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FASEB Journal : Official Publication of... May 2022The F prostanoid receptor (FP), which accounts for the therapeutic effect of PGF in uterine atony that leads to postpartum hemorrhage and maternal morbidity, could...
The F prostanoid receptor (FP), which accounts for the therapeutic effect of PGF in uterine atony that leads to postpartum hemorrhage and maternal morbidity, could possibly mediate vasoconstrictor effect in small or resistance arteries to elevate blood pressure that limits the clinical use of the agent in patients with cardiovascular disorders. This study aimed to test the above hypothesis with genetically altered mice. Ex vivo and in vivo experiments were performed on control wild-type (WT) mice and mice with deficiencies in FP (FP ) or thromboxane (Tx)-prostanoid receptor (the original receptor of TxA ; TP ), and/or those with an additional deficiency in E prostanoid receptor-3 (one of the vasoconstrictor receptors of PGE ; EP3 ). Here, we show that PGF indeed evoked vasoconstrictor responses in the above-mentioned tissues of WT mice, which were however unaltered by FP . Interestingly, such contractile responses were reversed into dilations by TP /EP3 . A similar pattern of results was observed with the pressor effect of PGF under in vivo conditions. However, TP alone (which could largely remove the contractile responses) did not result in relaxation to PGF . Also, either the ex vivo vasodilator effect or the in vivo depressor response of PGF obtained after the removal of TP and EP3-mediated actions was unaltered by FP . Therefore, both the ex vivo vasoconstrictor action in small or resistance arteries and the systemic pressor effect of PGF can reflect vasoconstrictor activities derived from the non-FP receptors TP and EP3 outweighing a concurrently activated dilator effect, which is again independent of FP.
Topics: Animals; Female; Mice; Prostaglandins; Prostaglandins F; Receptors, Prostaglandin; Receptors, Thromboxane; Vasoconstrictor Agents
PubMed: 35349198
DOI: 10.1096/fj.202101908R -
Expert Opinion on Pharmacotherapy Oct 2009At present, terlipressin is predominantly used for the management of bleeding gastric and esophageal varices, as well as hepato-renal syndrome secondary to liver... (Review)
Review
BACKGROUND
At present, terlipressin is predominantly used for the management of bleeding gastric and esophageal varices, as well as hepato-renal syndrome secondary to liver cirrhosis. Owing to its high and relatively selective affinity to vascular V1 receptors, terlipressin is also increasingly used as an adjunct vasopressor agent in the management of vasodilatory hyperdynamic septic shock.
OBJECTIVE
This review article aims to summarize the available knowledge related to hemodynamic support with terlipressin in septic shock.
METHODS
For literature search, PubMed and specific keywords from the MeSH Database were used.
RESULTS/CONCLUSIONS
Terlipressin represents an effective pressor agent in patients with catecholamine-unresponsive septic shock. However, caution should be exercised, as terlipressin may contribute dose-dependently to vasoconstriction and a reflectory decrease in cardiac output. Additional studies are needed to clarify: i) the optimal time of therapy institution; ii) the efficacy and the dosages of continuous infusion versus bolus administration; and iii) the safety and efficacy of this compound in comparison with other nonspecific vasopressinergic drugs, such as arginine vasopressin. Whether or not terlipressin may improve the outcome of septic shock patients compared with standard therapy with catecholamines remains to be determined.
Topics: Animals; Cardiac Output; Clinical Trials as Topic; Dose-Response Relationship, Drug; Humans; Lypressin; Shock, Septic; Terlipressin; Vasoconstrictor Agents
PubMed: 19735216
DOI: 10.1517/14656560903257808 -
Current Hypertension Reports May 2017This review is intended to briefly describe the primary mechanistic pathways by which several common drugs can increase blood pressure. We also propose potential... (Review)
Review
PURPOSE OF REVIEW
This review is intended to briefly describe the primary mechanistic pathways by which several common drugs can increase blood pressure. We also propose potential management strategies based on the underlying mechanisms responsible for the blood pressure elevation.
