View clinical trials related to Hypotension.
Filter by:300 consecutive patients with cirrhosis of any aetiology admitted with features of sepsis and sepsis induced hypotension to the intensive care unit, the emergency department and the step down units of Institute of Liver and Biliary Sciences, New Delhi, who fulfil the inclusion criteria. This study will be a single centre prospective randomized comparative trial. Patients will be randomized into two groups. Group A will receive crystalloid, 0.9% sodium chloride solution (total of 30ml/kg over 30 minutes) and Group B will receive colloid, 5% albumin (250 ml over 15 minutes).
The objective of this experiment is: To determine if nicotine chewing gum will improve acute episodes of orthostatic hypotension in PD subjects.
BACKGROUND: Hypotension occurs commonly during spinal anaesthesia for caesarean section and may result in detrimental effects to the mother and foetus. A previous pilot study where images of the pulse oximeter waveform study were taken, found that the dicrotic wave moved away from the systolic wave during the onset of hypotension. AIMS: The investigators wish to download electronic data which describe the pulse oximeter pulse wave to more accurately assess movement of the diastolic wave relative to the systolic wave during spinal anaesthesia for caesarean section. METHODOLOGY: 20 women undergoing caesarean section under spinal anaesthesia will be recruited by informed consent for this observational study. Data downloaded from the pulse oximeter will be analysed to identify movement of the dicrotic wave relative to the systolic wave and this will be related to changes in blood pressure. EXPECTED OUTCOMES: The investigators will establish best way to analyse changes in the pulse oximeter waveform and the relationship between changes in pulse oximeter waveform morphology and the onset of hypotension during spinal anaesthesia for caesarean section. IMPLICATIONS: Analysis of movement of the dicrotic wave could be used to anticipate and thus avoid severe hypotension during spinal anaesthesia for caesarean section.
Induction of general anesthesia to the patient could be a challenging period of anesthesia management. Due to autonomic system suppression, hemodynamic fluctuation, such as hypotension or hypertension, is commonly seen during this period. Furthermore, it has been observed that a fraction of patients who develop hypotension may be refractory to vasoactive medications to attempt to restore the systemic arterial blood pressure back to an acceptable level. Previous studies have shown that patients chronically taking angiotensin converting enzyme (ACE) inhibitors have a higher incidence of developing hypotension under general anesthesia as well as being refractory to adrenergic vasoconstrictor medications given to help restore systemic blood pressure. Interestingly, not all patients taking ACE inhibitors have shown the described hemodynamic response after induction of general anesthesia. Therefore, investigators are attempting to identify what changes in vascular physiology in those patients may contribute to acute refractory systemic hypotension. Specifically, investigators wish to explore whether differences in baseline levels of arterial stiffness potentially contribute to this phenomenon. Arterial applanation tonometry is a non-invasive technique that has been shown to reliably provide indices of arterial stiffness. In the proposed project, applanation tonometry will be performed on the right carotid and femoral arteries to assess carotid-femoral pulse wave velocity, a surrogate for aortic stiffness. (SphygmoCor system, AtCor Medical, Sydney, Australia) The measurement will be obtained before induction of general anesthesia in the pre-surgical area. During induction of general anesthesia with standard induction agents, brachial blood pressure will be measured by a cuff every minute up to 10 minutes after tracheal intubation. A hypotensive response to anesthesia will be defined by a systolic arterial blood pressure below 90mmHg upon induction. Hypotensive patients that do not respond to vasoconstrictor medications (i.e. requires more than 200 mcg phenylephrine to maintain systolic arterial blood pressure above 90 mmHg) will be classified as 'refractory hypotensive." Using non-invasive applanation tonometry, we will be able to examine if aortic stiffness has a propensity to become refractory hypotension after induction of general anesthesia. This information will potentially help identify future patients that might be at greater risk of developing refractory hypotension in response to induction of general anesthesia.
The purpose of this study is to compare the effects of two exercise protocols on post-exercise blood pressure versus a control group in elderly hypertensive men. Participants are allocated to all groups: control group and two experimental exercise protocols, in a random order. In the control group, participants remain resting sitting, and, in the exercise protocols, participants practice exercise bouts of aerobic exercise or a combination of resistance and aerobic exercises. In order to standardize baseline conditions, before the sessions subjects remain sitting quietly for 20 minutes. After each exercise protocol, participants have 60 minutes for recovery and, simultaneously, they have BP measured every 5 minutes. After the exercise sessions or control, an equipment for 24 hours ambulatory BP monitoring is installed in every participant.
