جستجوی مقالات مرتبط با کلیدواژه "hypotension" در نشریات گروه "پزشکی"

 Hypomagnesaemia secondary to the use of proton-pump inhibitor (PPI) is associated with the reduction of blood pressure.

 To determine the effect of PPI and ranitidine on the reduction of serum magnesium level and blood pressure in chronic hemodialysis patients with hypotension.

 In this double-blind randomized clinical trial, 44 hemodialysis patients who met the requirements entered the study. First, blood sample was taken from each of the patients and their serum magnesium level as well as their blood pressure was checked and recorded. Then, the patients in the intervention group received daily doses of ranitidine placebo (150 mg) and pantoprazole (40 mg) and those in the control group received daily doses of pantoprazole placebo (40 mg) and ranitidine (150 mg) for three months. After the intervention, blood samples were taken again in order to assess the patients’ serum magnesium level. The obtained data were fed into SPSS Software and analyzed.

 The mean age of the patients was 60.14±12.98 years. Moreover, 63.6% of the total patients were female. In the group of patients who had received pantoprazole, diastolic pressure reduced significantly at the end of the study as compared to the beginning of the study. Moreover, in the patients receiving pantoprazole indicated a significant reduction of magnesium at the end of the study as compared to the beginning of the study.

 In this study, a significant relationship was also observed between the use of PPI and hypomagnesemia in hemodialysis patients.
Trial registration: The trial protocol was approved in the Iranian Registry of Clinical Trials (identifier: IRCT20150808023559N19; https://en.irct.ir/trial/42478, ethical code# IR.ARUMS. REC.1398.295).

 Spinal anesthesia is considered to be the safest method of anesthesia for cesarean sections in patients with preeclampsia. Patients with preeclampsia are at an increased risk of experiencing severe hypotension following spinal anesthesia, which could have more profound and deleterious effects on both the fetus and the mother. However, bupivacaine, the most commonly used drug, can induce severe hypotension even at low doses. The purpose of this study is to minimize post-spinal hypotension in both the mother and the fetus.

 To determine and compare the reduction in hypotension following spinal anesthesia in patients with preeclampsia between the ropivacaine and bupivacaine groups.

 In a randomized clinical trial, a total of 90 parturients with preeclampsia undergoing spinal anesthesia were enrolled and randomly divided into 2 groups: One receiving ropivacaine and the other receiving bupivacaine. The dose of spinal ropivacaine was 15 mg of a 0.5% solution, and the dose of bupivacaine was also 15 mg of a 0.5 % solution. Hemodynamic parameters, including systolic and diastolic blood pressure and heart rate, were recorded following the administration of spinal anesthesia. Pain scores and the time until the return of motor movement were also documented.

 For statistical analysis, the t-test, Chi-square, and ANOVA tests were utilized to compare the groups. Demographic variables, including maternal age, gestational age, parity, and gravidity, were not significantly different between the 2 groups. The trend of mean systolic blood pressure (SBP) was significantly lower in the bupivacaine group compared to the ropivacaine group at all measured time points in the study (P < 0.05). The amount of ephedrine used after spinal anesthesia was significantly different at 2 and 4 minutes in the ropivacaine group compared to the bupivacaine group (P = 0.012, P = 0.025). Post-operative pain scores at 1 hour in recovery were not significantly different between the ropivacaine and bupivacaine groups (P = 0.015). The time to knee movement was also significantly shorter in the ropivacaine group compared to the bupivacaine group (P < 0.001).

 Ropivacaine reduces the incidence of hypotension in spinal anesthesia compared to bupivacaine for cesarean section in patients with preeclampsia. This is attributed to a lower occurrence of spinal-induced hypotension, improved hemodynamic control, reduced ephedrine usage, and faster patient ambulation. A future study could focus on investigating different dosages of both drugs with a larger number of participants.

We aimed to evaluate the effect of glucose-containing crystalloid infusion before anesthesia induction on hemodynamics and postanesthesia complications.