RECENT FINDINGS
As hypertension is a significant risk factor for cardiovascular events, healthcare providers must evaluate patients' concomitant medications that may contribute to elevations in blood pressure. The presence of these medications, if not properly addressed, can lead to consequences such as an inadvertent diagnosis of hypertension, as well as the potential need for unnecessary intensification of antihypertensive regimens in those already treated. Blood pressure elevation is an unfortunate by-product of multiple medications. The substances discussed in this review can elicit significant and persistent elevations in blood pressure, and health care providers must first evaluate whether the drug is necessary. If one exists, it is best to select a similar agent with lower risk of increasing blood pressure; if unavoidable, then clinicians should select an appropriate management strategy to compensate for the rise in blood pressure.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Blood Pressure; Glucocorticoids; Gonadal Steroid Hormones; Humans; Hypertension; Risk Factors; Sympathomimetics; Vasoconstrictor Agents; Water-Electrolyte Imbalance
PubMed: 28451850
DOI: 10.1007/s11906-017-0736-z -
The Cochrane Database of Systematic... Aug 2018Pelvic organ prolapse (POP) affects as many as 50% of parous women, with 14% to 19% of women undergoing a surgical correction. Although surgery for the treatment of POP... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pelvic organ prolapse (POP) affects as many as 50% of parous women, with 14% to 19% of women undergoing a surgical correction. Although surgery for the treatment of POP is common, limited supportive data can be found in the literature regarding the preoperative and postoperative interventions related to these procedures. The main goal of perioperative interventions is to reduce the rate of adverse events while improving women's outcomes following surgical intervention for prolapse. A broad spectrum of perioperative interventions are available, and although the benefits of interventions such as prophylactic antibiotics before abdominal surgery are well established, others are unique to women undergoing POP surgeries and as such need to be investigated separately.
OBJECTIVES
The aim of this review is to compare the safety and effectiveness of a range of perioperative interventions versus other interventions or no intervention (control group) at the time of surgery for pelvic organ prolapse.
SEARCH METHODS
We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In Process, ClinicalTrials.gov, WHO ICTRP, handsearching of journals and conference proceedings (searched 30 November 2017), and reference lists of relevant articles. We also contacted researchers in the field.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) of women undergoing surgical treatment for symptomatic pelvic organ prolapse that compared a perioperative intervention related to pelvic organ prolapse surgery versus no treatment or another intervention.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures recommended by Cochrane. Our primary outcomes were objective failure at any site and subjective postoperative prolapse symptoms. We also measured adverse effects, focusing on intraoperative blood loss and blood transfusion, intraoperative ureteral injury, and postoperative urinary tract infection.
MAIN RESULTS
We included 15 RCTs that compared eight different interventions versus no treatment for 1992 women in five countries. Most interventions were assessed by only one RCT with evidence quality ranging from very low to moderate. The main limitation was imprecision, associated with small sample sizes and low event rates.Pelvic floor muscle training (PFMT) compared with no treatment (three RCTs) - peri-operative intervention The simplest of the PFMT programmes required women to attend six perioperative consultations in the three months surrounding prolapse surgery. Trial results provided no clear evidence of a difference between groups in objective failure at any site at 12 to 24 months (odds ratio (OR) 0.93, 95% confidence interval (CI) 0.56 to 1.54; two RCTs, 327 women; moderate-quality evidence). With respect to awareness of prolapse, findings were inconsistent. One RCT found no evidence of a difference between groups at 24 months (OR 1.07, 95% CI 0.61 to 1.87; one RCT, 305 women; low-quality evidence), and a second small RCT reported symptom