更新于：2024-11-01

Intraoperative hypertension

术中高血压

更新于：2024-11-01

基本信息

别名

Intraoperative hypertension、術中高血圧、ｼﾞｭﾂﾁｭｳｺｳｹﾂｱﾂ

简介-

关联

项与术中高血压相关的药物

Alprostadil Alfadex

前列地尔α-环糊精包合物

靶点

EP1

作用机制

EP1激动剂

在研机构

Maruishi Pharmaceutical Co., Ltd. [+2]

原研机构

Nippon Chemiphar Co., Ltd.

在研适应症

勃起功能障碍 [+6]

非在研适应症-

最高研发阶段批准上市

首次获批国家/地区

日本

首次获批日期1979-08-27

项与术中高血压相关的临床试验

ACTRN12624000523505 / Not yet recruitingN/AIIT

The Relationship Between Postspinal Headache and Intraoperative Hemodynamic Changes After Cesarean Section Under Spinal Anesthesia

开始日期2024-05-20

申办/合作机构-

ChiCTR2400083380 / Suspended早期临床1期IIT

Remimazolam on hemodynamics in older patients under lower extremity orthopedic surgery with spinal anesthesia

开始日期2024-04-23

申办/合作机构-

NCT05301634 / Unknown status临床3期IIT

Comparison Between Hemodynamic Effect of Bilateral Infraorbital Block Versus Intranasal Application of Bupivacaine in Patients Undergoing Transsphenoidal Pituitary Adenoma Resection.A Comparative Randomized Controlled Study

The study will evaluate the efficacy of bilateral infraorbital nerve block versus preoperative nasal packing with long-acting local anesthetic bupivacaine in term of maintaining hemodynamics intraoperative within 20% below baseline to achieve adequate hypotensive anesthesia and longer duration of postoperative analgesia up to 24 hours in patients undergoing transsphenoidal pituitary adenoma resection.

开始日期2022-04-02

申办/合作机构

Cairo University

100 项与术中高血压相关的临床结果

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100 项与术中高血压相关的转化医学

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0 项与术中高血压相关的专利（医药）

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319

项与术中高血压相关的文献（医药）

2024-11-01·British Journal of Anaesthesia

Efficacy and safety of intraoperative controlled hypotension: a systematic review and meta-analysis of randomised trials

Review

作者: Dauterman, Leah ; Khan, Nabia ; Tebbe, Connor ; Adams, David C ; Gunderman, David ; Sun, Yanhua ; Liu, Ziyue ; Sessler, Daniel I ; Li, Jiangqiong ; Meng, Lingzhong

BACKGROUNDIntraoperative controlled hypotension improves surgical field visibility by reducing blood loss (efficacy) but poses potential risks linked to organ hypoperfusion (safety). The use of controlled hypotension persists despite increasing evidence of associations between intraoperative inadvertent hypotension and adverse outcomes. Therefore, we tested the hypothesis that the focus and results of intraoperative controlled hypertension research differ across anaesthesia and surgery investigators because of differing priorities.METHODSWe systematically reviewed randomised trials comparing controlled hypotension with usual care with trials categorised by investigators' affiliation.RESULTSWe identified 48 eligible trials, of which 37 were conducted by anaesthesia investigators and 11 by surgery investigators. For the primary outcome, 54% of the anaesthesia-led trials focused on safety, whereas all (100%) surgery-led trials focused on efficacy (P=0.004). Compared with usual care, mean arterial pressure in controlled hypotension was 23% (95% confidence interval [CI] 17-29%) lower in anaesthesia trials and 30% (95% CI 14-37%) lower in surgery trials; estimated blood loss was 44% (95% CI 30-55%) less in anaesthesia trials and 38% (95% CI 30-49%) less in surgery trials. Overall, blood loss was reduced by 43% (95% CI 32-53%), and trial sequential analysis supported an efficacy conclusion. Mean arterial pressure and estimated blood loss reductions were associated (R²=0.41, P=0.002). All trials were underpowered for safety outcomes, and none adequately evaluated myocardial or renal injury.CONCLUSIONSAnaesthesia researchers prioritised safety outcomes, whereas surgery researchers emphasised efficacy in controlled hypotension trials. Controlled hypotension significantly reduces blood loss. In contrast, safety outcomes were poorly studied. Given increasing observational evidence linking inadvertent hypotension to myocardial and renal injury, the safety of controlled hypotension remains to be addressed.SYSTEMATIC REVIEW PROTOCOLPROSPERO (CRD42023450397).

