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1
Magyar, Máté, Nóra Luca Nyilas, Dániel Bereczki, et al. "A spontán intracranialis hypotensio diagnosztikája mágneses rezonanciás képalkotással." Orvosi Hetilap 162, no. 7 (2021): 246–51. http://dx.doi.org/10.1556/650.2021.31961.
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Összefoglaló. A klasszikus esetben ortosztatikus fejfájást okozó, spontán intracranialis hypotensiót az esetek túlnyomó többségében a gerinccsatornában, annak nyaki-háti átmenetében, illetve a háti szakaszán található liquorszivárgás okozza. Meglévő kötőszöveti betegség, degeneratív gerincbetegségek, illetve kisebb traumák szerepet játszhatnak a szivárgás kialakulásában. Az ortosztatikus fejfájás létrejöttében szerepet játszhat a meningealis szerkezetek, érzőidegek és hídvénák vongálódása. A klasszikus pozicionális, ortosztatikus fejfájásban szenvedő betegek körében gondolni kell a spontán intracranialis hypotensio lehetőségére, és az agykoponya, illetve a gerinc kontrasztanyaggal végzett mágneses rezonanciás vizsgálata (MRI) javasolt. A kontrasztanyaggal végzett koponya-MRI-vel klasszikus esetben diffúz, nem nodularis, intenzív, vaskos pachymeningealis kontrasztanyag-halmozás, kitágult vénássinus-rendszer, subduralis effusiók és az agytörzs caudalis diszlokációja („slumping”) látható. Fontos azonban szem előtt tartani, hogy az esetek 20%-ában ezen eltérések nem detektálhatók. Jó minőségű, randomizált, kontrollált vizsgálatok nem történtek, a kezelés hagyományokon alapul. Kezdetben általában konzervatív terápiát alkalmaznak (ágynyugalom, koffein- és folyadékbevitel), ennek hatástalansága esetén epiduralis sajátvér-injekció, epiduralis fibrinragasztó-injektálás, illetve sebészi terápia jöhet szóba. Orv Hetil. 2021; 162(7): 246–251. Summary. Spontaneous intracranial hypotension, the classic feature of which is orthostatic headache, is most commonly caused by a cerebrospinal fluid leakage at the level of the spinal canal, in most cases at the thoracic level or cervicothoracic junction. Underlying connective tissue disorders, minor trauma, degenerative spinal diseases may play a role in the development of cerebrospinal fluid leaks. Traction on pain-sensitive intracranial and meningeal structures, particularly sensory nerves and bridging veins, may play a role in the development of orthostatic headache. In the case of patients with classic orthostatic headache, the possibility of spontaneous intracranial hypotension should be considered, and if suspected, brain magnetic resonance imaging (MRI) with gadolinium and additional spine MRI are recommended. Diffuse, non-nodular, intense, thick dural enhancement, subdural effusions, engorgement of cerebral venous sinuses, sagging of the brain are typical features on brain MRI, which, however, remain normal in up to 20 percent of patients with spontaneous intracranial hypotension. Unfortunately, no randomized clinical trials have evaluated the effectiveness of the various treatment strategies and no definitive treatment protocols have been established. In clinical practice, the first-line treatment of spontaneous intracranial hypotension is conservative (bed rest, caffeine and fluid intake). If conservative therapy is not effective, epidural blood patch, epidural fibrin glue, or surgical repair should be considered. Orv Hetil. 2021; 162(7): 246–251.
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ROUF, BASHIR M.D* Faisal M.Qureshi Sheikh Imran &. Showkat Ahmad Gurcoo M.D. "HAEMODYNAMIC CHANGES FOLLOWING SPINAL ANAESTHESIA: A COMPARISON IN PATIENTS UNDERGOING TURP BETWEEN PRELOADING WITH CRYSTALLOIDS AND COLLOIDS." Indian Journal of Medical Research and Pharmaceutical Sciences 5, no. 5 (2018): 10–18. https://doi.org/10.5281/zenodo.1254350.
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Spinal anesthesia consists of temporary interruption of nerve transmission within the subarachnoid space produced by injection of a local anesthetic solution into cerebrospinal fluid. Used widely, safely and successfully for more than 100 years, spinal anesthesia has many potential advantages over general anesthesia, especially for operations involving the lower abdomen,the perineum and the lower extremities. The advantages claimed with spinal analgesia for such operation include reduced blood loss and better operating conditions , minimal effect of arterial oxygen and carbon dioxide tensions of the patient , preference by surgical and nursing staff and a generally comfortable recovery. The technique can permit early detection of complications such as TUR syndrome and bladder perforation.[1,2]
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Fonseca, Neuber M., Saul Goldenberg, Duvaldo Eurides, Neil F. Novo, and Cirilo A. P. Lima. "An evaluation of new circle system of anesthesia. Quantitative anesthesia with isoflurane in new zealand rabbits." Acta Cirurgica Brasileira 12, no. 4 (1997): 246–48. http://dx.doi.org/10.1590/s0102-86501997000400006.
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A small circuit system of anesthesia was developed by Fonseca and Goldenberg in 1993. The authors used in this study New Zealand White (NZW) rabbits under closed system anesthetic regiment by insoflurane. Twenty male adult New Zealand rabbits were distributed in two groups of ten animals. No premedicant drugs were given. Endotraqueal intubation was made after intravenous administration of propofol (10mg/kg). Insoflurane was used to anesthesia management, administred by lowflow closed system technique with cooper kettle vaporizer, fixed by pre-calculated vaporizing flow in double times intervals. The group II underwent surgical periostal scratching in the medial tibial surface at the proximal shaft. Rabbits breathed spontaneously. Hypotensio, hypercapnia and respiratory acidosis were characteristic of the cardiopulmonary effects of the anesthesia. The corneal reflex and pinch reflex was useful as reliable indicators of anesthesic depth. Manual or mechanical ventilation should be considered as a way of improving alveolar ventilation and normalize blood-gas values. The system developed by Fonseca and Goldenberg was considered suitable for anesthesic management in rabbits.
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Duzzi, Bruno, Cristiane Castilho Fernandes Silva, Roberto Tadashi Kodama, Daniela Cajado-Carvalho, Carla Cristina Squaiella-Baptistão, and Fernanda Calheta Vieira Portaro. "New Insights into the Hypotensins from Tityus serrulatus Venom: Pro-Inflammatory and Vasopeptidases Modulation Activities." Toxins 13, no. 12 (2021): 846. http://dx.doi.org/10.3390/toxins13120846.
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The Tityus serrulatus scorpion is considered the most dangerous of the Brazilian fauna due to the severe clinical manifestations in injured victims. Despite being abundant components of the venom, few linear peptides have been characterized so far, such as hypotensins. In vivo studies have demonstrated that hypotensin I (TsHpt-I) exerts hypotensive activity, with an angiotensin-converting enzyme (ACE)-independent mechanism of action. Since experiments have not yet been carried out to analyze the direct interaction of hypotensins with ACE, and to deepen the knowledge about these peptides, hypotensins I and II (TsHpt-II) were studied regarding their modulatory action over the activities of ACE and neprilysin (NEP), which are the peptidases involved in blood pressure control. Aiming to search for indications of possible pro-inflammatory action, hypotensins were also analyzed for their role in murine macrophage viability, the release of interleukins and phagocytic activity. TsHpt-I and -II were used in kinetic studies with the metallopeptidases ACE and NEP, and both hypotensins were able to increase the activity of ACE. TsHpt-I presented itself as an inhibitor of NEP, whereas TsHpt-II showed weak inhibition of the enzyme. The mechanism of inhibition of TsHpt-I in relation to NEP was defined as non-competitive, with an inhibition constant (Ki) of 4.35 μM. Concerning the analysis of cell viability and modulation of interleukin levels and phagocytic activity, BALB/c mice’s naïve macrophages were used, and an increase in TNF production in the presence of TsHpt-I and -II was observed, as well as an increase in IL-6 production in the presence of TsHpt-II only. Both hypotensins were able to increase the phagocytic activity of murine macrophages in vitro. The difference between TsHpt-I and -II is the residue at position 15, with a glutamine in TsHpt-I and a glutamic acid in TsHpt-II. Despite this, kinetic analyzes and cell assays indicated different actions of TsHpt-I and -II. Taken together, these results suggest a new mechanism for the hypotensive effects of TsHpt-I and -II. Furthermore, the release of some interleukins also suggests a role for these peptides in the venom inflammatory response. Even though these molecules have been well studied, the present results suggest a new mechanism for the hypotensive effects of TsHpt-I
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Klijn, Eva, A. B. Johan Groeneveld, Michel E. van Genderen, Michiel Betjes, Jan Bakker, and Jasper van Bommel. "Peripheral Perfusion Index Predicts Hypotension during Fluid Withdrawal by Continuous Veno-Venous Hemofiltration in Critically Ill Patients." Blood Purification 40, no. 1 (2015): 92–98. http://dx.doi.org/10.1159/000381939.
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Aim: Peripheral perfusion may predict harmful hypovolemic hypotension during fluid withdrawal by continuous veno-venous hemofiltration (CVVH) in critically ill patients with acute kidney injury. Methods: Twenty-three critically ill AKI patients were subjected to progressive fluid withdrawal. Systemic hemodynamics and peripheral perfusion index (PPI) by pulse oximetry, forearm-to-fingertip skin temperature gradient (Tskin-diff) and tissue oxygen saturation (StO2, near infra-red spectroscopy) were measured. Results: Most hemodynamic values decreased with fluid withdrawal, particularly in the hypotensive group, except for stroke volume (SV) and cardiac output, which decreased to a great extent in the non-hypotensive patients. Increases in systemic vascular resistance (SVR) were less in hypotension. Baseline pulse pressure and PPI were lower in hypotensive (n = 10) than non-hypotensive patients and subsequent PPI values paralleled SV decreases. A baseline PPI ≤0.82 AU predicted hypotension with a sensitivity of 70%, and a specificity of 92% (AUC 0.80 ± 0.11, p = 0.004). Conclusion: Progressive fluid withdrawal during CVVH is poorly tolerated in patients with less increases in SVR. The occurrence of hypotension can be predicted by low baseline PPI.
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Ballester, Leonor, Rafael Martínez, Juan Méndez, et al. "Differences in Hypotensive vs. Non-Hypotensive Sepsis Management in the Emergency Department: Door-to-Antibiotic Time Impact on Sepsis Survival." Medical Sciences 6, no. 4 (2018): 91. http://dx.doi.org/10.3390/medsci6040091.
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Background: Sepsis diagnosis can be incorrectly associated with the presence of hypotension during an infection, so the detection and management of non-hypotensive sepsis can be delayed. We aimed to evaluate how the presence or absence of hypotension, on admission at the emergency department, affects the initial management and outcomes of patients with community-onset severe sepsis. Methods: Demographic, clinical, laboratory, process of care, and outcome variables were recorded for all patients, at the emergency department of our university hospital, who presented with community-onset severe sepsis, between 1 March and 31 August in three consecutive years. Patient management consisted of standardized bundled care with five measures: Detection, blood cultures and empirical antibiotics, oxygen supplementation and fluid resuscitation (if needed), clinical monitoring, and noradrenalin administration (if needed). We compared all variables between patients who had hypotension (mean arterial pressure <65 mmHg), on admission to the emergency department, and those who did not. Results: We identified 153 episodes (84 (54.5%) men; mean age 73.6 ± 1.2; mean Sequential Organ Failure Assessment (SOFA) score 4.9 ± 2.7, and 41.2% hospital mortality). Hypotension was present on admission to the emergency department in 57 patients (37.2%). Hemodynamic treatment was applied earlier in patients who presented hypotension initially. Antibiotics were administered 48 min later in non-hypotensive sepsis (p = 0.08). A higher proportion of patients without initial hypotension required admission to the intensive care unit (ICU) (43.1% for patients initially hypotensive vs. 56.9% in those initially non-hypotensive, p < 0.05). Initial hypotension was not associated with mortality. A delay in door-to-antibiotic administration time was associated with mortality [OR 1.150, 95%CI: 1.043–1.268). Conclusions: Initial management of patients with community-onset severe sepsis differed according to their clinical presentation. Initial hypotension was associated with early hemodynamic management and less ICU requirement. A non-significant delay was observed in the administration of antibiotics to initially non-hypotensive patients. The time of door-to-antibiotic administration was related to mortality.
