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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 (November 1, 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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KHAN, MUHAMMAD ASGHAR, SABIHA SHUJAAT, MUHAMMAD RASHID IQBAL, Muhammad Danish Hanif, and Aijaz Ahmed. "INTRA-OPERATIVE HYPOTENSION;." Professional Medical Journal 19, no. 05 (October 8, 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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Ballester, Leonor, Rafael Martínez, Juan Méndez, Gloria Miró, Manel Solsona, Elisabeth Palomera, Josep Capdevila, Alejandro Rodriguez, and Juan Yébenes. "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 (October 10, 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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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 (July 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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Gautam, B., and A. Bhattarai. "Thresholds for Spinal Anaesthesia-induced Hypotension During Caesarean Section." Kathmandu University Medical Journal 19, no. 1 (March 31, 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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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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Murabito, Paolo, Marinella Astuto, Filippo Sanfilippo, Luigi La Via, Francesco Vasile, Francesco Basile, Alessandro Cappellani, Lucia Longhitano, Alfio Distefano, and Giovanni Li Volti. "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 (January 13, 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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Dolla, Caterina, Alberto Mella, Giacinta Vigilante, Fabrizio Fop, Anna Allesina, Roberto Presta, Aldo Verri, 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 (April 5, 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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Tiboldi, Akos, Jonas Gernhold, Christian Scheuba, Philipp Riss, Wolfgang Raber, Barbara Kabon, Bruno Niederle, and Martin B. Niederle. "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 (November 22, 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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Vukotic, Aleksandra, Jasna Jevdjic, David Green, Milovan Vukotic, Nina Petrovic, Ana Janicijevic, Irina Nenadic, 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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Al Balushi, Asim, Stephanie Barbosa Vargas, Julie Maluorni, Priscille-Nice Sanon, Emmanouil Rampakakis, Christine Saint-Martin, and Pia Wintermark. "Hypotension and Brain Injury in Asphyxiated Newborns Treated with Hypothermia." American Journal of Perinatology 35, no. 01 (July 31, 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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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 (September 30, 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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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 (April 18, 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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Terwindt, Lotte E., Jaap Schuurmans, Björn J. P. van der Ster, Carin A. G. C. L. Wensing, Marijn P. Mulder, Marije Wijnberge, Thomas G. V. Cherpanath, 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 (November 18, 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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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 (February 1, 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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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 (September 1, 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 <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 <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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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 (November 1, 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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Collette, Sabine L., Maarten Uyttenboogaart, Noor Samuels, Irene C. van der Schaaf, H. Bart van der Worp, Gert Jan R. Luijckx, Allart M. Venema, et al. "Hypotension during endovascular treatment under general anesthesia for acute ischemic stroke." PLOS ONE 16, no. 6 (June 23, 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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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 (December 31, 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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Kesler, Natalie V., Curt C. Bay, Brook Chavarria, Elizabeth Thorstenson, Asia N. Quan, Nisha Talanki, Van Dobbe, et al. "25 Enteral Acetaminophen Induced Hypotension: Getting It Right vs Being Right." Journal of Burn Care & Research 45, Supplement_1 (April 17, 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 < .001), baseline SBP (p < .000), baseline temp (p=.007), bilirubin (p < .001), mechanical ventilation (p < .001), acute adrenal insufficiency (p=.036), compartment syndrome (p=.02), and ventilator associated pneumonia (p < .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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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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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 (April 6, 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 (August 23, 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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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 (January 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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z, Tolga, Hilal lu, Beng n, Rah Okyay, Gamze kosman, H. ztoprak, and zcan kin. "The Efficacy of Inferior Vena Cava Diameter, Perfusion Index and Pleth Variability Index on Predicting Hypotension in Spinal Anesthesia." Annals of Medical Research 29, no. 6 (2022): 1. http://dx.doi.org/10.5455/annalsmedres.2021.11.634.