reduction from the Pelvic Organ Prolapse Symptom Questionnaire completed by the intervention group at 12 months (mean difference (MD) -3.90, 95% CI -6.11 to -1.69; one RCT, 27 women; low-quality evidence). Researchers found no clear differences between groups at 24-month follow-up in rates of repeat surgery (or pessary) for prolapse (OR 1.92, 95% CI 0.74 to 5.02; one RCT, 316 women; low-quality evidence).Other interventionsSingle RCTs evaluated the following interventions: preoperative guided imagery (N = 44); injection of vasoconstrictor agent at commencement of vaginal prolapse surgery (N = 76); ureteral stent placement during uterosacral ligament suspension (N = 91); vaginal pack (N = 116); prophylactic antibiotics for women requiring postoperative urinary catheterisation (N = 159); and postoperative vaginal dilators (N = 60).Two RCTs evaluated bowel preparation (N = 298), and four RCTs assessed the method and timing of postoperative catheterisation (N = 514) - all in different comparisons.None of these studies reported our primary review outcomes. One study reported intraoperative blood loss and suggested that vaginal injection of vasoconstrictors at commencement of surgery may reduce blood loss by a mean of about 30 mL. Another study reported intraoperative ureteral injury and found no clear evidence that ureteral stent placement reduces ureteral injury. Three RCTs reported postoperative urinary tract infection and found no conclusive evidence that rates of urinary tract infection were influenced by use of a vaginal pack, prophylactic antibiotics, or vaginal dilators. Other studies did not report these outcomes.
AUTHORS' CONCLUSIONS
There was a paucity of data about perioperative interventions in pelvic organ prolapse surgery. A structured programme of pelvic floor muscle training before and after prolapse surgery did not consistently demonstrate any benefit for the intervention; however, this finding is based on the results of two small studies. With regard to other interventions (preoperative bowel preparation and injection of vasoconstrictor agent, ureteral stent placement during uterosacral ligament suspension, postoperative vaginal pack insertion, use of vaginal dilators, prophylactic antibiotics for postoperative catheter care), we found no evidence regarding rates of recurrent prolapse and no clear evidence that these interventions were associated with clinically meaningful reductions in adverse effects, such as intraoperative or postoperative blood transfusion, intraoperative ureteral injury, or postoperative urinary tract infection.
Topics: Antibiotic Prophylaxis; Exercise; Female; Humans; Imagery, Psychotherapy; Pelvic Floor; Pelvic Organ Prolapse; Perioperative Care; Pessaries; Randomized Controlled Trials as Topic; Recurrence; Reoperation; Stents; Vasoconstrictor Agents
PubMed: 30121957
DOI: 10.1002/14651858.CD013105 -
British Journal of Anaesthesia Jul 2009After fluid resuscitation, vasoactive drug treatment represents the major cornerstone for correcting any major impairment of the circulation. However, debate still rages... (Review)
Review
After fluid resuscitation, vasoactive drug treatment represents the major cornerstone for correcting any major impairment of the circulation. However, debate still rages as to the choice of agent, dose, timing, targets, and monitoring modalities that should optimally be used to benefit the patient yet, at the same time, minimize harm. This review highlights these areas and some new pharmacological agents that broaden our therapeutic options.
Topics: Blood Pressure; Cardiac Output; Cardiotonic Agents; Cardiovascular System; Humans; Monitoring, Physiologic; Oxygen Consumption; Vasoconstrictor Agents
PubMed: 19460775
DOI: 10.1093/bja/aep135 -
Arquivos Brasileiros de Cardiologia Sep 2008The routine use of local anesthetics associated to vasoconstrictors for the dental treatment of patients with cardiopathies is still controversial, due to the risk of... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The routine use of local anesthetics associated to vasoconstrictors for the dental treatment of patients with cardiopathies is still controversial, due to the risk of adverse cardiovascular effects.
OBJECTIVE
To evaluate and compare the hemodynamic effects of the use of local anesthetics with a non-adrenergic vasoconstrictor in patients with ventricular arrhythmia, when compared to the use of anesthetics without vasoconstrictor.
