Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UNIPROT:P01178 (oxytocin)
 15,767 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 23-year-old woman with Marfan's syndrome was scheduled for Cesarean section at 31 week gestation because of progressive aortic dissection. Since she had undergone two surgical corrections for scoliosis (Harrington rod instrumentation) 5 and 12 years ago, we selected general anesthesia. She had been taking diltiazem and propranolol for hypertension and tachycardia. Anesthesia was induced with thiopental 75 mg iv followed by O2-N2O-enflurane (4%) by face mask. Following iv administration of vecuronium 4 mg and tracheal injection of 4% lidocaine 120 mg, the trachea was intubated without a significant hemodynamic change. Anesthesia was maintained with O2-N2O-enflurane (0.5-1.5%) before delivery. Following delivery, enflurane was discontinued and small doses of fentanyl iv (total 0.2 mg) were given with iv infusion of nitroglycerin (0.2-0.5 micrograms.kg-1.min-1) during surgery. Bleeding after delivery was controllable by iv infusion of oxytocin. The Apgar score was good (9 at 1 min and 10 at 5 min respectively). Post-operative course was uneventful. Therapeutic abortion or Cesarean section should be performed as soon as possible in a patient with dissecting aortic aneurysm because of increasing risk of aneurysm rupture during pregnancy. During the surgery, minimal hemodynamic changes are required to prevent the rupture.
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PMID:[General anesthesia for cesarean section in a patient with Marfan's syndrome associated with dissecting aortic aneurysm]. 205 91

Maternal cardiac output and stroke volume increase significantly at the time of cesarean delivery. Parturients with baseline myocardial dysfunction are at increased risk of cardiovascular decompensation in the peripartum period and close hemodynamic monitoring is warranted. We report our use of intraoperative non-invasive cardiac output monitoring during cesarean delivery under epidural anesthesia in a 24-year-old woman with dilated cardiomyopathy secondary to Marfan syndrome, aortic arch, aortic valve and mitral valve replacements and a left ventricular ejection fraction of 37%. Three distinct hemodynamic trends were noted. After achieving adequate surgical anesthesia with 2% lidocaine 20mL, cardiac output and stroke volume rose for approximately 20min from baseline values of 6.3L/min and 69mL, respectively, to 9L/min and 107mL. Values subsequently trended down and remained depressed for nearly 20min following delivery. The lack of immediate post-delivery increases in both cardiac output and stroke volume were attributed to acute blood loss, intravascular volume depletion from fluid restriction, and slow infusion of oxytocin. By the end of surgery, cardiac output and stroke volume ultimately increased by 66% and 84% of baseline values, respectively. Systemic blood pressure, heart rate and cardiac output did not appear to correlate despite the use of phenylephrine to manage hypotension. The patient remained hemodynamically stable with no evidence of acute volume overload.
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PMID:Non-invasive cardiac output monitoring for cesarean delivery under epidural anesthesia in a patient with Marfan syndrome and cardiomyopathy. 2671 97

Women with Marfan syndrome (MFS) are at high risk for pregnancy-associated aortic dissection. Pathogenic models that singularly invoke hemodynamic stress are difficult to reconcile with predominant postnatal occurrence of aortic tear, often occurring weeks to months after delivery. In consideration of events that peak at term, are sustained after delivery, and might synergize with previously defined signaling pathways implicated in aneurysm progression, we examined the hormone oxytocin, which initiates uterine contraction and milk letdown for the duration of lactation through phosphorylation of extracellular signal-regulated kinase (ERK). In a mouse model of MFS that shows highly penetrant postnatal aortic dissection, risk was strongly attenuated by preventing lactation or use of an oxytocin receptor antagonist. Survival correlated inversely with the extent of ERK activation in the aortic wall, and strong protection was observed upon attenuation of ERK phosphorylation using an inhibitor of ERK kinase (MEK) or the U.S. Food and Drug Administration-approved medication hydralazine, offering potential therapeutic strategies for pregnancy-associated vascular catastrophe in the setting of MFS.
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PMID:Oxytocin antagonism prevents pregnancy-associated aortic dissection in a mouse model of Marfan syndrome. 3104 70