The incidence of arterial hypotension under general anesthesia using sevoflurane is particularly high in newborns and infants up to 6 months of age. A decrease of 20% of the initial mean blood pressure (mBP) is the definition of significant arterial hypotension in adults and children. In adults, intraoperative arterial hypotension is associated with an increase of intraoperative mortality and a certain neurological morbidity. In infants under 6 months of age, neurological disorders have been reported following general anesthesia. Neurotoxicity of hypnotics is often incriminated as should be the episodes of arterial hypotension. Current management of hypotension uses vascular filling with crystalloids and vasopressive amines in second intention. Dopamine is the most frequently used amine. Ephedrine can also be used. Ephedrine is particularly interesting because of its action on both α and β receptors and its mode of administration: one dose and peripheral access. Only one study is available in children from birth to adulthood; it demonstrates a lower hemodynamic response in infants than in adults, when administered a low dose of Ephedrine (0.1 to 0.2 mg/kg). A recent retrospective cohort suggests an under efficacy of low doses and the use of higher doses than those recommended. The primary objective is to determine the optimal dose of ephedrine (dose of ephedrine associated with a difference of proportion of newborns/infants in therapeutic success of 55%) compare to the reference dose of 0.1mg/kg as a first line treatment of intraoperative arterial hypotension. Secondary objectives: - Return to a mBP superior to 38mmHg post Ephedrine administration. - To assess occurrence of hypoxemic events during anesthesia. - To assess tolerance of ephedrine. One hundred and twenty newborn and infants up to 6 months of age will be recruited in 3 sites of the Rhone Alpes Auvergne area over 24 months.
Traditional devices to measure blood pressure include automatic sphygmomanometer (pressure) cuff systems or manual blood pressures obtained by auscultation (listening with a stethoscope). Both these techniques fail to provide accurate and consistent blood pressure in the hypotensive (low blood pressure) state, which is often encountered in emergency departments and intensive care units. Alternately, invasive arterial pressure measurement is time-intensive, painful, expensive, and risks include bleeding, infection, and neurovascular injury. In clinical practice, the Doppler velocimetry system is occasionally used in hypotensive, critically-ill patients when an immediate systolic blood pressure measurement is vital for clinical and therapeutic management. With a technique similar to that used to obtain a manual blood pressure, the Doppler velocimetry system can be used in place of the auscultation of the brachial pulse to accurately determine the systolic blood pressure. It is currently unknown whether additional information can be obtained by evaluation of the Doppler waveform in healthy vs. critically-ill patients. The goal is this project is to digitally record Doppler waveforms of critically-ill patients in the Emergency Department (ED) via a standard 8MHz (fetal) Doppler probe, correlate the Doppler readings with current blood pressure and heart rate, and determine if waveform shapes and parameters are predictive of hemodynamic compromise.
Cervical myelopathy is commonly associated with degenerative spinal disease. Dysfunction of the autonomic nervous system is also evident in many cases of cervical myelopathy. Autonomic dysfunction may result in haemodynamic instability and hypotension under anaesthesia. It is important to maintain adequate mean arterial pressure in order to perfuse the spinal cord and prevent cord ischemia. Heart rate variability, the physiological variations of the differences between heart beats, has been used to diagnose autonomic dysfunction. In patients with cervical myelopathy it may enable the anaesthetist to predict hypotension thereby allowing for early treatment and prevention of spinal cord ischemia.
This is a Phase 3, double-blind, randomized study of LJPC-501 (angiotensin II) in adult patients diagnosed with catecholamine-resistant hypotension (CRH) conducted in multiple centers globally.
Introduction: reduction of blood pressure after physical exercise is called post exercise hypotension (PEH). However, previous studies demonstrate that ingestion of caffeine equivalent to three tea-cup of coffee abolishes this phenomenon. Objective: evaluate the influence of different doses of coffee in PEH. Methods: eleven hypertensive performed four experimental sessions of aerobic exercise in cycle ergometer (40 minutes of duration, intensity between 60% and 80% of maximum heart rate) succeeds for the ingestion of one (CAF-1), two (CAF-2), three (CAF-3) doses of caffeinated coffee (144 mg/dose), or three doses of decaffeinated coffee (DESC). Blood pressure was measured in rest and during 120 minutes of recovery post exercise, each 10 minutes.