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Reproduction (Cambridge, England) Oct 2022There is a pregnancy-induced vasodilation of blood vessels, which is known to have a protective effect on cardiovascular function and can be maintained postpartum. This... (Review)
Review
IN BRIEF
There is a pregnancy-induced vasodilation of blood vessels, which is known to have a protective effect on cardiovascular function and can be maintained postpartum. This review outlines the cardiovascular changes that occur in a healthy human and rodent pregnancy, as well as different pathways that are activated by angiotensin II and relaxin that result in blood vessel dilation.
ABSTRACT
During pregnancy, systemic and uteroplacental blood flow increase to ensure an adequate blood supply that carries oxygen and nutrients from the mother to the fetus. This results in changes to the function of the maternal cardiovascular system. There is also a pregnancy-induced vasodilation of blood vessels, which is known to have a protective effect on cardiovascular health/function. Additionally, there is evidence that the effects of maternal vascular vasodilation are maintained post-partum, which may reduce the risk of developing high blood pressure in the next pregnancy and reduce cardiovascular risk later in life. At both non-pregnant and pregnant stages, vascular endothelial cells produce a number of vasodilators and vasoconstrictors, which transduce signals to the contractile vascular smooth muscle cells to control the dilation and constriction of blood vessels. These vascular cells are also targets of other vasoactive factors, including angiotensin II (Ang II) and relaxin. The binding of Ang II to its receptors activates different pathways to regulate the blood vessel vasoconstriction/vasodilation, and relaxin can interact with some of these pathways to induce vasodilation. Based on the available literature, this review outlines the cardiovascular changes that occur in a healthy human pregnancy, supplemented by studies in rodents. A specific focus is placed on vasodilation of blood vessels during pregnancy; the role of endothelial cells and endothelium-derived vasodilators will also be discussed. Additionally, different pathways that are activated by Ang II and relaxin that result in blood vessel dilation will also be reviewed.
Topics: Angiotensin II; Endothelial Cells; Endothelium, Vascular; Female; Humans; Oxygen; Pregnancy; Relaxin; Vasoconstrictor Agents; Vasodilator Agents
PubMed: 36018774
DOI: 10.1530/REP-21-0428 -
Journal of Burn Care & Research :... Mar 2023Acute burn surgery has long been associated with significant intra-operative bleeding. Several techniques were introduced to limit hemorrhage, including tourniquets,...
Acute burn surgery has long been associated with significant intra-operative bleeding. Several techniques were introduced to limit hemorrhage, including tourniquets, tumescent infiltration, and topical agents. To date, no study has comprehensively investigated the available data regarding topical hemostatic agents in burn surgery. A systematic review was performed by two independent reviewers using electronic databases (PubMed, Scopus, Web of Science) from first available to September 10, 2021. Articles were included if they were published in English and described or evaluated topical hemostatic agents used in burn excision and/or grafting. Data were extracted on the agent(s) used, their dosage, mode of delivery, hemostasis outcomes, and complications. The search identified 1982 nonduplicate citations, of which 134 underwent full-text review, and 49 met inclusion criteria. In total, 32 studies incorporated a vasoconstrictor agent, and 28 studies incorporated a procoagulant agent. Four studies incorporated other agents (hydrogen peroxide, tranexamic acid, collagen sheets, and TT-173). The most common vasoconstrictor used was epinephrine, with doses ranging from 1:1000 to 1:1,000,000. The most common procoagulant used was thrombin, with doses ranging from 10 to 1000 IU/ml. Among the comparative studies, outcomes of blood loss were not reported in a consistent manner, therefore meta-analysis could not be performed. The majority of studies (94%) were level of evidence III-V. Determining the optimal topical hemostatic agent is limited by low-quality data and challenges with consistent reporting of intra-operative blood loss. Given the routine use of topical hemostatic agents in burn surgery, high-quality research is essential to determine the optimal agent, dosage, and mode of delivery.
Topics: Humans; Burns; Administration, Topical; Vasoconstrictor Agents; Blood Loss, Surgical; Hemostatics; Antifibrinolytic Agents
PubMed: 36516423
DOI: 10.1093/jbcr/irac185 -
Microsurgery Mar 2019There is a hesitancy to utilize vasopressors in microsurgical reconstruction due to fear of vessel spasm and subsequent flap compromise. Although there are large... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
There is a hesitancy to utilize vasopressors in microsurgical reconstruction due to fear of vessel spasm and subsequent flap compromise. Although there are large literature reviews analyzing vasopressor usage in head and neck reconstruction, this has not been extrapolated to all regions of the body. The goal of this study was to perform a meta-analysis examining vasopressor usage and risk of complications in microsurgical reconstruction for all recipient sites.
MATERIALS AND METHODS
A meta-analysis was conducted for articles discussing the utilization of vasopressors in microsurgical reconstruction. The primary endpoint was total flap failure. Secondary endpoints were necessity for operative take-back and hematoma requiring intervention. Odds ratios were calculated for each complication and for each study.