This double-blind, randomized clinical trial was conducted on 60 parturient cases scheduled for elective Cesarean delivery under spinal anesthesia who were referred to the teaching hospitals of Mashhad University of Medical Sciences (Iran). The parturients were randomized into two groups. Both groups received 5 - 7 mL/kg of intravenous bolus serum before spinal anesthesia. The parturients in the glucose-containing normal saline (GcNS) group received 1% glucose solution in normal saline. The normal saline (NS) group received only normal saline. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), blood glucose concentrations, neonatal Apgar scores, postanesthesia complications, and ephedrine and atropine consumption were evaluated.

Sixty patients were recruited (30 in each group), with a mean age of 29.14 ± 6.01 and 29.76 ± 6.15 years in the GcNS and NS groups, respectively. There was no significant difference between the two groups in SBP, DBP, or HR after baseline adjustment. The incidence of hypotension was higher in the NS (70.0%) compared to the GcNS group (46.6%), but the difference was not significant. There was no significant difference in Apgar scores. The incidence of nausea, vomiting, pallor, and shivering was higher in the NS group. However, only nausea and vomiting 10 minutes after anesthesia induction were significant. Ephedrine and atropine consumption was higher in the NS group, but not significantly.

The present study did not show any clear benefit for adding 1% glucose to normal saline solution preload for hypotension in parturients undergoing Cesarean delivery with spinal anesthesia.

Rhinoplasty is a complex but popular surgery in Iran. The main complications of the surgery are post-operative bleeding and nasal septal hematoma due to poor intra-operative controlled hypertension. This study aimed to compare the efficacy of isoflurane-remifentanil (I-R) versus propofol-remifentanil (P-R) to induce controlled hypotension and to assess surgeon satisfaction with each of these combinations during rhinoplasty.  In 2020-2021, a single-blind clinical study was conducted on 98 patients aged 18-50 years undergoing rhinoplasty at Mother and Child Hospital (Shiraz, Iran). Patients were randomly divided into P-R (n=48) and I-R (n=50) groups. Changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were assessed during surgery and in the recovery room. A questionnaire was used to evaluate the level of surgeon satisfaction. Data were analyzed using independent samples t test, Chi-square test, and repeated measures ANOVA with SPSS software. P<0.05 was considered statistically significant. Five minutes after anesthesia induction, the P-R combination had a greater effect on reducing SBP (P=0.010), DBP (P=0.007), MAP (P=0.003), and HR (P=0.026) than I-R. However, from the 40th minute to the end of surgery and after 30 minutes of recovery, the I-R combination had a slightly better effect on blood pressure reduction than P-R. There was no difference in surgeon satisfaction with either of the two drug combinations. Both P-R and I-R combinations are recommended to induce hypotension during rhinoplasty. However, I-R is more effective than P-R in inducing the desired controlled hypotension.

Fluoxetine is a Selective Serotonin Reuptake Inhibitor (SSRI) that exerts its anti-depressive effect by blocking the presynaptic reuptake of the neurotransmitter serotonin, 5-hydroxytryptamine (5-HT). Although fluoxetine is usually considered safe for most patients, in the present case report, we describe a young patient with Mixed Anxiety and Depression Disorder (MADD) treated with fluoxetine 10 mg/day, who developed hypotension when the dosage was titrated up to 20 mg/day. After discontinuing the use of fluoxetine, the symptoms of hypotension improved. A temporal association and dose-dependent relationship between the hypotension and the use of fluoxetine was observed. To the best of our knowledge, this is the first case report that precisely associates regular doses of fluoxetine with the presence of hypotension. Because boosting central serotonergic function lowers blood pressure, it is suggested that a significant effect of fluoxetine on the vasomotor center may be responsible for the reduction of blood pressure. Thus, physicians should be aware of the possible risk of hypotension induced by fluoxetine and recommend patients discontinue the drug immediately if complications have occurred.

 It is essential to maintain the hemodynamic state of mothers during delivery in cesarean section (CS). Research has shown that hypotension can be controlled by applying a 15° left lateral tilt. This can be achieved using an obstetric wedge or by tilting the operating table leftward. A systematic review of further research shows insufficient evidence to suggest whether it is effective or practical.

 This study aims to evaluate the effectiveness of manual left tilting of the uterus on maintaining the hemodynamic status of mothers undergoing a CS delivery, where a spinal anesthetic has been given.

