Intradialytic hypotension(IDH)is a prevalent and critical complication of haemodialysis associated with significant morbidity,mortality,and reduced quality of life in end-stage renal disease patients.IDH results from ...Intradialytic hypotension(IDH)is a prevalent and critical complication of haemodialysis associated with significant morbidity,mortality,and reduced quality of life in end-stage renal disease patients.IDH results from multifactorial interactions,including excessive ultrafiltration rates(UFR),rapid osmotic shifts,impaired vascular resistance,and comorbidities such as diabetes and cardiovascular disease.It triggers hypovolemic stress,leading to myocardial stunning,cerebral ischemia,and organ dysfunction.Non-modifiable risk factors,including age and preexisting conditions,exacerbate susceptibility,while modifiable elements such as high interdialytic weight gain and improper dialysis prescriptions worsen outcomes.In this review,we aim to conduct an in-depth analysis of IDH,exploring its clinical relevance,underlying mechanisms,risk factors,and management approaches.Additionally,we advocate for a standardised definition and propose a strategic framework to guide future research efforts.Effective management requires individualised approaches,including optimised UFR,cooled dialysate,and nutritional adjustments,alongside emerging technologies like bio-impedance spectroscopy and artificial intelligence for real-time risk prediction.A multidisciplinary team approach,incorporating nephrologists,nurses,and dietitians,is essential for holistic patient care.Future research and technological advancements hold promise for mitigating IDH’s clinical and systemic impact,ultimately improving patient outcomes and survival.展开更多
Controlled hypotension is widely used to improve surgical field visibility and reduce intraoperative blood loss.This meta-analysis systematically compared the clinical effects of dexmedetomidine(DEX)and esmolol for in...Controlled hypotension is widely used to improve surgical field visibility and reduce intraoperative blood loss.This meta-analysis systematically compared the clinical effects of dexmedetomidine(DEX)and esmolol for intraoperative controlled hypotension.Randomized controlled trials were retrieved from PubMed,EMBASE,and the Cochrane Library,and hemodynamic parameters,surgical field score,blood loss,intraoperative fentanyl consumption,operation time,recovery period,emergence time,and adverse events were pooled using R version 4.0.2,with results expressed as standardized mean differences(SMDs)or odds ratios(ORs)with 95%confidence intervals(CIs).Nine RCTs involving 478 patients were included.Compared with esmolol,DEX significantly reduced intraoperative fentanyl requirements(SMD=−5.96,95%CI[−8.48,−3.43],p<0.0001)but was associated with a longer emergence time(SMD=3.11,95%CI[1.93,4.29],p<0.0001).No significant differences were observed in hemodynamic stability,surgical field quality,blood loss,operation time,recovery period,or adverse events.Overall,DEX and esmolol provide comparable hemodynamic control,bleeding conditions,operative duration,and recovery profiles during controlled hypotension,while DEX is associated with reduced intraoperative analgesic requirements and prolonged postoperative sedation.展开更多
Objective:To summarize evidence on the prevention and management of intradialytic hypotension in maintenance hemodialysis patients,providing reference for clinical practice.Method:Chinese and English databases,guideli...Objective:To summarize evidence on the prevention and management of intradialytic hypotension in maintenance hemodialysis patients,providing reference for clinical practice.Method:Chinese and English databases,guideline websites,and professional society websites were systematically searched for literature on intradialytic hypotension guidance,including clinical decisions,guidelines,evidence summaries,systematic reviews,and expert consensuses,from database inception to October 1,2024.Evidence was extracted after literature quality evaluation.Results:A total of 11 publications were included:2 clinical decisions,7 guidelines,1 systematic review,and 1 expert consensus.38 pieces of evidence were summarized across 4 themes:pre-dialysis assessment and prevention,monitoring and management during dialysis,medication use,and patient self-management.Conclusion:The best evidence for prevention and management of intradialytic hypotension in maintenance hemodialysis patients is scientific and comprehensive.Healthcare professionals are advised to apply this evidence judiciously in conjunction with clinical realities to ensure patient safety.展开更多
Objective To assess the prevalence of and risk factors for postprandial hypotension （PPH） among old and very old Chinese men. Methods The study included 349 Chinese men aged 65 and older, grouped into two age catego...Objective To assess the prevalence of and risk factors for postprandial hypotension （PPH） among old and very old Chinese men. Methods The study included 349 Chinese men aged 65 and older, grouped into two age categories： group 1 （old） included 163 men aged 65 to 80 years; group 2 （very old） included 186 men aged over 80 years. Blood pressure changes after meals were assessed every 15 min by ambulatory blood pressure monitoring. Symptoms after meal ingestion and after standing up and changes in the baseline condition relative to blood pressure changes were observed continuously. Additional baseline data included body mass index, medical history, and medication use Results The prevalence of PPH was 59.3% overall and was significantly higher in group 2 than group 1 （63.4% vs. 54.6%, P 〈 0.05）. In group 2, the prevalence of PPH after breakfast （33.8%） and lunch （32.1%） were higher than that after supper （20.9%）, P 〈 0.05. Hypertension and age were significant risk factors for PPH （OR = 2.188, 95% CI： 1.134-4.223, P = 0.02; OR = 1.86, 95% CI： 1.112-3.11, P = 0.018, respectively）. In contrast, acarbose use was protective against PPH （OR = 0.4, 95% CI： 0.189-0.847, P = 0.017）. The decrease in blood pres- sure during PPH was 20-40 mmHg and the maximum was 90 mmHg. PPH usually occurred at 30-60 min after a meal and lasted 30-120 rnin. Conclusions These findings demonstrate that the prevalence of PPH in men aged over 80 years is significantly higher than those in men aged 65 to 80 years, and the blood pressure decline is also higher for men aged over 80 years. In addition, hypertension and age were main risk factors for PPH in the older men, which suggest that preventing and treating PPH is worthwhile.展开更多
The present study was aimed to investigate the effects of infusion of different fluids combined with control-led hypotension on gastric intramucosal pH （pHi） and postoperative gastrointestinal function in patients u...The present study was aimed to investigate the effects of infusion of different fluids combined with control-led hypotension on gastric intramucosal pH （pHi） and postoperative gastrointestinal function in patients undergo-ing hepatocarcinoma surgery. Forty-five patients （ASAⅡ） scheduled for surgical resection of hepatocarcinoma undergoing controlled hypotension were randomly assigned to three groups and received infusion of 20 mL/kg Ringer’s solution （R group）, 6% HAES（H group） or 6% Voluven group （W group）. Intragastric PgCO2, pHi, he-matocrit and hemoglobin were measured. The significant decrease of pHi and increase of PgCO2 were produced at 1 and 2 h after controlled hypotension in the R group （P 0.05 or P 0.01）. The time of bowel movement af-ter operation was shorter in the W group than the R group. Meanwhile, we also did not find obvious difference in blood gas indexes among the three groups. The infusion of HAES and Voluven during controlled hypotension could improve gastrointestinal perfusion and accelerate the recovery of postoperative gastrointestinal function.展开更多