RESULTS
Four prospective and six retrospective studies were analyzed yielding 6321 patients and 7526 flaps. 67.4% (966/1433) of patients received vasopressors and 80.8% (6080/7526) of flaps received vasopressors. There were 100 failures in the vasopressor group (100/6080 = 15.9%) and 39 failures in the non-vasopressor group (39/1456 = 26.8%) (O.R. 0.73; p = 0.12). There were 177 take-backs in the vasopressor group (177/5916 = 29.9%) and 64 take-backs in the non-vasopressor group (64/1404 = 4.6%) (O.R. 0.65; p < 0.05). There were 73 hematomas in the vasopressor group (73/5099 = 14/3%) and 14 hematomas in the non-vasopressor group (14/979 = 14.3%) (O.R. 1; p = 0.89). The odds ratio for total flaps failures in the breast and head/neck cohorts were 0.788 (p = 0.76) and 1.2761 (p = 0.77), respectively, with neither significantly increased in flaps receiving vasopressors.
CONCLUSION
Our results suggest that vasopressor utilization does not directly result in increased complications. Flaps that received vasopressors had a statistically lower rate of take-back and failure. Due to the paucity of data available for analysis and limited reporting relating flap characteristics to outcomes, prospective, well-designed studies are necessary to verify the safety of vasopressor use in microsurgical reconstruction.
Topics: Free Tissue Flaps; Graft Survival; Hematoma; Humans; Microsurgery; Odds Ratio; Postoperative Complications; PubMed; Plastic Surgery Procedures; Treatment Outcome; Vasoconstriction; Vasoconstrictor Agents
PubMed: 30056632
DOI: 10.1002/micr.30341 -
Experimental Eye Research Aug 2023Adrenaline is a sympathomimetic drug used to maintain pupil dilation and to decrease the risk of bleeding. The aim of this study was to demonstrate if adrenaline could...
Adrenaline is a sympathomimetic drug used to maintain pupil dilation and to decrease the risk of bleeding. The aim of this study was to demonstrate if adrenaline could exert antifibrotic effects in glaucoma surgery. Adrenaline was tested in fibroblast-populated collagen contraction assays and there was a dose-response decrease in fibroblast contractility: matrices decreased to 47.4% (P = 0.0002) and 86.6% (P = 0.0036) with adrenaline 0.0005% and 0.01%, respectively. There was no significant decrease in cell viability even at high concentrations. Human Tenon's fibroblasts were also treated with adrenaline (0%, 0.0005%, 0.01%) for 24 h and RNA-Sequencing was performed on the Illumina NextSeq 2000. We carried out detailed gene ontology, pathway, disease and drug enrichment analyses. Adrenaline 0.01% upregulated 26 G1/S and 11 S-phase genes, and downregulated 23 G2 and 17 M-phase genes (P < 0.05). Adrenaline demonstrated similar pathway enrichment to mitosis and spindle checkpoint regulation. Adrenaline 0.05% was also injected subconjunctivally during trabeculectomy, PreserFlo Microshunt and Baerveldt 350 tube surgeries, and patients did not experience any adverse effects. Adrenaline is a safe and cheap antifibrotic drug that significantly blocks key cell cycle genes when used at high concentrations. Unless contraindicated, we recommend subconjunctival injections of adrenaline (0.05%) in all glaucoma bleb-forming surgeries.
Topics: Humans; Glaucoma; Epinephrine; Vasoconstrictor Agents; Genes, cdc; Trabeculectomy; Fibroblasts
PubMed: 37429521
DOI: 10.1016/j.exer.2023.109561 -
AORN Journal Mar 2022
Topics: Humans; Hypotension; Norepinephrine; Vasoconstrictor Agents
PubMed: 35213045
DOI: 10.1002/aorn.13627 -
European Annals of Otorhinolaryngology,... Feb 2015Due to their vasoconstrictive action on the nasal mucosa, ephedrine and pseudoephedrine are highly efficient amines for relief of nasal congestion. As with any... (Review)
Review
Due to their vasoconstrictive action on the nasal mucosa, ephedrine and pseudoephedrine are highly efficient amines for relief of nasal congestion. As with any vasoconstrictor and as underscored by the French Society of Otorhinolaryngology in its 2011 guideline, these molecules should not be used in patients under the age of 15. Furthermore, due to unpredictable severe cardiovascular and neurological adverse events that may occur even at low dose and in the absence of any pre-existing pathology, they should not be prescribed for the common cold, and ENT physicians must carefully weigh the risk/benefit ratio in patients with allergic rhinitis. Distribution should be regulated and over-the-counter sales banned.