 Seventy women who were candidates for CS deliveries were randomly assigned into 2 groups as follows: group 1, the anaesthesiologist manually maneuvered the mother’s uterus to the left shortly after spinal anesthesia; group 2, the mothers’ uteruses were not displaced to the left. Sixty-seven of 70 participants completed the study. The hemodynamic status of the mother was reported before, during, and after surgery. The total doses of inotropic-vasopressors used to maintain hemodynamic stability were recorded.

 The mother’s age, vital signs, and body mass index (BMI) before pregnancy and near term were not significantly different. Mothers maintained a significantly higher systolic blood pressure (SBP) when the uterus was displaced to the left (group 1). The mothers also required less ephedrine. Mothers in group 2 suffered a greater decrease in their SBP both after induction and before incision of the abdomen (group 2, P < 0.05).

 The manual tilting of the uterus to the left during CS is effective in maintaining blood pressure and decreases the need for vasopressors.

Glutamate is an important excitatory neurotransmitter in the pedunculopontine tegmental (PPT) nucleus. The cardiovascular effect of glutamate and its non‑N‑methyl‑D‑aspartate (NMDA) receptor in the PPT is unknown; therefore, we evaluated glutamate and its non‑NMDA receptor on cardiovascular parameters in normotensive and hypotensive induced by hydralazine (HLZ) in rat.

After anesthesia, the femoral artery was cannulated for recording of cardiovascular parameters. Microinjection of drugs was done stereotaxically. L‑Glutamate (L‑Glu) and 6‑cyano‑7‑nitroquinoxaline‑2,3‑dione (CNQX) (an antagonist of nonNMDA receptor) were microinjected into the PPT in normotensive and HLZ hypotensive rats. Changes (∆) of mean arterial pressure (MAP), systolic blood pressure (SBP), and heart rate (HR) were obtained and compared with the control group.

In normotensive rats, L‑Glu significantly increased SBP and MAP (P < 0.001) and decreased HR (P < 0.01), whereas CNQX alone did not significantly effect. Coinjection L‑Glu + CNQX significantly attenuates the cardiovascular effect of L‑Glu (P < 0.05 to P < 0.01). In hypotension induced by HLZ, SBP and MAP significantly decrease but HR did not change. In HLZ groups, L‑Glu significantly improves (P < 0.05) and CNQX deteriorated hypotension induced by HLZ (P < 0.05). Coinjection of L‑Glu + CNQX also attenuates the effect of L‑Glu on ∆ MAP and ∆ SBP. In hypotension, ∆HR induced by L‑Glu was significantly higher than CNQX (P < 0.01). In L‑Glu + CNQX group, ∆HR also was lower than L‑Glu (P < 0.05).

Our findings revealed that glutamatergic system of the PPT in both normotensive and hypotension induced by HLZ plays a pressor with bradycardic responses that partly mediated by non‑NMDA receptor.

An accurate non-invasive evaluation of coronary artery disease (CAD) is essential in choosing the right management plan. Dobutamine stress myocardial perfusion imaging (MPI) is a substitute test for patients who cannot exercise. This study aimed to assess the relationship between dobutamine-induced hypotension and risk stratification of annual hard cardiac events evaluated by MPI. This study is a retrospective study conducted on 1004 patients from October 2015 to august 2019.These patients referred to Rasoul Akram Hospital, because they could not exercise electrocardiography or had contraindications to vasodilator therapy, they were subjected to dobutamine Tc99m-Sestamibi single photon emission tomography (SPECT) protocol. During the protocol, blood pressure was measured with a one-minute interval.  From among the participants, 247 patients had decreased blood pressure by more than 20 mmHg during infusion. Then for patients, a gated MPI scan was performed, and  MPI with a quantitative and visual interpretation determined the risk stratification of the patients. Multivariable logistic regression model assessed the associations between decrease in blood pressure (above 20 mmHg) and risk stratification. A total of 1004 patients with a mean age of 59.07 years were studied. Of these patients, 247 had > 20mmHg drop in systolic BP from baseline. This study revealed a significant correlation between hypotension during the dobutamine stress test and high-risk scan patterns in myocardial perfusion scan. Moreover, there was a significant correlation between age increase, smoking, diabetes mellitus, transient ischemic dilation (TID), high baseline blood pressure, and history of CABG or angioplasty with a high-risk scan pattern in MPI. This study demonstrated that hypotension during the dobutamine stress test is correlated with high-risk scan patterns in MPI.