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Baranov, Dimitry, and William M. Armstead. "Selective Blockade of AT1 Receptor Attenuates Impairment of Hypotensive Autoregulation and Improves Cerebral Blood Flow after Brain Injury in the Newborn Pig." Anesthesiology 99, no. 5 (2003): 1118–24. http://dx.doi.org/10.1097/00000542-200311000-00018.
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Background Fluid percussion injury (FPI) in piglets produces vasoconstriction of pial arteries (PAs), decreases in cerebral blood flow (CBF), and impairment of hypotensive autoregulation. Two types of angiotensin II receptors, AT1 and AT2, have been identified in the brain. This study characterized the effect of pretreatment with AT1- and AT2-selective antagonists on CBF and hypotensive autoregulation after FPI. Methods Fluid percussion injury was induced in chloralose-anesthetized newborn pigs equipped with closed cranial windows. CBF was determined by the radiolabeled microsphere technique. Results Moderate and severe hypotension (71 +/- 3, 53 +/- 2, and 40 +/- 1 mmHg for normotension, moderate hypotension, and severe hypotension, respectively) elicited PA dilation without changes in CBF in sham control piglets. The AT1 antagonist ZD 7155 partially restored impaired hypotension-induced PA dilation after FPI (19 +/- 1 and 34 +/- 1 vs. 5 +/- 1 and 7 +/- 1 vs. 12 +/- 1 and 20 +/- 3% for PA dilation during moderate and severe hypotension in sham control, FPI, and FPI + ZD 7155 animals, respectively). ZD 7155 also blunted the reductions in CBF during normotension and hypotension observed in untreated animals (43 +/- 4, 38 +/- 5, and 55 +/- 3 vs. 32 +/- 4, 19 +/- 2, and 27 +/- 5% CBF reductions during normotension, moderate hypotension, and severe hypotension in untreated and pretreated animals, respectively). The AT2 selective antagonist PD 123,319 did not restore hypotension-induced PA dilation and did not prevent decreases in CBF observed during normotension and moderate and severe hypotension after FPI. Conclusion These data indicate that blockade of the AT1 and not the AT2 receptor diminished the reduction in hypotensive PA dilation after FPI. AT1 blockade also blunted the decrease in CBF during normotension as well as the further decrease in CBF observed during hypotension after FPI. These data suggest that AT1 receptor activation by angiotensin II contributes to cerebrovascular dysregulation during hypotension after FPI.
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Ali, Iftikhar, Hina Iftikhar, Habib Ur Rahman, Kaukab Majeed, Usman Khalid, and Hira Latif. "Effect of Lower Limb Compression Stockings on Hemodynamic Stability in Obstetric Patients undergoing Lower Segment Cesarean Section under Spinal Anaesthesia." Pakistan Armed Forces Medical Journal 73, no. 2 (2023): 456–59. http://dx.doi.org/10.51253/pafmj.v73i2.8109.
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Objective: To compare the effects of lower limb compression stockings and control in terms of frequency of bradycardia, hypotension and hypotensive symptoms in a group of obstetric patients undergoing lower segment cesarean section under spinal anaesthesia.
 Study Design: Quasi-experimental study.
 Place and Duration of Study: Department of Anesthesiology Combined Military Hospital, Multan Pakistan, from Aug 2020 to Feb 2021.
 Methodology: One hundred women undergoing cesarean section under spinal anaesthesia from 18-45 years were included. Obstetric patients between 18–45 years of age, Non-labouring parturient, ASA Status I / II planned for Caesarean section were included. Patients were randomly divided into two treatment groups, i.e., Mechanical pump Group (Group M) and the Control Group (Group C), with Consecutive Non-probability sampling. The frequency of hypotensive symptoms, hypotension and bradycardia in both groups was noted.
 Results: Frequency of hypotensive symptoms, hypotension and bradycardia in the compression stockings group was found in 18(36.0%), 8(16.0%) and 11(22.0%) patients while in 38(76.0%), 32(64.0%) and 30(60.0%) patients in the control group (p-value = 0.0001).
 Conclusion: We concluded that the frequency of hypotensive symptoms, hypotension and bradycardia is less after lower limb compression stockings given to obstetric patients undergoing lower-segment cesarean section under spinal anaesthesia.
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Vukotic, Aleksandra, Jasna Jevdjic, David Green, et al. "Detection of hypotension during spinal anesthesia for caesarean section with continuous non-invasive arterial pressure monitoring and intermittent oscillometric blood pressure monitoring in patients treated with ephedrine or phenylephrine." Srpski arhiv za celokupno lekarstvo 149, no. 7-8 (2021): 442–48. http://dx.doi.org/10.2298/sarh200317030v.
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Introduction/Objective. Despite frequent side effects such as hypotension, spinal anesthesia (SA) is still one of the best anesthetic methods for elective cesarean section (CS). Intermittent, oscillometric, noninvasive blood pressure monitoring (NIBP) frequently leads to missed hypotensive episodes. The objective was to compare continuous non-invasive arterial pressure (CNAP) monitoring with NIBP in the terms of efficiency to detect hypotension. Methods. In this study, we compared CNAP and NIBP monitoring for hypotension detection in 76 patients divided into two groups of 38 patients treated with ephedrine (E) or phenylephrine (P), during threeminute intervals, starting from SA, by the end of the surgery. Results. In E group, significantly lower mean systolic blood pressure (SBP) values with CNAP compared with NIBP (p = 0.008) was detected. By monitoring CNAP, we detected 31 (81.6%) hypotensive patients in E group and significantly lower number, 20 (52.6%), with NIBP (p = 0.001), while in P group CNAP detected 34 patients (89.5%) and NIBP only 18 (47.3%), p = 0.001. By monitoring CNAP, we detected significantly higher number of hypotensive intervals in E and P groups (p < 0.001). Umbilical vein pH was lower within hypotensive compared with normotensive patients in E and P groups, with CNAP and NIBP, respectively (p < 0.001, p = 0.027 in E, and p = 0.009, p < 0.001, in P group). Conclusion. CNAP is more efficient in hypotension detection for CS during SA, which allows faster treatment of hypotension, thus improving fetal and maternal outcome.
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Dolla, Caterina, Alberto Mella, Giacinta Vigilante, et al. "Recipient pre-existing chronic hypotension is associated with delayed graft function and inferior graft survival in kidney transplantation from elderly donors." PLOS ONE 16, no. 4 (2021): e0249552. http://dx.doi.org/10.1371/journal.pone.0249552.
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Background Pre-existing chronic hypotension affects a percentage of kidney transplanted patients (KTs). Although a relationship with delayed graft function (DGF) has been hypothesized, available data are still scarce and inconclusive. Methods A monocentric retrospective observational study was performed on 1127 consecutive KTs from brain death donors over 11 years (2003–2013), classified according to their pre-transplant Mean Blood Pressure (MBP) as hypotensive (MBP < 80 mmHg) or normal-hypertensive (MBP ≥ 80 mmHg, with or without effective antihypertensive therapy). Results Univariate analysis showed that a pre-existing hypotension is associated to DGF occurrence (p<0.01; OR for KTs with MBP < 80 mmHg, 4.5; 95% confidence interval [CI], 2.7 to 7.5). Chronic hypotension remained a major predictive factor for DGF development in the logistic regression model adjusted for all DGF determinants. Adjunctive evaluations on paired grafts performed in two different recipients (one hypotensive and the other one normal-hypertensive) confirmed this assumption. Although graft survival was only associated with DGF but not with chronic hypotension in the overall population, stratification according to donor age revealed that death-censored graft survival was significantly lower in hypotensive patients who received a KT from >50 years old donor. Conclusions Our findings suggest that pre-existing recipient hypotension, and the subsequent hypotension-related DGF, could be considered a significant detrimental factor, especially when elderly donors are involved in the transplant procedure.
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Mantovani, Matheus M., Any C. A. Costa, Mayara T. de Lima, et al. "Agreement and Diagnostic Accuracy of New Linear Deflection Oscillometry and Doppler Devices for Hypotension Detection Compared to Invasive Blood Pressure in Anesthetized Dogs." Veterinary Sciences 12, no. 2 (2025): 116. https://doi.org/10.3390/vetsci12020116.
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Blood pressure (BP) monitoring is essential during anesthesia to maintain cardiovascular stability and detect hypotension. This study evaluated the agreement and diagnostic accuracy of linear deflection oscillometry (LDO) and Doppler compared to invasive blood pressure (IBP) in anesthetized dogs. Eleven healthy dogs were anesthetized, and BP measurements were taken using LDO, Doppler, and IBP methods under normotensive and hypotensive conditions. The LDO device demonstrated superior agreement, assessed using Bland–Altman analysis, with IBP, especially in hypotensive conditions, compared to the Doppler method. LDO showed bias and standard deviation in the hypotensive state, with a mean and systolic arterial pressure (MAP and SAP) of −5.1 ± 7.9 and −5.6 ± 12.5 mmHg, respectively. Conversely, Doppler measurements tended to overestimate SAP during hypotension, presenting a bias of −13 ± 15.45 mmHg. The LDO achieved an area under the curve (AUC) of 0.809 for hypotension detection, with an MAP cutoff of ≤72 mmHg (sensitivity: 90%, specificity: 63%). Meanwhile, the best threshold for Doppler measurements was an AUC of 0.798, SAP ≤ 100 mmHg (sensitivity: 77.8%, specificity: 81.8%). These results indicate that LDO is a reliable method for hypotension detection in anesthetized dogs, with potential applications for real-time monitoring. In contrast, the Doppler method may help confirm hypotension diagnoses.
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KHAN, MUHAMMAD ASGHAR, SABIHA SHUJAAT, MUHAMMAD RASHID IQBAL, Muhammad Danish Hanif, and Aijaz Ahmed. "INTRA-OPERATIVE HYPOTENSION;." Professional Medical Journal 19, no. 05 (2012): 695–99. http://dx.doi.org/10.29309/tpmj/2012.19.05.2400.
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Objective: To determine the frequency of intra-operative hypotension following induction of Anesthesia in patients continuingtheir routine dose of angiotensin system inhibitor therapy before surgery. Study design: Cross-sectional study. Setting: Department ofAnaesthesiology, Combined Military Hospital, Quetta. Duration of study: One year from 20-08-2010 to 19-08-2011. Subjects and methods:Total 92 hypertensive patients were included in this study. Diagnostic criteria for patients was those cases receiving ACEI/ARA therapy for atleast 3 months with admission preoperative arterial blood pressure of >150/90mmHg. Results: Mean age of the patients was 47.70±8.47years. Out of 92 patients, 38 patients (41.3%) were male while remaining 54 patients (58.7%) were female. Distribution of cases by hypotensionafter induction of anesthesia shows, hypotension at 30 minute in 55 patients (59.8%) and hypotension at 60 minute in 37 patients (40.2%). Outof 55 hypotensive patients (at 30 minute) 17 patients (30.9%) had mild hypotension, 32 patients (58.2%) had moderate hypotension and 6patients (10.9%) had severe hypotension. Out of 37 hypotensive patients (at 60 minute) 8 patients (21.6%) had mild hypotension, 25 patients(67.6%) had moderate hypotension and 4 patients (10.8%) had severe hypotension. Conclusions: Hypertensive patients continuing theirroutine angiotensin system inhibitors therapy (<10 hr preoperative) have a variable risk of developing moderate hypotension within 30 minutesafter induction. This moderate hypotension proved to be of little clinical significance as it responded to conventional therapy.
