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Abstract Background To enhance the utility of functional hemodynamic monitoring, the variables systolic slope (dP/dt) and dynamic arterial elastance (Eadyn) are calculated by the Hypotension Prediction Index (HPI) Acumen® Software. This study was designed to characterize the effects of phenylephrine and ephedrine on dP/dt and Eadyn. Methods This was a retrospective, non-randomized analysis of data collected during two clinical studies. All patients required intra-operative controlled mechanical ventilation and had an indwelling radial artery catheter connected to an Acumen IQ sensor. Raw arterial pressure waveform data was downloaded from the patient monitor and all hemodynamic measurements were calculated off-line. The anesthetic record was reviewed for bolus administrations of either phenylephrine or ephedrine. Cardiovascular variables prior to drug administration were compared to those following vasopressor administrations. The primary outcome was the difference for dP/dt and Eadyn at baseline compared with the average after the bolus administration. All data sets demonstrated non-normal distributions so statistical analysis of paired and unpaired data followed the Wilcoxon matched pairs signed-rank test or Mann-Whitney U test, respectively. Results 201 doses of phenylephrine and 100 doses of ephedrine were analyzed. All data sets are reported as median [95% CI]. Mean arterial pressure (MAP) increased from 62 [54,68] to 78 [76,80] mmHg following phenylephrine and from 59 [55,62] to 80 [77,83] mmHg following ephedrine. Stroke volume and cardiac output both increased. Stroke volume variation and pulse pressure variation decreased. Both drugs produced significant increases in dP/dt, from 571 [531, 645] to 767 [733, 811] mmHg/sec for phenylephrine and from 537 [509, 596] to 848 [779, 930] mmHg/sec for ephedrine. No significant changes in Eadyn were observed. Conclusion Bolus administration of phenylephrine or ephedrine increases dP/dt but does not change Eadyn. dP/dt demonstrates potential for predicting the inotropic response to phenylephrine or ephedrine, providing guidance for the most efficacious vasopressor when treating hypotension. Trial registration Data was collected from two protocols. The first was deemed to not require written, informed consent by the Institutional Review Board (IRB). The second was IRB-approved (Effect of Diastolic Dysfunction on Dynamic Cardiac Monitors) and registered on ClinicalTrials.gov (NCT04177225).

Background: Subarachnoid block, although being highly efficient, often has limitation such as hypotension which can result in adverse maternal and fetal outcome, continues to be a matter of concern to the Anesthesiologist. The study was to compare the effect of phenylephrine, ephedrine and mephentermine, for maintenance of arterial pressure during spinal anaesthesia for caesarean section. Methodology: A prospective randomized double blinded study involving 90 patients with hypotension after subarachnoid block under spinal anesthesia was conducted, dividing them into three groups: P (Phenylephrine) 100 mcg, E (Ephedrine) 6 mg, and M (Mephentermine) 6 mg. Patients were compared based on age, weight, height, hemodynamic parameters, complications, and neonatal APGAR scores. Results: On inter-group comparison rise in systolic, diastolic and mean arterial blood pressure at 1,2,4 and 6min after drug administration were significantly high in phenylephrine group (p /= 7 in the three groups at the 1st and 5th min. Conclusion: The study found that phenylephrine, ephedrine, and mephentermine effectively maintained arterial blood pressure in intravenous bolus form during subarachnoid block for caesarean section. Phenylephrine, a fast-acting, short-lived normotensive drug, significantly reduced heart rate compared to ephedrine and mephentermine, but did not cause significant adverse effects on mother and fetus.

Understanding the intricate relationship between cancer clinicopathological features and anesthetics dosage is crucial for optimizing patient outcomes and safety during surgery. This retrospective study investigates this relationship in patients with non-small cell lung cancer (NSCLC) undergoing video-assisted thoracic surgery (VATS). A comprehensive analysis of medical records was undertaken for NSCLC patients who underwent VATS with intravenous compound inhalation general anesthesia. Patients were categorized based on histological, chemotherapy, radiotherapy, and epidural anesthesia factors. Statistical analysis was performed to compare the differences between the groups. The results revealed compelling insights. Specifically, patients with lung adenocarcinoma (LUAD) undergoing VATS exhibited higher dosages of rocuronium bromide and midazolam during general anesthesia, coupled with a shorter post-anesthesia care unit (PACU) stay compared to those with squamous cell carcinoma (sqCL). Furthermore, chemotherapy patients undergoing VATS demonstrated diminished requirements for phenylephrine and remifentanil in contrast to their non-chemotherapy counterparts. Similarly, radiotherapy patients undergoing VATS demonstrated a decreased necessity for rocuronium bromide compared to non-radiotherapy patients. Notably, patients who received epidural anesthesia in combination with general anesthesia manifested reduced hydromorphone requirements and prolonged hospital stays compared to those subjected to general anesthesia alone. In conclusion, the findings from this study indicate several important observations in diverse patient groups undergoing VATS. The higher dosages of rocuronium bromide and midazolam in LUAD patients point to potential differences in drug requirements among varying lung cancer types. Additionally, the observed shorter PACU stay in LUAD patients suggests a potentially expedited recovery process. The reduced anesthetic requirements of phenylephrine and remifentanilin chemotherapy patients indicate distinct responses to anesthesia and pain management. Radiotherapy patients requiring lower doses of rocuronium bromide imply a potential impact of prior radiotherapy on muscle relaxation. Finally, the combination of epidural anesthesia with general anesthesia resulted in reduced hydromorphone requirements and longer hospital stays, suggesting the potential benefits of this combined approach in terms of pain management and postoperative recovery. These findings highlight the importance of tailoring anesthesia strategies for specific patient populations to optimize outcomes in VATS procedures.