Background Frailty and orthostatic hypotension (OH),which is common in older adults,is associated with morbidity and mortality.The relationship between them remains unclear.The aim of the study is to determine whether...Background Frailty and orthostatic hypotension (OH),which is common in older adults,is associated with morbidity and mortality.The relationship between them remains unclear.The aim of the study is to determine whether there is a relationship between frailty and OH.Methods A total of 496 patients who were admitted to the geriatric clinic and underwent comprehensive geriatric assessment were retrospectively reviewed.In a cross-sectional and observational study,OH was measured by the Head-up Tilt Table test at 1,3,and 5 min (respectively,OH1,OH3,and OH5) and the frailty was measured by the Fried’s frailty scale.Results The mean age of all patients was 75.4 ± 7.38.The prevalence of females was 69.8%.When the frail people were compared with the pre-frail and the robust ones,the frailty was associated with OH1.There was no relationship between the groups in terms of OH1 when the pre-frail group was compared with the robust group.OH3 were higher in the frail group than in the pre-frail group (P < 0.05) and the OH5 were higher in the frail group than in the pre-frail and robust group (P < 0.05),but OH3 and OH5 were not associated with frailty status when they were adjusted for age (P > 0.05).Slowness and weakness were associated with OH1 (P < 0.05),whereas the other components of the Fried’s test were not.Conclusions Frailty may be a risk factor for OH1.The 1^st min measurements of OH should be routinely evaluated in frail older adults to prevent OH-related poor outcomes.展开更多
Objectives: This study aimed to determine the effect of lower leg compression during cesarean section (CS) on post-spinal hypotension (PSH) and neonatal hemodynamic parameters.Methods: This study is a nonrandomized co...Objectives: This study aimed to determine the effect of lower leg compression during cesarean section (CS) on post-spinal hypotension (PSH) and neonatal hemodynamic parameters.Methods: This study is a nonrandomized controlled clinical trial conducted in the cesarean delivery unit of the National Medical institute,Damanhour,Egypt.The sample included 120 parturients (60 intervention and 60 control).The researchers developed three tools for data collection: sociodemographic data and reproductive history interview schedule,electronic monitoring of maternal hemodynamic parameters,and neonatal hemodynamic assessment sheet.All parturients received ordinary preoperative care.For the intervention group,a long elastic stocking (ordinary pressure 20-30 mmHg,1 mmHg =0.133 kPa) was applied on both legs during cesarean section.The control group received the same care without the elastic stocking.Results: Systolic blood pressure,diastolic blood pressure,and mean arterial blood pressure were significantly higher in the intervention group throughout the entire operation period except in the last 5 -15 min.Heart rate was significantly lower in the intervention group.Only 13.3% of the intervention group took ephedrine compared with 45% of the control group.Apgar score was higher among neonates of intervention group compared with the control group at 1 min.Neonatal acidosis was significantly higher in the control group than in the contral group.Conclusion: Lower leg compression technique can effectively reduce PSH and neonatal acidosis.展开更多
BACKGROUND:The aim of the present study is to describe the clinical correlates of hypotension and its associated outcomes in patients with acute organophosphorus poisoning(AOPP).METHODS:In this retrospective cohort st...BACKGROUND:The aim of the present study is to describe the clinical correlates of hypotension and its associated outcomes in patients with acute organophosphorus poisoning(AOPP).METHODS:In this retrospective cohort study,we analyzed data pertaining to 871 patients with AOPP who were treated at two hospitals.Data from hypotensive and non-hypotensive patients were compared to identify clinical correlates of hypotension.We also evaluated the association between clinical parameters(including hypotension)and in-hospital mortality.RESULTS:The incidence of hypotension in AOPP patients was 16.4%.Hypotensive patients showed signifi cantly higher in-hospital mortality(1.1%vs.39.9%,P<0.001).Advanced age(odds ratio[OR]1.25,95%confi dence interval[CI]1.08–1.44),history of diabetes(OR 2.65,95%CI 1.14–5.96),and increased white blood cell count(OR 1.06,95%CI 1.03–1.09),plasma cholinesterase(OR 0.91,95%CI 0.84–0.94),plasma albumin(OR 0.88,95%CI 0.85–0.92),serum amylase(OR 1.01,95%CI 1.01–1.02),and blood pH(OR 0.64,95%CI 0.54–0.75)were signifi cantly associated with hypotension.After adjusting for potential confounders,hypotension was associated with increased in-hospital mortality(hazard ratio 8.77–37.06,depending on the controlled variables).CONCLUSIONS:Hypotension is a common complication of AOPP and is associated with increased in-hospital mortality.Advanced age,history of diabetes,and changes in laboratory parameters were associated with hypotension in AOPP patients.展开更多
BACKGROUND Duchenne muscular dystrophy(DMD),which is caused by a mutation/deletion in the dystrophin gene on the X-chromosome,is the most common type of neuromuscular disorder in pediatrics.Skeletal muscle weakness pr...BACKGROUND Duchenne muscular dystrophy(DMD),which is caused by a mutation/deletion in the dystrophin gene on the X-chromosome,is the most common type of neuromuscular disorder in pediatrics.Skeletal muscle weakness progressively develops in DMD patients and usually leads to respiratory failure in the early adolescent years.Cardiac muscle is frequently affected in DMD patients,which leads to a high burden of cardiomyopathy and heart failure.In the era of improved respiratory care,cardiac deaths are becoming the major cause of mortality in DMD patients.CASE SUMMARY We report the case of a 15-year-old boy who presented to the hospital due to recurrent orthopnea for 6 mo and palpitations for 4 mo.He was diagnosed with progressive muscular dystrophy at the age of 3 years and was confined to a wheelchair at 12 years.He was prescribed diuretics and digoxin at the outpatient clinic;however,his symptoms did not resolve.Sacubitril/valsartan was added 1 mo prior to presentation,but he experienced recurrent episodes of palpitations.The electrocardiogram showed atrial tachycardia with a heart rate of 201 bpm,and he was then hospitalized.Hypotension was found following the administration of sacubitril/valsartan tablets;he could not tolerate even a small dose,always developing tachyarrhythmia.His symptoms were relieved after discontinuing sacubitril/valsartan,and his heart rate was controlled by a small dose of metoprolol tartrate and digoxin.Atrial tachycardia spontaneously converted in this patient,and his symptoms attenuated in the following 6 mo,without palpitation episodes.CONCLUSION Blood pressure should be closely monitored in DMD patients with advanced heart failure when taking sacubitril/valsartan.展开更多
