Intraoperative Hypotonie: Bedeutung und Monitoring in der klinischen Praxis

Frank, P; Ilies, C.; Schmidt, René; Bein, Berthold

doi:10.1055/s-0042-107915

Cited by 3 publications

(1 citation statement)

References 29 publications

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“…As there is no general consensus regarding optimal blood pressure targets, the minimum target SBPmin was defined here on a case by case basis by the treating physician. Recent studies indicated that individualized blood pressure management may in fact be preferable compared with a more standard strategy using predefined threshold values [18,19]. While numerically higher AUC values were observed in patients treated with C/T, these values were not significantly different between treatment arms; however, when evaluating the AUC data it must be taken into account that these values reflect not only the course of SBP but also the targeted increase in SBP.…”

Section: Discussionmentioning

confidence: 99%

Treatment of intraoperative hypotension with cafedrine/theodrenaline versus ephedrine

et al. 2020

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Background Sympathomimetic drugs are a therapeutic cornerstone for the management of hypotensive states like intraoperative hypotension (IOH). While cafedrine/theodrenaline (C/T) is widely used in Germany to restore blood pressure in patients with IOH, more research is required to compare its effectiveness with alternatives such as ephedrine (E) that are more commonly available internationally. Methods HYPOTENS (NCT02893241, DRKS00010740) was a prospective, national, multicenter, open-label, two-armed, non-interventional study that compared C/T with E for treatment of IOH. We describe a prospectively defined cohort of patients ≥50 years old with comorbidities undergoing general anesthesia induced with propofol and fentanyl. Primary objectives were to examine treatment precision, rapidity of onset and the ability to restore blood pressure without relevant increases in heart rate. Secondary endpoints were treatment satisfaction and the number of required additional boluses or other accompanying measures. Results A total of 1496 patients were included in the per protocol analysis. Overall, effective stabilization of blood pressure was achieved with both C/T and E. Post-hoc analysis showed that blood pressure increase from baseline was more pronounced with C/T. Fewer additional boluses or other accompanying measures were required in the C/T arm. The incidence of tachycardia was comparable between groups. Post-hoc analysis showed that E produced dose-dependent elevated heart rate values. By contrast, heart rate remained stable in patients treated with C/T. Physicians reported a higher level of treatment satisfaction with C/T, with a higher proportion of anesthetists rating treatment precision and rapidity of onset as good or very good when compared with E. Conclusion Neither drug was superior in restoring blood pressure levels; however, post-hoc analyses suggested that treatment is more goal-orientated and easier to control with C/T. Heart rate was shown to be more stable with C/T and fewer additional interventions were required to restore blood pressure, which could have contributed to the increased treatment satisfaction reported by anesthetists using C/T.

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Section: Discussionmentioning

confidence: 99%

Treatment of intraoperative hypotension with cafedrine/theodrenaline versus ephedrine

et al. 2020

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Wie mache ich eine Allgemeinanästhesie?

Wilhelm

Wietasch

2017

Praxis Der Anästhesiologie

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Flow down gradients: the problem of pressure in this physiology core concept

Nocke

Meyer

Leßmann

2023

Advances in Physiology Education

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The core concepts of physiology, as first published in this journal in 2011, not only provide a noteworthy teaching approach but also encourage reflection on the fundamentals of physiology. Unfortunately, a fundamental flaw has crept into the core concept of flow down gradients. Fluids do not generally flow from high to low pressure, as claimed, but only because of a specific pressure difference, that is, the perfusion pressure. This is related to a problem that is widespread in physiology, from which even the core concepts are not free, namely, the description of mean arterial pressure (MAP) solely by means of Ohm's law of circulation, although this law actually describes perfusion pressure. Both pressures can be numerically approximately equal in the physiological case, but conceptually they remain different in principle. We solved this problem using the extended Bernoulli equation (a combination of Ohm's law and the simple Bernoulli equation). Thereafter, MAP depends on the following pressure components, all of which are essential for a basic understanding of circulation: perfusion, central venous, gravitational, and dynamic pressures. These pressures also have great pathophysiological and clinical importance, which we exemplify here. Towards the end of this paper, we provide recommendations that should be considered in teaching, whether it is a beginner or advanced course. We address physiology teachers who are open to critical constructive improvements in their teaching, especially in hemodynamics. In particular, we encourage the authors of the flow down gradients core concept to improve and refine its "unpacking."

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Intraoperative Hypotonie: Bedeutung und Monitoring in der klinischen Praxis

Cited by 3 publications

References 29 publications

Treatment of intraoperative hypotension with cafedrine/theodrenaline versus ephedrine

Treatment of intraoperative hypotension with cafedrine/theodrenaline versus ephedrine

Wie mache ich eine Allgemeinanästhesie?

Flow down gradients: the problem of pressure in this physiology core concept

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