No abstract available.
Basilar Artery* ; Rabbits* ; Vasoconstrictor Agents* ; Vasodilator Agents*

Hepatorenal Syndrome ; drug therapy ; Humans ; Vasoconstrictor Agents ; therapeutic use

Nasotracheal intubation is often the method of choice in oral or maxillofacial operations. During the insertion of endotracheal tube (ETT) through nostril, a considerable damage can be inflicted on the nasal mucosa by forcing ETT into the nasal cavity, and epistaxis may occur as a result of mucosal damage even when vasoconstrictors, a lubricated tube, and careful manipulation are employed. This study was conducted to observe whether balloon dilation technique(BDT) can help to minimize the expected problems during nasotracheal tube insertion and was to tried to get a data for further studies. In 30 patients in whom the nasotracheal tube was placed, smooth passage into the nasal cavity without using BDT occurred in 9 patients(30.0%). Of 21 patients(70.0%) who were come into the use of BDT when resistance to tube insertion due to anatomical structures of the nasal cavity was encountered, epistaxis was not developed. By the above results, The BDT appers to prevent epistaxis during nasotracheal tube insertion and to make an easy and smooth passage of the tube and then it suggest that the BDT should provide a basic data and an alternative to conventional techniques for a safe and atraumatic nasotracheal intubation.
Epistaxis ; Humans ; Intubation ; Nasal Cavity ; Nasal Mucosa ; Vasoconstrictor Agents

Hepatorenal Syndrome ; therapy ; Humans ; Liver Transplantation ; Vasoconstrictor Agents ; therapeutic use

BACKGROUND: Septic shock causes life threatening organ dysfunction needing vasopressor despite adequate fluid resuscitation. Numerous studies and meta-analysis have proven norepinephrine as the initial vasopressor of choice in septic shock with vasopressin as add-on. Although guidelines have established the goal monitoring response in septic shock, optimal approach in discontinuation of the vasopressors in the recovery phase of septic shock remains limited. METHODS: A systematic review and meta-analysis was performed on randomized controlled trials (RCTs) and nonrandomized studies comparing incidence of hypotension within 24 hours of discontinuing norepinephrine first versus vasopressin. Three reviewers independently selected studies, assessed their quality, and extracted the following data: the number and characteristics of patients enrolled, inclusion and exclusion criteria for each study, the description of interventions (discontinuing norepinephrine first versus discontinuing vasopressin first) and outcomes (incidence of hypotension within 24 hours). RESULTS: Seven retrospective cohort studies and one prospective randomized control trial were included. Compared with norepinephrine, risk of hypotension is higher when vasopressin is discontinued first among patients in the recovery phase of septic shock (RR 2.06; 95% CI [1.11,3.82]; I 2 91%). Results were consistent in the subgroup analysis after excluding abstract-only and poor-quality studies (RR 1.73; 95% CI [0.74, 4.03]; I 2 93%). There is no difference in ICU (RR 0.97; 95% CI [0.71, 1.32]; I 2 38%) and in-hospital mortality (RR 0.88; 95% CI [0.66, 1.16]; I 2 41%) between the two vasopressor weaning strategies. Finally ICU length of stay was reported on 5 studies with no significant difference between the two strategies. CONCLUSION: Based on the results, there is increased risk of hypotension when vasopressin is discontinued first versus norepinephrine.
Norepinephrine ; Shock, Septic ; AVP protein, human ; Vasopressins ; Vasoconstrictor Agents ; Neurophysins

BACKGROUND: When the insertion of endotracheal tubes(ETTs) through the nostril, The tubemay be encountered some resistance. Forcing ETT into the nasal cavity develop mucosal and soft tissue injuries and subsequent epistaxis during passage of the tube even when vasoconstrictors and/or a lubricated tube are employed. Therefore, We determined whether balloon dilation technique(BDT) reduces the incidence of epistaxis and increases the ease of the tube advancement in the nasal cavity during nasotracheal intubation. METHODS: Sixty adult patients who scheduled for maxillofacial surgery were divided into two groups, BDT(n=30) and non BDT(n=30). The BDT group received an armored tube, which a 14 Fr-all-silicone Foley catheter insert through the tube, while non BDT group received a plain armored tube. All patients in both groups was inserted ETTs by conventional nasotracheal insertion techniques. RESULTS: The BDT group had a signifieantly lower incidence of epistaxis(0/30 vs 8/30 : p<0.05) and provided a significantly easier passage in the nasal cavity than non BDT group (difficult tube advancement in the nasal cavity, 3/30 vs 17/30 : p<0.05). CONCLUSIONS: The BDT helps to make an easy and smooth passage of the tube and to prevent epistaxis during nasotracheal tube insertion. This study indicates that nasotracheal intubation using BDT is an easily learned, safe, effective and atraumatic method.
Adult ; Catheters ; Epistaxis* ; Humans ; Incidence* ; Intubation ; Nasal Cavity* ; Soft Tissue Injuries ; Surgery, Oral ; Vasoconstrictor Agents