Background and Aims: The safety of subarachnoid block (SAB) was established in preeclamptic parturients, but most of studies are of low quality. The study aimed to compare the hemodynamic parameters, phenylephrine requirement, and the neonatal outcome between normotensive and preeclamptic parturients undergoing cesarean section. Methods: This prospective observational study was conducted in 100 parturients, aged between 18 and 35 years, American Society of Anesthesiologists II/III scheduled for elective cesarean section under SAB. The heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean blood pressure (MBP) were recorded at the baseline, before SAB, and every 2 min till 30 min and then every 5 min till the end of the surgery. Phenylephrine was administered in a bolus of 50 μg when the MBP falls by 20% from the baseline. Neonatal outcomes were measured with the umbilical artery pH and APGAR scores at 1 and 5 min. The Statistical Package for the Social Science (SPSS) 26 was used for analysis. Results: The percentage fall in DBP and mean arterial BP from baseline was statistically significant between groups (26.83% ± 9.58% vs. 20.06% ± 14.17% and 24.90% ± 6.49% vs. 20.11% ± 9.75%). The mean requirement of phenylephrine was higher in the normotensive group than the preeclamptic (95.16 ± 41.54, 68.42 ± 31.14) (P < 0.001). The umbilical artery pH and APGAR scores at 1 and 5 min were comparable in both the groups. Conclusion: The incidence of hypotension was less in preeclamptic and required less phenylephrine compared to normotensives, with comparable neonatal parameters in parturients undergoing cesarean section under spinal anesthesia.

PurposeWe evaluated the noninferiority of 10.4 μl of eye drops eluted with a commercially available eye drop adapter, the Nanodropper (Nanodropper, Inc), on pupillary dilation and cycloplegia in children compared with the standard of care (SOC), 50 μl of eye drops.DesignProspective randomized trial.ParticipantsPediatric patients scheduled for routine pupillary dilation at the University of California, San Francisco, at the Pediatric Ophthalmology Clinic were enrolled. Each participant provided 1 eye for the intervention group (Nanodropper) and 1 eye for the control group (SOC).MethodsParticipants were randomized to receive small-volume dilating drops in 1 eye (Nanodropper) and SOC dilating drops in the other eye. Dilation was performed using 1 drop each of 1% cyclopentolate, 1% tropicamide, and 2.5% phenylephrine. Refraction and pupillometry were obtained before and 30 minutes after dilation. A noninferiority analysis was performed to assess change from before to after dilation in spherical equivalent and in pupil constriction percentage and maximum pupil diameter after dilation.Main outcome measuresSpherical equivalent, maximum pupil diameter, and pupil constriction percentage.ResultsOne hundred eyes of 50 patients were included, with a mean ± standard deviation age of 9 ± 3 years. After controlling for baseline measurements, the spherical equivalent after dilation was 0.05 diopter (D) more (95% confidence interval [CI], -0.28 to 0.37 D) in the Nanodropper arm, which did not achieve noninferiority. Maximum pupil diameter after dilation was lower in the Nanodropper group (mean, -0.01 mm; 95% CI, -0.20 to -0.03), which did achieve noninferiority. Constriction percentage after dilation was 0.57 percentage points more (95% CI, -1.38 to 2.51 percentage points) in the Nanodropper group, which did not achieve noninferiority.ConclusionsAdministration of eye drops using a small-volume adapter demonstrated similar efficacy to SOC in a pediatric population. Strict noninferiority was met only for pupillary dilation and not for cycloplegia or constriction percentage; however, the small differences in the effect of the Nanodropper versus SOC on all primary outcomes were not clinically significant. We conclude that small-volume eye drops have the potential to decrease unnecessary medical waste and medication toxicity while maintaining therapeutic effect.Financial disclosure(s)Proprietary or commercial disclosure may be found after the references.

Seasonal allergies have a negative impact on patients' quality of life. Nurses must be aware of the different treatment options and lifestyle modifications to help patients manage their symptoms. This article discusses the benefits and risks of over-the-counter medications for seasonal allergies and other implications for nurses. [ABSTRACT FROM AUTHOR]

Introduction: Angiotensin II (ATII) maintains blood pressure via RAAS with a beneficial adverse effect profile versus catecholamines and phenylephrine. Head‐to‐head data comparing ATII to phenylephrine are lacking regarding renal allograft function, hemodynamic efficacy, and safety within the perioperative period of kidney transplantation. Methods: This single‐center, retrospective study included adult kidney transplant recipients who received continuous infusions of ATII or phenylephrine within a 24‐h perioperative period as a first‐line vasopressor according to an institutional algorithm. The primary endpoint was allograft function. Secondary endpoints were hemodynamic efficacy and adverse effects. Results: Among 105 patients, there was no significant difference in IGF (p = 0.545), SGF (p = 0.557), or DGF (p = 0.878) between patient cohorts. In the 34 patients with cold ischemia time (CIT) > 14‐h, IGF was higher (p = 0.013) and DGF (p = 0.045) was lower in the ATII cohort versus phenylephrine. In all patients, ATII was associated with a decreased need for additional vasopressor agents (p < 0.001). Adverse effect profiles were similar between cohorts (p > 0.05). Conclusion: Among kidney transplant recipients, ATII may be a suitable first‐line alternative compared with phenylephrine in the perioperative period for hypotension management with a reduced need for additional vasopressor support. Allograft benefits were observed in patients with prolonged CIT. [ABSTRACT FROM AUTHOR]