BACKGROUND Empty sella syndrome is a condition in which the pituitary gland shrinks or flattens. Patients with empty sella syndrome often present with headache,hypertension, obesity, visual disturbances, cerebrospinal...BACKGROUND Empty sella syndrome is a condition in which the pituitary gland shrinks or flattens. Patients with empty sella syndrome often present with headache,hypertension, obesity, visual disturbances, cerebrospinal fluid(CSF) rhinorrhoea,or endocrine dysfunction. Herein, we report a rare case of empty sella syndrome discovered after the patient experienced postoperative hypotension and respiratory failure.CASE SUMMARY A 60-year-old man was admitted for further workup of left shoulder pain. He was assessed by the orthopaedics team and booked for internal fixation of the left clavicle. General anaesthesia with a nerve block was administered. His blood pressure continued to decrease post-operation. Endocrine tests were performed,with the results supporting a diagnosis of hypopituitarism with hypocortisolism and hypothyroidism. Brain magnetic resonance imaging demonstrated that the sella was enlarged and filled with CSF, confirming a diagnosis of empty sella syndrome. The patient was started on endocrine replacement therapy. The patient regained consciousness and spontaneous breath finally.CONCLUSION This case highlights the importance of considering pituitary hormone insufficiency in the context of respiratory and hemodynamic failure during the perioperative period.展开更多
Objective： To observe the effects of controlled hypotension on gastric intrarnucosal pH and post-operational gastrointestinal functions using two specific anesthesia methods. Methods： Thirty patients（ASA II ）sched...Objective： To observe the effects of controlled hypotension on gastric intrarnucosal pH and post-operational gastrointestinal functions using two specific anesthesia methods. Methods： Thirty patients（ASA II ）scheduled for ectomy of hepatocarcinoma, were randomly assigned to two groups： epidural block combined with intravenous anesthesia group（E group） and inhalation anesthesia group（G group）. Gastric PgCO2 and phi were monitored at different time points, before theintravenous induction of controlled hypotension, after 1 h and 2 h, and 1 h after the termination of controlled hypotension. In the meanwhile, the artery blood gas was analyzed. Results： There was no significant difference in blood gas indexes between E group and G group. However, phi decreased significantly after I h and 2 h of controlled hypotension（P 〈 0.05）, and during the same periods PgCO2 increased significantly（P 〈 0.05 or P 〈 0.01）, the time of bowel movement and defecating deferred significantly shorter in G group patients, when compared with E group patients. Conclusion： Epidural block in combination with general anesthesia can improve gastrointestinal blood flow during controlled hypotension and facilitates post-operational recovery of gastrointestinal functions.展开更多
Objective： Spontaneous intracranial hypotension （SIH） is recognized far more commonly than ever before. Though usually characterized by low cerebrospinal fluid （CSF） pressure, some patients with SIH are observed ...Objective： Spontaneous intracranial hypotension （SIH） is recognized far more commonly than ever before. Though usually characterized by low cerebrospinal fluid （CSF） pressure, some patients with SIH are observed to have normal pressure values. In this study, we aimed to confirm the proportion of patients with normal CSF opening pressure （CSF OP） and explore the factors affecting CSF OP in SIH patients. Methods： We retrospectively reviewed 206 consecutive SIH patients and analyzed their clinical and imaging variables （including demographic data, body mass index （BMI）, duration of symptoms, and brain imaging findings）. Univariate and multiVariate analyses were performed to identify the potential factors affecting CSF OP. Results： In a total of 114 （55.3%） cases the CSF OP was 〈60 mmH2O （1 mmH2O=9.80665 Pa）, in 90 （43.7%） cases it was between 60 and 200 mmH2O, and in 2 （1.0%） cases it was 〉200 mmH2O. Univadate analysis showed that the duration of symptoms （P〈0.001）, BMI （P〈0.001）, and age （P=0.024） were positively correlated with CSF OP. However, multivariate analysis suggested that only the duration of symptoms （P〈0.001） and BMI （P〈0.001） were strongly correlated with CSF OP. A relatively high R2 of 0.681 was obtained for the multivariate model. Conclusions： Our study indicated that in patients without a low CSF OP, a diagnosis of SIH should not be excluded. BMI and the duration of symptoms can influence CSF OP in SIH patients, and other potential factors need further investigation.展开更多
BACKGROUND It is not clear whether sacubitril/valsartan is beneficial for patients with heart failure(HF)with reduced ejec-tion fraction(HFrEF)and low systolic blood pressure(SBP).This study aimed to investigate the e...BACKGROUND It is not clear whether sacubitril/valsartan is beneficial for patients with heart failure(HF)with reduced ejec-tion fraction(HFrEF)and low systolic blood pressure(SBP).This study aimed to investigate the efficacy and tolerability of sacu-bitril/valsartan in HFrEF patients with SBP<100 mmHg.METHODS&RESULTS An observational study was conducted on 117 patients,40.2%of whom had SBP<100 mmHg wit-hout symptomatic hypotension,and 59.8%of whom had SBP≥100 mmHg in an optimized HF follow-up management system.At the 6-month follow-up,52.4%of patients with SBP<100 mmHg and 70.0%of those with SBP≥100 mmHg successfully rea-ched the target dosages of sacubitril/valsartan.A reduction in the concentration of N-terminal pro-B-type natriuretic peptide was similar between patients with SBP<100 mmHg and SBP≥100 mmHg(1627.5 pg/mL and 1340.1 pg/mL,respectively;P=0.75).The effect of sacubitril/valsartan on left ventricular ejection fraction was observed in both SBP categories,with a 10.8%increase in patients with SBP<100 mmHg(P<0.001)and a 14.0%increase in patients with SBP≥100 mmHg(P<0.001).The effects of sac-ubitril/valsartan on SBP were statistically significant and inverse across both SBP categories(P=0.001),with an increase of 7.5 mmHg in patients with SBP<100 mmHg and a decrease of 11.5 mmHg in patients with SBP≥100 mmHg.No statistically signi-ficant differences were observed between the two groups in terms of the occurrence of symptomatic hypotension,deteriorating re-nal function,hyperkalemia,angioedema,or stroke.CONCLUSIONS Within an optimized HF follow-up management system,sacubitril/valsartan exhibited excellent tolerability and prompted left ventricular reverse remodeling in patients with HFrEF who presented asymptomatic hypotension.展开更多
Orthostatic hypotension (OH)is a common condition in older persons.According to the 2011criteria,OH is defined by a sustained reduction of systolic blood pressure of 20 mmHg or a 10mmHg-fall of diastolic blood pressur...Orthostatic hypotension (OH)is a common condition in older persons.According to the 2011criteria,OH is defined by a sustained reduction of systolic blood pressure of 20 mmHg or a 10mmHg-fall of diastolic blood pressure,[1] Its prevalence increases with age and according to a recent systematic review the pooled prevalence in community dwelling older people is 22.2%.[2]Although OH is largely explained by concurrent clinical conditions (in particular, hypertension,diabetes,malnutrition,vascular encephalopa- thy,anemia,Parkinson's disease)[3],aging per se determines a series of physiological dysfunctions potentially representing its biological substratum (e.g.,reduction in barore- flex-mediated cardiovascular function,altered salt and water balance at renal level,impaired cardiac diastolic filling).It is also noteworthy that age-related changes in pharmacokinetic and pharmacodynamic mechanisms of drugs (especially in the context of polypharmacy)also increase the risk of OH.展开更多