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Martín-Pérez, Mar, Alexander Michel, Mark Ma, and Luis Alberto García Rodríguez. "Development of hypotension in patients newly diagnosed with heart failure in UK general practice: retrospective cohort and nested case–control analyses." BMJ Open 9, no. 7 (2019): e028750. http://dx.doi.org/10.1136/bmjopen-2018-028750.
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ObjectivesHypotension is of particular relevance for patients with heart failure (HF), since almost all HF drugs cause lowering of blood pressure (BP) and it is associated with a poor prognosis. We aimed to investigate hypotension incidence and risk factors in patients with incident HF in the UK.DesignRetrospective cohort study including nested case–control analyses.SettingThe Health Improvement Network UK primary care database.Participants18 677 adult patients with incident HF during 2000–2005 were followed and cases of hypotension (systolic BP ≤90 mm Hg) were identified. Controls were age-matched, sex-matched and date-matched to cases (1:2).Primary and secondary outcome measuresWe estimated hypotension incidence in the full study population and relevant subgroups (eg, sex and age). Potential risk factors for hypotension overall and for multiple versus single hypotensive episodes were evaluated using conditional logistic regression and unconditional regression models, respectively.ResultsDuring a mean follow-up of 3.31 years, 2565 patients (13.7%) developed hypotension. The incidence of hypotension was 3.17 cases per 100 patient years (95% confidence interval (CI): 3.05–3.30), and was markedly increased in women aged 18–39 years (n=32; 17.72 cases per 100 patient-years; 95% CI: 9.69–29.73). Hypotension risk factors included high healthcare utilisation (proxy measure for HF severity and general comorbidity; eg, ≥10 primary care physician visits versus none, odds ratio (OR): 2.29; 95% CI: 1.34–3.90), previous hypotensive episodes (OR: 2.32; 95% CI: 1.84–2.92), renal failure and use of aldosterone antagonists, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Risk factors identified for hypotension generally overlapped with those for multiple versus single hypotensive episodes.ConclusionsHypotension occurs frequently in patients with incident HF. Our findings may help identify patients most likely to benefit from close BP monitoring. The increased incidence of hypotension in young women with HF requires investigation.
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Dan, Adriana Mihaela, Magdalena Florina Mihai, and Diana Iulia Vasilescu. "Questions and controversies in the management of hypotension in preterm infants." Newborn Research & Reviews 2, no. 4 (2024): 143–54. https://doi.org/10.37897/newborn.2024.4.5.
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Hypotension is a frequent condition that affects preterm infants during the first days of life, within the transition period to an extrauterine environment, or associated with neonatal pathology. Persistent hypotension in the neonatal period is associated with increased neonatal morbidity and mortality. Understanding neonatal hemodynamics is the first step in approaching hypotensive neonatal patients. Treating hypotension should aim to restore impaired blood flow and maintain cellular metabolism. Neonatologists should look beyond values of blood pressure and check for markers of low systemic blood flow and inadequate organ perfusion. There are many anti-hypotensive agents, but choosing the most appropriate intervention should take into consideration the underlying pathophysiologic process, the effectiveness versus side effects of the drug, and medium- and long-term developmental outcomes. This article intends to review the therapeutic options for neonatal hypotension to offer clinicians support for an evidence-based choice.
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Kennedy, Martin J., and Michele Barletta. "Agreement Between Doppler and Invasive Blood Pressure Monitoring in Anesthetized Dogs Weighing <5 kg." Journal of the American Animal Hospital Association 51, no. 5 (2015): 300–305. http://dx.doi.org/10.5326/jaaha-ms-6163.
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The objectives of this study were to determine if Doppler (DOP) blood pressure measurements more closely estimate either invasive systolic or invasive mean arterial blood pressures (ISAP or IMAP, respectively) in small dogs under general anesthesia and to assess the ability of DOP to detect anesthesia-related hypotension in small dogs. Blood pressure measurements (n = 203) were obtained from 10 client-owned dogs. DOP, ISAP, and IMAP were recorded simultaneously, and the data were categorized into two groups: hypotensive (ISAP &lt;90 mm Hg) and normotensive (ISAP ≥90 mm Hg and ≤160 mm Hg). DOP overestimated ISAP and IMAP in both the normotensive and hypotensive groups. The DOP was highly specific (97%) but poorly sensitive (56%) for detecting hypotension. The smallest bias was achieved when using DOP as an estimate of systolic arterial blood pressure in both normotensive and hypotensive dogs, suggesting that DOP measures systolic arterial blood pressure in dogs &lt;5 kg. For dogs with hypotension, DOP met all of the performance criteria for noninvasive blood pressure monitors recommended by the American College of Veterinary Internal Medicine. DOP is an acceptably accurate and highly specific means of detecting hypotension in small dogs under general anesthesia.
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Armstead, William M. "Role of endothelin-1 in age-dependent cerebrovascular hypotensive responses after brain injury." American Journal of Physiology-Heart and Circulatory Physiology 277, no. 5 (1999): H1884—H1894. http://dx.doi.org/10.1152/ajpheart.1999.277.5.h1884.
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This study was designed to compare the effect of fluid percussion brain injury (FPI) on the hypotensive cerebrovascular response in newborn and juvenile pigs as a function of time postinsult and to determine the role of endothelin-1 (ET-1) in any age-dependent differences in hypotensive cerebrovascular regulation after injury. Ten minutes of hypotension (10–15 ml blood/kg) decreased mean arterial blood pressure uniformly in both groups (∼45%). In the newborn, hypotensive pial artery dilation (PAD) was blunted within 1 h, remained diminished for at least 72 h, but was resolved within 168 h postinjury (66 ± 4, 69 ± 4, 71 ± 4, and 64 ± 4% inhibition at 1, 4, 8, and 72 h post-FPI). During normotension, regional cerebral blood flow (rCBF) was decreased by FPI, and hypotension further reduced the already decremented rCBF for at least 72 h. Cerebrospinal fluid (CSF) ET-1 was increased from 26 ± 4 to 206 ± 25 pg/ml within 72 h post-FPI, whereas an ET-1 antagonist partially restored impaired hypotensive PAD and altered hypotensive rCBF. In contrast, hypotensive PAD and altered CBF were only inhibited for 4 h post-FPI in the juvenile (56 ± 3 and 34 ± 4% inhibition at 1 and 4 h post-FPI). CSF ET-1 was only increased from 27 ± 4 to 67 ± 9 pg/ml at 4 h, whereas the concentration returned to preinjury value by 8 h post-FPI. ET-1 antagonism similarly partially restored impaired hypotensive PAD and altered hypotensive rCBF. These data show that FPI disturbs cerebral autoregulation during hypotension both to a greater magnitude and for a longer duration in the newborn than in the juvenile. These data suggest that the greater FPI-induced ET-1 release in the newborn could contribute to age-dependent differences in impaired hypotensive cerebral autoregulation after FPI.
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Oláh, Zsolt, Béla Fülesdi, János Gál, Andrea Matusovits, and Barna Babik. "A perioperatív vérgazdálkodási program alapelvei." Orvosi Hetilap 161, no. 37 (2020): 1554–68. http://dx.doi.org/10.1556/650.2020.31787.
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Absztrakt: A perioperatív Patient Blood Management hazai adaptációja, a Nemzeti Véradó és Vérmentő Program átfogó, komplex megközelítést alkalmazó, multidiszciplináris konszenzuson alapuló és egyénre szabott klinikai gyakorlat, mely támogatja a vérkészítmények észszerű és indokolt alkalmazását, de megszünteti az irracionális transzfúziós gyakorlatot. A program gyakorlati megvalósítása három pilléren nyugszik: 1) a vérkép rendezése, lehetőleg transzfúzió nélkül; restriktív transzfúziós gyakorlat alkalmazása; 2) a vérvesztés minimalizálása; 3) az anaemiával szembeni tolerancia fokozása. A nagy vérzésveszéllyel járó műtétek előtt az anaemia mihamarabbi észlelése, az etiológia tisztázása és megfelelő kezelése a legfontosabb a vérkép rendezése érdekében. A vérvesztés minimalizálása a veleszületett vagy szerzett vérzékenységben szenvedő betegek kiszűrésével és megfelelő műtéti előkészítésével, az antikoaguláns, illetve thrombocytaaggregáció-gátló készítmények műtét előtti, az aktuális ajánlások szerint történő kihagyásával, szükség esetén hatásuk felfüggesztésével érhető el. Előnyben részesítendők a minimálinvazív eljárások. A műtét alatt a sebész részéről fontos az atraumatikus technika és a gondos lokális vérzéscsillapítás. Az autológ vérmentési technikák és ellenjavallat hiányában a kontrollált hypotensio szintén csökkenti az elvesztett vér mennyiségét. Perioperatív vérzés ellátása során a nemzetközi ajánlásokat tartalmazó, de a helyi viszonyokhoz adaptált kezelési protokoll alkalmazása szükséges, mely ideális esetben faktorkoncentrátum-alapú, viszkoelasztikus teszttel monitorozott, célvezérelt és egyénre szabott. A teljes perioperatív időszakban biztosítani kell az oxigén kereslet/kínálat ideális arányát, kerülve az oxigénadósság kialakulását. A homeostasis helyreállítása és fenntartása alapvető jelentőségű a haemostasisrendszer hatékony működéséhez és az oxigénadósság elkerüléséhez is. A Nemzeti Véradó és Vérmentő Program alkalmazása növeli a betegbiztonságot, csökkenti a betegellátás költségeit, és országos szinten elősegíti a vérkészítmény-ellátás biztosítását. Sikeres bevezetése mindannyiunk közös érdeke. Orv Hetil. 2020; 161(37): 1554–1568.
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Dan, Adriana Mihaela, Magdalena Florina Mihai, and Diana Iulia Vasilescu. "Questions and controversies in the management of hypotension in preterm infants." Newborn Research & Reviews 2, no. 3 (2024): 124–35. http://dx.doi.org/10.37897/newborn.2024.3.2.
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Hypotension is a frequent condition that affects preterm infants during the first days of life, within the transition period to an extra uterine environment, or associated with neonatal pathology. Persistent hypotension in the neonatal period is associated with increased neonatal morbidity and mortality. Understanding neonatal hemodynamics is the first step in approaching hypotensive neonatal patients. Treating hypotension should be to restore impaired blood flow and maintain cellular metabolism. Neonatologists should look beyond values of blood pressure and check for markers of low systemic blood flow and inadequate organ perfusion. There are many anti-hypotensive agents, but choosing the most appropriate intervention should take into consideration the underlying pathophysiologic process, the effectiveness versus side effects of the drug, and medium and long-term developmental outcomes. This article intends to review the therapeutic options for neonatal hypotension to offer the clinicians support for an evidence-based choice.