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Objective: One of the most common side effects of spinal anesthesia (SA) is hypotension. The aim of the study was to evaluate the efficacay of inferior vena cava (IVC) diameter measurements, perfusion index (PI) and pleth variability index (PVI) values in determining the risk of developing hypotension after SA. Materials and Methods: This study was conducted on 81 patients who underwent transurethral prostatectomy. Before administration of SA, PI and PVI values, IVC diameters (IVCmin: during inspiration and IVCmax: during expiration) and IVC collapsibility index (IVCCI) values and non-invasive blood pressure were recorded. Patients with a baseline systolic arterial pressure reduction rate of ≥25% were determined as the group developing hypotension. IVC diameter measurements were measured immediately after SA then 5 min, and at the end of the operation. The heart rate, mean arterial pressure, PI and PVI values were recorded at regular intervals. Results: Hypotension occured in 32 patients (39.5%). In the hypotensive group, IVCmax and IVCmin values were observed lower and IVCCI values higher. The optimal threshold value of IVCmin was ≤0.99 and threshold value of IVCCI was >%44.5 for predicting hypotension after SA. Conclusion: While IVCmin and IVCCI values were effective in determining hypotension risk after SA, PI and PVI values were not. To predict hypotension by IVC diameter measurements after SA will allow a more effective intervention and avoid hypotension.
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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 (April 1, 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 (January 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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Oh, Chahyun, Boohwi Hong, Yumin Jo, Seungbin Jeon, Sooyong Park, Woosuk Chung, Youngkwon Ko, Sun Yeul Lee, and Chaeseong Lim. "Perineural Epinephrine for Brachial Plexus Block Increases the Incidence of Hypotension during Dexmedetomidine Infusion: A Single-Center, Randomized, Controlled Trial." Journal of Clinical Medicine 10, no. 12 (June 11, 2021): 2579. http://dx.doi.org/10.3390/jcm10122579.
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Background: Sedation using dexmedetomidine is frequently associated with hypotension. In contrast, epinephrine, a commonly used adjunctive agent in regional anesthesia, is a potent vasopressor. We hypothesized that perineural epinephrine used in brachial plexus blockade may reduce hypotension during dexmedetomidine infusion. Methods: Patients scheduled for upper extremity surgery were randomly allocated into a control and an epinephrine group. All patients received brachial plexus blockade, consisting of 25 mL of a 1:1 mixture of 1% lidocaine and 0.75% ropivacaine, with patients in the epinephrine group also receiving 125 μg epinephrine. Intraoperative sedation was induced using dexmedetomidine at a loading dose of 1 µg/kg and maintenance dose of 0.4 µg/kg/hr. The primary outcome was the incidence of intraoperative hypotension or hypotension in the post-anesthesia care unit (PACU). Results: One hundred and thirty patients were included (65 per group). The incidence of hypotension was significantly higher in the epinephrine than in the control group (80.6% vs. 56.9%, p = 0.009). The duration of hypotension and the maximal change in blood pressure were also greater in the epinephrine group. Conclusions: Perineural epinephrine for brachial plexus blockade does not reduce hypotension due to dexmedetomidine infusion and may actually augment the occurrence of hypotensive events.
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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 (October 3, 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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KOIKE, Yasuo, and Akira TAKAHASHI. "Orthostatic Hypotension and Postprandial Hypotension." Internal Medicine 35, no. 1 (1996): 48–50. http://dx.doi.org/10.2169/internalmedicine.35.48.
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Lombardi, F., K. Lucarelli, L. Frassanito, V. Casamassima, F. Troisi, V. Bellomo, A. Argentiero, 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 (April 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 – < 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 < 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 < 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 < 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 < 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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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 (August 30, 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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Hatib, Feras, Zhongping Jian, Sai Buddi, Christine Lee, Jos Settels, Karen Sibert, Joseph Rinehart, and Maxime Cannesson. "Machine-learning Algorithm to Predict Hypotension Based on High-fidelity Arterial Pressure Waveform Analysis." Anesthesiology 129, no. 4 (October 1, 2018): 663–74. http://dx.doi.org/10.1097/aln.0000000000002300.