AIM: To determine if dopamine is effective in treating neonatal hypotension and safe to use comparing to other inotropes. METHODS: This is a review of evidence on inotropic treatment of neonatal hypotension. Databases...AIM: To determine if dopamine is effective in treating neonatal hypotension and safe to use comparing to other inotropes. METHODS: This is a review of evidence on inotropic treatment of neonatal hypotension. Databases searched were MEDLINE and the Cochrane Library, a total of 134 studies were identified. Only studies with high quality evidence(level 1a and b and 2a) were included. After review, only eight studies were included in the final analysis. Pooled risk ratios derived for each outcome [Mantel-Haenzel(M-H) fixed effect] with CI, as reported in the Cochrane reviews were plotted in forest plot form. RESULTS: Eight articles met inclusion criteria, which all included treatment in preterm infants. Dopamine increased mean arterial blood pressure(BP)(n = 163; r = 0.88, 95%CI: 0.76 to 0.94) and systolic BP(n = 142; r = 0.81, 95%CI: 0.42 to 0.94) comparing to placebo. Dopamine has been shown overall to be statistically more effective in increasing BP than dobutamine(n = 251, r = 0.26, 95%CI: 0.20-0.32). However there were no differences in short term outcomes(periventricular leucomalacia, periventricular haemorrhage) and mortality between both drugs. There is no statistical evidence of dopamine being more effective than adrenaline or corticosteroids. There was no difference in morbidity and mortality outcomes when dopamine was compared to hydrocortisone(RR 1.81, 95%CI: 0.18 to 18.39) or adrenaline. CONCLUSION: In preterms, dopamine is the most studied drug, and we suggest it could be used as first line treatment in hypotension.展开更多
BACKGROUND Hypotension after the induction of anesthesia is known to be associated with various adverse events.The involvement of a series of factors makes the prediction of hypotension during anesthesia quite challen...BACKGROUND Hypotension after the induction of anesthesia is known to be associated with various adverse events.The involvement of a series of factors makes the prediction of hypotension during anesthesia quite challenging.AIM To explore the ability and effectiveness of a random forest(RF)model in the prediction of post-induction hypotension(PIH)in patients undergoing cardiac surgery.METHODS Patient information was obtained from the electronic health records of the Second Affiliated Hospital of Hainan Medical University.The study included patients,≥18 years of age,who underwent cardiac surgery from December 2007 to January 2018.An RF algorithm,which is a supervised machine learning technique,was employed to predict PIH.Model performance was assessed by the area under the curve(AUC)of the receiver operating characteristic.Mean decrease in the Gini index was used to rank various features based on their importance.RESULTS Of the 3030 patients included in the study,1578(52.1%)experienced hypotension after the induction of anesthesia.The RF model performed effectively,with an AUC of 0.843(0.808-0.877)and identified mean blood pressure as the most important predictor of PIH after anesthesia.Age and body mass index also had a significant impact.CONCLUSION The generated RF model had high discrimination ability for the identification of individuals at high risk for a hypotensive event during cardiac surgery.The study results highlighted that machine learning tools confer unique advantages for the prediction of adverse post-anesthesia events.展开更多
Intracranial hypotension syndrome(IHS) is a rare disorder characterized by a decrease in cerebrospinal fluid pressure to less than 60 mm H2 O. The syndrome is associated with occipital headache radiating to the fronta...Intracranial hypotension syndrome(IHS) is a rare disorder characterized by a decrease in cerebrospinal fluid pressure to less than 60 mm H2 O. The syndrome is associated with occipital headache radiating to the frontal and temporal zones. The current clinical case describes the manifestation of IHS in a twenty-five year old female with a history of suboccipital craniectomy due to Chiari I malformation nine years earlier. The patient was admitted to the hospital complaining about postural, mainly occipital, headache during the last three months, aggravated by being in an upright position. The magnetic resonance imaging(MRI) revealed engorgement of the dural venous sinuses, significant enlargement of the pituitary gland and download displacement or sagging of the brain with effacement of the perichiasmatic cisterns and the prepontine cistern, while the spinal T2 W MRI revealed a 7 mm × 2.5 mm dural defect with an extradural cerebrospinal fluid collection at the dorsal soft tissues of the cervical spine. The previous imaging did not reveal subdural effusions.展开更多
Intraoperative hypotension happens in everyday clinical practice. It was suggested to have a strong association with adverse postoperative outcomes. Hypotension prediction index(HPI) was developed to predict intraoper...Intraoperative hypotension happens in everyday clinical practice. It was suggested to have a strong association with adverse postoperative outcomes. Hypotension prediction index(HPI) was developed to predict intraoperative hypotension(mean arterial pressure <65 mmHg) in real time. However, pressure autoregulation also plays an important role in maintaining adequate organ perfusion/oxygenation during hypotension. A cerebral oxygenation monitor provides clinicians with the values of organ oxygenation. We reported a case that the cerebral oxygenation monitor was used together with HPI to guide intraoperative blood pressure management. We found that cerebral oxygenation was maintained in the event of hypotension during surgery. The patient had no intraoperative or postoperative adverse outcomes despite the hypotension. We believe this can provide an individualized intraoperative blood pressure management to avoid over-or under-treating hypotension.展开更多
BACKGROUND Pheochromocytomas are rare endocrine tumors with various clinical manifestations,and few of them might present with profound,life-threatening conditions.CASE SUMMARY We report the case of a 65-year-old man ...BACKGROUND Pheochromocytomas are rare endocrine tumors with various clinical manifestations,and few of them might present with profound,life-threatening conditions.CASE SUMMARY We report the case of a 65-year-old man who complained of sudden dyspnea and hemoptysis for half a day.There was no obvious cause for the patient to have dyspnea,coughing,or coughing up to approximately 100 mL of fresh blood.Finally,he was diagnosed with pheochromocytoma crisis(PCC),coexisting with an abdominal aortic aneurysm(AAA).CONCLUSION We report a case of pheochromocytoma presenting with recurrent hemoptysis,dyspnea and hypotension coexisting with an AAA.It not only proved the uncommon manifestations of pheochromocytoma but also directed clinicians to consider PCC among the possible diagnoses when meeting similar cases.Moreover,surgical excision is the most beneficial method for the treatment of pheochromocytoma coexisting with AAA when the situation is stable.展开更多