Nitroglycerin, a vasodilator, is commonly administered to treat ischemic heart disease. Adverse effects after toxicity are light-headedness, nausea, blurry vision, and syncope due to low systolic blood pressure as well as methemoglobinemia. A 19-year-old female was admitted to our toxicology department after suicidal ingestion of 320 mg extended-release nitroglycerin about 45 minutes before the admission. She was conscious, and her initial blood pressure was 98/65 mm Hg, which was decreased to 77 mmHg within 1.5 hours despite administration of 1 liter of normal saline. Due to severe hypotension, norepinephrine infusion was started for systolic blood pressure maintenance above 80mm Hg; however, she started complaining of palpitation and chest pain. So, the dose of norepinephrine was reduced, and glucose, insulin, and potassium protocol were started. After 3 hours of therapy, her hemodynamic condition stabilized with systolic blood pressure above 90mm Hg; hence norepinephrine was discontinued. She was discharged on the 3rd day after the psychiatric consultation, with regular clinical and paraclinical examinations.

In the present study, the cardiovascular effects of glutamate NMDA receptor of the pedunculopontine tegmental nucleus (PPT) in normotensive and hydralazine (HLZ) hypotensive rats were evaluated. 

In the normotensive condition, MK-801(1 nmol; an NMDA receptor antagonist) and L-glutamate (L-Glu, 50 nmol an agonist) alone and together were microinjected into the nucleus using a stereotaxic device. In hypotensive condition, 2 min after induction of hypotension by HLZ (10 mg/kg, intravenous), drugs, same as in normotensive condition, were microinjected into the PPT. Recorded mean arterial pressure (MAP), systolic blood pressure (SBP), and heart rate (HR) were recorded throughout the experiment by a Power lab apparatus that was connected to a catheter inserted into the femoral arty. The cardiovascular changes (Δ) induced by microinjection drugs were computed and statistically analyzed.

In the normotensive condition, L-Glu significantly increased ΔMAP and ΔSBP (P<0.001) and decreased ΔHR (P<0.01) compared with the control. MK-801 alone significantly increased HR (P<0.05) while co-injected with L-Glu + MK-801 it significantly attenuated the L-Glu effect on ΔMAP and ΔSBP but augmented ΔHR (P<0.01). In the hydralazine hypotension condition, L-Glu significantly improved hypotension (P<0.01) and deteriorated bradycardia induced by HLZ (P<0.05). MK-801 alone did not significantly affect ΔMAP, ΔSBP, and ΔHR but when co-injected with L-Glu (L-Glu + MK-801) it could significantly attenuate the cardiovascular effect of L-Glu in the PPT. 

We found that activation of NMDA receptors of the glutamatergic system in the PPT evoked blood pressure and inhibited HR in both normotensive and hypotensive conditions in rats.

Since the beginning of the coronavirus disease 2019 (COVID-19) outbreak, it was assumed that infection rate in pediatric patients is lower than in adults and that infection is less severe in children than adult patients. Recently, there have been several reports and case series presenting critically-ill children with COVID-19, but still, severe hypotension is rare in pediatric patients with COVID-19.

We describe three pediatric cases with COVID-19 who presented with multi-system organ failure and severe hypotension treated with the guidance of the parameters of an invasive continuous hemodynamic monitoring device. We also compare their parameters with few articles on pediatric sepsis parameters.

Although we usually start the treatment of hypotensive pediatric patients with hydration and epinephrine as an inotrope, in our cases, we required a different treatment plan according to the hemodynamic monitoring parameters, which indicates the value of the utilization of these devices in pediatric intensive care units

Post spinal anesthesia hypotension (PSAH) is frequently encountered in anesthetic practice, especially during cesarean section. Ultrasound is a safe and easy technique for hemodynamic monitoring.

