, in cases of severe deterioration of vital functions, intubation must be performed without any delay at the site of the accident or in the emergency room. Three options are available: blind naso-tracheal intubation with spontaneous breathing, modified rapid sequence induction with orotracheal intubation under double protection, and immediate surgical airway if these techniques fail. Patients with cervical spine injury may demonstrate severe hypotension requiring sympathomimetic agents and careful fluid loading to avoid pulmonary oedema. To prevent aggravation of the spinal cord injury by systemic factors, the goal of initial resuscitation is to restore an adequate perfusion pressure of at least 60 mmHg, a PaO2 > 100 mmHg, and to keep PaCO2 below 45 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Anesthesia of patients with injury to the cervical spine]. 130 64

Despite the widespread use of beta-sympathomimetic agents for preterm labour there appears to be a limited appreciation of the need for cardiovascular monitoring in the mother. Four patients in whom pulmonary oedema developed during tocolysis with hexoprenaline are described and the aetiological factors and pathogenesis of this potentially lethal complication discussed. Guidelines for the safe use of hexoprenaline in preterm labour are suggested.
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PMID:Pulmonary oedema after hexoprenaline administration in preterm labour. A report of 4 cases. 202 58

Plasma renin activity, active renin concentrations, and total renin concentrations were measured serially in 15 women in preterm labor treated with ritodrine. All three parameters showed rapid increases during treatment that depended on ritodrine doses and paralleled changes in maternal pulse rate. The slope of the correlation between plasma renin activity and active renin concentrations suggested an increase in both active renin and renin substrate during ritodrine treatment. In contrast, levels of inactive renin remained unchanged for several hours during ritodrine infusion, showing only a late and much smaller response than that of either total or active renin concentrations. Thus ritodrine treatment results in further activation of an already activated renin-angiotensin system in pregnancy. This activation relates to an increase in both renin enzyme and its substrate. It may be responsible for the disturbance in water balance and the risk of pulmonary edema associated with beta-sympathomimetic drug treatment in preterm labor.
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PMID:Activation of the renin-angiotensin system during ritodrine treatment in preterm labor. 218 11

The treatment of premature labor with beta-adrenergic substances is complicated by side effects. Although most human control mechanisms are pulsatile, therapy is usually administered continuously. We designed a microprocessor-controlled pump to allow pulsatile tocolytic infusion, hoping to reduce the total dose and thus the side effects. In 33 patients pulsatile bolus tocolysis was compared with continuous tocolysis in a control group of 38 patients. Bolus tocolysis required considerably less beta-sympathomimetic agent for comparable therapeutic success (median dosage 3.0 versus 15.9 mg, p less than 0.001). Duration of therapy under bolus tocolysis was also significantly shorter (p less than 0.05). Birth weight was higher after bolus tocolysis (median 3070 versus 2580 gm, p = 0.05). Additional indicators favored bolus tocolysis but were not statistically significant: a longer gestational period, fewer infants weighing less than 2500 gm, and a lower incidence of respiratory distress syndrome. Pulmonary edema occurred in one patient during continuous tocolysis.
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PMID:Bolus tocolysis: treatment of preterm labor with pulsatile administration of a beta-adrenergic agonist. 256 41

Hemodynamic changes after intravenous application of 10 mg celiprolol-HCl (3-[3-acetyl-4-(3-tert-butylamino-2-hydroxy-propoxy)-phenyl]-1,1-diethyl urea hydrochloride. Selectol; in the following briefly called celiprolol) were investigated over an interval of 30 min in 15 patients with angiographically determined coronary heart disease and depressed left ventricular function (ejection fraction less than 60%, left ventricular end-diastolic pressure (LVEDP) greater than 12 mmHg). One patient suffered from severe left ventricular failure with lung edema and could not be evaluated. The heart rate was not influenced, the arterial pressure was significantly reduced (p less than 0.01), similarly LVEDP (p less than 0.001), and pulmonary pressure (p less than 0.01). Cardiac output and total peripheral resistance were not changed significantly. The hemodynamic working profile of celiprolol in patients with depressed left ventricular function is that of a beta 1-receptor blocker with a strong intrinsic sympathomimetic activity (ISA = Intrinsic Sympathetic Activity) and vasodilating properties--even on preload. The intravenous application of celiprolol in patients with severely depressed left ventricular function can cause pump failure.
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PMID:[Hemodynamic effects of intravenously administered celiprolol in patient with coronary heart disease and depressed left ventricular function]. 288 31

We describe a patient who developed acute pulmonary edema while taking oral ritodrine for the treatment of premature labor and recovered after its discontinuation. The mechanism of development of pulmonary edema associated with beta-sympathomimetic agents is still not fully understood. Patients taking oral ritodrine should be observed for cardiopulmonary signs and symptoms.
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PMID:Acute pulmonary edema associated with the use of oral ritodrine for premature labor. 291 9

A 26 year old previously healthy woman who was treated with fenoterol for premature labor at 30 gestational weeks developed pulmonary edema requiring intubation and mechanical ventilation. Vaginal delivery was accomplished with forceps after tocolytic therapy had been stopped. Right heart catheterization with measurement of pulmonary wedge pressure did not reveal left ventricular failure. Protein determination in lung edema fluid provided evidence of increased pulmonary capillary permeability. Recovery was rapid and ventilatory support was stopped after 36 hours. It is suggested that the infusion of beta-sympathomimetic drugs may alter the permeability of the alveolar-capillary membranes which together with triggering factors such as fluid overload might lead to clinically manifest pulmonary edema.
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PMID:High permeability pulmonary edema (ARDS) during tocolytic therapy--a case report. 340 80

Ritodrine hydrochloride, a beta-sympathomimetic treatment for premature labor, has been associated with the development of pulmonary edema, various metabolic derangements, myocardial ischemia, and infarction. We present the first reported case of absolute neutropenia after prolonged intravenous administration of ritodrine with rapid, spontaneous reversal once the medication was discontinued.
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PMID:Ritodrine-induced neutropenia. 396 86

Widespread use of beta 2-sympathomimetic therapy for premature labor has resulted in a diverse number of serious maternal complications, ie, pulmonary edema, myocardial ischemia, etc. However, to the authors' knowledge, there has been only one previous report of mild maternal liver impairment associated with this therapy. Recently, a patient developed marked elevation of liver enzymes (serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase) during therapy with terbutaline sulfate for premature labor.
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PMID:Maternal liver impairment associated with prolonged high-dose administration of terbutaline for premature labor. 402 9

The effects of long-term infusion of fenoterol (a beta 2-sympathomimetic drug) in combination with the calcium antagonist verapamil on water balance, the renin-angiotensin-aldosterone system and antidiuretic hormone during pregnancy were studied. Within two hours of the start of infusion, plasma renin and antidiuretic hormone levels were significantly increased, but plasma aldosterone was strongly decreased. There was a concomitant marked reduction of urinary, sodium, and potassium excretion and a decreased creatinine clearance. The long-lasting reduction of urinary excretion which resulted in an elevated water retention is apparently due to other unknown factors. Results are discussed with special regard to the relationship between water balance disturbances and pulmonary edema.
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PMID:The renin-angiotensin-aldosterone system, antidiuretic hormone levels and water balance under tocolytic therapy with Fenoterol and Verapamil. 610 79


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