Alteration of intracranial pressure, cerebral blood flow, autoregulation and carbondioxide-reactivity by hypotensive agents in baboons with intracranial hypertension

Hartmann, A.; Buttinger, C.; Rommel, Th.; Czernicki, Z; Trtinjiak, F.

doi:10.1055/s-2008-1053998

Cited by 10 publications

(9 citation statements)

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“…These findings indicate that the increase in MABP (the Cushing response) is ac tivated at ICP levels between 30 and 50 mm Hg, which corresponds to previous findings in experi mental intracranial hypertension (Johnston et al , 1972;Nagao et al, 1984;Schrader et al, 1985a,b;Zierski, 1987;Hartmann et al, 1989;Barz6 et al , 1991).…”

Section: Discussion Baseline Valuessupporting

confidence: 90%

Cerebral Blood Flow Autoregulation in Acute Intracranial Hypertension

Hauerberg

Juhler

1994

J Cereb Blood Flow Metab

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Summary: The present series of experiments was carried out to investigate CBP autoregulation during fixed levels of acute increased intracranial pressure (ICP). Three groups of six rats each, one with normal ICP (8 mm Hg), one with moderately increased ICP (30 mm Hg), and one with severely increased ICP (50 mm Hg), were investi gated. ICP was maintained by continuous infusion of lac tated Ringer solution into the cisterna magna. Cerebral perfusion pressure (CPP), calculated as mean arterial blood pressure -ICP, was increased by intravenously infused norepinephrine and decreased by controlled bleeding. In all groups the corresponding autoregulation curve included a plateau where CBP was independent of Abbreviations used: CPP, cerebral perfusion pressure; CVR, cerebrovascular resistance; ICP, intracranial pressure; JVP, jug ular venous pressure; LL, lower limit of autoregulation; MABP, mean arterial blood pressure. 519changes in CPP, demonstrating intact autoregulation. However, a significant shift of the lower limit of autoreg ulation (LL) toward lower CPP levels during severe in tracranial hypertension was observed (p < 0.006). In the controls the LL was found at CPP = 73 ± 6 mm Hg, in moderately increased ICP the LL was 59 ± 4 mm Hg, and in severely increased ICP the LL was 51 ± 4 mm Hg. These results indicate that an acute elevation of ICP ac tivates a reserve capacity of cerebral resistance vessels that dilate further below the normal physiological LL to maintain CBP at low levels of CPP.

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Section: Discussion Baseline Valuessupporting

confidence: 90%

Cerebral Blood Flow Autoregulation in Acute Intracranial Hypertension

Hauerberg

Juhler

1994

J Cereb Blood Flow Metab

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“…Although there is evidence that nitroprusside may increase ICP in patients with mass lesions due to venodilation [13–16], comparative superiority of nicardipine in this regard is not demonstrated. The increase in ICP concomitant with reduction in systemic BP may reduce cerebral perfusion pressure and increase the risk of secondary ischemia.…”

Section: Discussionmentioning

confidence: 99%

A Multicenter Comparison of Outcomes Associated with Intravenous Nitroprusside and Nicardipine Treatment Among Patients with Intracerebral Hemorrhage

et al. 2009

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Introduction No clinical data exist to compare outcomes between patients with intracerebral hemorrhage (ICH) treated with different intravenous antihypertensive agents. This study was performed to compare outcomes among patients with ICH who were treated with intravenous infusion of different antihypertensive medications during the first 24 hours after admission. Methods We analyzed one-year data (2005–2006) from the Premier database which is a nationally representative hospital discharge database containing data pertaining to admissions in the United States. We compared discharge outcomes, length of stay, and cost of hospitalization between groups of patients who were treated using either intravenous nicardipine or nitroprusside infusion. Chi-square and ANOVA were used for univariate analysis. Logistic and linear regression analyses were performed to adjust for baseline risk of mortality between the two groups. Results A total of 12,767 admissions with primary diagnosis of ICH were identified. Nicardipine was administered in 926 patients (7.3%) and nitroprusside was administered in 530 (4.3%) patients. There was no difference in baseline disease severity or risk of mortality among patients who were administered nicardipine or nitroprusside. After adjustment for baseline risk of mortality, the risk of in-hospital mortality (odds ratio [OR] 1.7, 95% confidence interval [95% CI] 1.3–2.2) was higher among patients treated with nitroprusside compared with nicardipine. The risk of in-hospital mortality was also higher after adjustment for baseline risk of mortality and hospital characteristics in patients treated with nitroprusside (OR 1.6, 95% CI 1.2–2.1). After exclusion of patients who died during hospitalization, there was no difference in length of stay and total hospital cost in the multivariate analysis. Conclusion Use of nicardipine compared with nitroprus-side infusion during the first 24 h after ICH may be associated with reduced risk of in-hospital mortality without any increase in the hospitalization cost or length of stay.

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“…Nitroprusside decreases cerebral blood flow while increasing intracranial pressure (ICP), effects that are particularly detrimental in patients with hypertensive encephalopathy or following a cerebrovascular accident (Anile et al 1981; Griswold et al 1981; Kondo et al 1984; Hartmann et al 1989). In unanesthetized patient’s sodium nitroprusside can increase ICP, causing cerebral perfusion pressure to drop (Turner et al 1977; Henriksen and Paulson 1982; Murphy and Sage 1988).…”

Section: Pharmacotherapymentioning

confidence: 99%

Perioperative hypertension management

Varon¹

2008

VHRM

159

117

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Perioperative hypertension is commonly encountered in patients that undergo surgery. While attempts have been made to standardize the method to characterize the intraoperative hemodynamics, these methods still vary widely. In addition, there is a lack of consensus concerning treatment thresholds and appropriate therapeutic targets, making absolute recommendations about treatment diffi cult. Nevertheless, perioperative hypertension requires careful management. When treatment is necessary, therapy should be individualized for the patient. This paper reviews the pharmacologic agents and strategies commonly used in the management of perioperative hypertension.

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Alteration of intracranial pressure, cerebral blood flow, autoregulation and carbondioxide-reactivity by hypotensive agents in baboons with intracranial hypertension

Cited by 10 publications

References 0 publications

Cerebral Blood Flow Autoregulation in Acute Intracranial Hypertension

Cerebral Blood Flow Autoregulation in Acute Intracranial Hypertension

A Multicenter Comparison of Outcomes Associated with Intravenous Nitroprusside and Nicardipine Treatment Among Patients with Intracerebral Hemorrhage

Perioperative hypertension management

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