Blood Coagulation ; Hemorrhage ; etiology ; prevention & control ; Humans ; Hypotension ; etiology ; prevention & control ; Infection ; etiology ; Liver, Artificial ; adverse effects

We conducted a study to determine whether the hemocontrol biofeedback system (HBS) can improve intradialytic hypotension (IDH) in hypotension-prone hemodialysis (HD) patients compared with conventional HD. In this multicenter prospective crossover study, 60 hypotension-prone patients were serially treated by conventional HD for 8 weeks (period A), by HD with hemoscan blood volume monitoring for 2 weeks (period B0), and by HBS HD for 8 weeks (period B1). The number of sessions complicated by symptomatic IDH during 24 HD sessions (14.9+/-5.8 sessions, 62.1% in period A vs 9.2+/-7.2 sessions, 38.4% in period B1, P<0.001) and the number of IDH-related nursing interventions in a session (0.96+/-0.66 in period A vs 0.56+/-0.54 in period B1, P<0.001) significantly decreased in period B1 than in period A. Recovery time from fatigue after dialysis was significantly shorter in period B1 than in period A. The patients with higher post-dialysis blood pressure, lower difference between pre- and post-dialysis blood pressure, less frequent IDH, and higher pre- and post-dialysis body weight in period A responded better to HBS in period B1 in regard to the reduction of IDH. In conclusion, HBS may improve the patient tolerability to HD by reducing the IDH frequency and promoting faster recovery from fatigue after dialysis.
Adolescent ; Adult ; Aged ; *Biofeedback, Psychology ; Blood Pressure ; Blood Volume ; Body Weight ; Cross-Over Studies ; Fatigue ; Female ; Humans ; Hypotension/etiology/*prevention & control ; Kidney Failure, Chronic/*therapy ; Male ; Middle Aged ; Prone Position ; Prospective Studies ; Renal Dialysis/adverse effects ; Young Adult

OBJECTIVETo explore the optimal approach to the prevention of hypotension during cesarean section for the benefits of both the parturients and the newborns.

METHODSForty singleton full-term pregnant women undergoing elective cesarean delivery were randomly allocated into two equal groups. For prevention of hypotension during spinal anesthesia, ephedrine or pre-anesthetic volume with Voluven was administered. The changes of blood pressure, heart rate, and Apgar scores of the newborns were monitored and recorded, and the umbilical arterial blood gas variables were compared between the two groups. The placental samples were collected and immunohistochemistry for CD34 was performed for stereological study of the placental villous capillaries.

RESULTSThe umbilical arterial PaCO(2), PaO(2) and Apgar scores showed no significant differences between the two groups (P<0.05). The heart rate, incidence of hypotension and the lactic acid value were significantly higher, and the umbilical arterial pH significantly lower in ephedrine group than in the Voluven group (P>0.05). While the length density of the villous capillaries was comparable between the two groups (P>0.05), the volume density of the villous capillaries was significantly decreased in ephedrine group (P<0.05).

CONCLUSIONPre-anesthetic volume expansion with Voluven can maintain stable hemodynamics during spinal anesthesia and also efficiently improve the tissue perfusion, microcirculation and uteroplacental blood flow, thus increasing the oxygen supply to the fetus.

Adult ; Anesthesia, Obstetrical ; adverse effects ; Anesthesia, Spinal ; adverse effects ; Cesarean Section ; Elective Surgical Procedures ; Female ; Humans ; Hydroxyethyl Starch Derivatives ; administration & dosage ; Hypotension ; etiology ; prevention & control ; Placenta ; anatomy & histology ; blood supply ; Placental Circulation ; drug effects ; Plasma Substitutes ; administration & dosage ; Pregnancy