This study was conducted to assess the efficacy of pre-operative inferior vena cava collapsibility index (IVCCI) and internal jugular vein collapsibility index (IJVCI) in predicting PSAH.

This cross-sectional blinded study included 55 pregnant females prepared for elective cesarean section. They were divided into two groups based on the incidence of PSAH: (1) cases with PSAH (26 cases); and (2) cases without PSAH (29 cases). All the cases underwent ultrasound-guided measurement of IVCCI and IJVCI. The efficacy of these parameters was assessed in predicting PSAH.

Cases in both groups expressed non-significant differences regarding demographic data. However, IVCCI had mean values of 38.27 and 23.97%, while IJVCCI had mean values of 46.50 and 33.41%, respectively, in cases with and without PSAH. For IVCCI, using a cut-off point of 33% had sensitivity and specificity (84.6 and 93.1%, respectively) for predicting PSAH, with a diagnostic accuracy of 89.1%. IJVCI had sensitivity and specificity of 84.6 and 82.8%, respectively, for predicting the same complication using a cut-off value of 38.5%.

IVCCI and IJVCI are efficacious and reliable tools in predicting PSAH in pregnant ladies undergoing cesarean section, with a slight superiority for IVCCI regarding specificity and accuracy.

When performing spinal anesthesia for cesarean section, it is important to determine the appropriate anesthetic dose as well as to predict the level of spinal anesthesia. In this study, it was hypothesized that some anthropometric measurements may be related to maximum sensory block and hemodynamic changes.

The aim of this study are to find maternal anthropometric values that are correlate with the level of spinal anesthesia.

Maternal anthropometric measurements, including height, weight, supine and standing abdominal circumference (AC), and hip circumference, were recorded before spinal anesthesia for cesarean section. Spinal anesthesia was induced by administering 8 mg of 0.5% hyperbaric bupivacaine and 20 μg of fentanyl at the L3-L4 interspace. The level of sensory block was determined using pin-prick at 1, 5, 10, and 15 minutes after spinal anesthesia. The sensory block level and hemodynamic adverse events were analyzed in relationship to anthropometric measurements.

The supine AC/height ratios significantly correlate with the maximal sensory block level at 5, 10, and 15 minutes after the injection of spinal anesthetic (P = 0.001, P < 0.001 and P < 0.001, respectively). Further, there were significant correlations between body mass index (BMI) and sensory block level at every assessment (P = 0.041, P = 0.002, P = 0.001 and P < 0.001, respectively). When comparing the groups with and without hypotension, BMI, weight, and supine AC/height ratio were found to be significantly higher in the group with hypotension (P = 0.002, P = 0.004 and P = 0.006, respectively).

We conclude that BMI and AC/height ratio correlate with the sensory block level of spinal anesthesia for cesarean section.

We aimed to explore and analyze the relationships between mean corpuscular volume (MCV), red blood cell distribution width (RDW) and hypotension in patients with hemodialysis.

The clinical data of 163 patients from the Xinghua People’s Hospital, Taizhou, China with hemodialysis were retrospectively analyzed. The incidence of hypotension was counted and the levels of MCV and RDW were compared between the patients with and without hemodialysis. MCV and RDW were analyzed as possible influencing factors of hypotension. Receiver operating characteristic curve (ROC) was drawn to analyze the effect of MCV and RDW on the risk assessment of hypotension in patients with hemodialysis.

MCV in patients with hypotension was significantly lower than those without hypotension (P < 0.05), and RDW was higher than those without hypotension (P < 0.05). The constituent ratio of higher age (>60), diabetic nephropathy, maintenance hemodialysis, MCV < 80fl, RDW > 14.8%, malnutrition, anemia, ultra-filtration rate, diet during dialysis, coronary heart disease, atrial fibrillation and antihypertensive drugs before dialysis were higher in patients with hypotension than those without hypotension (P < 0.05). The sensitivity, specificity and AUC of the combination of MCV and RDW were higher than those of the single assessment. MCV is lower in patients with hypotension and RDW is higher than those in patients without hypotension.

MCV combined with RDW has a good evaluation effect.