Topics: Ephedrine; Humans; Nasal Decongestants; Pseudoephedrine; Vasoconstrictor Agents
PubMed: 25532441
DOI: 10.1016/j.anorl.2014.11.001 -
Cardiology in Review 2019Septic shock, a form of vasodilatory shock associated with high morbidity and mortality, requires early and effective therapy to improve patient outcomes. Current... (Review)
Review
Septic shock, a form of vasodilatory shock associated with high morbidity and mortality, requires early and effective therapy to improve patient outcomes. Current management of septic shock includes the use of intravenous fluids, catecholamines, and vasopressin for hemodynamic support to ensure adequate perfusion. Despite these interventions, hospital mortality rates are still greater than 40%. Practitioners are continuously faced with cases of refractory shock that are associated with poor clinical outcomes. In December of 2017, the Food and Drug Administration approved the first synthetic human angiotensin II, a potent vasoconstrictor, to increase blood pressure in adults with septic or other distributive shock. This approval was based (ATHOS) on the results from the Angiotensin II for the Treatment of High Output Shock study. In this randomized, double-blind, placebo-controlled trial, patients in the angiotensin II group achieved higher rates of target mean arterial pressure and had lower catecholamine requirements in the first 3 hours of therapy compared with patients in the placebo group. There was no significant difference in the 28-day mortality. Safety issues including the risk of thromboembolic events, infection, and delirium have made clinicians cautious in adopting angiotensin II into practice. Ongoing studies are needed to more clearly define the role of this agent and its utility in the management of shock.
Topics: Angiotensin II; Animals; Blood Pressure; Global Health; Humans; Infusions, Intravenous; Morbidity; Shock, Septic; Survival Rate; Vasoconstrictor Agents; Vasodilation
PubMed: 30601161
DOI: 10.1097/CRD.0000000000000247 -
Journal of Cardiothoracic and Vascular... Dec 2022The renin-angiotensin-aldosterone system (RAAS), whose major vasopressor effector is angiotensin II (ATII), has multiple activities and regulates sodium-water... (Review)
Review
The renin-angiotensin-aldosterone system (RAAS), whose major vasopressor effector is angiotensin II (ATII), has multiple activities and regulates sodium-water homeostasis and fluid and blood pressure homeostasis. RAAS plays a crucial role in cardiocirculatory shock because it counteracts hypotension and hypovolemia by activating different physiologic responses. Based on the encouraging results of the ATHOS-3 trial, the US Food and Drug Administration and the European Medicines Agency approved the use of ATII for catecholamine-resistant vasodilatory shock. More recently, ATII was used for the compassionate treatment of critically ill patients with COVID-19. Beyond its vasopressor properties, ATII was hypothesized to have antiviral activity because it induces internalization and degradation of angiotensin-converting enzyme 2 receptors used by SARS-Cov-2 to infect cells. Overall, the use of ATII in patients with COVID-19 showed promising results because its administration was associated with the achievement and maintenance of target mean arterial pressure, increased PO/FO ratio, and decreased FO. The aim of this narrative review is to summarize the available knowledge on the use of ATII in patients with COVID-19.
Topics: Humans; SARS-CoV-2; Angiotensin II; COVID-19; Renin-Angiotensin System; Vasoconstrictor Agents; Sepsis
PubMed: 35995637
DOI: 10.1053/j.jvca.2022.07.022 -
Journal of Cerebral Blood Flow and... Apr 2021Adrenoceptor and calcium channel modulating medications are widely used in clinical practice for acute neurological and systemic conditions. It is generally assumed that... (Review)
Review
Adrenoceptor and calcium channel modulating medications are widely used in clinical practice for acute neurological and systemic conditions. It is generally assumed that the cerebrovascular effects of these drugs mirror that of their systemic effects - and this is reflected in how these medications are currently used in clinical practice. However, recent research suggests that there are distinct cerebrovascular-specific effects of these medications that are related to the unique characteristics of the cerebrovascular anatomy including the regional heterogeneity in density and distribution of adrenoceptor subtypes and calcium channels along the cerebrovasculature. In this review, we critically evaluate existing basic science and clinical research to discuss known and putative interactions between adrenoceptor and calcium channel modulating pharmacotherapies, the neurovascular unit, and cerebrovascular anatomy. In doing so, we provide a rationale for selecting vasoactive medications based on lesion location and lay a foundation for future investigations that will define neuroprotective paradigms of adrenoceptor and calcium channel modulating therapies to improve neurological outcomes in acute neurological and systemic disorders.
Topics: Adrenergic Agents; Animals; Calcium Channel Blockers; Calcium Channels; Cerebrovascular Disorders; Humans; Nervous System Diseases; Receptors, Adrenergic; Vasoconstrictor Agents
PubMed: 33210576
DOI: 10.1177/0271678X20972869 -
Intensive Care Medicine Dec 2022
Topics: Humans; Shock, Septic; Sepsis; Vasoconstrictor Agents
PubMed: 36102944
DOI: 10.1007/s00134-022-06852-5