Background: This systematic review and meta-analysis aimed to compare the effects of using phenylephrine or norepinephrine on the pH and base excess (BE) of the umbilical artery and vein in parturients undergoing cesarean section. Methods: The study protocol was registered in INPLASY. Independent researchers searched Ovid-Medline, Ovid-EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases and Google Scholar for relevant randomized controlled trials (RCTs). The primary outcome of this study was the umbilical artery (UA) or umbilical vein (UV) pH as neonatal condition at birth, and the secondary outcome was the UA or UV BE as an additional prognostic value over the measurement of umbilical pH. Results: There was no evidence of a difference between phenylephrine and norepinephrine for overall, UA, and UV pH (mean difference (MD) −0.001, 95% confidence interval (CI) −0.004 to 0.007; MD 0.000, 95%CI −0.004 to 0.004; and MD 0.002, 95%CI −0.013 to 0.017). There was also no evidence of a difference between phenylephrine and norepinephrine for overall, UA, and UV BE (MD 0.096, 95% CI −0.258 to 0.451; MD 0.076, 95%CI −0.141 to 0.294; and MD 0.121, 95%CI; −0.569 to 0.811). A meta-regression showed that factors such as umbilical artery or vein, infusion method, single or twin, and the number of parturients per study had no effect on the UA pH, UV pH, UA BE, or UV BE. No evidence of publication bias was detected. Conclusions: There was no evidence of a difference between phenylephrine and norepinephrine for umbilical pH and BE. A subgroup analysis and meta-regression also did not show evidence of differences. [ABSTRACT FROM AUTHOR]

Background: The prevalence of contact allergy to various ophthalmic medications appears to be rare; however, data on culprits, clinical relevance of sensitizations, and changes in frequency within recent decades are limited. Objective: This study aimed to investigate the clinical relevance, risk factors, and prevalence of contact allergy to topical ophthalmic medications in patients suspected of allergic contact dermatitis to ophthalmic medication. Methods: We retrospectively analysed patch test results and clinical data for 754 patients patch‐tested with an ophthalmic medication series at our tertiary referral centre between January 1992 and December 2022. Results: In total, 37.5% (283/754) of patch‐tested patients had a contact allergy to at least one ophthalmic allergen, with 87.3% (247) being clinically relevant sensitization. Phenylephrine (31.8%, 192/604), povidone‐iodine (29%, 27/93), and tobramycin (23%, 46/200) were the most important sensitizers. The incidence of contact allergies increased significantly in a linear manner (p = 0.008) from 20% to 44.1% within the study period. Male sex and age above 40 were risk factors for contact allergy to ophthalmic medication. Conclusions: One third of patch tested patients had allergic contact dermatitis to ophthalmic medication, particularly phenylephrine. Male sex and age above 40 years were independent risk factors and drove the linear increase in contact allergy to ophthalmic medications within the past 31 years. [ABSTRACT FROM AUTHOR]

Background: Vasculogenic erectile dysfunction is the most common type of erectile dysfunction, and penile Doppler ultrasound (PDUS) is a useful tool to assess erectile hemodynamics in the clinician's effort to discuss prognosis and management strategies with the patient. Aim: We herein describe the PDUS protocol used at our center, including indications, technique, and data interpretation. Methods: We describe our institutional experience with PDUS and discuss it in the context of a contemporary review of the literature for this investigation. Outcome: Our institutional PDUS protocol. Results: To perform PDUS properly, adequate training, equipment, setting, technique, and interpretation are critical. The accuracy of PDUS is entirely predicated on achieving complete cavernosal smooth muscle relaxation. A redosing protocol optimizes the reliability and reproducibility of the hemodynamic data acquired during PDUS. A rigidity-based assessment is performed, and patients are scanned according to the erection rigidity achieved (full hardness) or by administration of maximum dose of the vasoactive agent. Peak systolic velocity is considered a measure of arterial inflow (normal, >30 cm/s), while end diastolic velocity evaluates the veno-occlusive mechanism (normal, <5 cm/s). After the procedure, the patient is evaluated to confirm detumescence. If the patient has a persistent penetration rigidity erection, intracavernosal phenylephrine is administered; however, if detumescence is not achieved with intracavernosal phenylephrine injections alone, corporal aspiration is potentially performed. Conclusion: PDUS is a valuable minimally invasive tool for erectile hemodynamics assessment and an accurate assessment of such, provided that complete cavernosal smooth muscle relaxation is achieved. [ABSTRACT FROM AUTHOR]

