cardiovascular-agents and cafedrine--theodrenaline-drug-combination

Hypotension in anesthesia and obstetric anesthesia in particular, is a widespread problem. After the temporary withdrawal of Akrinor from the market, the internationally available drug ephedrine is available for prevention and therapy of hypotension in anesthesia and its effect is comparable with Akrinor. In obstetric epidural anesthesia the intravenous prophylactic drug application of ephedrine seems to be superior to therapeutic application only. The aim of this overview is to show alternatives to the currently administered catecholamines for prevention of hypotension in obstetric anesthesia.

Topics: Acidosis; Adult; Anesthesia, Conduction; Anesthesia, Epidural; Anesthesia, Obstetrical; Cardiovascular Agents; Drug Combinations; Ephedrine; Female; Humans; Hypotension; Infant, Newborn; Pregnancy; Theophylline; Vasoconstrictor Agents

The discussion about perioperative withdrawal or continuation of angiotensin-converting enzyme inhibitors (ACEI) remains controversial. Should it be continued to avoid peaks in blood pressure and heart rate during anesthesia? Or should it be discontinued the day before to avoid clinically relevant hypotonia? What is the greater risk? Since there are only a few studies dealing with this question, we compared the cardio-circulatory reaction during anesthesia after withdrawal and with continuation of ACEI therapy.. A total of 100 hypertonic patients chronically treated with ACEIs were included in this prospective, randomized, double blind study. The last ACEI medication was given with the premedication in the morning (premed) or on the day before (withdrawal). Blood pressure and heart rate during induction and termination of anesthesia were compared between both groups. A threshold value for vasopressor therapy was determined to be a mean arterial pressure of 60 mmHg.. In the premed group Akrinor was necessary significantly more often and in higher dosages. Nevertheless, following induction the blood pressure and heart rates were significantly lower compared to the withdrawal group. The highest blood pressure and heart rate during induction and termination of anesthesia did not differ between the groups.. The continuation of ACEI therapy in the morning is not associated with a better control of blood pressure and heart rate but causes a more pronounced hypotension which forced a therapy more often. Patients chronically treated with ACEI should receive the ACEI the last time on the day before the operation and not with the premedication in the morning.

Topics: Aged; Anesthesia; Anesthetics, Inhalation; Angiotensin-Converting Enzyme Inhibitors; Blood Pressure; Cardiovascular Agents; Double-Blind Method; Drug Combinations; Female; Heart Rate; Humans; Hypertension; Male; Middle Aged; Preoperative Care; Prospective Studies; Theophylline

Hypotensive states that require fast stabilisation of blood pressure can occur during anaesthesia. In 1963, the 20:1 mixture of cafedrine/theodrenaline (Akrinor) was introduced in Germany for use in anaesthesia and emergency medicine in the first-line management of hypotensive states. Though on the market for many years, few pharmacodynamic data are available on this combination net beta-mimetic agent.. This study aimed to examine the drug combination in real-life clinical practice and recorded time to 10 % mean arterial blood pressure (MAP) increase and heart rate. Furthermore, potential factors that influence drug effectiveness under anaesthesia were assessed.. Data were collected within a standardised anaesthesia protocol. A total of 353 consecutive patients (female/male = 149/204) who received cafedrine/theodrenaline after a drop in MAP ≥ 5% were included in the study. The time to 10 % increase in MAP, dosage of cafedrine/theodrenaline, volume loading, blood pressure and heart rate were monitored over time.. Patients were a mean (standard deviation) of 64.4 ± 15.1 years old with a baseline MAP of 82 ± 14 mmHg, which dropped to a mean of 63 ± 10 mmHg during anaesthesia without gender differences. Cafedrine/theodrenaline (1.27 ± 1.0 mg/kg; 64 ± 50 µg/kg) significantly increased MAP (p < 0.001) by 11 ± 16 mmHg within 5 min, reaching peak values within 17.4 ± 9.0 min. Heart rate was not affected in a clinically significant manner. Cafedrine/theodrenaline induced a 10% MAP increase after 7.2 ± 4.6 min (women) and after 8.6 ± 6.3 min (men) (p = 0.018). Independent of gender, the dose of cafedrine/theodrenaline required to achieve the observed MAP increase of 14 ± 16 mmHg at 15 min was significantly different in patients with heart failure [1.78 ± 1.67 mg/kg (cafedrine)/89.0 ± 83.5 µg/kg (theodrenaline)] compared with healthy patients [1.16 ± 0.77 mg/kg (cafedrine)/58.0 ± 38.5 µg/kg (theodrenaline)] (p = 0.005). Concomitant medication with beta-blocking agents significantly prolonged the time to 10 % MAP increase [9.0 ± 7.0 vs. 7.3 ± 4.3 min (p = 0.008)].. Cafedrine/theodrenaline quickly restores MAP during anaesthesia. Female gender is associated with higher effectiveness, while heart failure and beta-blocker administration lower the anti-hypotonic effect. Prospective studies in defined patient populations are warranted to further characterise the effect of cafedrine/theodrenaline.

Topics: Adrenergic beta-Antagonists; Adult; Aged; Anesthesia; Blood Pressure; Cardiovascular Agents; Drug Combinations; Drug Interactions; Female; Heart Failure; Heart Rate; Humans; Hypotension; Intraoperative Care; Kaplan-Meier Estimate; Male; Middle Aged; Retrospective Studies; Sex Characteristics; Theophylline

Topics: Arginine Vasopressin; Cardiovascular Agents; Critical Care; Drug Approval; Drug Combinations; Drug Industry; Germany; Humans; Theophylline; Vasoconstrictor Agents

The circulatory effects of Akrinor were investigated in anaesthetized patients during extracorporeal circulation and following open heart surgery. Arterial pressure, cardiac index and the maximal rate of rise of left ventricular pressure increased, whereas the resistance to flow in both circuits and the cardiac filling pressures remained unchanged. The compliance of the extrathoracic capacitance vessels during extracorporeal circulation was unaltered compared with the control group, but the volume content was less after Akrinor (200 ml). If this volume is shifted to the intrathoracic compartment in the intact circulation, the amounts seems too small to explain the increase in cardiac index. This increase and the subsequent rise of the arterial pressure seemed to be due to increased myocardial contractility.

Topics: Anesthesia; Cardiac Surgical Procedures; Cardiovascular Agents; Coronary Circulation; Drug Combinations; Extracorporeal Circulation; Hemodynamics; Humans; Phenethylamines; Regional Blood Flow; Theophylline