cardiovascular-agents and Acidosis

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

Topics: Acidosis; Adrenal Cortex Hormones; Arteriovenous Anastomosis; Blood Coagulation Disorders; Blood Transfusion; Cardiovascular Agents; Child; Child, Preschool; Hemodynamics; Hormones; Humans; Hypoxia; Infant; Infant, Newborn; Microcirculation; Receptors, Adrenergic; Shock; Shock, Hemorrhagic; Shock, Septic

Amniotic fluid embolism (AFE) is a rare, but often catastrophic, complication of pregnancy and associated with severe coagulopathy. We present an algorithm-based approach in managing coagulopathy and hemorrhage in a fatal case of histopathologically proven AFE. Thrombelastometry was used for rapid evaluation of the coagulation status. Stop of extensive hyperfibrinolysis with tranexamic acid, stabilization of initial clot formation with high-dose fibrinogen and platelet transfusions, and use of prothrombin complex concentrate together with a 1: 1 transfusion regimen of red packed cells and fresh frozen plasma was successful to control diffuse bleeding and restore clot firmness after hysterectomy. Stable clotting situation was maintained despite further clinical deterioration and development of multiple organ failure in this patient.

Topics: Acidosis; Adult; Algorithms; Blood Coagulation Factors; Blood Component Transfusion; Cardiovascular Agents; Case Management; Catastrophic Illness; Combined Modality Therapy; Diagnosis, Differential; Drug Therapy, Combination; Embolism, Amniotic Fluid; Fatal Outcome; Female; Fibrinogen; Humans; Hypotension; Hysterectomy; Infant, Newborn; Male; Multiple Organ Failure; Placenta, Retained; Postpartum Hemorrhage; Pregnancy; Sperm Injections, Intracytoplasmic; Thrombelastography; Tranexamic Acid

In recent years, continuous intravenous propofol infusion has been widely used in pediatric intensive care units. Several case reports have raised concerns about its safety. The objective of this study was to report our experience with continuous intravenous propofol in consecutive patients during an 18-month period.. The study design was a retrospective review of a case series. Case was defined as a critically ill child who was treated with continuous intravenous propofol. The attending physician staff agreed to prescribe propofol via continuous intravenous infusion at a dose not to exceed 50 microg/kg/min. The protocol allowed for each patient to receive an additional intravenous bolus of propofol at a dose of 1 mg/kg no more than once per hour. The study entailed data collection from consecutive patients who were prescribed a continuous infusion of propofol in either the pediatric intensive care unit or bone marrow transplant unit.. Data from 142 patients were analyzed. Each patient enrolled was adequately sedated. Administration of propofol via continuous intravenous infusion was not associated with metabolic acidosis or hemodynamic compromise. No patient in the study group was inadvertently extubated or had a central venous catheter accidentally discontinued.. Propofol can be safely and effectively used to provide sedation to critically ill infants and children. We speculate that continuous infusion of propofol for extended periods of time should not exceed 67 microg/kg/min.

Topics: Acidosis; Adolescent; Analgesics; Cardiovascular Agents; Child; Child, Preschool; Comorbidity; Critical Illness; Hemodynamics; Humans; Hypnotics and Sedatives; Infant; Infusions, Intravenous; Monitoring, Physiologic; Propofol; Retrospective Studies

The cardioprotective effects of fructose-1,6-diphosphate (FDP) were investigated in infarcted rats and in conscious rabbits with myocardial ischemia. The influence of FDP on metabolic acidosis was studied in isolated hypoxic rat hearts. It was shown that FDP did not change the threshold of the initiation of ischemia in conscious rabbits, but decreased necrotic zone in infarcted rat hearts. After administration of FDP the myocardial contractility was prolonged significantly as compared with control under conditions of severe metabolic acidosis. However, FDP was not effective in hypoxic hearts with compensated metabolic acidosis. It was considered, that FDP influenced only ischemic myocytes with the changes in sarcolemmal permeability.

Topics: Acidosis; Animals; Cardiovascular Agents; Coronary Disease; Disease Models, Animal; Drug Evaluation, Preclinical; Fructosediphosphates; Male; Myocardial Infarction; Rabbits; Rats; Time Factors

The management of cardiac arrest in adults is a well known and, in most hospitals, a well practised procedure. Similarly the resuscitation of the newborn is usually well provided for. However, cardiac arrests occurring in older children can cause difficulties.

Topics: Acidosis; Aftercare; Cardiovascular Agents; Child; Child, Preschool; Heart Arrest; Heart Massage; Humans; Infant; Respiration, Artificial; Resuscitation