Bolus norepinephrine and phenylephrine for maternal hypotension during elective cesarean section with spinal anesthesia: a randomized, double-blinded study.
Bolus norepinephrine and phenylephrine for maternal hypotension during elective cesarean section with spinal anesthesia: a randomized, double-blinded study. Chin Med J (Engl). 2020 Jan 28;: Authors: Wang X, Mao M, Zhang SS, Wang ZH, Xu SQ, Shen XF Abstract BACKGROUND: In recent years, norepinephrine has attracted increasing attention for the management of maternal hypotension during elective cesarean section with spinal anesthesia. Intermittent bolus is a widely used administration paradigm for vasopressors in obstetric anesthesia in China. Thus, in this randomized, double-blinded study, we compared the efficacy and safety of equivalent bolus norepinephrine and phenylephrine for rescuing maternal post-spinal hypotension. METHODS: In a tertiary women's hospital in Nanjing, China, 102 women were allocated with computer derived randomized number to receive prophylactic 8 μg norepinephrine (group N; n = 52) or 100 μg phenylephrine (group P; n = 50) immediately post-spinal anesthesia, followed by an extra bolus of the same dosage until delivery whenever maternal systolic blood pressure became lower than 80% of the baseline. Our primary outcome was standardized maternal cardiac output (CO) reading from spinal anesthesia until delivery analyzed by a two-step method. Other hemodynamic parameters related to vasopressor efficacy and safety were considered as secondary outcomes. Maternal side effects and neonatal outcomes were collected as well. ...
Contributors : Ashley McDonough ; Richard V Lee ; Shahani Noor ; Chungeun Lee ; Thu Le ; Michael Iorga ; Jessica L Phillips ; Sean Murphy ; Thomas M öller ; Jonathan R WeinsteinSeries Type : Expression profiling by arrayOrganism : Mus musculusStroke is the fifth leading cause of death in the United States and is a leading cause of serious long-term disability worldwide. Innate immune responses are critical in stroke pathophysiology, and microglia are key cellular effectors in the CNS response to ischemia/reperfusion. Using a transcriptional analysis approach, we identified a robust interferon (IFN)-stimulated gene res...
Contributors : Bing Han ; Honghong YaoSeries Type : Expression profiling by array ; Non-coding RNA profiling by arrayOrganism : Mus musculusAstrocyte activation is involved in the context of stroke. Our study provides a potential new therapeutic strategy to astrocyte activation in the context of stroke.
Stroke is considered one of the major hurdles in applying Left Ventricular Assist Device (LVAD) technology to a broader population, and remains a leading cause of mortality and morbidity despite advances in both technology and management. In the general population, incidence of stroke in African Americans (AA) has been reported to be twice that of their Caucasian counterparts, and the mortality following stroke higher in AA. We sought to assess the effect of race on both rate of stroke, as well as post stroke survival in the LVAD population.
Blood pressure (BP) control reduces stroke in LVAD patients. Home monitoring is key for optimal control. Measurement by Doppler is the most reliable non-invasive method. No study assessed the feasibility of Doppler BP obtained by LVAD patients and caregivers.
Hypertension (HTN) has been implicated as a risk factor for stroke in continuous-flow Left Ventricular Assist Device (LVAD) populations. Active treatment of HTN has been shown to decrease cerebrovascular accident rates in the recent trial. Current guidelines recommend a mean arterial pressure (MAP) of 80mmHg in LVAD patients; however, it is difficult to reliably measure Blood Pressure (BP) in this cohort. Increased BP will further affect pump output since LVAD flows are altered by both preload and afterload.
Ventricular assist devices (VADs) increase waitlist survival, yet the risk of stroke is not trivial. There is a knowledge gap regarding the impact of these strokes on heart transplant outcomes. We sought to analyze how strokes during VAD support impact post-transplant (post-Tx) outcomes in children.
Bleeding is the most common complication of left ventricular assist device (LVAD) placement. However, excessive transfusion has been linked to heart failure, stroke, and alloimmunization. We compared 90-day outcomes in patients receiving a blood conservation (BCS) versus liberal transfusion strategy during surgery and the subsequent 24 hours.
Advanced heart failure predisposes patients to intracardiac thrombus (ICT) formation. There is a paucity of evidence examining the impact of pre-existing left atrial (LA) or left ventricular (LV) thrombi on post-operative outcomes in patients undergoing durable LVAD implantation.
In the field of lung transplantation, there is a high wait list mortality. Broader use of extended criteria donors would provide additional organs for transplantation. An increasing number of organ donors are dying from drug overdose. These donors are often considered “high risk” because of their exposure to infectious diseases such as HIV and Hepatitis B and C. However, these organ donors are often younger and healthier than those that die from stroke or cardiac arrest. Successful use of lung donors who have a history of drug abuse may serve to provide addit ional organs for those patients on the wait list.
The left atrium (LA) in heart transplant (HT) recipients is a surgically created chamber from variable portions of donor and recipient. In the non-HT patients there is strong evidence that left atrial volume (LAV) is a robust predictor of cardiovascular outcomes such as atrial fibrillation, stroke, heart failure and cardiovascular death. Thus, we thought to 1) characterize LA size in HT recipients and 2) investigate the implications of “new” LA volume on HT outcomes.