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Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background With appropriate algorithms, computers can learn to detect patterns and associations in large data sets. The authors’ goal was to apply machine learning to arterial pressure waveforms and create an algorithm to predict hypotension. The algorithm detects early alteration in waveforms that can herald the weakening of cardiovascular compensatory mechanisms affecting preload, afterload, and contractility. Methods The algorithm was developed with two different data sources: (1) a retrospective cohort, used for training, consisting of 1,334 patients’ records with 545,959 min of arterial waveform recording and 25,461 episodes of hypotension; and (2) a prospective, local hospital cohort used for external validation, consisting of 204 patients’ records with 33,236 min of arterial waveform recording and 1,923 episodes of hypotension. The algorithm relates a large set of features calculated from the high-fidelity arterial pressure waveform to the prediction of an upcoming hypotensive event (mean arterial pressure < 65 mmHg). Receiver-operating characteristic curve analysis evaluated the algorithm’s success in predicting hypotension, defined as mean arterial pressure less than 65 mmHg. Results Using 3,022 individual features per cardiac cycle, the algorithm predicted arterial hypotension with a sensitivity and specificity of 88% (85 to 90%) and 87% (85 to 90%) 15 min before a hypotensive event (area under the curve, 0.95 [0.94 to 0.95]); 89% (87 to 91%) and 90% (87 to 92%) 10 min before (area under the curve, 0.95 [0.95 to 0.96]); 92% (90 to 94%) and 92% (90 to 94%) 5 min before (area under the curve, 0.97 [0.97 to 0.98]). Conclusions The results demonstrate that a machine-learning algorithm can be trained, with large data sets of high-fidelity arterial waveforms, to predict hypotension in surgical patients’ records.
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Ngamprasertwong, Pornswan, Mounira Habli, Anne Boat, Foong Yen Lim, Hope Esslinger, Lili Ding, and Senthilkumar Sadhasivam. "Maternal Hypotension during Fetoscopic Surgery: Incidence and Its Impact on Fetal Survival Outcomes." Scientific World Journal 2013 (2013): 1–7. http://dx.doi.org/10.1155/2013/709059.
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In this retrospective cohort study, we aimed to determine the incidence of intraoperative maternal hypotension during fetoscopic surgery for twin-twin transfusion syndrome (TTTS) and to evaluate the impact of intraoperative hypotension on fetal survival. A total of 328 TTTS patients with recipient twin cardiomyopathy who underwent fetoscopic surgery under epidural anesthesia were included. The exposure of interest was maternal medical therapy with nifedipine for the treatment of fetal cardiomyopathy. We found that intraoperative hypotension occurred in 53.4% (175/328 patients). There was no statistically significant difference in incidence of hypotension between nifedipine exposure and nonexposure groups (54.8% versus 50.8%,P=0.479). However, the nifedipine exposure group received a statistically significant higher dose of phenylephrine (7.04 ± 6.38 mcg/kg versus 4.70 ± 4.14 mcg/kg,P=0.018) and higher doses of other vasopressor, as counted by number of treatments (6.06 ± 4.58 versus 4.96 ± 3.42,P=0.022). There were no statistically significant differences in acute fetal survival rate (within 5 days) and fetal survival rate at birth between hypotensive and nonhypotensive patients. We concluded that preoperative exposure to nifedipine resulted in increased intraoperative maternal vasopressor requirement during fetoscopic surgery under epidural anesthesia. In patients who had intraoperative maternal hypotension, there was no correlation between the presence of maternal hypotension and postoperative fetal survival.
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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 (September 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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Dietrich, W. Dalton, Ricardo Prado, Cristina Pravia, Weizhao Zhao, Myron D. Ginsberg, and Brant D. Watson. "Delayed Hypovolemic Hypotension Exacerbates the Hemodynamic and Histopathologic Consequences of Thromboembolic Stroke in Rats." Journal of Cerebral Blood Flow & Metabolism 19, no. 8 (August 1999): 918–26. http://dx.doi.org/10.1097/00004647-199908000-00011.