METHODS
A prospective randomized study evaluated 33 patients with positive serology for Chagas' disease and 32 patients with coronary artery disease that presented complex ventricular arrhythmia at Holter monitoring (>10 EV/h and NSVT), of which 21 were females, aged 54.73 + 7.94 years, submitted to routine dental treatment with pterygomandibular anesthesia. These patients were divided in two groups: group I received prilocaine 3% associated with felypressin 0.03 IU/ml and group II received lidocaine 2% without vasoconstrictor. The number and complexity of extrasystoles were analyzed, as well as the heart rate and systemic arterial pressure of the patients on the day before, one hour before, during the procedure and one hour after the dental procedure.
RESULTS
No hemodynamic alterations or increase in the number and complexity of the ventricular arrhythmia related to the anesthetic used in the dental procedure were observed in either group.
CONCLUSION
The results suggest that prilocaine 3% associated to a felypressin 0.03 IU/ml can be safely used in patients with Chagas' disease or coronariopathy with complex ventricular arrhythmia.
Topics: Adolescent; Adult; Aged; Anesthesia, Dental; Anesthetics, Local; Arrhythmias, Cardiac; Blood Pressure; Chagas Cardiomyopathy; Electrocardiography, Ambulatory; Felypressin; Female; Heart Rate; Humans; Lidocaine; Male; Middle Aged; Prilocaine; Prospective Studies; Time Factors; Vasoconstrictor Agents; Young Adult
PubMed: 18853053
DOI: 10.1590/s0066-782x2008001500002 -
The Medical Journal of Australia Oct 1969
Topics: Adolescent; Adult; Anesthesia, Local; Epinephrine; Hemodynamics; Hemostatics; Humans; Middle Aged; Ornithine; Surgical Procedures, Operative; Vasoconstrictor Agents; Vasopressins
PubMed: 5356805
DOI: 10.5694/j.1326-5377.1969.tb107385.x -
International Anesthesiology Clinics 1989Lidocaine, tetracaine, and bupivacaine are the local anesthetic agents most commonly employed for spinal anesthesia in the U.S. Lidocaine provides a short duration of... (Review)
Review
Lidocaine, tetracaine, and bupivacaine are the local anesthetic agents most commonly employed for spinal anesthesia in the U.S. Lidocaine provides a short duration of anesthesia and is primarily useful for surgical and obstetrical procedures lasting less than one hour. Tetracaine and bupivacaine are used for procedures lasting 2 to 5 hours. Tetracaine appears to provide a somewhat longer duration of anesthesia and a more profound degree of motor block than does bupivacaine. On the other hand, compared with tetracaine, bupivacaine has been demonstrated to be associated with a decreased incidence of hypotension. In addition, bupivacaine may be better than tetracaine for use in orthopedic surgical procedures since it appears to be associated with a lower incidence of tourniquet pain. Vasoconstrictors can prolong the duration of spinal anesthesia of all three agents. However, the greatest duration is seen when vasoconstrictors are added to tetracaine solutions. Lidocaine and bupivacaine do not appear to benefit as much from the addition of vasoconstrictors. In general, the local anesthetic agents that are currently available for spinal anesthesia provide significant versatility. By carefully considering the planned surgical procedure, the surgeon's requirements, and the patient's characteristics (e.g., age, height, gravidity), and by understanding the factors that influence spinal anesthesia, the anesthesiologist can select a local anesthetic agent that will assure adequate and satisfying spinal anesthesia.
Topics: Anesthesia, Spinal; Anesthetics, Local; Humans; Vasoconstrictor Agents
PubMed: 2646230
DOI: 10.1097/00004311-198902710-00005 -
Toxicon : Official Journal of the... Nov 2002
Review
Topics: Amino Acid Sequence; Animals; Endothelins; Molecular Sequence Data; Structure-Activity Relationship; Vasoconstrictor Agents; Viper Venoms
PubMed: 12419504
DOI: 10.1016/s0041-0101(02)00159-9 -
Anaesthesia and Intensive Care Nov 2016
Topics: Humans; Hypotension; Vasoconstrictor Agents
PubMed: 27832569
DOI: 10.1177/0310057X1604400608