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Murabito, Paolo, Marinella Astuto, Filippo Sanfilippo, et al. "Proactive Management of Intraoperative Hypotension Reduces Biomarkers of Organ Injury and Oxidative Stress during Elective Non-Cardiac Surgery: A Pilot Randomized Controlled Trial." Journal of Clinical Medicine 11, no. 2 (2022): 392. http://dx.doi.org/10.3390/jcm11020392.
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Background: Intraoperative hypotension is associated with increased postoperative morbidity and mortality. Methods: We randomly assigned patients undergoing major general surgery to early warning system (EWS) and hemodynamic algorithm (intervention group, n = 20) or standard care (n = 20). The primary outcome was the difference in hypotension (defined as mean arterial pressure < 65 mmHg) and as secondary outcome surrogate markers of organ injury and oxidative stress. Results: The median number of hypotensive episodes was lower in the intervention group (−5.0 (95% CI: −9.0, −0.5); p < 0.001), with lower time spent in hypotension (−12.8 min (95% CI: −38.0, −2.3 min); p = 0.048), correspondent to −4.8% of total surgery time (95% CI: −12.7, 0.01%; p = 0.048).The median time-weighted average of hypotension was 0.12 mmHg (0.35) in the intervention group and 0.37 mmHg (1.11) in the control group, with a median difference of −0.25 mmHg (95% CI: −0.85, −0.01; p = 0.025). Neutrophil Gelatinase-Associated Lipocalin (NGAL) correlated with time-weighted average of hypotension (R = 0.32; p = 0.038) and S100B with number of hypotensive episodes, absolute time of hypotension, relative time of hypotension and time-weighted average of hypotension (p < 0.001 for all). The intervention group showed lower Neuronal Specific Enolase (NSE) and higher reduced glutathione when compared to the control group. Conclusions: The use of an EWS coupled with a hemodynamic algorithm resulted in reduced intraoperative hypotension, reduced NSE and oxidative stress.
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Hirsch, A. T., J. A. Majzoub, C. J. Ren, K. M. Scales, and M. A. Creager. "Contribution of vasopressin to blood pressure regulation during hypovolemic hypotension in humans." Journal of Applied Physiology 75, no. 5 (1993): 1984–88. http://dx.doi.org/10.1152/jappl.1993.75.5.1984.
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In animals subjected to hemorrhage, plasma arginine vasopressin concentrations increase to levels sufficient to cause vasoconstriction, thus attenuating the hypotensive response. The purpose of this study was to examine the contribution of vasopressin to blood pressure regulation during hypotension in humans. Hypotension was induced in twelve normal subjects by lower body negative pressure (LBNP) before and after intravenous administration of vasopressin V1 receptor antagonist. Before drug administration, LBNP reduced systolic blood pressure from 125 +/- 4 to 78 +/- 12 mmHg (P < 0.01) as vasopressin concentration increased from 2.9 +/- 0.6 to 17 +/- 6 pg/ml (P < 0.05). After administration of the vasopressin antagonist, LBNP reduced systolic blood pressure from 128 +/- 3 to 89 +/- 11 mmHg (P < 0.01). The hypotensive response to LBNP was not potentiated by inhibiting vasopressin's vasoconstrictive effects (P = NS). Thus hypotension causes marked increases in plasma vasopressin concentration. In contrast to findings in animal studies, however, vasopressin does not contribute to the maintenance of blood pressure during hypotension in humans.
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Gautam, B., and A. Bhattarai. "Thresholds for Spinal Anaesthesia-induced Hypotension During Caesarean Section." Kathmandu University Medical Journal 19, no. 1 (2021): 85–89. http://dx.doi.org/10.3126/kumj.v19i1.49552.
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Background Spinal anaesthesia is the current standard for caesarean section. Hypotension, a common complication, potentially results in adverse foetal and maternal outcomes. However, hypotension-defining criteria are varied.
 Objective To identify the blood pressure thresholds for spinal anaesthesia-induced hypotension during caesarean section.
 Method This is a retrospective cohort study of spinal anaesthesia-induced hypotension that occurred till baby-delivery during caesarean section. Reports on intraoperative hypotension, collected previously from January to December 2019, were reviewed to identify the hypotension-defining thresholds. The thresholds were categorized into systolic blood pressure (SBP) of 80, 90 or 100 mmHg, mean arterial pressure (MAP) of 60, 65 or 70 mmHg, combinations, and others. Parturient and anaesthesia characteristics, and associated hypotensive symptoms were also recorded for descriptive analysis.
 Result Spinal anaesthesia-induced hypotension was identified in 129 (11.5%) cases among 1116 caesarean sections. Altogether, 12 hypotension-defining thresholds were employed. Thresholds of SBP 90, MAP 60, and SBP 80 mmHg were used in 53 (41%), 28 (21.7%), and 21 (16.2%) cases respectively. Mean maternal age was 28 (±4.22) years and 87 (67.4%) cases underwent emergency surgery. Median sensory blockade level was T4. Nausea-vomiting, bradycardia, and tachycardia were associated during five (3.8%), six (4.6%), and 15 (11.6%) hypotensive incidents respectively. Two cases had unrecordable blood pressure but there was no maternal mortality.
 Conclusion Systolic blood pressure of 90 mmHg and mean arterial pressure of 60 mmHg included the most common thresholds for spinal anaesthesia-induced hypotension during caesarean section. Identifying the safe and clinically relevant hypotension-defining criteria needs further investigation.
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Huang, Zheng, Zeng Wen MA, and Shu Yun Xu. "Risk Factors and Prognostic Implications of Post-Intubation Hypotension in Emergency Department Critical Care Patients: A Retrospective Cohort Study." Asploro Journal of Biomedical and Clinical Case Reports 8, no. 1 (2024): 12–19. https://doi.org/10.36502/2024/asjbccr.6383.
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Objective: To investigate the risk factors and patient prognosis after the implementation of tracheal intubation in critically ill patients in the emergency department and to provide a theoretical basis for the development of clinical decisions for the treatment of critically ill patients in the emergency department. Methods: According to the inclusion and exclusion criteria, the clinical data of tracheal intubation patients admitted to the Emergency Department of Huaxi Shangjin Nanfu Hospital during the period of 1 January 2020–2022 were collected and analyzed. The patients were divided into the hypotensive group and the normotensive group according to whether hypotension occurred after tracheal intubation. A univariate analysis was used to analyze the risk factors for the development of hypotension in patients after intubation, and a multifactorial logistic regression analysis was performed to determine the independent risk factors for hypotension after intubation. The efficacy of each variable in predicting the development of hypotension in intubated patients was analyzed using a subject’s work characteristics (ROC) curve. The 28-day mortality rate, number of days in the ICU, and number of days in the hospital were compared between the two groups. Results: Hypotension occurred in 48 of 155 patients after tracheal intubation. Univariate analysis showed statistically significant differences between groups for 18 factors, including body mass index, preintubation systolic blood pressure, preintubation diastolic blood pressure, preintubation heart rate, postintubation diastolic blood pressure, postintubation heart rate, preintubation hemoglobin, preintubation creatinine, preintubation albumin, preintubation potassium, preintubation glucose, preintubation pH, postintubation neutrophil percentage, postintubation blood glucose, postintubation blood pH, postintubation PCO2, postintubation HCO3, and preintubation inducer use (P < 0.05). Logistic regression analysis showed that body mass index and pre-tracheal intubation systolic blood pressure were the independent risk factors for the development of hypotension in patients after tracheal intubation (P < 0.05). ROC analysis showed that the area under the curve (AUC) of body mass index predicting post-tracheal intubation hypotension was 0.734, with a 95% CI of 0.657–0.802 (P < 0.05), and the sensitivity and specificity of prediction were 52.08% and 84.11%, respectively. The area under the curve (AUC) of pre-tracheal systolic blood pressure predicting post-tracheal intubation hypotension was 0.894, with a 95% CI of 0.835–0.938 (P < 0.05), the optimal threshold was 90, the sensitivity of prediction was 87.50%, and the specificity was 83.18%. The area under the curve (AUC) of body mass index combined with preintubation systolic blood pressure to predict post-tracheal intubation hypotension was 0.934, with a sensitivity of prediction of 89.60% and a specificity of 83.20%. The 28-day mortality rate was significantly higher in the hypotensive group than in the non-hypotensive group (41.67% vs. 19.63%, P = 0.004), and the number of ICU days (4.804 ± 1.321 vs. 9.896 ± 2.868, P < 0.001) and the number of days of hospitalization (20.598 ± 5.297 vs. 25.354 ± 5.602, P < 0.001) were significantly prolonged in the hypotensive group compared with the non-hypotensive group. Conclusion: Hypotension after tracheal intubation in critically ill patients is more common in patients with low body weight or low systolic blood pressure before intubation, and hypotension after intubation increases the number of days in the ICU, the number of hospitalization days, and the 28-day mortality rate.
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Al Balushi, Asim, Stephanie Barbosa Vargas, Julie Maluorni, et al. "Hypotension and Brain Injury in Asphyxiated Newborns Treated with Hypothermia." American Journal of Perinatology 35, no. 01 (2017): 031–38. http://dx.doi.org/10.1055/s-0037-1604392.
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Objective This study aimed to assess the incidence of hypotension in asphyxiated newborns treated with hypothermia, the variability in treatments for hypotension, and the impact of hypotension on the pattern of brain injury. Study Design We conducted a retrospective cohort study of asphyxiated newborns treated with hypothermia. Mean blood pressures, lactate levels, and inotropic support medications were recorded during the hospitalization. Presence and severity of brain injury were scored using the brain magnetic resonance imaging (MRI) obtained after the hypothermia treatment was completed. Results One hundred and ninety term asphyxiated newborns were treated with hypothermia. Eighty-one percent developed hypotension. Fifty-five percent of the newborns in the hypotensive group developed brain injury compared with 35% of the newborns in the normotensive group (p = 0.04). Twenty-nine percent of the newborns in the hypotensive group developed severe brain injury, compared with only 15% in the normotensive group. Nineteen percent of the newborns presenting with volume- and/or catecholamine-resistant hypotension had near-total injury, compared with 6% in the normotensive group and 8% in the group responding to volume and/or catecholamines. Conclusion Hypotension was common in asphyxiated newborns treated with hypothermia and was associated with an increased risk of (severe) brain injury in these newborns.
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Horne, R. S., P. J. Berger, G. Bowes, and A. M. Walker. "Effect of sinoaortic denervation on arousal responses to hypotension in newborn lambs." American Journal of Physiology-Heart and Circulatory Physiology 256, no. 2 (1989): H434—H440. http://dx.doi.org/10.1152/ajpheart.1989.256.2.h434.
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To examine whether hypotension reflexly initiates arousal from sleep and the mechanisms involved, we subjected sleeping lambs to hypotensive stimuli of 1-min duration, before and after sinoaortic denervation (SAD). In intact lambs, hypotension increased the probability of arousal from both quiet sleep (QS) and rapid-eye-movement (REM) sleep. Hypotension resulted in nonarousal in 42% (QS) and 47% (REM) of tests. Arousal time was significantly longer in REM (34.9 +/- 1.8 s, means +/- SE) than in QS (26.0 +/- 1.8 s). Arterial saturation of O2 (SO2) and PO2 measured at the point of arousal were unchanged from control values in those tests in which arousal occurred. In nonarousal tests, there was a significant fall in both SO2 (4.9 +/- 1.2%) and PO2 (21.6 +/- 4.2 mmHg). After SAD, hypotension did not increase the probability of arousal. Nonarousals significantly increased to 75% (QS and REM, P less than 0.02). We conclude that acute hypotension is a potent stimulus for arousal from sleep in newborn lambs. As the arousal response is abolished by SAD and is not correlated with arterial oxygenation, hypotensive arousal appears to be mediated via arterial baroreceptors.