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Abnormalities in cerebrovascular reactivity or hemodynamic reserve are risk factors for stroke. The authors determined whether hemodynamic reserve is reduced in an experimental model of thromboembolic stroke. Nonocclusive common carotid artery thrombosis (CCAT) was produced in rats by a rose bengal-mediated photochemical insult, and moderate hypotension (60 mm Hg/30 min) was induced 1 hour later by hemorrhage. Alterations in local cerebral blood flow (lCBF) were assessed immediately after the hypotensive period by 14C-iodoantipyrine“ autoradiography, and histopathologic outcome was determined 3 days after CCAT. Compared to normotensive CCAT rats (n = 5), induced hypotension after CCAT (n = 7) led to enlarged regions of severe ischemia (i.e., mean lCBF < 0.24 mL/g/min) in the ipsilateral hemisphere. For example, induced hypotension increased the volume of severely ischemic sites from 16 ±4 mm3 (mean ± SD) to 126 ± 99 mm3 ( P < 0.05). Histopathologic data also showed a larger volume of ischemic damage with secondary hypotension (n = 7) compared to normotension (22 ± 15 mm3 versus 5 ±5 mm3, P < .05). Both hypotension-induced decreases in lCBF and ischemic pathology were commonly detected within cortical anterior and posterior borderzone areas and within the ipsilateral striatum and hippocampus. In contrast to CCAT, mechanical ligation of the common carotid artery plus hypotension (n = 8) did not produce significant histopathologic damage. Nonocclusive CCAT with secondary hypotension therefore predisposes the post-thrombotic brain to hemodynamic stress and structural damage.
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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 (August 2, 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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Lee, Subin, Misoon Lee, Sang-Hyun Kim, and Jiyoung Woo. "Intraoperative Hypotension Prediction Model Based on Systematic Feature Engineering and Machine Learning." Sensors 22, no. 9 (April 19, 2022): 3108. http://dx.doi.org/10.3390/s22093108.
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Arterial hypotension is associated with incidence of postoperative complications, such as myocardial infarction or acute kidney injury. Little research has been conducted for the real-time prediction of hypotension, even though many studies have been performed to investigate the factors which affect hypotension events. This forecasting problem is quite challenging compared to diagnosis that detects high-risk patients at current. The forecasting problem that specifies when events occur is more challenging than the forecasting problem that does not specify the event time. In this work, we challenge the forecasting problem in 5 min advance. For that, we aim to build a systematic feature engineering method that is applicable regardless of vital sign species, as well as a machine learning model based on these features for real-time predictions 5 min before hypotension. The proposed feature extraction model includes statistical analysis, peak analysis, change analysis, and frequency analysis. After applying feature engineering on invasive blood pressure (IBP), we build a random forest model to differentiate a hypotension event from other normal samples. Our model yields an accuracy of 0.974, a precision of 0.904, and a recall of 0.511 for predicting hypotensive events.
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Matsushita, Yoshitaro, Helen M. Bramlett, John W. Kuluz, Ofelia Alonso, and W. Dalton Dietrich. "Delayed Hemorrhagic Hypotension Exacerbates the Hemodynamic and Histopathologic Consequences of Traumatic Brain Injury in Rats." Journal of Cerebral Blood Flow & Metabolism 21, no. 7 (July 2001): 847–56. http://dx.doi.org/10.1097/00004647-200107000-00010.
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Alterations in cerebral autoregulation and cerebrovascular reactivity after traumatic brain injury (TBI) may increase the susceptibility of the brain to secondary insults, including arterial hypotension. The purpose of this study was to evaluate the consequences of mild hemorrhagic hypotension on hemodynamic and histopathologic outcome after TBI. Intubated, anesthetized male rats were subjected to moderate (1.94 to 2.18 atm) parasagittal fluid–percussion (FP) brain injury. After TBI, animals were exposed to either normotension (group 1: TBI alone, n = 6) or hypotension (group 2: TBI + hypotension, n = 6). Moderate hypotension (60 mm Hg/30 min) was induced 5 minutes after TBI or sham procedures by hemorrhage. Sham-operated controls (group 3, n = 7) underwent an induced hypotensive period, whereas normotensive controls (group 4, n = 4) did not. For measuring regional cerebral blood flow (rCBF), radiolabeled microspheres were injected before, 20 minutes after, and 60 minutes after TBI (n = 23). For quantitative histopathologic evaluation, separate groups of animals were perfusion-fixed 3 days after TBI (n = 22). At 20 minutes after TBI, rCBF was bilaterally reduced by 57% ± 6% and 48% ± 11% in cortical and subcortical brain regions, respectively, under normotensive conditions. Compared with normotensive TBI rats, hemodynamic depression was significantly greater with induced hypotension in the histopathologically vulnerable (P1) posterior parietal cortex ( P < 0.01). Secondary hypotension also increased contusion area at specific bregma levels compared with normotensive TBI rats ( P < 0.05), as well as overall contusion volume (0.96 ± 0.46 mm3 vs. 2.02 ± 0.51 mm3, mean ± SD, P < 0.05). These findings demonstrate that mild hemorrhagic hypotension after FP injury worsens local histopathologic outcome, possibly through vascular mechanisms.