Background: Carcinoid tumors are rare neuroendocrine malignancies presenting in an increasing number in our center. The incidence of carcinoid tumors is approximatively between 2.5 and 5 cases per 100,000 people of whom about 50% develop carcinoid syndrome. Once the carcinoid syndrome has developed, a carcinoid cardiomyopathy can occur. Carcinoid heart disease (CaHD) remains a serious and rare complication associated with a significant increase in morbidity and mortality. Although carcinoid tumors have been known and studied for several years, there are still scarce data on the anesthetic management and the peri operative period. Case presentation: We describe a case of a Caucasian 44-year-old woman with an unusual presentation of left CaHD with an ileal neuroendocrine tumor and liver metastases. Our preoperative somatostatin administration protocol, limit the cardiac damage. The maintenance of stable hemodynamics, the use of balanced anesthetic technique, all along with a good understanding of the pathology, played a major role in the successful management of anesthesia. This case report allows us to introduce our decision algorithm for the management of this type of pathology in our tertiary hospital, Cliniques Universitaires Saint-Luc. Conclusion: Despite the paucity of data, anesthetic management of patients with carcinoid tumor can be safely performed with effective hemodynamic monitoring and a good understanding of the pathophysiology. Knowledge and application of a clear institutional algorithm for octreotide administration and multidisciplinary consultation at a referral center are essential for the management of these patients. [ABSTRACT FROM AUTHOR]

Background: To enhance the utility of functional hemodynamic monitoring, the variables systolic slope (dP/dt) and dynamic arterial elastance (Eadyn) are calculated by the Hypotension Prediction Index (HPI) Acumen® Software. This study was designed to characterize the effects of phenylephrine and ephedrine on dP/dt and Eadyn. Methods: This was a retrospective, non-randomized analysis of data collected during two clinical studies. All patients required intra-operative controlled mechanical ventilation and had an indwelling radial artery catheter connected to an Acumen IQ sensor. Raw arterial pressure waveform data was downloaded from the patient monitor and all hemodynamic measurements were calculated off-line. The anesthetic record was reviewed for bolus administrations of either phenylephrine or ephedrine. Cardiovascular variables prior to drug administration were compared to those following vasopressor administrations. The primary outcome was the difference for dP/dt and Eadyn at baseline compared with the average after the bolus administration. All data sets demonstrated non-normal distributions so statistical analysis of paired and unpaired data followed the Wilcoxon matched pairs signed-rank test or Mann-Whitney U test, respectively. Results: 201 doses of phenylephrine and 100 doses of ephedrine were analyzed. All data sets are reported as median [95% CI]. Mean arterial pressure (MAP) increased from 62 [54,68] to 78 [76,80] mmHg following phenylephrine and from 59 [55,62] to 80 [77,83] mmHg following ephedrine. Stroke volume and cardiac output both increased. Stroke volume variation and pulse pressure variation decreased. Both drugs produced significant increases in dP/dt, from 571 [531, 645] to 767 [733, 811] mmHg/sec for phenylephrine and from 537 [509, 596] to 848 [779, 930] mmHg/sec for ephedrine. No significant changes in Eadyn were observed. Conclusion: Bolus administration of phenylephrine or ephedrine increases dP/dt but does not change Eadyn. dP/dt demonstrates potential for predicting the inotropic response to phenylephrine or ephedrine, providing guidance for the most efficacious vasopressor when treating hypotension. Trial registration: Data was collected from two protocols. The first was deemed to not require written, informed consent by the Institutional Review Board (IRB). The second was IRB-approved (Effect of Diastolic Dysfunction on Dynamic Cardiac Monitors) and registered on ClinicalTrials.gov (NCT04177225). [ABSTRACT FROM AUTHOR]

In addition to stabilizing blood pressure (BP), ephedrine and phenylephrine have distinct effects on regional cerebral oxygen saturation (rSO2). However, whether its effect on rSO2 affects the occurrence of postoperative delirium (POD) remains unclear. Therefore, the aim of this study is to compare the effects of ephedrine and phenylephrine for BP maintenance on the incidence of POD in olderly adults who underwent knee arthroplasty under general anesthesia. One hundred twenty patients who were between 60 and 90 years old and underwent knee arthroplasty were included in this study. The patients were randomly divided into two groups: the ephedrine group and the phenylephrine group. After anesthesia induction, ephedrine and phenylephrine were continuously infused to maintain the intraoperative mean arterial pressure within the normal range (baseline mean arterial pressure ± 20%). The primary outcome measures included the incidence of POD within 1–3 days after surgery. The incidence of POD on the first day after surgery was lower in the ephedrine group than in the phenylephrine group (33% vs. 7%, P < 0.001). However, there was no significant difference in the incidence of POD between the two groups on the second and third postoperative days. Compared with the phenylephrine group, the ephedrine group experienced significantly greater cardiac output (CO) and rSO2 (P < 0.05). Clinical Trials Registry: ChiCTR2200064849, principal investigator: Changjian Zheng. [ABSTRACT FROM AUTHOR]

Determination and evaluation active substances in chemical settings is extremely difficult, linked to chemical waste in water sewage, and may eventually have an influence on public health. As a result, efforts are being made globally to find other, perhaps less hazardous ways. Hereby, we aimed to determine two pharmaceutical products for the detection of phenylephrine hydrochloride and terbutaline sulphate using green chemistry. The procedure involves oxidizing phenylephrine hydrochloride and terbutaline sulphate using potassium permanganate as an oxidant and decolorizing the surplus of potassium permanganate in the reaction with Nile blue dye. The results confirmed that this method has provided easy and precise evaluation of phenylephrine hydrochloride and terbutaline sulphate at concentrations ranging from (0.4-4.5) µg /ml, with molar absorption capacity of (6.9x104 ) l‧mol-1 ‧cm -1 for phenylephrine hydrochloride and (1.44×105 ) l‧mol-1 ‧cm-1 for terbutaline sulphate. The methodologies have precisely determined the pharmaceutical dosage forms of the tested drugs, agreeing with previously tested and stated values and standard compounds. [ABSTRACT FROM AUTHOR]