BACKGROUND Tamsulosin,a selectiveα1-adrenergic receptor antagonist,is commonly used for treating neurogenic bladder in patients with spinal cord injury(SCI).No severe adverse events have been described with such tams...BACKGROUND Tamsulosin,a selectiveα1-adrenergic receptor antagonist,is commonly used for treating neurogenic bladder in patients with spinal cord injury(SCI).No severe adverse events have been described with such tamsulosin use.To our knowledge,we report the first case of severe life-threatening hypotension as an adverse effect of tamsulosin in a person with SCI.Therefore,we report this case to inform that this severe adverse effect of tamsulosin can occur when treating patients with SCI.CASE SUMMARY A 59-year-old woman was diagnosed with cervical spinal cord myelopathy and was classified as American Spinal Injury Association Impairment Scale D,neurological level of injury C3.Because she suffered from voiding difficulty due to neurogenic bladder,we prescribed tamsulosin.Her vital signs remained stable,but occasional hypotensive symptoms followed defecation.We reduced the dose of tamsulosin,but after administering tamsulosin for 9 d,she experienced lifethreatening hypotension with no evidence of hypovolemic shock,neurogenic shock,cardiogenic shock,or septic shock.A hypotensive condition induced by tamsulosin was the suspected cause,and her symptoms could be associated with adverse effects of tamsulosin.As symptoms resolved after stopping tamsulosin,and no other reason was found,we concluded that tamsulosin was the cause of her symptoms.CONCLUSION Caution for severe hypotension is needed when administering tamsulosin for neurogenic bladder in a patient with SCI.展开更多
文摘Intradialytic hypotension(IDH)is a prevalent and critical complication of haemodialysis associated with significant morbidity,mortality,and reduced quality of life in end-stage renal disease patients.IDH results from multifactorial interactions,including excessive ultrafiltration rates(UFR),rapid osmotic shifts,impaired vascular resistance,and comorbidities such as diabetes and cardiovascular disease.It triggers hypovolemic stress,leading to myocardial stunning,cerebral ischemia,and organ dysfunction.Non-modifiable risk factors,including age and preexisting conditions,exacerbate susceptibility,while modifiable elements such as high interdialytic weight gain and improper dialysis prescriptions worsen outcomes.In this review,we aim to conduct an in-depth analysis of IDH,exploring its clinical relevance,underlying mechanisms,risk factors,and management approaches.Additionally,we advocate for a standardised definition and propose a strategic framework to guide future research efforts.Effective management requires individualised approaches,including optimised UFR,cooled dialysate,and nutritional adjustments,alongside emerging technologies like bio-impedance spectroscopy and artificial intelligence for real-time risk prediction.A multidisciplinary team approach,incorporating nephrologists,nurses,and dietitians,is essential for holistic patient care.Future research and technological advancements hold promise for mitigating IDH’s clinical and systemic impact,ultimately improving patient outcomes and survival.
文摘Controlled hypotension is widely used to improve surgical field visibility and reduce intraoperative blood loss.This meta-analysis systematically compared the clinical effects of dexmedetomidine(DEX)and esmolol for intraoperative controlled hypotension.Randomized controlled trials were retrieved from PubMed,EMBASE,and the Cochrane Library,and hemodynamic parameters,surgical field score,blood loss,intraoperative fentanyl consumption,operation time,recovery period,emergence time,and adverse events were pooled using R version 4.0.2,with results expressed as standardized mean differences(SMDs)or odds ratios(ORs)with 95%confidence intervals(CIs).Nine RCTs involving 478 patients were included.Compared with esmolol,DEX significantly reduced intraoperative fentanyl requirements(SMD=−5.96,95%CI[−8.48,−3.43],p<0.0001)but was associated with a longer emergence time(SMD=3.11,95%CI[1.93,4.29],p<0.0001).No significant differences were observed in hemodynamic stability,surgical field quality,blood loss,operation time,recovery period,or adverse events.Overall,DEX and esmolol provide comparable hemodynamic control,bleeding conditions,operative duration,and recovery profiles during controlled hypotension,while DEX is associated with reduced intraoperative analgesic requirements and prolonged postoperative sedation.
文摘Objective:To summarize evidence on the prevention and management of intradialytic hypotension in maintenance hemodialysis patients,providing reference for clinical practice.Method:Chinese and English databases,guideline websites,and professional society websites were systematically searched for literature on intradialytic hypotension guidance,including clinical decisions,guidelines,evidence summaries,systematic reviews,and expert consensuses,from database inception to October 1,2024.Evidence was extracted after literature quality evaluation.Results:A total of 11 publications were included:2 clinical decisions,7 guidelines,1 systematic review,and 1 expert consensus.38 pieces of evidence were summarized across 4 themes:pre-dialysis assessment and prevention,monitoring and management during dialysis,medication use,and patient self-management.Conclusion:The best evidence for prevention and management of intradialytic hypotension in maintenance hemodialysis patients is scientific and comprehensive.Healthcare professionals are advised to apply this evidence judiciously in conjunction with clinical realities to ensure patient safety.
文摘Objective To assess the prevalence of and risk factors for postprandial hypotension （PPH） among old and very old Chinese men. Methods The study included 349 Chinese men aged 65 and older, grouped into two age categories： group 1 （old） included 163 men aged 65 to 80 years; group 2 （very old） included 186 men aged over 80 years. Blood pressure changes after meals were assessed every 15 min by ambulatory blood pressure monitoring. Symptoms after meal ingestion and after standing up and changes in the baseline condition relative to blood pressure changes were observed continuously. Additional baseline data included body mass index, medical history, and medication use Results The prevalence of PPH was 59.3% overall and was significantly higher in group 2 than group 1 （63.4% vs. 54.6%, P 〈 0.05）. In group 2, the prevalence of PPH after breakfast （33.8%） and lunch （32.1%） were higher than that after supper （20.9%）, P 〈 0.05. Hypertension and age were significant risk factors for PPH （OR = 2.188, 95% CI： 1.134-4.223, P = 0.02; OR = 1.86, 95% CI： 1.112-3.11, P = 0.018, respectively）. In contrast, acarbose use was protective against PPH （OR = 0.4, 95% CI： 0.189-0.847, P = 0.017）. The decrease in blood pres- sure during PPH was 20-40 mmHg and the maximum was 90 mmHg. PPH usually occurred at 30-60 min after a meal and lasted 30-120 rnin. Conclusions These findings demonstrate that the prevalence of PPH in men aged over 80 years is significantly higher than those in men aged 65 to 80 years, and the blood pressure decline is also higher for men aged over 80 years. In addition, hypertension and age were main risk factors for PPH in the older men, which suggest that preventing and treating PPH is worthwhile.