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Higuchi, S., A. Takeshita, H. Higashi, N. Ito, T. Imaizumi, H. Matsuguchi, and M. Nakamura. "Lowering calcium in the nucleus tractus solitarius causes hypotension and bradycardia." American Journal of Physiology-Heart and Circulatory Physiology 250, no. 2 (February 1, 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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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 (November 1, 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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Matouk, M., N. Saadi, and F. Chettibi. "Impact of Arterial Hypotension During Spinal Anesthesia for Cesarean Delivery on the Newborn at Kouba Hospital." International Journal of Advanced Multidisciplinary Research and Studies 4, no. 3 (May 5, 2024): 57–59. http://dx.doi.org/10.62225/2583049x.2024.4.3.2741.
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Introduction: Spinal anesthesia is commonly used for cesarean deliveries but can lead to maternal hypotension, a frequent complication that may adversely affect the fetus. The objective of this study was to determine the incidence of post-spinal hypotension for cesarean delivery and identify associated risk factors. Methods: This was a prospective descriptive study conducted at Kouba Hospital over one month. Inclusion criteria were patients admitted for scheduled or emergency cesarean under spinal anesthesia after informed consent, without absolute contraindication to spinal anesthesia, baseline blood pressure ≥100 mmHg, and heart rate ≤100 bpm. Patients were excluded if hypotensive, vagotonic, had pre-existing cardiac disease, or received general anesthesia. All patients received 8 mg 0.5% bupivacaine, 2.5 μg sufentanil, and 100 μg intrathecal morphine with standard monitoring and 250 ml fluid preloading. Hypotension was defined as ≥20% decrease from baseline blood pressure. Data collected included demographics, obstetric history, and anesthetic/surgical details. Analysis was done using EPI Info software. Results: 42 parturients were included, mostly ASA II, with mean BMI 26.5±4.1 kg/m2 and gestational age 37.4±2.1 weeks. 50% had a history of hypotension in previous cesareans, and 68% underwent emergency cesarean. Sensory block reached T4 level on average. Hypotension incidence was 80%, with 40% requiring additional fluids and mean 15±10 mg ephedrine. Despite hypotension, most neonates had satisfactory Apgar scores. High BMI, emergency cesarean, and previous hypotension history were significantly associated with increased hypotension risk. Discussion: The high 80% hypotension incidence aligns with literature reports of 70-90%, likely exacerbated by using isobaric/hypobaric rather than hyperbaric bupivacaine. Identified risk factors were consistent with published data. Prompt management likely prevented major neonatal consequences. Conclusion: Intraoperative hypotension is frequent after spinal anesthesia for cesarean delivery. Guidelines recommend a standardized approach with fluid loading, vasopressors, and lateral tilt positioning to prevent maternal and fetal complications. Larger studies are needed to further characterize risk factors.
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Jaremko, Inna, Asta Mačiulienė, Arūnas Gelmanas, Tautvydas Baranauskas, Ramūnas Tamošiūnas, Alfredas Smailys, and Andrius Macas. "Can the inferior vena cava collapsibility index be useful in predicting hypotension during spinal anaesthesia in a spontaneously breathing patient? A mini fluid challenge." Acta medica Lituanica 26, no. 1 (May 7, 2019): 1–7. http://dx.doi.org/10.6001/actamedica.v26i1.3948.