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Lombardi, F., K. Lucarelli, L. Frassanito, et al. "ROLE OF THE MACHINE LEARNING–DERIVED HYPOTENSION INDEX (HPI) TO CONTAIN INTRAOPERATIVE HYPOTENSION DURING TRANSCATHETER EDGE TO EDGE REPAIR PROCEDURES." European Heart Journal Supplements 26, Supplement_2 (2024): ii117. http://dx.doi.org/10.1093/eurheartjsupp/suae036.291.
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Abstract Introduction Percutaneous endovascular valvular interventions can result in profound hemodynamic instability, elevated burden of intraoperative hypotension (IOH) and related postoperative complications: ischemic stroke, acute kidney injury and increased mortality. Machine learning(ML),a branch of Artificial intelligence (AI), can analyze large volumes of data, find associations and allowing predictive rather than reactive interventions. The Hypotension Prediction Index (HPI)a ML derived algorithm,provides a unitless number from 0 to 100, that increases accordingly to the risk of developing a hypotensive event (mean arterial pressure – MAP – &lt; 65 mmHg for more than 1 minute) in the following minutes. The aim of this study is to describe IOH in patients undergoing percutaneous valve repair under general anesthesia treated according to an HPI–based hemodynamic guidance (fig.1). Methods Eligible adult patients undergoing transcatheter valve repair procedures (MitraclipTM, TriclipTM)were included in the study. When HPI value exceeded 85,a proactive individualized treatment protocol to prevent hypotension was provided according to the following modalities (fig. 2). Primary outcome measure was TWA–MAP (time weighted average mean arterial pressure)under the threshold of 65 mmHg. Secondary outcomes were number of patients with at least one hypotensive event, number of events per patient,depth and duration of hypotensive events and area under MAP threshold of 65 mmHg (AUT–MAP &lt; 65). Results Twenty–five consecutive patients were prospectively enrolled and treated. During an average monitoring time per patient of 187 ± 31 minutes, the global burden of hypotension, measured as TWA–MAP &lt; 65 mmHg, was 0.12 [0.02, 0.8] mmHg. Two thirds of the patients(16/25) experienced hypotensive events, with a median number of hypotensive events of 1 [0, 3.25] per patient and about 11% of the time spent &lt; 65 mmHg. Each event lasted 4 [1.7, 8.6] minutes with a MAP of 59 [56, 62] mmHg, leading to a total AUT–MAP &lt; 65 mmHg of 20.3 [3.5, 142.2] mmHg x minutes. The majority of hypotensive events occurred after induction of general anesthesia, while hypotension was rare during the procedure (fig. 3). Conclusions HPI algorithm provides accurate and continuous prediction of impending IOH before its occurrence. Machine learning models,as in the case of HPI, could facilitate the physicians to treat IOH which is a potentially modifiable risk factor for major postoperative complications.
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Gong, Xiang, Hong-Lin Chen, Jun-Hua Shen, and Bao-Feng Zhu. "Hypotension at emergency department admission and hospital-acquired pressure ulcers in older patients: prospective study." Journal of Wound Care 28, no. 8 (2019): 527–31. http://dx.doi.org/10.12968/jowc.2019.28.8.527.
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Objective:To investigate the relationship between admission hypotension and hospital acquired pressure ulcers (PU) among older patients in an emergency department.Methods:The study was a prospective cohort conducted between March and May 2017 in the emergency department of a tertiary care hospital in Eastern China. Data on PUs and possible PU risk factors were collected using a pre-designed form. Multivariate logistic regression was used to calculate the adjusted odds ratio (OR).Results:A total of 157 older patients were included in the study. PU incidence was 8.3%, with 95% confidence interval (CI) of 4.5 to 13.7%. The majority (76.9%) of PUs developed in the first three days of admission. On admission, 28 patients were found to be hypotensive, and 129 non-hypotensive. In the hypotensive group, PU incidence was 21.4% (6/28), and 5.4% (7/129) in the non-hypotensive group, respectively. The crude OR was 4.753 (95%CI: 1.183 to 18.086). After adjustment by patients' age, admission to emergency intensive care unit and if requiring assistance to move, the adjusted OR of hypotension on admission for PU risk was 1.755 (95%CI: 1.356 to 3.224).Conclusion:Our study showed that admission hypotension was an independent risk factor of PU among elderly patients in emergency department. However, this conclusion should be confirmed by further studies with large sample size.
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Brizzee, B. L., R. D. Russ, and B. R. Walker. "Role of vasopressin in acutely altered baroreflex sensitivity during hemorrhage in rats." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 261, no. 3 (1991): R677—R685. http://dx.doi.org/10.1152/ajpregu.1991.261.3.r677.
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Experiments were performed to examine the potential role of circulating arginine vasopressin (AVP) on baroreflex sensitivity during hypotensive and nonhypotensive hemorrhage in the conscious rat. Animals were chronically instrumented for measurement of cardiac output, blood pressure, and heart rate (HR). Three potential stimuli for release of AVP were utilized: 1) rapid 20% arterial hemorrhage that resulted in hypotension, 2) nonhypovolemic hypotension induced by intravenous infusion of nitroprusside, and 3) nonhypotensive hemorrhage (rapid 10% arterial blood withdrawal). Hypotensive hemorrhage was associated with significant reductions in blood pressure, cardiac output, HR, and calculated total peripheral resistance, an increase in baroreflex (BRR) bradycardia in response to pressor infusions of phenylephrine, and a moderate elevation in circulating AVP. Prior intravenous administration of a specific V1-vasopressinergic antagonist augmented the hypotensive response to hemorrhage; however, neither V1- nor V2-blockade affected hemorrhage-induced augmentation of the BRR. Inducement of hypotension by infusion of nitroprusside did not alter subsequent BRR sensitivity. Finally, nonhypotensive hemorrhage was associated with an increase in resting HR and augmented BRR sensitivity. However, in contrast to hypotensive hemorrhage, either V1- or V2-antagonism attenuated the increase in BRR sensitivity seen with 10% hemorrhage. These data suggest that, although AVP may play a role in blood pressure maintenance via its direct vasoconstrictor actions during hypotensive hemorrhage, the observed augmentation of BRR sensitivity associated with severe blood loss is not attributable to a vasopressinergic mechanism activated by circulating AVP. However, blood-borne AVP may contribute to BRR sensitivity alterations in response to mild blood loss.
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Goyal, Vipin Kumar, Praveenkumar Shekhrajka, Saurabh Mittal, and Medha Bhardwaj. "Impact of FloTrac versus hypotension prediction index (HPI)-guided haemodynamic management on intraoperative hypotension in kidney transplantation: A retrospective observational study." Indian Journal of Anaesthesia 69, no. 5 (2025): 496–501. https://doi.org/10.4103/ija.ija_927_24.
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Background and Aims: Intraoperative hypotension (IOH) is inevitable during moderate-to-high-risk surgeries. In kidney transplantation, intraoperative hypotensive events can badly affect postoperative graft and patient outcomes. Traditionally, central venous pressure monitoring has been regarded as a fundamental aspect of intraoperative haemodynamic management during kidney transplantation. Recently, the focus has changed by including newer haemodynamic tools (FloTrac, Hemosphere, etc.) to reduce intraoperative hypotensive events and postoperative complications. The primary objective was to record IOH (incidence, duration, and severity). Methods: This study was done retrospectively to observe the effect of haemodynamic monitoring on IOH. Recipients with dilated cardiomyopathy (DCMP) aged 18–60 years who underwent kidney transplantation from June 2022 to May 2024 were included and had cardiac output measured by FloTrac or Hemosphere. The primary outcome was to record the time-weighted average (TWA) of IOH. Secondary outcomes were to record the average number of hypotensive events per patient and the average duration of each hypotensive event. Results: Twenty-eight patients with DCMP were included. The primary outcome of TWA of the area under threshold (MAP < 65 mmHg) per patient was more in patients in the FloTrac group in comparison to the Acumen group (P = 0.613). Secondary outcomes, namely the incidence of hypotensive events per patient and total time of hypotension, were significantly higher in the FloTrac group as compared to the Acumen group (P < 0.0001). Conclusion: Hypotension prediction index (HPI) provides superior intraoperative haemodynamic management in kidney transplant recipients with DCMP in terms of reduced duration, incidence, and severity of IOH.
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Kesler, Natalie V., Curt C. Bay, Brook Chavarria, et al. "25 Enteral Acetaminophen Induced Hypotension: Getting It Right vs Being Right." Journal of Burn Care & Research 45, Supplement_1 (2024): 21. http://dx.doi.org/10.1093/jbcr/irae036.025.
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Abstract Introduction Fevers in burn injured patients is a common phenomenon and is typically managed with enteral acetaminophen (APAP) in our center. While hypotension is a known side effect of IV APAP, it has not been reported with enteral administration. However, burn nurses report episodes of hypotension in critically ill patients following APAP that are reproducible and report hesitancy to give additional doses, fearing a cause-and effect relationship. Conversely, the medical team views the relationship as temporal in nature and believes continued use of APAP an appropriate therapy to treat hyperthermia. The purpose of this study was to examine the relationship between administration of enteral APAP and hypotension in critically ill patients with thermal burns ≥ 20% total body surface area (TBSA). Methods This was a retrospective chart review of patients over a 5-year period. Primary outcome measures were number of patients receiving oral APAP, incidence of patients experiencing a drop in systolic blood pressure (SBP) of 20 points mmHg and/or a 15% decrease from baseline, within 3 hours, and number of qualifying hypotensive events. Descriptive statistics and Pearson correlation were calculated. Results A total of 203 patients suffered a burn injury of ≥ 20% TBSA during the study period. Among those 196 received enteral Tylenol, 180 (92%) experienced a hypotensive event as defined in the protocol. After consultation with a biostatistician and burn surgeon, hypotension was redefined as a SBP ≤ 100 mmHg. Using this definition 78 (40%) patients experienced at least one hypotensive event within 3 hours of APAP administration with a mean SBP of 88 mmHg, (range 58-100 mmHg). There was a positive correlation between hypotension and %TBSA (p &lt; .001), baseline SBP (p &lt; .000), baseline temp (p=.007), bilirubin (p &lt; .001), mechanical ventilation (p &lt; .001), acute adrenal insufficiency (p=.036), compartment syndrome (p=.02), and ventilator associated pneumonia (p &lt; .005). There was no correlation between hypotension and APAP. Conclusions Based on our data, larger TBSA, mechanical ventilation, ventilator associated pneumonia, lower baseline SBP, increased temperature, adrenal insufficiency and compartment syndrome showed an increase in probability of a hypotensive event occurring. However, despite strong convictions from bedside nurses the study did not demonstrate a significant relationship between hypotension and enteral APAP administration. A prospective, observational study is warranted to further examine this phenomenon. Applicability of Research to Practice Enteral APAP can be given by bedside nursing to control hyperthermia in critically ill burn patients without hesitation or fear of causing hypotension.
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Tiboldi, Akos, Jonas Gernhold, Christian Scheuba, et al. "Hypotension with and Without Hypertensive Episodes During Endoscopic Adrenalectomy for Pheochromocytoma or Paraganglioma—Should Perioperative Treatment Be Individualized?" Journal of Clinical Medicine 13, no. 23 (2024): 7054. http://dx.doi.org/10.3390/jcm13237054.