Effects of various peripheral vasoconstrictors on isolated porcine basilar and posterior communicating arteries(BA and PCA) were investingated and effected of flunarizine on the contractile responses were compared with those of a vasodilator, nitroglycerin. KCl elicited dose-dependent contractions in BA and PCA. 50mM KCl-induced contraction was not affected by nitroglycerin but dose-dependently inhibited by nimodipin and flunarizine in both rings. Epinephrine produced contractile response of BA and PCA in a dose-dependent fashion, but norepinephrine or phenylephrine did not cause obvious contraction by itself. Norepinephrine and phenylephrine elicited dose-dependent contractions in both rings treated with 10 -6M propranolol and the epinephrine-induced contractions were potentiated by pretreatment with propranolol, 5-hydroxytryptamine and histamine contracted BA and PCA in a dose-dependent manner and the contraction of PCA was more prominent than that of BA. In PCA rings, 10(-6)M 5-hydroxytryptamine and 10 -6M orepinephrine-induced contractions were not changed by nitroglycerin but inhibited by flunarizine in a dose-dependent manner. Small doses of flunarizine inhibited gradually both drug-induced contractions and large doses(3.5 x 10(-6) and 10(-6)M) steeply inhibit ed the contractions. Then the slopes of inhibitory curves in both cases were biphasic. Above results suggest that responsibility of catecholamine in porcine brain artery is more prominent in alpha-adrenoceptors than in beta-adrenoceptors, and inhibitory effect of flunarizine on brain artery results from inhibition of calcium influx through stimulated receptor-operated calcium channel(ROC) and potential-operated calcium channel(POC) .
Arteries* ; Brain* ; Calcium ; Epinephrine ; Flunarizine* ; Histamine ; Nitroglycerin ; Norepinephrine ; Passive Cutaneous Anaphylaxis ; Phenylephrine ; Propranolol ; Serotonin ; Vasoconstrictor Agents

Epinephrine is one of the most widely-used vasoconstrictors in dental treatment including endodontic microsurgery. However, the systemic safety of epinephrine has been in debate for many years because of its potential risk to cause cardiovascular complications. The purpose of this review was to assess the cardiovascular effect of epinephrine use in endodontic microsurgery. Endodontic microsurgery directly applies epinephrine into the bone cavity, and the amount is reported to be much larger than other dental surgeries. Moreover, when considering that systemic potency of intraosseous application is reported to be comparable to intravenous application, the systemic influence of epinephrine could be increased in endodontic microsurgery. Besides, pre-existing cardiovascular complications or drug interactions can enhance its systemic influence, resulting in increased susceptibility to cardiovascular complications. Although clinical studies have not reported significant complications for patients without severe systemic complications, many epinephrine-induced emergency cases are warning the cardiovascular risk related with pre-existing systemic disease or drug interactions. Epinephrine is a dose-sensitive drug, and its hypersensitivity reaction can be fatal to patients when it is related to cardiovascular complications. Therefore, clinicians should recognize the risk, and the usage of pre-operative patient evaluation, dose control and patient monitoring are required to ensure patient's safety during endodontic microsurgery.
Cardiovascular Diseases ; Drug Interactions ; Emergencies ; Epinephrine* ; Hemostasis ; Humans ; Hypersensitivity ; Microsurgery* ; Monitoring, Physiologic ; Vasoconstrictor Agents

Vasoconstrictors such as epinephrine or phenylephrine have been used as an adjunct to local anesthetics to prolong the duration of spinal anesthesia. Recently, clonidine, an areceptor agonist, has been proved to have analgesic effect and to prolong epidural and spinal anesthesia. We used 0.3mg of epinephrine, 75 ug and 150 ug of clonidine in spinal anesthesia with 12 mg of T-Cain respectively and compared hemodynamic and analgesic effects of each drug. Heart rate and blood pressure were checked before, during and after anesthesia. Sensory level was checked by pin-prick method and motor blockade was measured by Bromages scale. The results were as follows. 1) Heart rate changed little in the epinephrine group and decreased significantly in all other groups.2) Systolic blood pressure decreased significantly in all groups except the epinephrine group. Both 75 ug and 150 ug of clonidine caused a significant fall in diastolic pressure. 3) The onset time for sensory and motor blockade varied little among all groups. 4) Sensory blockade was significantly higher in the 150 ug of clonidine group than the control group. Time to achieve the maximum level of sensory blockade was significantly faster in control group than 150 ug of clonidine group. 5) The duration of sensory and motor blockade was significantly prolonged in epinephrine and clonidine group than control group. The results indicate that clonidine, when used as an adjunct to T-Cain spinal anesthesia, is as effective as epinephrine in prolongation of motor and sensory blockade.
Anesthesia ; Anesthesia, Spinal* ; Anesthetics, Local ; Blood Pressure ; Clonidine* ; Epinephrine* ; Heart Rate ; Hemodynamics ; Phenylephrine ; Vasoconstrictor Agents

BACKGROUND: After cardiopulmonary bypass (CPB), the radial arterial pressure is often lower than that of the femoral artery. If this difference is overlooked, the patients might be treated with unnecessary vasoconstrictors or inotropes. However, the exact etiology or mechanism of this discrepancy is not known. If a patients group with the risk of a high pressure gradient after CPB could be predicted, the femoral arterial pressure from pre-CPB period might be monitored in order to not be inadequately managed after weaning from CPB. We studied the predicting factors of this phenomenon in patients undergoing a valvular replacement. METHODS: One hundred patients undergoing valvular replacement were included in this study. The radial and femoral arterial pressures were measured in the same monitoring system during entire procedure of the operation. The radial to femoral arterial pressure ratio (R/F) was calculated. Demographic data and hemodynamic variables after induction of anesthesia were studied using correlation analysis to assess which data could be associated with R/F. A best predictive model was developed with stepwise multiple linear regression analysis. RESULTS: Correlation analysis showed that age, preoperative ejection fraction (EF), and cardiac index after induction were statistically significant. A predictive model was developed including age and preoperative EF. The regression equation is R/F = 86.249 - (0.294 X age) + (0.329 X preoperative EF). CONCLUSIONS: It could be predicted in the patients with old age or low preoperative ejection fraction that radial arterial pressure might be lower than that of femoral artery in a valvular replacement operation.
Anesthesia ; Arterial Pressure* ; Cardiopulmonary Bypass* ; Femoral Artery ; Hemodynamics ; Humans ; Linear Models ; Vasoconstrictor Agents ; Weaning