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The study was performed at the Department of Orthopaedics and Traumatology of the Kauno Klinikos Hospital of Lithuanian University of Health Sciences. Background. Intravascular fluids are empirically administered to prevent hypotension induced by spinal anaesthesia. Ultrasound measurements of the inferior vena cava (IVC) and the IVC collapsibility index (IVC-CI) is a non-invasive method to evaluate the intravascular volume status. The aim of the study was to identify the prognostic value of the IVC collapsibility index in spontaneously breathing patients to predict severe intraoperative hypotension. Materials and methods. Sixty patients undergoing elective knee arthroplasty under spinal anaesthesia were included in the prospective study. The diameters of IVCex, IVCin, and IVC-CI were measured before and 15 min after spinal anaesthesia when administration of 500 ml of normal saline using infusion pump was finished. The haemodynamic parameters (heart rate, systolic, diastolic, and mean blood pressures, breathing rate) were collected. Results. Severe arterial hypotension was noticed in 18.3% of the patients. No statistically significant differences were detected between changes in IVCex, IVCin, and IVC-CI comparing hypotensive and non-hypotensive patients at the baseline and after the interventions (p > 0.005). According to receiver operating characteristic (ROC) analysis, IVC-CI is not effective in the prediction of severe hypotension during spinal anaesthesia in spontaneously breathing patients: the area under the ROC curve for IVC-CI was 0.05. Conclusions. IVC-CI is not an effective predictor of severe hypotension after induction of spinal anaesthesia followed by normal saline administration in spontaneously breathing patients undergoing elective knee arthroplasty. More trials, including different patient subgroups, will be needed.
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Chung, Nam Sik. "Hypotension." Journal of the Korean Medical Association 40, no. 5 (1997): 630. http://dx.doi.org/10.5124/jkma.1997.40.5.630.
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Hravnak, Marilyn, and Arthur Boujoukos. "Hypotension." AACN Clinical Issues: Advanced Practice in Acute and Critical Care 8, no. 3 (August 1997): 303–18. http://dx.doi.org/10.1097/00044067-199708000-00003.
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Scott, David a., and Michael J. Davies. "Hypotension." Baillière's Clinical Anaesthesiology 7, no. 2 (January 1993): 237–59. http://dx.doi.org/10.1016/s0950-3501(05)80242-9.
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Peeraully, Tasneem, and Michael L. Rosenberg. "Spontaneous Intracranial Hypotension Without Intracranial Hypotension." Journal of Neuro-Ophthalmology 31, no. 3 (September 2011): 248–51. http://dx.doi.org/10.1097/wno.0b013e3181fcc04a.
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Arbogast, Steven D., Amer Alshekhlee, Zulfiqar Hussain, Kevin McNeeley, and Thomas C. Chelimsky. "Hypotension Unawareness in Profound Orthostatic Hypotension." American Journal of Medicine 122, no. 6 (June 2009): 574–80. http://dx.doi.org/10.1016/j.amjmed.2008.10.040.
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Wiseman, Douglas, James D. McDonald, Dhaval Patel, Electron Kebebew, Karel Pacak, and Naris Nilubol. "Epidural anesthesia and hypotension in pheochromocytoma and paraganglioma." Endocrine-Related Cancer 27, no. 9 (September 2020): 519–27. http://dx.doi.org/10.1530/erc-20-0139.
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Postoperative hypotension frequently occurs after resection of pheochromocytoma and/or paraganglioma (PPGLs). Epidural anesthesia (EA) is often used for pain control in open resection of these tumors; one of its side effects is hypotension. Our aim is to determine if EA is associated with an increased risk of postoperative hypotension after open resection of PPGLs. We conducted a retrospective review of patients who underwent open resection of PPGLs at the National Institutes of Health from 2004 to 2019. Clinical and perioperative parameters were analyzed by the use of EA. The primary endpoint was postoperative hypotension. Ninety-seven patients (46 female and 51 male; mean age, 38.5 years) underwent open resection of PPGLs and 69 (71.1%) received EA. Patients with EA had a higher rate beta-blocker use (79.7% vs 57.1%, P = 0.041), metastasis (69.6% vs 39.3%, P = 0.011), and were more frequently hypotensive after surgery (58.8% vs 25.0%, P = 0.003) compared to those without EA. Patients with postoperative hypotension had higher plasma normetanephrines than those without (7.3 fold vs 4.1 fold above the upper limit of normal, P = 0.018). Independent factors associated with postoperative hypotension include the use of beta-blockers (HR = 3.35 (95% CI: 1.16–9.67), P = 0.026) and EA (HR = 3.49 (95% CI: 1.25–9.76), P = 0.017). Data from this retrospective study suggest that, in patients with open resection of PPGLs, EA is an independent risk factor for early postoperative hypotension. Special caution is required in patients on beta-blockade. A prospective evaluation with standardized protocols for the use of EA and management of hemodynamic variability is necessary.
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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 (September 1, 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.