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Background: Hemodynamic instability is common during adrenalectomy for pheochromocytoma and paraganglioma (PPGL). Most analyses focus on the risk factors for intraoperative hypertension, but hypotension is a frequent and undesirable phenomenon during PPGL surgery. This study aimed to analyze the risk factors for hypotensive episodes during the removal of PPGL, and whether these episodes are always associated with concomitant intraoperative hypertensive events. Methods: A consecutive series of 121 patients (91.7% receiving preoperative alpha-blockade) treated with transperitoneal endoscopic adrenalectomy at a university hospital were analyzed, and pre- and intraoperative risk factors for intraoperative hypotension with or without intraoperative hypertension were analyzed using univariable and multivariable logistic regression analyses. Results: In total, 58 (56.2%) patients presented with intraoperative hypotension. Of these, 25 (20.7%) patients showed only hypotensive episodes but no hypertensive episodes (group 1), and 43 (35.5%) patients had both intraoperative hypotension and hypertension (group 2). The remaining 53 patients did not present with hypotension at all (group 3). When comparing group 1 (hypotension only) to all other patients with incidental diagnosis, higher age and lower preoperative diastolic arterial blood pressure (ABP) were significant risk factors for intraoperative hypotension; only the latter two were still significant in multivariate analysis. The significant risk factors for hypotension independent of hypertension (group 1 + 2 vs. group 3) were age and incidental diagnosis, pre-existing diabetes mellitus, and intraoperative use of remifentanil. Incidental diagnosis and use of remifentanil reached the level of significance in multivariate analysis. Conclusions: Since older age, incidental diagnosis of PPGL, lower preoperative ABP, and diabetes mellitus are risk factors for intraoperative hypotension, preoperative alpha-blocker treatment should be individualized for those at risk for hypotension. In addition, remifentanil should be used cautiously in the risk group.
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Gedmintas, Audra, Matthew Grabove, and Paul Atkinson. "My Patient Has No Blood Pressure: Have They Got an Abdominal Aortic Aneurysm? Point-Of-Care Ultrasound of the Abdominal Aorta in Hypotensive Patients." Ultrasound 19, no. 4 (2011): 236–41. http://dx.doi.org/10.1258/ult.2011.010048.
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Among patients presenting to the emergency department (ED) with undifferentiated hypotension, how can point-of-care ultrasound (PoCUS) help identify abdominal aortic aneurysm (AAA) as the cause of the hypotension? Many hypotensive patients in the ED are critically ill, with only minutes available to find the cause of the hypotension and treat it before the patient decompensates. While the classic description of the presentation of a ruptured AAA is of collapse with sudden onset abdominal pain and a palpable, pulsatile abdominal mass, detection of AAA by palpation is notoriously unreliable, and many patients are unaware of their underlying condition. This life-threatening situation is made even more difficult by virtue of the fact that the patient is often too unstable to travel for traditional diagnostics such as computed tomography. This article will address the use of PoCUS for the detection of AAA in the evaluation of the hypotensive patient.
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Udaya, Rejin Kumar, Deepanjali Sharma, Saba Khan, Laxmi Pathak, and Pradip Chhetri. "Utility of Supine Stress Test to Anticipate Spinal Anaesthesia Induced Hypotension in Patients Undergoing Elective Cesarean Section." Journal of Universal College of Medical Sciences 11, no. 03 (2023): 18–22. http://dx.doi.org/10.3126/jucms.v11i03.61471.
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INTRODUCTION Reduction in venous return caused by compression of the inferior vena cava by the gravid uterus, known as the supine hypotensive syndrome of pregnancy, is one of the reasons for particular susceptibility to hypotension at cesarean delivery. The hypotensive effect of spinal anaesthesia further exacerbates maternal hypotension in the supine position in term parturients. This study was conducted with the objective to evaluate the ability of supine stress test to predict spinal anaesthesia induced hypotension in patients undergoing elective cesarean section. MATERIAL AND METHODS A prospective observational study was done among 232 singleton parturients scheduled for elective cesarean delivery under spinal anaesthesia in Universal College of Medical Sciences Teaching Hospital. Patients were subjected preoperatively to supine stress test and divided into two group of 116 patients each. SBP, DBP, MAP, HR were compared between two groups. Descriptive as well as inferential statistics were used to analyze the data. RESULTS Supine stress test was positive by heart rate criteria in 50% of positive patient. The incidence of hypotension in positive test group was 73.3%, while it was 11.2% in negative test group, which was statistically significant (p<0.001). CONCLUSION This study demonstrates supine stress test preferably can easily identify parturients in risk of developing hypotension during cesarean section under spinal anaesthesia.
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Leffler, C. W., and D. W. Busija. "Prostanoids and pial arteriolar diameter in hypotensive newborn pigs." American Journal of Physiology-Heart and Circulatory Physiology 252, no. 4 (1987): H687—H691. http://dx.doi.org/10.1152/ajpheart.1987.252.4.h687.
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Effects of hypotensive hemorrhage on pial arteriolar diameter and cortical subarachnoid fluid prostanoid concentrations were investigated in newborn pigs. Chloralose-anesthetized piglets were equipped with closed cranial windows over the parietal cortex for observation of pial arterioles and collection of cerebrospinal fluid (CSF) passing over the cerebral surface (cortical subarachnoid CSF). Prostanoids in the CSF were determined by radioimmunoassay. Measurements of pial arterioles were made during normotension (63 +/- 4 mmHg) and hypotension (28 +/- 3 mmHg). Hypotension caused pial arteriolar diameters to increase from 162 +/- 22 to 193 +/- 22 microns. During normotension, the cortical subarachnoid prostanoid concentrations were (in ng/ml) prostaglandin E2 (PGE2) 2.6 +/- 0.7, 6-ketoprostaglandin F1 alpha (6-keto-PGF1 alpha) 1.7 +/- 0.4, thromboxane B2 (TXB2) 0.25 +/- 0.02. Hypotension caused 6-keto-PGF1 alpha to increase 245 +/- 104% and PGE2 to increase 132 +/- 38%. TXB2 increased slightly (37 +/- 21%). Topical application of PGE2 and prostacyclin caused marked dilation of pial arterioles. Treatment of hypotensive newborn pigs with indomethacin caused constriction of pial arterioles to diameters not significantly different from the normotensive diameters. These data are consistent with the hypothesis that the prostanoid system contributes to the maintenance of cerebral blood flow during hypotension in piglets.
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Fitts, Douglas A., Jeannine R. Lane, Elizabeth M. Starbuck, and Chi-Pei Li. "Drinking and blood pressure during sodium depletion or ANG II infusion in chronic cholestatic rats." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 276, no. 1 (1999): R23—R31. http://dx.doi.org/10.1152/ajpregu.1999.276.1.r23.
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After a chronic ligation of the common bile duct (BDL), Long-Evans rats are hypotensive and have elevated saline intake during both sodium-depleted and nondepleted conditions. We tested whether BDL rats have exaggerated hypotension during sodium depletion or an elevated dipsogenic response to angiotensin II (ANG II) that might help to explain the saline intake. After 4 wk of BDL, rats were hypotensive at baseline and developed exaggerated hypotension during acute furosemide-induced diuresis. Without saline to drink, BDL rats increased water intake during depletion equal to sham-ligated rats. However, with saline solution available at 22 h after sodium depletion, the BDL rats drank more water and saline than did sham-ligated rats. This rapid intake temporarily increased their mean arterial pressure to equal that of sham-ligated rats. Intravenous infusion of ANG II induced equal drinking responses despite reduced pressor responses in the BDL rats relative to sham-ligated rats during both ad libitum and sodium-depleted conditions. Thus BDL rats have exaggerated hypotension during diuresis, and their hypotension is corrected by drinking an exaggerated volume of saline, but they do not have an increased drinking response to ANG II.
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Collette, Sabine L., Maarten Uyttenboogaart, Noor Samuels, et al. "Hypotension during endovascular treatment under general anesthesia for acute ischemic stroke." PLOS ONE 16, no. 6 (2021): e0249093. http://dx.doi.org/10.1371/journal.pone.0249093.
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Objective The effect of anesthetic management (general anesthesia [GA], conscious sedation, or local anesthesia) on functional outcome and the role of blood pressure management during endovascular treatment (EVT) for acute ischemic stroke is under debate. We aimed to determine whether hypotension during EVT under GA is associated with functional outcome at 90 days. Methods We retrospectively collected data from patients with a proximal intracranial occlusion of the anterior circulation treated with EVT under GA. The primary outcome was the distribution on the modified Rankin Scale at 90 days. Hypotension was defined using two thresholds: a mean arterial pressure (MAP) of 70 mm Hg and a MAP 30% below baseline MAP. To quantify the extent and duration of hypotension, the area under the threshold (AUT) was calculated using both thresholds. Results Of the 366 patients included, procedural hypotension was observed in approximately half of them. The occurrence of hypotension was associated with poor functional outcome (MAP <70 mm Hg: adjusted common odds ratio [acOR], 0.57; 95% confidence interval [CI], 0.35–0.94; MAP decrease ≥30%: acOR, 0.76; 95% CI, 0.48–1.21). In addition, an association was found between the number of hypotensive periods and poor functional outcome (MAP <70 mm Hg: acOR, 0.85 per period increase; 95% CI, 0.73–0.99; MAP decrease ≥30%: acOR, 0.90 per period; 95% CI, 0.78–1.04). No association existed between AUT and functional outcome (MAP <70 mm Hg: acOR, 1.000 per 10 mm Hg*min increase; 95% CI, 0.998–1.001; MAP decrease ≥30%: acOR, 1.000 per 10 mm Hg*min; 95% CI, 0.999–1.000). Conclusions Occurrence of procedural hypotension and an increase in number of procedural hypotensive periods were associated with poor functional outcome, whereas the extent and duration of hypotension were not. Randomized clinical trials are needed to confirm our hypothesis that hypotension during EVT under GA has detrimental effects.
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Oh, Si-Eun, Jie-Hyun Kim, Hee-Jong Shin, Seong-Ah Kim, Chan-Kee Park, and Hae-Young Lopilly Park. "Angiotensin II-Related Activation of Scleral Fibroblasts and Their Role on Retinal Ganglion Cell Death in Glaucoma." Pharmaceuticals 16, no. 4 (2023): 556. http://dx.doi.org/10.3390/ph16040556.
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We identify the angiotensin II (AngII)-associated changes in the extracellular matrix (ECM) and the biomechanical properties of the sclera after systemic hypotension. Systemic hypotension was induced by administering oral hydrochlorothiazide. AngII receptor levels and ECM components in the sclera and biomechanical properties were evaluated based on the stress–strain relationship after systemic hypotension. The effect of inhibiting the AngII receptor with losartan was determined in the systemic hypotensive animal model and the cultured scleral fibroblasts from this model. The effect of losartan on retinal ganglion cell (RGC) death was evaluated in the retina. Both AngII receptor type I (AT-1R) and type II (AT-2R) increased in the sclera after systemic hypotension. Proteins related to the activation of fibroblasts (transforming growth factor [TGF]-β1 and TGF-β2) indicated that transformation to myofibroblasts (α smooth muscle actin [SMA]), and the major ECM protein (collagen type I) increased in the sclera after systemic hypotension. These changes were associated with stiffening of the sclera in the biomechanical analysis. Administering losartan in the sub-Tenon tissue significantly decreased the expression of AT-1R, αSMA, TGF-β, and collagen type I in the cultured scleral fibroblasts and the sclera of systemic hypotensive rats. The sclera became less stiff after the losartan treatment. A significant increase in the number of RGCs and decrease in glial cell activation was found in the retina after the losartan treatment. These findings suggest that AngII plays a role in scleral fibrosis after systemic hypotension and that inhibiting AngII could modulate the tissue properties of the sclera, resulting in the protection of RGCs.
