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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Circulatory changes and the degree of sympathetic block were evaluated in 15 elderly patients with high thoracic epidural anaesthesia (T1-T5). Bupivacaine 5-6 ml 0.5% was injected via an epidural catheter at the T3-level. The quality of the sympathetic block was determined with the Valsalva manoeuvre. Induced hypercapnia was used to quantify the degree of sympathetic block. Following thoracic epidural anaesthesia (TEA), cardiac output, stroke volume and arterial blood pressure decreased. During hypercapnia, heart rate and arterial blood pressure increased both before and after established TEA. Thus the block of the sympathetic innervation to the heart with a high TEA using 0.5% bupivacaine was not sufficient to prevent mobilization of circulatory reserves during sympathetic stimulation. The most likely explanation is considered to be the lack of neural block of the efferent nerves leading to the adrenal medulla and the peripheral vascular bed.
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PMID:Circulatory effects of short-term hypercapnia during high thoracic epidural anaesthesia in elderly patients. 310 68

The effect of high thoracic epidural analgesia (TEA) on the cardiovascular system was investigated in 10 patients (5 with cardiovascular disease and 5 without known cardiovascular disorder), who were scheduled for a thoracotomy. An epidural catheter was inserted at T1-T2 level. Plain bupivacaine (Marcaine) 0.5%, 4 to 6 ml was used and resulted in a mean analgesic level from C7 to T5. TEA did not significantly affect the following parameters: heart rate, mean arterial pressure, cardiac index, central venous pressure, pulmonary capillary wedge pressure, stroke volume index, systemic vascular resistance, pulmonary vascular resistance, right and left ventricular stroke work index. From this study it is concluded that high TEA with bupivacaine has only minor effects on the cardiovascular system.
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PMID:The influence of high thoracic epidural analgesia on the cardiovascular system. 336 71

The hemodynamic effects and ability to resuscitate animals experiencing bupivacaine cardiovascular toxicity after partial inferior vena cava occlusion were investigated in anesthetized dogs (n = 12). Partial occlusion of the inferior vena cava resulted in a 12% decrease in mean arterial pressure, a 62% decrease in cardiac output, a 66% decrease in stroke volume, and a 135% increase in systemic vascular resistance. Bupivacaine, 20 mg/kg intravenously, resulted in cardiovascular collapse in all animals. The resuscitation time for animals without partial caval occlusion was 2.1 +/- 0.5 min, whereas that for animals with partial caval occlusion was 22.2 +/- 6.9 min (P less than 0.05). Significantly increased amounts of epinephrine and NaHCO3 were required to resuscitate the animals with caval occlusion. We conclude that partial inferior vena cava occlusion can significantly alter the ability to resuscitate animals experiencing bupivacaine cardiovascular toxicity.
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PMID:Resuscitation from bupivacaine-induced cardiovascular toxicity during partial inferior vena cava occlusion. 395 8

Using anesthetized dogs, this study compared treatment with lidocaine or bretylium for bupivacaine-induced cardiovascular toxicity. Pentobarbital-anesthetized and -ventilated dogs (n = 10) were given a bolus dose of bupivacaine, 4 mg/kg, and a constant infusion of 0.2 mg X kg-1 X min-1 to produce steady-state serum levels of 7.1 +/- 1.8 microgram/ml of bupivacaine. Using burst ventricular pacing, the ventricular tachycardia threshold was determined, along with hemodynamic and electrophysiologic parameters. The animals were then treated with bretylium, 20 mg/kg (n = 5), or lidocaine, 2 mg/kg, followed by a continuous infusion of lidocaine, 0.1 mg X kg-1 X min-1 (n = 5). Bupivacaine-induced alterations in cardiac output, stroke volume, heart rate, and systemic vascular resistance were corrected by bretylium but not lidocaine. Bupivacaine caused a significant lowering of the ventricular tachycardia threshold, which was consistently raised by bretylium, while lidocaine was either ineffective or caused a further lowering of the threshold. Bupivacaine caused a significant increase in the Q-TU interval and resulted in an undulating polymorphic ventricular tachycardia, similar to that seen in Torsades de Pointes.
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PMID:Bupivacaine cardiovascular toxicity: comparison of treatment with bretylium and lidocaine. 402 54

Patients that undergo major abdominal surgery often receive epidural postoperative analgesia. Septic complications are frequently seen in this cohort. In a porcine model of endotoxemic shock, resembling human gram-negative septic shock, we evaluated the effects of two widely used local anaesthetics, bupivacaine and ropivacaine given intravenously. In the endotoxin-ropivacaine group mixed venous saturation and platelet count were higher as compared to endotoxemic controls. Mean arterial blood pressure and platelet count were higher in ropivacaine-endotoxin pigs than in bupivacaine-endotoxin ones. Bupivacaine augmented endotoxin-mediated decrease in left ventricular stroke work index. Ropivacaine displays pathophysiological advantages compared to bupivacaine in septic shock, which may be explained by improved tissue perfusion by ropivacaine.
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PMID:Ropivacaine may have advantages compared to bupivacaine in porcine endotoxemic shock. 1696 Nov 74