To better understand mechanisms of serotonin‐ (5‐HT) mediated vasorelaxation, isolated lateral saphenous veins from cattle were assessed for vasoactivity using myography in response to increasing concentrations of 5‐HT or selective 5‐HT receptor agonists. Vessels were pre‐contracted with 1 × 10−4 M phenylephrine and exposed to increasing concentrations of 5‐HT or 5‐HT receptor agonists that were selective for 5‐HT1B, 5‐HT2B, 5‐HT4, and 5‐HT7. Vasoactive response data were normalized as a percentage of the maximum contractile response induced by the phenylephrine pre‐contraction. At 1 × 10−7 M 5‐HT, a relaxation was observed with an 88.7% decrease (p < 0.01) from the phenylephrine maximum. At 1 × 10−4 M 5‐HT, a contraction was observed with a 165% increase (p < 0.01) from the phenylephrine maximum. Increasing concentrations of agonists selective for 5‐HT2B, 5‐HT4, or 5‐HT7 resulted in a 27%, 92%, or 44% (p < 0.01) decrease from the phenylephrine maximum, respectively. Of these 5‐HT receptor agonists, the selective 5‐HT4 receptor agonist resulted in the greatest potency (−log EC50) value (6.30) compared with 5‐HT2B and 5‐HT7 receptor agonists (4.21 and 4.66, respectively). To confirm the involvement of 5‐HT4 in 5‐HT‐mediated vasorelaxation, blood vessels were exposed to either DMSO (solvent control) or a selective 5‐HT4 antagonist (1 × 10−5 M) for 5‐min prior to the phenylephrine pre‐contraction and 5‐HT additions. Antagonism of the 5‐HT4 receptor attenuated the vasorelaxation caused by 5‐HT. Approximately 94% of the vasorelaxation occurring in response to 5‐HT could be accounted for through 5‐HT4, providing strong evidence that 5‐HT‐mediated vasorelaxation occurs through 5‐HT4 activation in bovine peripheral vasculature. [ABSTRACT FROM AUTHOR]

Purpose: To study the pupil dynamics with premixed intracameral anesthetic mydriatic combination of phenylephrine (0.31%), tropicamide (0.02%), and lidocaine (1%) in pediatric cataract surgery. Methods: Consecutive children aged ≤12 years planned for cataract surgery were recruited. A commercially available premixed combination of phenylephrine (0.31%), tropicamide (0.02%), and lidocaine (1%) was injected at the beginning of surgery without any topical/infusion drugs for mydriasis. Pupil sizes at various points of surgery were studied. Results: We recruited 75 patients with a mean age of 24.3 ± 33.4 months (range: 1 month–11 years). Adequate mydriasis with a single injection was achieved in 93.5% (n = 73 eyes of 70 patients) without additional pharmacotherapy or intervention. The mean pupillary diameter increased from 1.8 ± 0.79 to 6.1 ± 1.4 mm after injection (mean change of 4.2 ± 1.25 mm from baseline). The mean variability in pupillary diameter was 0.73 ± 1.3 mm. In five eyes, good dilatation was not possible even after repeat injection. Conclusion: Fixed‑dose premixed intracameral injection is effective in pupil dilatation. It alleviates the need for any topical dilators or additional intraoperative supplementation for pediatric cataract surgery. [ABSTRACT FROM AUTHOR]

Background and Aims: Maternal hypotension is a common concern during cesarean sections (CS) with spinal anesthesia and can have adverse consequences for both the mother and fetus. This study aimed to investigate the prophylactic effectiveness of intermittent boluses of phenylephrine and norepinephrine in preventing maternal bradycardia during maintenance of systolic blood pressure (SBP) within 90–100% of baseline. Material and Methods: Two hundred American Society of Anesthesiologists physical status -II parturients scheduled for CS with subarachnoid block (SAB) were randomly assigned to Group A (phenylephrine, 50 µg) or Group B (norepinephrine, 4 µg). The primary goal was to assess the incidence of maternal bradycardia (≤50 bpm) whilst SBP maintenance at 90-100% of baseline. The secondary objectives encompassed total boluses administered, episodes of hypertension (≥120% of baseline), Intraoperative nausea and vomiting (IONV), and neonatal APGAR scores. The time from intrathecal injection to fetal delivery (induction–delivery interval) was also evaluated. Results: Both norepinephrine and phenylephrine groups effectively prevented spinal-induced hypotension, with similar outcomes However, Group A (phenylephrine) experienced a significantly higher incidence of bradycardia (18%) compared to Group B (norepinephrine) with only 5% (P=0.016). Episodes of hypertension, IONV, and neonatal APGAR scores were comparable between the two groups. Conclusion: Intermittent boluses of norepinephrine and phenylephrine demonstrated equivalent efficacy in preventing spinal-induced hypotension during CS. However, norepinephrine exhibited an advantage over phenylephrine by significantly reducing the incidence of bradycardia. These findings support the consideration of norepinephrine as an effective alternative vasopressor for maintaining maternal hemodynamics during CS under SAB. [ABSTRACT FROM AUTHOR]