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Runge, Julian, Jessica Graw, Carla D. Grundmann, Thomas Komanek, Jan M. Wischermann, and Ulrich H. Frey. "Hypotension Prediction Index and Incidence of Perioperative Hypotension: A Single-Center Propensity-Score-Matched Analysis." Journal of Clinical Medicine 12, no. 17 (2023): 5479. http://dx.doi.org/10.3390/jcm12175479.
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(1) Background: Intraoperative hypotension is common and is associated with increased morbidity and mortality. The Hypotension Prediction Index (HPI) is an advancement of arterial waveform analysis and allows preventive treatments. We used a propensity-score-matched study design to test whether application of the HPI reduces hypotensive events in non-cardiac surgery patients; (2) Methods: 769 patients were selected for propensity score matching. After matching, both HPI and non-HPI groups together comprised n = 136 patients. A goal-directed treatment protocol was applied in both groups. The primary endpoint was the incidence and duration of hypotensive events defined as MAP < 65 mmHg, evaluated by the time-weighted average (TWA) of hypotension. (3) Results: The median TWA of hypotension below 65 mmHg in the matched cohort was 0.180 mmHg (IQR 0.060, 0.410) in the non-HPI group vs. 0.070 mmHg (IQR 0.020, 0.240) in the HPI group (p < 0.001). TWA was higher in patients with ASA classification III/IV (0.170 mmHg; IQR 0.035, 0.365) than in patients with ASA status II (0.100; IQR 0.020, 0.250; p = 0.02). Stratification by intervention group showed no differences in the HPI group while TWA values in the non-HPI group were more than twice as high in patients with ASA status III/IV (p = 0.01); (4) Conclusions: HPI reduces intraoperative hypotension in a matched cohort seen for TWA below 65 mmHg and relative time in hypotension. In addition, non-HPI patients with ASA status III/IV showed a higher TWA compared with HPI-patients, indicating an advantageous effect of using HPI in patients at higher risk.
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Alghalayini, Kamal. "Value of ambulatory blood pressure measurement in diagnosing hypotension in hypertensive diabetic patients with medication-controlled BP." JRSM Cardiovascular Disease 9 (January 2020): 204800402093088. http://dx.doi.org/10.1177/2048004020930883.
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Background Hypotension is a common clinical finding in diabetic patients on anti-hypertensive medications. In the absence of clearly defined and documented hypotensive episodes, clinicians are faced with the challenge of modifying antihypertensive medication in potentially symptomatic diabetic patients. Objective To determine the value of ambulatory blood pressure monitor (ABPM) in diagnosing hypotensive episodes in hypertensive diabetic patients with medication-controlled blood pressure. Patients and methods The records of all hypertensive diabetic patients with medication-controlled were obtained between 2017 and 2018. Patients’ demographic data, comorbid conditions, hypotensive symptoms and echocardiography results were obtained and compared to office-based blood pressure and ABPM. Results Of 926 patients screened in the department of medicine outpatient clinics, 231 patients had diabetes and hypertension and were taking antihypertension medications, so only 86 patients were recruited. Using 24 h ABPM, hypotensive events were documented in 65 (75.6%) patients without correlated hypotensive symptoms in the patient sheet. Patients who had hypotensive episodes recorded by ABPM tended to have these between 5 and 10 a.m. and were significantly older – 60.71 versus 58.76 ( P = .022) – and more likely to have lower ejection fractions by echocardiography 46.31 versus 62.85 (EF) ( P < .001). Conclusion In treated hypertensive diabetic patients with antihypertensive medication, ABPM may be beneficial in capturing bouts of asymptomatic (silent) hypotension readings that occur in the out-of-hospital setting. Diabetic patients with controlled hypertension based on office reading showed a significant number of asymptomatic hypotensive readings detected with ambulatory BP monitoring that can have a role in following up such patients.
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Koyama, Yuhei, and Shinsuke Hamaguchi. "Challenging treatment of severe hypotension following tracheal intubation in a patient with primary hyperparathyroidism: A case report." Medicine 103, no. 35 (2024): e39510. http://dx.doi.org/10.1097/md.0000000000039510.
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Rationale: Primary hyperparathyroidism (PHPT), which is characterized by increased parathyroid hormone secretion, typically manifests as hypercalcemia and hypertension. Here, we report a case of severe hypotension following tracheal intubation during anesthesia induction in a patient with PHPT, in contrast to the expected hypertensive response. Patient concerns: A 52-year-old man presented with nausea after eating, leg pain when walking, and headaches. Diagnosis: Based on the blood test and computed tomography results, he was diagnosed with PHPT. Interventions: The patient underwent parathyroidectomy under general anesthesia. After induction anesthesia and tracheal intubation, severe acute hypotension and tachycardia suddenly developed. To treat hypotensive shock, we immediately administered ephedrine and phenylephrine and infused Ringer solution. Outcomes: The symptoms of hypotensive shock were alleviated by this intervention. Lessons: We speculate that the cause of his severe hypotension was vasodilation due to the transient release of parathyroid hormone from mechanical stimulation by anesthetic procedures, such as tracheal intubation, combined with hypercalcemia-induced severe dehydration. Moreover, we speculate that fluid resuscitation stabilized his condition and helped achieve a successful surgical outcome. The possibility of severe hypotension after anesthesia induction should be anticipated, and management of cases with severe dehydration should be optimized during the anesthetic management of patients with PHPT.
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Higuchi, S., A. Takeshita, H. Higashi, et al. "Lowering calcium in the nucleus tractus solitarius causes hypotension and bradycardia." American Journal of Physiology-Heart and Circulatory Physiology 250, no. 2 (1986): H226—H230. http://dx.doi.org/10.1152/ajpheart.1986.250.2.h226.
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It has been shown that saline microinjected into the region of the nucleus tractus solitarius (NTS) causes, but artificial cerebrospinal fluid (CSF) in the same volume does not cause, hypotension and bradycardia. This study was done to examine the possibility that the difference in effects between saline and artificial CSF may be due to the lack of calcium ions in saline. In anesthetized rats, saline or artificial CSF with or without calcium ions was microinjected into the region of the NTS. Saline microinjected in volumes of 0.2 and 0.5 microliter produced the volume-dependent decreases in arterial pressure and heart rate. Saline with added calcium ions and artificial CSF did not elicit the hypotensive and bradycardic response, but artificial CSF without calcium ions produced hypotension and bradycardia. These results suggest that the lack of calcium ions in the injected solutions is the factor that determines the hypotensive and bradycardic response. These results suggest that lowering the local availability of calcium to the NTS neurons results in hypotension and bradycardia.
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Brignole, Michele, and Giulia Rivasi. "New insights in diagnostics and therapies in syncope: a novel approach to non-cardiac syncope." Heart 107, no. 11 (2021): 864–73. http://dx.doi.org/10.1136/heartjnl-2020-318261.
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This article aims to give advice on how to identify and manage patients with syncope who are at risk of severe outcomes, that is, at risk of trauma, potentially life-threatening episodes or frequent recurrences reducing quality of life. The first step of syncope diagnostic assessment is to identify patients with cardiac syncope, and once established, these patients must receive the adequate mechanism-specific treatment. If cardiac syncope is unlikely, reflex (neurally mediated) syncope and orthostatic hypotension are the most frequent causes of transient loss of consciousness. For these presentations, efficacy of therapy is largely determined by the mechanism of syncope rather than its aetiology or clinical features. The identified mechanism of syncope should be carefully assessed and assigned either to hypotensive or bradycardic phenotype, which will determine the choice of therapy (counteracting hypotension or counteracting bradycardia). The results of recent trials indicate that ‘mechanism-specific therapy’ is highly effective in preventing recurrences. Established mechanism-specific treatment strategies include withdrawal of hypotensive drugs, applying fludrocortisone and midodrine for the hypotensive phenotype and cardiac pacing in the bradycardic phenotype.
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Mukul, Sailesh Kumar, Amit Kumar, Ejaz Ahmad Mokhtar, and Shweta Pandey. "Limiting blood loss in orthognathic surgery with Esmolol as a hypotensive agent." Journal of Applied and Advanced Research 2, no. 2 (2017): 86. http://dx.doi.org/10.21839/jaar.2017.v2i2.66.
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Orthognathic surgery may be complicated by difficulty in achieving hemostasis because unlike soft tissue, the vessels traversing bone cannot be identified and isolated before osteotomy. In this study we evaluated the amount of blood loss and duration of surgery under deliberate hypotensive anesthesia in comparison to amount of blood loss and duration of surgery under normotensive anesthesia on patients undergoing orthognathic surgical procedures. A total of 16 cases undergoing orthognathic surgery were included in this clinical study.Patients were randomly grouped under normotensive (group I) or hypotensive group (group 2). Patients in hypotensive anesthesia group were given Esmolol to maintain mean arterial pressure in the range of 70-80 mm of Hg till osteotomy segments were fixed. There was more than 40% reduction in blood loss in orthognathic surgical procedures when induced hypotension was used, but there was not statistically significant (p=0.91) reduction in the operative time. Based on surgeons and anesthetist’s assessment fast acting agents like Esmolol can be used intraoperatively to induce hypotension as and when required.
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Agakidou, Eleni, Ilias Chatziioannidis, Angeliki Kontou, Theodora Stathopoulou, William Chotas, and Kosmas Sarafidis. "An Update on Pharmacologic Management of Neonatal Hypotension: When, Why, and Which Medication." Children 11, no. 4 (2024): 490. http://dx.doi.org/10.3390/children11040490.
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Anti-hypotensive treatment, which includes dopamine, dobutamine, epinephrine, norepinephrine, milrinone, vasopressin, terlipressin, levosimendan, and glucocorticoids, is a long-established intervention in neonates with arterial hypotension (AH). However, there are still gaps in knowledge and issues that need clarification. The main questions and challenges that neonatologists face relate to the reference ranges of arterial blood pressure in presumably healthy neonates in relation to gestational and postnatal age; the arterial blood pressure level that potentially affects perfusion of critical organs; the incorporation of targeted echocardiography and near-infrared spectroscopy for assessing heart function and cerebral perfusion in clinical practice; the indication, timing, and choice of medication for each individual patient; the limited randomized clinical trials in neonates with sometimes conflicting results; and the sparse data regarding the potential effect of early hypotension or anti-hypotensive medications on long-term neurodevelopment. In this review, after a short review of AH definitions used in neonates and existing data on pathophysiology of AH, we discuss currently available data on pharmacokinetic and hemodynamic effects, as well as the effectiveness and safety of anti-hypotensive medications in neonates. In addition, data on the comparisons between anti-hypotensive medications and current suggestions for the main indications of each medication are discussed.
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Armstead, William M., Robert Mirro, David W. Busija, and Charles W. Leffler. "Opioids and the Prostanoid System in the Control of Cerebral Blood Flow in Hypotensive Piglets." Journal of Cerebral Blood Flow & Metabolism 11, no. 3 (1991): 380–87. http://dx.doi.org/10.1038/jcbfm.1991.78.