基金supported by a grant from the Foundation of Six Top Talents of Jiangsu Province Personnel Department
文摘The present study was aimed to investigate the effects of infusion of different fluids combined with control-led hypotension on gastric intramucosal pH （pHi） and postoperative gastrointestinal function in patients undergo-ing hepatocarcinoma surgery. Forty-five patients （ASAⅡ） scheduled for surgical resection of hepatocarcinoma undergoing controlled hypotension were randomly assigned to three groups and received infusion of 20 mL/kg Ringer’s solution （R group）, 6% HAES（H group） or 6% Voluven group （W group）. Intragastric PgCO2, pHi, he-matocrit and hemoglobin were measured. The significant decrease of pHi and increase of PgCO2 were produced at 1 and 2 h after controlled hypotension in the R group （P 0.05 or P 0.01）. The time of bowel movement af-ter operation was shorter in the W group than the R group. Meanwhile, we also did not find obvious difference in blood gas indexes among the three groups. The infusion of HAES and Voluven during controlled hypotension could improve gastrointestinal perfusion and accelerate the recovery of postoperative gastrointestinal function.
文摘Background Frailty and orthostatic hypotension (OH),which is common in older adults,is associated with morbidity and mortality.The relationship between them remains unclear.The aim of the study is to determine whether there is a relationship between frailty and OH.Methods A total of 496 patients who were admitted to the geriatric clinic and underwent comprehensive geriatric assessment were retrospectively reviewed.In a cross-sectional and observational study,OH was measured by the Head-up Tilt Table test at 1,3,and 5 min (respectively,OH1,OH3,and OH5) and the frailty was measured by the Fried’s frailty scale.Results The mean age of all patients was 75.4 ± 7.38.The prevalence of females was 69.8%.When the frail people were compared with the pre-frail and the robust ones,the frailty was associated with OH1.There was no relationship between the groups in terms of OH1 when the pre-frail group was compared with the robust group.OH3 were higher in the frail group than in the pre-frail group (P < 0.05) and the OH5 were higher in the frail group than in the pre-frail and robust group (P < 0.05),but OH3 and OH5 were not associated with frailty status when they were adjusted for age (P > 0.05).Slowness and weakness were associated with OH1 (P < 0.05),whereas the other components of the Fried’s test were not.Conclusions Frailty may be a risk factor for OH1.The 1^st min measurements of OH should be routinely evaluated in frail older adults to prevent OH-related poor outcomes.
文摘Objectives: This study aimed to determine the effect of lower leg compression during cesarean section (CS) on post-spinal hypotension (PSH) and neonatal hemodynamic parameters.Methods: This study is a nonrandomized controlled clinical trial conducted in the cesarean delivery unit of the National Medical institute,Damanhour,Egypt.The sample included 120 parturients (60 intervention and 60 control).The researchers developed three tools for data collection: sociodemographic data and reproductive history interview schedule,electronic monitoring of maternal hemodynamic parameters,and neonatal hemodynamic assessment sheet.All parturients received ordinary preoperative care.For the intervention group,a long elastic stocking (ordinary pressure 20-30 mmHg,1 mmHg =0.133 kPa) was applied on both legs during cesarean section.The control group received the same care without the elastic stocking.Results: Systolic blood pressure,diastolic blood pressure,and mean arterial blood pressure were significantly higher in the intervention group throughout the entire operation period except in the last 5 -15 min.Heart rate was significantly lower in the intervention group.Only 13.3% of the intervention group took ephedrine compared with 45% of the control group.Apgar score was higher among neonates of intervention group compared with the control group at 1 min.Neonatal acidosis was significantly higher in the control group than in the contral group.Conclusion: Lower leg compression technique can effectively reduce PSH and neonatal acidosis.
基金approved by the Medical Ethics Committee of the First Hospital of Jilin University(approval number:2018-146).
文摘BACKGROUND:The aim of the present study is to describe the clinical correlates of hypotension and its associated outcomes in patients with acute organophosphorus poisoning(AOPP).METHODS:In this retrospective cohort study,we analyzed data pertaining to 871 patients with AOPP who were treated at two hospitals.Data from hypotensive and non-hypotensive patients were compared to identify clinical correlates of hypotension.We also evaluated the association between clinical parameters(including hypotension)and in-hospital mortality.RESULTS:The incidence of hypotension in AOPP patients was 16.4%.Hypotensive patients showed signifi cantly higher in-hospital mortality(1.1%vs.39.9%,P<0.001).Advanced age(odds ratio[OR]1.25,95%confi dence interval[CI]1.08–1.44),history of diabetes(OR 2.65,95%CI 1.14–5.96),and increased white blood cell count(OR 1.06,95%CI 1.03–1.09),plasma cholinesterase(OR 0.91,95%CI 0.84–0.94),plasma albumin(OR 0.88,95%CI 0.85–0.92),serum amylase(OR 1.01,95%CI 1.01–1.02),and blood pH(OR 0.64,95%CI 0.54–0.75)were signifi cantly associated with hypotension.After adjusting for potential confounders,hypotension was associated with increased in-hospital mortality(hazard ratio 8.77–37.06,depending on the controlled variables).CONCLUSIONS:Hypotension is a common complication of AOPP and is associated with increased in-hospital mortality.Advanced age,history of diabetes,and changes in laboratory parameters were associated with hypotension in AOPP patients.
基金Natural Science Foundation of Zhejiang Province,No.LQ16H020004
文摘BACKGROUND Duchenne muscular dystrophy(DMD),which is caused by a mutation/deletion in the dystrophin gene on the X-chromosome,is the most common type of neuromuscular disorder in pediatrics.Skeletal muscle weakness progressively develops in DMD patients and usually leads to respiratory failure in the early adolescent years.Cardiac muscle is frequently affected in DMD patients,which leads to a high burden of cardiomyopathy and heart failure.In the era of improved respiratory care,cardiac deaths are becoming the major cause of mortality in DMD patients.CASE SUMMARY We report the case of a 15-year-old boy who presented to the hospital due to recurrent orthopnea for 6 mo and palpitations for 4 mo.He was diagnosed with progressive muscular dystrophy at the age of 3 years and was confined to a wheelchair at 12 years.He was prescribed diuretics and digoxin at the outpatient clinic;however,his symptoms did not resolve.Sacubitril/valsartan was added 1 mo prior to presentation,but he experienced recurrent episodes of palpitations.The electrocardiogram showed atrial tachycardia with a heart rate of 201 bpm,and he was then hospitalized.Hypotension was found following the administration of sacubitril/valsartan tablets;he could not tolerate even a small dose,always developing tachyarrhythmia.His symptoms were relieved after discontinuing sacubitril/valsartan,and his heart rate was controlled by a small dose of metoprolol tartrate and digoxin.Atrial tachycardia spontaneously converted in this patient,and his symptoms attenuated in the following 6 mo,without palpitation episodes.CONCLUSION Blood pressure should be closely monitored in DMD patients with advanced heart failure when taking sacubitril/valsartan.
