Effect of l-norepinephrine on left ventricular diastolic pressures in man

Cudkowicz, Leon

doi:10.1136/thx.23.1.63

Cited by 6 publications

(2 citation statements)

References 15 publications

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“…Secondly, not having access to the ventricular or atrial pressure, we used a validated semi-quantitative method to classify LV filling pressure as a high or normal preload [30]. Moreover, the filling pressure was kept at the same level during NOR administration, even though NOR is known to increase the LV filling pressure [49]. This approximation is likely to have led to an overestimation of contractility in response to NOR.…”

Section: Limitationsmentioning

confidence: 99%

Monitoring of cardiovascular physiology augmented by a patient-specific biomechanical model during general anesthesia. A proof of concept study

et al. 2020

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During general anesthesia (GA), direct analysis of arterial pressure or aortic flow waveforms may be inconclusive in complex situations. Patient-specific biomechanical models, based on data obtained during GA and capable to perform fast simulations of cardiac cycles, have the potential to augment hemodynamic monitoring. Such models allow to simulate Pressure-Volume (PV) loops and estimate functional indicators of cardiovascular (CV) system, e.g. ventricular-arterial coupling (V va), cardiac efficiency (CE) or myocardial contractility, evolving throughout GA. In this prospective observational study, we created patient-specific biomechanical models of heart and vasculature of a reduced geometric complexity for n = 45 patients undergoing GA, while using transthoracic echocardiography and aortic pressure and flow signals acquired in the beginning of GA (baseline condition). If intraoperative hypotension (IOH) appeared, diluted norepinephrine (NOR) was administered and the model readjusted according to the measured aortic pressure and flow signals. Such patients were a posteriori assigned into a so-called hypotensive group. The accuracy of simulated mean aortic pressure (MAP) and stroke volume (SV) at baseline were in accordance with the guidelines for the validation of new devices or reference measurement methods in all patients. After NOR administration in the hypotensive group, the percentage of concordance with 10% exclusion zone between measurement and simulation was >95% for both MAP and SV. The modeling results showed a decreased V va (0.64±0.37 vs 0.88±0.43; p = 0.039) and an increased CE (0.8±0.1 vs 0.73±0.11; p = 0.042) in hypotensive vs normotensive patients. Furthermore, V va increased by 92±101%, CE decreased by 13±11% (p < 0.001 for both) and contractility increased by 14±11% (p = 0.002) in the hypotensive group post-NOR administration. In this work we demonstrated the application of fast-running patient-specific biophysical models to estimate PV loops and functional indicators of CV system using

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Section: Limitationsmentioning

confidence: 99%

Monitoring of cardiovascular physiology augmented by a patient-specific biomechanical model during general anesthesia. A proof of concept study

et al. 2020

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“…Both increases and decreases in cardiac output after these drugs have been noted in shock, but elevation of arterial pressure occurs almost uniformly.44• 104 Central venous pressure rises, and, although studies of the effects of norepinephrine on left ventricular diastolic pressures in man in shock are not available, elevations occur in normal persons. 28 In studies on dogs, comparisons have demonstrated isoproterenol to be superior to norepinephrine in increasing cardiac output and lowering left ventricular enddiastolic pressure. 37 Both norepinephrine and metaraminol may induce tachycardia and ectopic arrhythmias.…”

Section: Hemolysis Equipmentmentioning

confidence: 99%

Cardiogenic shock: A review

Perlroth

Harrison

1969

Clin Pharma and Therapeutics

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A great expansion of interest has occurred in the syndrome of circulatory shock. The measurement of hemodynamic and metabolic variables in human beings and experimental animals now allows an orderly and integrated approach to the ill patient. In cardiogenic shock the minute output of the acutely iniured heart abruptly decreases with attendant fall in arterial blood pressure, tissue perfusion, and pH. Effective venous return to the right and left heart may be monitored by central venous pressure and pulmonary artery diastolic pressure. If low, infusion of volume expanders alone may be sufficient to reverse the shock syndrome. If drugs are required, a variety of catecholamines with alpha and beta stimulating properties are available, as well as inotropic agents such as digitalis and glucagon. Principles for their selection are discussed. The potential roles and hazards of alpha-and beta-adrenergic blocking agents and steroids are also considered. When limits of pharmacologic resuscitation have been reached, mechanical aid and surgical assistance to the cardiovascular system are available. The latter promises to pe of greater importance in the future.

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Pump Failure: Role of Vasopressor Agents

Reddy¹,

El‐Sherif²

1986

The Pathophysiology and Pharmacotherapy of Myocardial Infarction

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Effect of l-norepinephrine on left ventricular diastolic pressures in man

Cited by 6 publications

References 15 publications

Monitoring of cardiovascular physiology augmented by a patient-specific biomechanical model during general anesthesia. A proof of concept study

Monitoring of cardiovascular physiology augmented by a patient-specific biomechanical model during general anesthesia. A proof of concept study

Cardiogenic shock: A review

Pump Failure: Role of Vasopressor Agents

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