Hypotension

Prevention of hypotension associated with the induction dose of propofol: A randomized controlled trial comparing equipotent doses of phenylephrine and ephedrine Farhan M, Hoda MQ, Ullah H – J Anaesthesiol Clin Pharmacol

Posted by

0


Background and Aims: Propofol, the most commonly used intravenous (IV) anesthetic agent is associated with hypotension on induction of anesthesia. Different methods have been used to prevent hypotension but with variable results. The objective of this study was to evaluate efficacy of equipotent doses of phenylpehrine and ephedrine in preventing the hypotensive response to the induction dose of propofol.
Material and Methods: One hundred thirty five adult patients were randomised to one of the study groups: “propofol-saline (PS),” “propofol-phenylephrine (PP)” or “propofol-ephedrine (PE)” by adding study drugs to propofol. Anesthesia was induced with a mixture of propofol and the study drug. Patients were manually mask-ventilated for 5 min using 40% oxygen in nitrous oxide and isoflurane at 1%. A baseline mean arterial pressure (MAP) was recorded prior to induction of anesthesia. Systolic, diastolic and mean blood pressure and heart rate were recorded every minute for up to 5 min after induction. Hypotension was defined as a 20% decrease from the baseline MAP.
Results: There were no significant demographic differences between the groups. Overall incidence of hypotension in this study was 38.5% (52/135). Rate of hypotension was significantly higher in group PS than group PP (60% vs. 24.4% P = 0.001) and group PE (60% vs. 31.1% P = 0.005). In contrast, a significant difference in rate of hypotension was not observed between groups PP and group PE.
Conclusion: In equipotent doses, phenylephrine is as good as ephedrine in preventing the hypotensive response to an induction dose of propofol.

Adrenal fatigue symptoms and seven ways to support and heal your adrenal glands.

Posted by

2


In our modern world, adrenal fatigue is extremely common and estimated by some experts to affect approximately 80 percent of the population to some degree. Adrenal fatigue is caused by all types of stress – physical and emotional – and if left unchecked, it can lead to other illnesses such as type 2 diabetes, thyroid disease and heart attack.

fatigue

The symptoms caused by adrenal fatigue are numerous and varied. The following are some of the more common ones:

  • Anxiety
  • Panic attacks
  • Diarrhea
  • Frequent urination
  • Thyroid issues
  • Salt cravings
  • Sugar cravings
  • Insomnia
  • Waking tired
  • Needing caffeine to ‘get going’ in the morning
  • Feeling stressed
  • Inability to handle stress
  • Overthinking (having a brain that won’t turn off)
  • Dizziness when rising from seated or lying position
  • Fluid retention in feet and ankles
  • Low blood pressure


As you can see, adrenal fatigue can cause many symptoms and eventually lead to many health challenges. However, the good news is that there are plenty of things we can do to support our adrenal glands to help return them to a healthy state.

Reduce or eliminate stimulants

Stimulants such as caffeine, alcohol, nicotine and drugs cause a stress response in the body and, if used chronically, will wear out the adrenal glands. Those who feel that they need their morning coffee should understand that, although it might feel as though caffeine is helping, it is actually stealing their health by exacerbating their adrenal fatigue.

Practice meditation

Meditating daily can help reduce stress levels. Finding even 10 or 15 minutes a day to quiet the mind by meditation has been proven to be of benefit for reducing stress.

Clean up your diet

Eating a highly processed diet creates stress in the body. Many people don’t consider the stress caused to the body by eating processed foods. Processed foods contain chemicals that have no place in the body, such as preservatives, colors, stabilizers and more. These chemicals can have negative effects on the various systems of the body and add additional waste products that need to either be eliminated or stored.

Make good use of adaptogenic herbs

There are a number of adaptogens that are useful for the adrenal glands. These herbs can be taken in the form of teas, tinctures, powders or capsules and include:

  • Rhodalia
  • Ashwaganda
  • Tulsi, or Holy basil
  • Korean Ginseng
  • He Shou Wu
  • Licorice (Note: Licorice can raise blood pressure)

 

Make time to relax

Take time to chill out and make the time to do the things that you love doing and make you happy.

Eat more salt

Adrenal glands love salt. Buy a good quality, unprocessed salt, such as Celtic sea salt or Himalayan salt, and use it liberally.

Try this adrenal cocktail

Try taking this adrenal cocktail either before bed if you suffer from insomnia or upon rising if you have trouble getting going in the morning. It really works!

1/2 cup orange juice (or another form of vitamin C)
1/2 teaspoon cream of tartar
1/2 teaspoon Celtic sea salt
Mix and drink.

Finally, don’t watch horror movies and don’t do things that get your adrenaline pumping. They will simply cause more stress for your already overworked adrenal glands, leaving you feeling tired and wired.

Characteristics and Outcomes of Patients With Vasoplegic Versus Tissue Dysoxic Septic Shock.

Posted by

0


Abstract

Background: The current consensus definition of septic shock requires hypotension after adequate fluid challenge or vasopressor requirement. Some patients with septic shock present with hypotension and hyperlactatemia greater than 2 mmol/L (tissue dysoxic shock), whereas others have hypotension alone with normal lactate (vasoplegic shock).

Objective: The objective of this study was to determine differences in outcomes of patients with tissue dysoxic versus vasoplegic septic shock.

Methods: This was a secondary analysis of a large, multicenter randomized controlled trial. Inclusion criteria were suspected infection, two or more systemic inflammatory response criteria, and systolic blood pressure less than 90 mmHg after a fluid bolus. Patients were categorized by presence of vasoplegic or tissue dysoxic shock. Demographics and Sequential Organ Failure Assessment scores were evaluated between the groups. The primary outcome was in-hospital mortality.

Results: A total of 247 patients were included, 90 patients with vasoplegic shock and 157 with tissue dysoxic shock. There were no significant differences in age, race, or sex between the vasoplegic and tissue dysoxic shock groups. The group with vasoplegic shock had a lower initial Sequential Organ Failure Assessment score than did the group with tissue dysoxic shock (5.5 vs. 7.0 points; P = 0.0002). The primary outcome of in-hospital mortality occurred in 8 (9%) of 90 patients with vasoplegic shock compared with 41 (26%) of 157 in the group with tissue dysoxic shock (proportion difference, 17%; 95% confidence interval, 7%–26%; P < 0.0001; log-rank test P = 0.02). After adjusting for confounders, tissue dysoxic shock remained an independent predictor of in-hospital mortality.

Conclusions: In this analysis of patients with septic shock, we found a significant difference in in-hospital mortality between patients with vasoplegic versus tissue dysoxic septic shock. These findings suggest a need to consider these differences when designing future studies of septic shock therapies.

Source: http://journals.lww.com