基金Supported by the Zhejiang Clinical Funding,No.2016YC-A86
文摘BACKGROUND Empty sella syndrome is a condition in which the pituitary gland shrinks or flattens. Patients with empty sella syndrome often present with headache,hypertension, obesity, visual disturbances, cerebrospinal fluid(CSF) rhinorrhoea,or endocrine dysfunction. Herein, we report a rare case of empty sella syndrome discovered after the patient experienced postoperative hypotension and respiratory failure.CASE SUMMARY A 60-year-old man was admitted for further workup of left shoulder pain. He was assessed by the orthopaedics team and booked for internal fixation of the left clavicle. General anaesthesia with a nerve block was administered. His blood pressure continued to decrease post-operation. Endocrine tests were performed,with the results supporting a diagnosis of hypopituitarism with hypocortisolism and hypothyroidism. Brain magnetic resonance imaging demonstrated that the sella was enlarged and filled with CSF, confirming a diagnosis of empty sella syndrome. The patient was started on endocrine replacement therapy. The patient regained consciousness and spontaneous breath finally.CONCLUSION This case highlights the importance of considering pituitary hormone insufficiency in the context of respiratory and hemodynamic failure during the perioperative period.
文摘Objective： To observe the effects of controlled hypotension on gastric intrarnucosal pH and post-operational gastrointestinal functions using two specific anesthesia methods. Methods： Thirty patients（ASA II ）scheduled for ectomy of hepatocarcinoma, were randomly assigned to two groups： epidural block combined with intravenous anesthesia group（E group） and inhalation anesthesia group（G group）. Gastric PgCO2 and phi were monitored at different time points, before theintravenous induction of controlled hypotension, after 1 h and 2 h, and 1 h after the termination of controlled hypotension. In the meanwhile, the artery blood gas was analyzed. Results： There was no significant difference in blood gas indexes between E group and G group. However, phi decreased significantly after I h and 2 h of controlled hypotension（P 〈 0.05）, and during the same periods PgCO2 increased significantly（P 〈 0.05 or P 〈 0.01）, the time of bowel movement and defecating deferred significantly shorter in G group patients, when compared with E group patients. Conclusion： Epidural block in combination with general anesthesia can improve gastrointestinal blood flow during controlled hypotension and facilitates post-operational recovery of gastrointestinal functions.
文摘Objective： Spontaneous intracranial hypotension （SIH） is recognized far more commonly than ever before. Though usually characterized by low cerebrospinal fluid （CSF） pressure, some patients with SIH are observed to have normal pressure values. In this study, we aimed to confirm the proportion of patients with normal CSF opening pressure （CSF OP） and explore the factors affecting CSF OP in SIH patients. Methods： We retrospectively reviewed 206 consecutive SIH patients and analyzed their clinical and imaging variables （including demographic data, body mass index （BMI）, duration of symptoms, and brain imaging findings）. Univariate and multiVariate analyses were performed to identify the potential factors affecting CSF OP. Results： In a total of 114 （55.3%） cases the CSF OP was 〈60 mmH2O （1 mmH2O=9.80665 Pa）, in 90 （43.7%） cases it was between 60 and 200 mmH2O, and in 2 （1.0%） cases it was 〉200 mmH2O. Univadate analysis showed that the duration of symptoms （P〈0.001）, BMI （P〈0.001）, and age （P=0.024） were positively correlated with CSF OP. However, multivariate analysis suggested that only the duration of symptoms （P〈0.001） and BMI （P〈0.001） were strongly correlated with CSF OP. A relatively high R2 of 0.681 was obtained for the multivariate model. Conclusions： Our study indicated that in patients without a low CSF OP, a diagnosis of SIH should not be excluded. BMI and the duration of symptoms can influence CSF OP in SIH patients, and other potential factors need further investigation.
基金supported by the National Natural Science Foundation of China(No.81873516&No.821704-63)the National Key Research and Development Program of China(2021YFF0501404&2021YFF0501403&2017YFC1308303)+1 种基金the Natural Science Foundation of Shandong Province(ZR2019PH030&ZR2019BH052)the China International Medical Foundation(Z-2019-42-1908-2).
文摘BACKGROUND It is not clear whether sacubitril/valsartan is beneficial for patients with heart failure(HF)with reduced ejec-tion fraction(HFrEF)and low systolic blood pressure(SBP).This study aimed to investigate the efficacy and tolerability of sacu-bitril/valsartan in HFrEF patients with SBP<100 mmHg.METHODS&RESULTS An observational study was conducted on 117 patients,40.2%of whom had SBP<100 mmHg wit-hout symptomatic hypotension,and 59.8%of whom had SBP≥100 mmHg in an optimized HF follow-up management system.At the 6-month follow-up,52.4%of patients with SBP<100 mmHg and 70.0%of those with SBP≥100 mmHg successfully rea-ched the target dosages of sacubitril/valsartan.A reduction in the concentration of N-terminal pro-B-type natriuretic peptide was similar between patients with SBP<100 mmHg and SBP≥100 mmHg(1627.5 pg/mL and 1340.1 pg/mL,respectively;P=0.75).The effect of sacubitril/valsartan on left ventricular ejection fraction was observed in both SBP categories,with a 10.8%increase in patients with SBP<100 mmHg(P<0.001)and a 14.0%increase in patients with SBP≥100 mmHg(P<0.001).The effects of sac-ubitril/valsartan on SBP were statistically significant and inverse across both SBP categories(P=0.001),with an increase of 7.5 mmHg in patients with SBP<100 mmHg and a decrease of 11.5 mmHg in patients with SBP≥100 mmHg.No statistically signi-ficant differences were observed between the two groups in terms of the occurrence of symptomatic hypotension,deteriorating re-nal function,hyperkalemia,angioedema,or stroke.CONCLUSIONS Within an optimized HF follow-up management system,sacubitril/valsartan exhibited excellent tolerability and prompted left ventricular reverse remodeling in patients with HFrEF who presented asymptomatic hypotension.
文摘Orthostatic hypotension (OH)is a common condition in older persons.According to the 2011criteria,OH is defined by a sustained reduction of systolic blood pressure of 20 mmHg or a 10mmHg-fall of diastolic blood pressure,[1] Its prevalence increases with age and according to a recent systematic review the pooled prevalence in community dwelling older people is 22.2%.[2]Although OH is largely explained by concurrent clinical conditions (in particular, hypertension,diabetes,malnutrition,vascular encephalopa- thy,anemia,Parkinson's disease)[3],aging per se determines a series of physiological dysfunctions potentially representing its biological substratum (e.g.,reduction in barore- flex-mediated cardiovascular function,altered salt and water balance at renal level,impaired cardiac diastolic filling).It is also noteworthy that age-related changes in pharmacokinetic and pharmacodynamic mechanisms of drugs (especially in the context of polypharmacy)also increase the risk of OH.