Significance: Cerebral oximeters have the potential to detect abnormal cerebral blood oxygenation to allow for early intervention. However, current commercial systems have two major limitations: (1) spatial coverage of only the frontal region, assuming that surgery-related hemodynamic effects are global and (2) susceptibility to extracerebral signal contamination inherent to continuous-wave near-infrared spectroscopy (NIRS). Aim: This work aimed to assess the feasibility of a high-density, time-resolved (tr) NIRS device (Kernel Flow) to monitor regional oxygenation changes across the cerebral cortex during surgery. Approach: The Flow system was assessed using two protocols. First, digital carotid compression was applied to healthy volunteers to cause a rapid oxygenation decrease across the ipsilateral hemisphere without affecting the contralateral side. Next, the system was used on patients undergoing shoulder surgery to provide continuous monitoring of cerebral oxygenation. In both protocols, the improved depth sensitivity of trNIRS was investigated by applying moment analysis. A dynamic wavelet filtering approach was also developed to remove observed temperatureinduced signal drifts. Results: In the first protocol (28 ± 5 years; five females, five males), hair significantly impacted regional sensitivity; however, the enhanced depth sensitivity of trNIRS was able to separate brain and scalp responses in the frontal region. Regional sensitivity was improved in the clinical study given the age-related reduction in hair density of the patients (65 ± 15 years; 14 females, 13 males). In five patients who received phenylephrine to treat hypotension, different scalp and brain oxygenation responses were apparent, although no regional differences were observed. Conclusions: The Kernel Flow has promise as an intraoperative neuromonitoring device. Although regional sensitivity was affected by hair color and density, enhanced depth sensitivity of trNIRS was able to resolve differences in scalp and brain oxygenation responses in both protocols. [ABSTRACT FROM AUTHOR]

A spectrophotometric method has been developed for the determination of certain amine-phenol-containing drugs, namely, adrenaline, phenylephrine hydrochloride, and terbutaline sulfate. The method depends on the formation of new products by the reaction of drugs with the Gibbs reagent (2,6-dichloroquinone-4-chloroamide) in a basic borate buffer medium with a pH value of 11. The products were measured at 475, 652.5, and 547 nm for the aforementioned drugs, respectively. Beer–Lambert law was obeyed in the ranges of 0.3–9.5, 0.5–17, and 0.5–55 µg/mL with average recovery of 101.10, 99.13, and 99.78% and a relative standard deviation of ≤3.31%, respectively. The method was free from excipient interferences and applied successfully for the assay of the studied drugs in their pharmaceutical formulations. The resulting products were found in the ratio of 1 : 1. [ABSTRACT FROM AUTHOR]

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) with orthostatic intolerance (OI) is characterized by neurocognitive deficits perhaps related to upright hypocapnia and loss of cerebral autoregulation (CA). We performed N-back neurocognition testing and calculated the phase synchronization index (PhSI) between arterial pressure (AP) and cerebral blood velocity (CBV) as a time-dependent measurement of cerebral autoregulation in 11 control (mean age = 24.1 yr) and 15 patients with ME/CFS (mean age = 21.8 yr). All patients with ME/CFS had postural tachycardia syndrome (POTS). A 10-min 60° head-up tilt (HUT) significantly increased heart rate (109.4 ± 3.9 vs. 77.2 ± 1.6 beats/min, P < 0.05) and respiratory rate (20.9 ± 1.7 vs. 14.2 ± 1.2 breaths/min, P < 0.05) and decreased end-tidal CO2 (ETCO2; 33.9 ± 1.1 vs. 42.8 ± 1.2 Torr, P < 0.05) in ME/CFS versus control. In ME/CFS, HUT significantly decreased CBV compared with control (-22.5% vs. -8.7%, P < 0.005). To mitigate the orthostatic CBV reduction, we administered supplemental CO2, phenylephrine, and acetazolamide and performed N-back testing supine and during HUT. Only phenylephrine corrected the orthostatic decrease in neurocognition by reverting % correct n = 4 N-back during HUT in ME/CFS similar to control (ME/CFS = 38.5 ± 5.5 vs. ME/CFS þ PE= 65.6 ± 5.7 vs. Control 56.9 ± 7.5). HUT in ME/CFS resulted in increased PhSI values indicating decreased CA. Although CO2 and acetazolamide had no effect on PhSI in ME/CFS, phenylephrine caused a significant reduction in PhSI (ME/CFS = 0.80 ± 0.03 vs. ME/CFS þ PE= 0.69 ± 0.04, P < 0.05) and improved cerebral autoregulation. Thus, PE improved neurocognitive function in patients with ME/CFS, perhaps related to improved neurovascular coupling, cerebral autoregulation, and maintenance of CBV. NEW & NOTEWORTHY We evaluated cognitive function before and after CO2, acetazolamide, and phenylephrine, which mitigate orthostatic reductions in cerebral blood velocity. Neither CO2 nor acetazolamide affected N-back testing (% correct answers) during an orthostatic challenge. Only phenylephrine improved upright N-back performance in ME/CFS, as it both blocked hyperventilation and increased CO2 significantly compared with those untreated. And only phenylephrine resulted in improved PSI values in both ME/CFS and control while upright, suggesting improved cerebral autoregulation. [ABSTRACT FROM AUTHOR]