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The interaction between opioid and prostanoid mechanisms in the control of cerebral hemodynamics was investigated in the conscious hypotensive piglet. Radiomicrospheres were used to determine regional cerebral blood flow (rCBF) in piglets pretreated with the opioid receptor antagonist, naloxone, or its vehicle, saline, during normotension, hypotension, and after the administration of indomethacin, a cyclooxygenase inhibitor, during hypotension. Hemorrhage (30 ml/kg) decreased systemic arterial pressure from 68 ± 12 to 40 ± 10 mm Hg but did not decrease blood flow to any brain region. Indomethacin treatment (5 mg/kg) of hypotensive piglets decreased blood flow to all brain regions within 20 min; this decrease in CBF resulted from increases in cerebral vascular resistance of 65 and 281% at 20 and 40 min after treatment, respectively. In hypotensive piglets, cerebral oxygen consumption was reduced from 2.62 ± 0.71 to 0.53 ± 0.27 ml 100g−1 min−1 and to 0.11 ± 0.04 ml 100 g−1 min−1 at 20 and 40 min following indomethacin, respectively. Treatment with naloxone (1 mg/kg) had no effect on rCBF, calculated cerebral vascular resistance, or cerebral oxygen consumption of normotensive or hypotensive piglets. However, decreases in CBF and oxygen consumption and increases in cerebral vascular resistance upon treatment of hypotensive piglets with indomethacin were attenuated in animals pretreated with naloxone. These data indicate that the removal of prostanoid modulation of an opioid-mediated constrictor influence on the cerebral circulation is a potential mechanism for the increase in cerebral vascular resistance that follows indomethacin treatment of hypotensive piglets.
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Hohimer, A. Roger, Conrad R. Chao, and John M. Bissonnette. "The Effect of Combined Hypoxemia and Cephalic Hypotension on Fetal Cerebral Blood Flow and Metabolism." Journal of Cerebral Blood Flow & Metabolism 11, no. 1 (1991): 99–105. http://dx.doi.org/10.1038/jcbfm.1991.11.
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The effect of hypoxemia and cephalic hypotension, alone and in combination, on hemispherical CBF and metabolism was examined in seven chronically catheterized fetal sheep. Hypoxemia was induced by lowering the maternal inspired oxygen fraction and cephalic hypotension was generated by partial occlusion of the fetal brachiocephalic artery. CBF was measured with radionuclide-labeled microspheres. During control, the arterial blood oxygen content (Cao2) was 3.2 ± 1.0 (SD) m M and CBF averaged 131 ± 21 (SD) ml min−1 100 g−1. The cephalic perfusion pressure (PP, mean cephalic arterial - sagittal venous) was 40 ± 4 mm Hg and cerebral vascular resistance (CVR, PP/CBF) was 0.31 ± 0.06 mm Hg ml−1 min 100 g. During induced hypoxemia, Cao2 was 1.4 ± 0.7 m M and CBF was elevated to 223 ± 60 ml min−1 100 g−1. PP was not different from control and CVR was lower at 0.19 ± 0.04 mm Hg ml−1 min 100 g, reflecting cerebral vasodilation. With cephalic hypotension alone (PP = 21 ± 4 mm Hg; Cao2 = 3.4 ± 0.9 m M), CBF fell to 83 ± 23 ml min−1 100 g−1 and there was no significant change in CVR (0.26 ± 0.05 mm Hg ml−1 min 100 g). During combined hypoxemia and hypotension (Cao2 = 1.5 ± 0.8 m M and PP = 18 ± 4 mm Hg), CBF was significantly greater than during hypotension alone (100 ± 6 ml min−1 100 g). CVR was 0.19 ± 0.05 mm Hg ml−1 min 100 g, identical to that measured in normotensive hypoxemia and significantly less than found during hypotension alone. Cerebral oxygen consumption was lower during combined hypoxemia and cephalic hypotension than during hypoxemia alone. Cerebral glucose uptake was significantly higher than control in both the hypoxemic and combined hypoxemic-hypotensive conditions. The glucose:oxygen quotient (6 × molar glucose uptake/molar oxygen consumption) was not different from unity during control or hypotension but was 2.31 ± 1.16 and 3.63 ± 1.99 during the hypoxemic and hypoxemic-hypotensive conditions, respectively, suggesting an anaerobic glucose utilization. No significant lactate efflux could be measured in any of these conditions.
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El-Mas, Mahmoud M., Jian Zhang, and Abdel A. Abdel-Rahman. "Upregulation of vascular inducible nitric oxide synthase mediates the hypotensive effect of ethanol in conscious female rats." Journal of Applied Physiology 100, no. 3 (2006): 1011–18. http://dx.doi.org/10.1152/japplphysiol.01058.2005.
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Previous reports from our laboratory have shown that ethanol elicits hypotension in female but not in male rats and that this effect of ethanol is estrogen dependent (El-Mass MM and Abdel-Rahman AA. Alcohol Clin Exp Res 23: 624–632, 1999; El-Mass MM and Abdel-Rahman AA. Clin Exp Hypertens 21: 1429–1445, 1999). In the present study, we tested the hypothesis that ethanol lowers blood pressure in female rats via upregulation of the inducible nitric oxide synthase (iNOS) in vascular tissues. The effects of pretreatment with NG-nitro-l-arginine (NOARG; nonselective nitric oxide synthase inhibitor) or aminoguanidine (selective iNOS inhibitor) on hemodynamic responses elicited by intragastric (ig) ethanol were determined in conscious female rats. Changes in vascular (aortic) iNOS protein expression evoked by ethanol in the presence and absence of aminoguanidine were also measured by immunohistochemistry. Compared with control (water treated) female rats, ethanol (1 g/kg ig) elicited hypotension that was associated with a significant increase in the aortic iNOS activity. The hypotensive effect of ethanol was virtually abolished in rats infused with the nitric oxide synthase inhibitor NOARG, suggesting a role for nitric oxide in ethanol hypotension. The inability of ethanol to lower blood pressure in NOARG-treated rats cannot be attributed to the presence of elevated blood pressure in these rats because ethanol produced hypotension when blood pressure was raised to comparable levels with phenylephrine infusion. Selective inhibition of iNOS by aminoguanidine (45 mg/kg ip), which had no effect on baseline blood pressure, abolished both the hypotensive action of subsequently administered ethanol and the associated increases in aortic iNOS content. These findings implicate vascular iNOS, at least partly, in the acute hypotensive action of ethanol in female rats.
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Terwindt, Lotte E., Jaap Schuurmans, Björn J. P. van der Ster, et al. "Incidence, Severity and Clinical Factors Associated with Hypotension in Patients Admitted to an Intensive Care Unit: A Prospective Observational Study." Journal of Clinical Medicine 11, no. 22 (2022): 6832. http://dx.doi.org/10.3390/jcm11226832.
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Background: The majority of patients admitted to the intensive care unit (ICU) experience severe hypotension which is associated with increased morbidity and mortality. At present, prospective studies examining the incidence and severity of hypotension using continuous waveforms are missing. Methods: This study is a prospective observational cohort study in a mixed surgical and non-surgical ICU population. All patients over 18 years were included and continuous arterial pressure waveforms data were collected. Mean arterial pressure (MAP) below 65 mmHg for at least 10 s was defined as hypotension and a MAP below 45 mmHg as severe hypotension. The primary outcome was the incidence of hypotension. Secondary outcomes were the severity of hypotension expressed in time-weighted average (TWA), factors associated with hypotension, the number and duration of hypotensive events. Results: 499 patients were included. The incidence of hypotension (MAP < 65 mmHg) was 75% (376 out of 499) and 9% (46 out of 499) experienced severe hypotension. Median TWA was 0.3 mmHg [0–1.0]. Associated clinical factors were age, male sex, BMI and cardiogenic shock. There were 5 (1–12) events per patients with a median of 52 min (5–170). Conclusions: In a mixed surgical and non-surgical ICU population the incidence of hypotension is remarkably high.
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Srivastava, Karan, Vikas Y. Sacher, Craig T. Nelson, and John I. Lew. "Multifactorial Model and Treatment Approaches of Refractory Hypotension in a Patient Who Took an ACE Inhibitor the Day of Surgery." Case Reports in Anesthesiology 2013 (2013): 1–5. http://dx.doi.org/10.1155/2013/723815.
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In the field of anesthesiology, there is wide debate on discontinuing angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) therapy the day of noncardiac surgery. Although there have been many studies attributing perioperative hypotension to same-day ACEI and ARB use, there are many additional variables that play a role in perioperative hypotension. Additionally, restoring blood pressure in these patients presents a unique challenge to anesthesiologists. A case report is presented in which a patient took her ACEI the day of surgery and developed refractory hypotension during surgery. The evidence of ACEI use on the day of surgery and development of hypotension is reviewed, and additional variables that contributed to this hypotensive episode are discussed. Lastly, current challenges in restoring blood pressure are presented, and a basic model on treatment approaches for refractory hypotension in the setting of perioperative ACEI use is proposed.
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Ment, Laura R., William B. Stewart, Charles C. Duncan, Bruce R. Pitt, Aldo Rescigno, and Judy Cole. "Beagle puppy model of perinatal cerebral infarction." Journal of Neurosurgery 63, no. 3 (1985): 441–47. http://dx.doi.org/10.3171/jns.1985.63.3.0441.
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✓ Asphyxia, with its attendant hypotension, is by far the most common cause of neonatal cerebral infarction and frequently results in lesions of the parieto-occipital white matter. This study examines the effects of hypotension on regional cerebral blood flow (CBF), local cerebral glucose utilization (LCGU), and serum prostaglandin levels in newborn beagle pups. The animals (24 to 96 hours old) were anesthetized, tracheotomized, and paralyzed. Pups were randomly divided into two groups: one was subjected to hemorrhagic hypotension and the other received no insult. Hypotension was induced by slow venous hemorrhage to maintain a mean arterial blood pressure of 20 to 30 mm Hg. Autoradiographic determinations of LCGU using carbon-14 (14C)-2-deoxyglucose were performed 45 minutes after randomization to groups. Autoradiographic determinations of CBF were performed using 14C-iodoantipyrine on a second group of pups 15 minutes after randomization. Prostaglandins were measured immediately before and 15 minutes after insult or control manipulation. There were no significant differences in the values for thromboxane B2 or 6-keto-prostaglandin F1α, the stable breakdown products of thromboxane A2, and prostacyclin. Prostaglandin E2 levels significantly increased in response to hemorrhagic hypotensive insult. In addition, although regional CBF was maintained in cortical and central gray matter structures during hypotension, CBF to the periventricular temporal and parietal white matter zones significantly decreased, and LCGU was increased in these same regions during hypotensive insult. The uncoupling of CBF and metabolism in these periventricular white matter regions may be responsible for the neuropathological sequelae of perinatal asphyxia.
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Cardozo, Diogo, and Denise de Souza Destro. "Exercise order in resistance training – a brief review of the acute effects on cardiovascular response in the post-exercise period." Research, Society and Development 11, no. 13 (2022): e272111335489. http://dx.doi.org/10.33448/rsd-v11i13.35489.
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This study aims to review the main effects of the performance order of resistance exercises on cardiovascular response in strength training (ST) sessions. To do so, a search was carried out in PubMed, BIREME, and Google Scholar databases using as descriptors: 'order', 'resistance training order', 'resistance exercise order', 'blood pressure' 'hypotension', 'effect hypotensive', 'post-exercise hypotension' and 'cardiovascular responses'. After applying the inclusion/exclusion criteria, six studies were considered in this review. The results suggest that ST can be considered as a non-pharmacological therapeutic option against arterial hypertension. Although the alternate exercise sequence and the sequence that progresses from multi-joint exercises towards single-joint ones present a longer duration of the hypotensive effect in hypertensive individuals, literature needs more studies that investigate the influence of different exercise orders in the hypertensive audience for further conclusions on the subject.