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Cardiopulmonary bypass (CPB) in cardiac surgery is associated with a high risk of postoperative neurological complications. Perioperative use of vasopressors is common to counteract arterial hypotension in this setting. However, use of α-agonist vasopressors has been associated with cerebral desaturations.
View Article and Find Full Text PDFEffect of remimazolam on intraoperative hemodynamic stability in patients undergoing cerebrovascular bypass surgery: a prospective randomized controlled trial.
Korean J Anesthesiol
January 2025
Department of Anesthesiology & Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Background: Maintenance of stable blood pressure (BP) during cerebrovascular bypass surgery is crucial to prevent cerebral ischemia. We compared the effect of remimazolam anesthesia with that of propofol-induced and desflurane-maintained anesthesia on intraoperative hemodynamic stability and the need for vasoactive agents in patients undergoing cerebrovascular bypass surgery.
Methods: Sixty-five patients were randomized into remimazolam (n = 31, remimazolam-based intravenous anesthesia) and control groups (n = 34, propofol-induced and desflurane-maintained anesthesia).
A Case Report of Angiotensin II Use in the Treatment of Refractory Shock due to Amlodipine and Lisinopril Toxicity.
Case Rep Crit Care
December 2024
Department of Emergency Medicine, University of California San Francisco, San Francisco, California, USA.
Coingestion of cardiovascular drugs with angiotensin-converting enzyme inhibitors (ACEIs) can be associated with refractory shock derangements complicated by vasopressor resistance, prompting the use of novel, unconventional, or uncommonly used agents. A young adult male presented to the emergency department (ED) 10 h after ingesting lisinopril and amlodipine. On arrival, he was hypotensive with a blood pressure of 72/39 mmHg.
View Article and Find Full Text PDFPostoperative Delirium in a Randomized Trial of Intraoperative Norepinephrine versus Phenylephrine Infusion.
Anesthesiology
January 2025
University of California San Francisco, San Francisco, California (E.L.W.).
Comparison of vasopressors for management of hypotension in high-risk caesarean section under neuraxial anesthesia: a systematic review and network meta-analysis.
BMC Anesthesiol
December 2024
Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Article Synopsis
- Vasopressors like ephedrine, noradrenaline, and phenylephrine are used to manage hypotension during Caesarean sections in high-risk pregnant women receiving neuraxial anesthesia, but the best option is still being researched.
- In a study analyzing 13 trials with 1,262 patients, it was found that while no significant differences were noted in hypotension episodes among the vasopressors, phenylephrine was ranked as the most effective in preventing hypotension.
- Additionally, those on phenylephrine experienced higher rates of bradycardia, but lower instances of nausea and vomiting compared to those on ephedrine, with no major differences in fetal outcomes between noradrenaline and phenylephrine.
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