Diabetes causes dysfunctions and damages in different tissues over time. It has been known that exercise has beneficial effects on the pathologies associated with diabetes. This study was aimed to evaluate the effects of moderate swimming exercise on vascular responses in rats with type 1 diabetes. The groups in the experiment were conducted as diabetes, diabetes exercise, exercise, and control. Streptozotocin (50 mg/kg) was intraperitoneally given to induce type 1 diabetes. The rats in group diabetes exercise and exercise were subjected to a swimming protocol was applied 5 days a week and 1 hour a day for 4 weeks after streptozotocin injection. The initial and final blood glucose levels and weekly body weights were measured. At the end of the study, in vitro thoracic aorta responses were recorded. A reduction in body weight of rats with type 1 diabetes was determined from week 1 to week 4 (p<0.001). Blood glucose levels were significantly (p<0.001) higher in both diabetic groups than those of controls and group exercise. The 4-week swimming exercise had no effect on blood glucose levels of diabetic rats. The responses of the thoracic aorta to norepinephrine and sodium nitroprusside were not different between groups. The control rats showed the highest relaxation response of the thoracic aorta to acetylcholine while this response gradually decreased in groups diabetes exercise, exercise, and diabetes. In conclusion, it was observed that 4-week moderate swimming exercise regimen corrected endothelium-dependent relaxation responses in rats with type 1 diabetes. [ABSTRACT FROM AUTHOR]

The aim of this research was to eventually come up with the simultaneous estimation of Phenylephrine HCl, Chlorpheniramine maleate and Dextromethorphan hydrobromide and its degradant products by Reverse Phase High Performance Liquid Chromatography [RP-HPLC] with green analytical chemistry principles. An Agilent Inertsil ODS 3 (250 mm x 4.6 mm, 5 μm) was used to achieve separation. A 0.45 μm membrane filter was used to filter the solutions. Phosphate buffer and ethanol were employed as the mobile phase. The injection volume was set to 10 μL, the flow rate was set to 1 mL/min and the detection wavelength was set to 220 nm. The gradient elution was used. Phenylephrine HCl had a retention time of 6.8 minutes, chlorpheniramine maleate of 3.5 minutes and dextromethorphan hydrobromide of 12.2 minutes. Phenylephrine HCl, chlorpheniramine maleate and dextromethorphan hydrobromide had linear concentration ranges of 1-6 μg/ml, 1-6 μg/ml, and 2-12 μg/ml, respectively. Phenylephrine HCl, chlorpheniramine maleate and dextromethorphan hydrobromide had correlation coefficients of R2 of 0.999, 0.998, and 0.998, respectively. The method that was developed was environmentally friendly, according to the results of the greenness evaluation tools. Optimized using Central composite design and greenness of the method evaluated using green evaluation techniques. [ABSTRACT FROM AUTHOR]

Xiao-Xia Sun, Jing Qian, Jia-Ming Fan, Lin Liu, Xia-Fang Jin, Fei Xiao Department of Anesthesia, Jiaxing University Affiliated Women and Children Hospital, Jiaxing City, People’s Republic of ChinaCorrespondence: Xia-Fang Jin; Fei Xiao, Department of Anesthesia, Jiaxing University Affiliated Women and Children Hospital, Jiaxing City, People’s Republic of China, Tel +86573-83963131, Email jxjxf@126.com; 13706587501@163.comBackground: Ondansetron reduces the median effective dose (ED50) of prophylactic phenylephrine to prevent spinal-induced hypotension (SIH) during cesarean delivery. However, the exact dose response of phenylephrine in combination with prophylactic ondansetron for preventing SIH is unknown. Therefore, this study aimed to determine the dose-response of phenylephrine to prevent SIH in cesarean delivery when 4 mg of ondansetron was used as a preventive method.Methods: A total of 80 parturients were enrolled and divided randomly into four groups (n = 20 in each group) who received either 0.2, 0.3, 0.4, or 0.5 μg/kg/min of prophylactic phenylephrine. Ten minutes before the initiation of spinal induction, 4 mg prophylactic ondansetron was administered. The effective dose of prophylactic phenylephrine was defined as the dose required to prevent hypotension after the period of intrathecal injection and up to neonatal delivery. The ED50 and ED90 of prophylactic phenylephrine and 95% confidence intervals (95% CI) were calculated using probit analysis.Results: The ED50 and ED90 for prophylactic phenylephrine to prevent SIH were 0.25 (95% CI, 0.15 to 0.30), and 0.45 (95% CI, 0.39 to 0.59) μg/kg/min, respectively. No significant differences were observed in the side effects and neonatal outcomes between the four groups.Conclusion: The administration of 4 mg of prophylactic ondansetron was associated with an ED50 of 0.25 (95% CI, 0.15~0.30) and ED90 of 0.45 (95% CI, 0.39~0.59) μg/kg/min for phenylephrine to prevent SIH.Keywords: phenylephrine, ondansetron, dose-response, hypotension, cesarean delivery, spinal

Cesarean sections are commonly performed under spinal anesthesia, which can lead to hypotension, adversely affecting maternal and fetal outcomes. Hypotension following spinal anesthesia is generally defined as a blood pressure of 80–90% below the baseline value. Various strategies have been implemented to reduce the incidence of spinal anesthesia-induced hypotension. The administration of vasopressors is a crucial method for preventing and treating hypotension. In the past decade, phenylephrine, a primarily alpha-adrenergic agonist, has been the preferred vasopressor for cesarean sections. Recently, norepinephrine, a potent alpha-agonist with modest beta-agonist activity, has gained popularity owing to its advantages over phenylephrine. Vasopressors can be administered via a bolus or continuous infusion. Although administering boluses alone is simpler in a clinical setting, continuous prophylactic infusion initiated immediately after spinal anesthesia is more effective in reducing the incidence of hypotension. Tailoring the infusion dose based on the patient’s body weight and adjusting the rate in response to blood pressure changes, in addition to using a prophylactic or rescue bolus, helps reduce blood pressure variability during cesarean sections under spinal anesthesia until neonatal delivery.

