Neurological and humoral control of blood pressure

Abstract: There is a relationship between arterial blood pressure, cardiac output and vascular resistance which can be described mathematically, and helps us to understand the short-term control of blood pressure in the terms of a hydraulic system. The sensors in this system are the arterial baroreceptors which mediate changes in the hydraulic system though control of the autonomic nervous system, which in turn influences heart rate, inotropy and vascular tone. Altering the distribution of blood between the arterial and venous systems compensates for acute changes in total blood volume. The total blood volume is controlled predominantly by the kidney, with the renin–angiotensin–aldosterone system acting as both the ‘sensor’ of blood pressure/volume (via renin release in the juxtaglomerular apparatus) and the ‘effector’ of blood pressure/volume (via aldosterone secretion by the adrenal cortex). Overall control is shared; the baroreceptors being responsible for mediating short-term changes, and renal mechanisms determining the long-term control of blood pressure. These systems have to be adaptable in order to deal with physiological variation in the delivery of blood to tissues from rest to exercise, and with the large shifts in blood volume seen in acute haemorrhage. Pathophysiological changes in these systems lead to maladaptive responses, with systemic hypertension the most commonly seen.
Source: Anaesthesia and intensive care medicine - Category: Anesthesiology Authors: Tags: Physiology Source Type: research

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AbstractPurpose of ReviewThe purpose of this paper is to review updates to the definition of pulmonary hypertension (PH), its diagnosis, and management. New treatment options, the role of mechanical support, outcome studies, and intraoperative management will be emphasized.Recent FindingsThe definition of PH has been recently changed, with a decrease in the qualifying mean pulmonary artery pressure and the addition of pulmonary vascular resistance. There have been minor changes to PH classifications. Some new medications are available to treat PH, and new associations between drugs and PH have been discovered. Recommended ...
Source: Current Anesthesiology Reports - Category: Anesthesiology Source Type: research
Background: The use of drugs to attenuate the haemodynamic response to laryngoscopy and endotracheal intubation is the standard of care during elective surgery. Current evidence is conflicting concerning the best agent and optimal dose for this purpose. In the majority of cases, fentanyl is widely utilized to attenuate haemodynamic responses. Ketamine, an established available drug, has been scarcely studied in this regard at low doses and against varying doses of other common agents.Objective: To compare the overall occurrence of hypertension and tachycardia immediately pre-intubation (post-induction) until 10 minutes pos...
Source: African Health Sciences - Category: African Health Source Type: research
A 72-year-old, 94-kg, 173-cm man with hypertension, diabetes mellitus, obstructive sleep apnea, and a family history of coronary artery disease presented to the authors ’ preoperative evaluation clinic before an elective carpal tunnel release. An electrocardiogram obtained in the clinic showed previously undocumented atrial flutter. The hand surgery was postponed; the patient was referred to the electrophysiology service for further evaluation. He subsequently un derwent a radiofrequency ablation, but then developed recurrent paroxysmal atrial fibrillation after the procedure.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Diagnostic Dilemma Source Type: research
Purpose of review Although both cost and patient preference tend to favor the office-based setting, one must consider the hidden costs in managing complications and readmissions. The purpose of this review is to provide an update on safety outcomes of office-based procedures, as well as to identify common patient-specific factors that influence the decision for office-based surgery or impact patient outcomes. Recent findings Office-based anesthesia (OBA) success rates from the latest publications of orthopedic, plastic, endovascular, and otolaryngologic continue to improve. A common thread among these studies is the a...
Source: Current Opinion in Anaesthesiology - Category: Anesthesiology Tags: AMBULATORY ANESTHESIA: Edited by Claude Meistelman Source Type: research
CONCLUSION: Strict monitoring and control of hemodynamic parameters as well as meticulous fluid therapy is the cornerstone in improving outcome in patients with dilated cardiomyopathy undergoing renal transplant surgery. PMID: 31669040 [PubMed - as supplied by publisher]
Source: Revista Brasileira de Anestesiologia - Category: Anesthesiology Tags: Rev Bras Anestesiol Source Type: research
Publication date: November 2019Source: The Journal of Foot and Ankle Surgery, Volume 58, Issue 6Author(s): James Stimpson, Damien F. Gill, Arman Memarzadeh, Mike Dunne, Laura Perry, Ahmed Magan, Adam Devany, Chandra PasapulaAbstractWe evaluated whether moving the “line of crush” from thigh to the calf before onset of tourniquet-mediated hypertension would prevent or diminish it. We also evaluated any change in pain or functional outcome. Twenty adult patients were recruited and randomly assigned to either control or intervention groups. Inclusion criteria: any willing participant>18 years old with foot and/o...
Source: The Journal of Foot and Ankle Surgery - Category: Orthopaedics Source Type: research
Conclusions: The ACS Risk Calculator accurately predicted complications in the categories of “any complication” (P
Source: Journal of Spinal Disorders and Techniques - Category: Surgery Tags: PRIMARY RESEARCH Source Type: research
Conclusions Acute oculomotor palsy may be a risk factor for rupture of ipsilateral unruptured aneurysms, but more basic research and clinical trial evidence of intracranial aneurysms are needed to confirm this.
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
We evaluated whether moving the “line of crush” from thigh to the calf before onset of tourniquet-mediated hypertension would prevent or diminish it. We also evaluated any change in pain or functional outcome. Twenty adult patients were recruited and randomly assigned to either control or intervention groups. Inclusion criteri a: any willing participant>18 years old with foot and/or ankle pathology requiring an operation lasting>90 minutes. Exclusion criteria included contraindication to general anesthesia, peripheral neuropathy affecting lower limbs of any etiology, or chronic pain requiring regular opiate analgesia.
Source: Journal of Foot and Ankle Surgery - Category: Orthopaedics Authors: Source Type: research
Abstract Obstructive Sleep Apnea is characterized by interrupted breathing that leads to cardiovascular sequelae including chronic hypertension that can persist into waking hours. Chronic intermittent hypoxia, which models the hypoxemia associated with sleep apnea, is sufficient to cause a sustained increase in blood pressure that involves the central nervous system. The median preoptic nucleus (MnPO) is an integrative forebrain region that contributes to blood pressure regulation and neurogenic hypertension. The MnPO projects to the paraventricular nucleus (PVN), a pre-autonomic region. We hypothesized that pathw...
Source: American Journal of Physiology. Heart and Circulatory Physiology - Category: Physiology Authors: Tags: Am J Physiol Heart Circ Physiol Source Type: research
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