文摘AIM: To determine if dopamine is effective in treating neonatal hypotension and safe to use comparing to other inotropes. METHODS: This is a review of evidence on inotropic treatment of neonatal hypotension. Databases searched were MEDLINE and the Cochrane Library, a total of 134 studies were identified. Only studies with high quality evidence(level 1a and b and 2a) were included. After review, only eight studies were included in the final analysis. Pooled risk ratios derived for each outcome [Mantel-Haenzel(M-H) fixed effect] with CI, as reported in the Cochrane reviews were plotted in forest plot form. RESULTS: Eight articles met inclusion criteria, which all included treatment in preterm infants. Dopamine increased mean arterial blood pressure(BP)(n = 163; r = 0.88, 95%CI: 0.76 to 0.94) and systolic BP(n = 142; r = 0.81, 95%CI: 0.42 to 0.94) comparing to placebo. Dopamine has been shown overall to be statistically more effective in increasing BP than dobutamine(n = 251, r = 0.26, 95%CI: 0.20-0.32). However there were no differences in short term outcomes(periventricular leucomalacia, periventricular haemorrhage) and mortality between both drugs. There is no statistical evidence of dopamine being more effective than adrenaline or corticosteroids. There was no difference in morbidity and mortality outcomes when dopamine was compared to hydrocortisone(RR 1.81, 95%CI: 0.18 to 18.39) or adrenaline. CONCLUSION: In preterms, dopamine is the most studied drug, and we suggest it could be used as first line treatment in hypotension.
文摘BACKGROUND Hypotension after the induction of anesthesia is known to be associated with various adverse events.The involvement of a series of factors makes the prediction of hypotension during anesthesia quite challenging.AIM To explore the ability and effectiveness of a random forest(RF)model in the prediction of post-induction hypotension(PIH)in patients undergoing cardiac surgery.METHODS Patient information was obtained from the electronic health records of the Second Affiliated Hospital of Hainan Medical University.The study included patients,≥18 years of age,who underwent cardiac surgery from December 2007 to January 2018.An RF algorithm,which is a supervised machine learning technique,was employed to predict PIH.Model performance was assessed by the area under the curve(AUC)of the receiver operating characteristic.Mean decrease in the Gini index was used to rank various features based on their importance.RESULTS Of the 3030 patients included in the study,1578(52.1%)experienced hypotension after the induction of anesthesia.The RF model performed effectively,with an AUC of 0.843(0.808-0.877)and identified mean blood pressure as the most important predictor of PIH after anesthesia.Age and body mass index also had a significant impact.CONCLUSION The generated RF model had high discrimination ability for the identification of individuals at high risk for a hypotensive event during cardiac surgery.The study results highlighted that machine learning tools confer unique advantages for the prediction of adverse post-anesthesia events.
文摘Intracranial hypotension syndrome(IHS) is a rare disorder characterized by a decrease in cerebrospinal fluid pressure to less than 60 mm H2 O. The syndrome is associated with occipital headache radiating to the frontal and temporal zones. The current clinical case describes the manifestation of IHS in a twenty-five year old female with a history of suboccipital craniectomy due to Chiari I malformation nine years earlier. The patient was admitted to the hospital complaining about postural, mainly occipital, headache during the last three months, aggravated by being in an upright position. The magnetic resonance imaging(MRI) revealed engorgement of the dural venous sinuses, significant enlargement of the pituitary gland and download displacement or sagging of the brain with effacement of the perichiasmatic cisterns and the prepontine cistern, while the spinal T2 W MRI revealed a 7 mm × 2.5 mm dural defect with an extradural cerebrospinal fluid collection at the dorsal soft tissues of the cervical spine. The previous imaging did not reveal subdural effusions.
基金Department of Anesthesiology and Pain Medicine, University of California Davis Health, and NIH grant No. of UL1 TR001860 of University of California Davis Health。
文摘Intraoperative hypotension happens in everyday clinical practice. It was suggested to have a strong association with adverse postoperative outcomes. Hypotension prediction index(HPI) was developed to predict intraoperative hypotension(mean arterial pressure <65 mmHg) in real time. However, pressure autoregulation also plays an important role in maintaining adequate organ perfusion/oxygenation during hypotension. A cerebral oxygenation monitor provides clinicians with the values of organ oxygenation. We reported a case that the cerebral oxygenation monitor was used together with HPI to guide intraoperative blood pressure management. We found that cerebral oxygenation was maintained in the event of hypotension during surgery. The patient had no intraoperative or postoperative adverse outcomes despite the hypotension. We believe this can provide an individualized intraoperative blood pressure management to avoid over-or under-treating hypotension.
基金Supported by the Peking Union Medical Foundation-Rui E(Rui Yi)Emergency Medical Research Special Fund,No.R2018001the Beijing Science and Technology Association Jinqiao Project Seed Fund,No.JQ18057.
文摘BACKGROUND Pheochromocytomas are rare endocrine tumors with various clinical manifestations,and few of them might present with profound,life-threatening conditions.CASE SUMMARY We report the case of a 65-year-old man who complained of sudden dyspnea and hemoptysis for half a day.There was no obvious cause for the patient to have dyspnea,coughing,or coughing up to approximately 100 mL of fresh blood.Finally,he was diagnosed with pheochromocytoma crisis(PCC),coexisting with an abdominal aortic aneurysm(AAA).CONCLUSION We report a case of pheochromocytoma presenting with recurrent hemoptysis,dyspnea and hypotension coexisting with an AAA.It not only proved the uncommon manifestations of pheochromocytoma but also directed clinicians to consider PCC among the possible diagnoses when meeting similar cases.Moreover,surgical excision is the most beneficial method for the treatment of pheochromocytoma coexisting with AAA when the situation is stable.
文摘BACKGROUND Tamsulosin,a selectiveα1-adrenergic receptor antagonist,is commonly used for treating neurogenic bladder in patients with spinal cord injury(SCI).No severe adverse events have been described with such tamsulosin use.To our knowledge,we report the first case of severe life-threatening hypotension as an adverse effect of tamsulosin in a person with SCI.Therefore,we report this case to inform that this severe adverse effect of tamsulosin can occur when treating patients with SCI.CASE SUMMARY A 59-year-old woman was diagnosed with cervical spinal cord myelopathy and was classified as American Spinal Injury Association Impairment Scale D,neurological level of injury C3.Because she suffered from voiding difficulty due to neurogenic bladder,we prescribed tamsulosin.Her vital signs remained stable,but occasional hypotensive symptoms followed defecation.We reduced the dose of tamsulosin,but after administering tamsulosin for 9 d,she experienced lifethreatening hypotension with no evidence of hypovolemic shock,neurogenic shock,cardiogenic shock,or septic shock.A hypotensive condition induced by tamsulosin was the suspected cause,and her symptoms could be associated with adverse effects of tamsulosin.As symptoms resolved after stopping tamsulosin,and no other reason was found,we concluded that tamsulosin was the cause of her symptoms.CONCLUSION Caution for severe hypotension is needed when administering tamsulosin for neurogenic bladder in a patient with SCI.