2024-11-01·Annals of Surgery

Implementation of a Treatment Strategy in Discordance With Current Guidelines

Article

作者: Hollmann, Markus W. ; Nieveen van Dijkum, Els J.M. ; Holscher, Isabelle ; Engelsman, Anton F. ; van den Berg, Tijs J. ; Dreijerink, Koen M.A.

Objective:This study describes the effects of introducing a protocol omitting preoperative α-blockade dose-escalation (de-escalation) in a prospective patient group.Background:The decline of mortality and morbidity associated with pheochromocytoma resection is frequently attributed to the introduction of preoperative α-blockade. Current protocols require preoperative α-blockade dose-escalation and multiple-day hospital admissions. However, correlating evidence is lacking. Moreover, recent data suggest equal perioperative safety regardless of preoperative α-blockade escalation.Methods:Single-institution evaluation of protocol implementation, including patients who underwent adrenalectomy for pheochromocytoma between 2015 and 2023. Intraoperative hemodynamic control was regulated by active adjustment of blood pressure using vasoactive agents. The primary outcome was intraoperative hypertension, defined as the time-weighted average of systolic blood pressure (TWA-SBP) above 200 mm Hg. Secondary outcomes included perioperative hypotension, postoperative blood pressure support requirement, hospital stay duration, and complications.Results:Of 102 pheochromocytoma patients, 82 were included; 44 in the de-escalated preoperative α-adrenergic protocol and 38 following the previous dose-escalation protocol. Median [IQR] TWA-SBP above 200 mm Hg was 0.01 [0.0–0.4] mm Hg in the de-escalated group versus 0.0 [0.0–0.1] mm Hg in the dose-escalated group (P=0.073). The median duration of postoperative continuous norepinephrine administration was 0.3 hours [0.0–5.5] versus 5.1 hours [0.0–14.3], respectively (P=0.003). Postoperative symptomatic hypotension occurred in 34.2% versus 9.1% of patients (P=0.005). Median hospital stay was 2.5 days [1.9–3.6] versus 7.1 days [6.0–11.9] (P<0.001). No significant differences in complication rates were observed.Conclusion:Our data suggest that adrenalectomy for pheochromocytoma employing a de-escalated preoperative α-blockade protocol is safe and results in a shorter hospital stay.

2024-09-01·Journal of Medical Cases

Intraoperative Takotsubo Syndrome

Article

作者: Lilaj, Krenar ; Coniglione, Filadelfo ; Lulaj, Diamant ; Huti, Gentian ; Abdyli, Asead ; Drishti, Alert ; Bajraktari, Mustafa ; Domi, Rudin ; Xhaja, Alert

Takotsubo cardiomyopathy is a rare condition that presents a diagnostic challenge due to its close resemblance to acute myocardial ischemia and other cardiac disorders. The excessive production of catecholamines triggers abnormal and severe changes in the myocardium, typically resulting in significant dyskinesia of the left ventricle's apex, reduced ejection fraction, hypotension, and pulmonary edema. Recent reports suggest that potential risk factors may include postmenopausal syndrome and intense, unexpected stress, whether related to life events or medical conditions. Complications such as heart failure, thrombosis, and severe arrhythmias are infrequent and more likely to occur in patients with pre-existing cardiac conditions. We present the case of a 22-year-old woman who developed intraoperative Takotsubo cardiomyopathy during a transsphenoidal resection of a prolactin-secreting pituitary tumor under general anesthesia. Perioperative combination of cabergoline and oxymetazoline induced intraoperative hypertension, pulmonary edema, and Takotsubo stress cardiomyopathy. To our knowledge, this is the first reported case in the literature of intraoperative Takotsubo cardiomyopathy, potentially linked to the specific combination of intraoperative cabergoline and oxymetazoline.