Abstract Background Tracking preload dependency non-invasively to maintain adequate tissue perfusion in the perioperative period can be challenging.The effect of phenylephrine on stroke volume is dependent upon preload. Changes in stroke volume induced by phenylephrine administration can be used to predict preload dependency. The change in the peripheral perfusion index derived from photoplethysmography signals reportedly corresponds with changes in stroke volume in situations such as body position changes in the operating room. Thus, the peripheral perfusion index can be used as a non-invasive potential alternative to stroke volume to predict preload dependency. Herein, we aimed to determine whether changes in perfusion index induced by the administration of phenylephrine could be used to predict preload dependency. Methods We conducted a prospective single-centre observational study. The haemodynamic parameters and perfusion index were recorded before and 1 and 2 min after administering 0.1 mg of phenylephrine during post-induction hypotension in patients scheduled to undergo surgery. Preload dependency was defined as a stroke volume variation of ≥ 12% before phenylephrine administration at a mean arterial pressure of

Objective Mydriatic eye drops used for retinopathy of prematurity (ROP) examination can cause systemic effects, and there are case reports of serious adverse effects in the literature. In this prospective study, we aimed to evaluate the early hemodynamic effects of mydriatic eye drops to understand the possible mechanisms of adverse effects. Study Design Between December 2018 and March 2019, preterm babies less than 32 gestational weeks and who underwent ophthalmologic examination in our unit were included. The vital signs (heart rate, respiratory rate, oxygen saturation [SpO 2 ], and blood pressure values), cerebral and mesenteric tissue saturation by near-infrared spectroscopy (NIRS), and left ventricular functions of infants were recorded before and after applying mydriatic eye drops (2.5% phenylephrine and 0.5% tropicamide). The data were compared statistically. Strict adherence to prevent systemic absorption of the eye drops was applied. Results Thirty-two mydriasis procedures were evaluated in 26 patients. The mean gestational age was 28.5 ± 1.7 weeks, and the mean birth weight was 943 ± 233 g. There were no significant differences in terms of vital signs of infants including heart rate, blood pressure, and oxygen saturation [SpO 2 ] levels before and after eye-drop application. In addition, NIRS values showed no significant differences between before and after measurements. No significant differences were detected at echocardiographic evaluation performed before and after mydriatic administration. No adverse reaction was observed in the study population during the study. Conclusion This is the first study that evaluated the early hemodynamic effects of mydriatic eye drops used for ROP screening by vital signs, NIRS, and echocardiographic evaluation. Mydriatic eye drops have no significant effect on early hemodynamic parameters including vital signs, NIRS, and echocardiographic findings in preterm infants. We suggest that a cautious approach for avoiding the systemic absorption of these agents may prevent the possible early systemic effects in this high-risk population. Key Points Mydriatic eye drops are commonly used for pupil dilatation before retinopathy of prematurity examination, and there are reports of serious adverse events caused by these drops. Due to the adverse events of eye drops, hemodynamic effects of these agents were investigated by clinical findings, near-infrared spectroscopy, and echocardiography. No significant early hemodynamic effect was observed so avoiding systemic effects may be prevented with precautions. [ABSTRACT FROM AUTHOR]

Background: Phenylephrine (PE) is one of the vasopressor used to treat hypotension during anaesthesia. The primary aim of this study was to compare the effect of prophylactic infusion and rescue bolus of PE on the haemodynamic changes during spinal anaesthesia (SA) for Caesarean section (CS) in obese parturients. Methods: A total of 74 obese parturients scheduled for elective CS under SA were randomised into two groups; Group A (n = 37) received prophylactic PE infusion starting at 50 μg min-1 and adjusted according to the given algorithm and Group B (n = 37) received 100 μg PE bolus to treat hypotension. The measured parameters were systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), the total requirement of PE and neonatal Apgar score. Results: Six patients were excluded from the analysis due to missing data and only 68 were analysed. Group A showed significantly higher SBP, DBP and MAP than Group B (P < 0.05). The requirement of PE was higher in Group A than Group B [817.7 (265.7) µg versus 360.6 (156.0) µg; P = < 0.05]. Both groups had no difference in terms of the neonatal Apgar score. Conclusion: Prophylactic PE infusion provided better haemodynamic control than therapeutic boluses in obese parturients undergoing CS under SA. [ABSTRACT FROM AUTHOR]

BACKGROUND: The most common complication after spinal Anesthesia is hypotension. In order to help and treat this complication different styles have been used. But, hypotension remains the most common problem, in spite of preloading the patient with Crystalloid and colloid. Among utmost of the cases, to treat spinal Anesthesia convinced hypotension, vasopressors are needed. Studies involving both administration of phenylephrine and ephedrine are multitudinous. But, studies regarding precautionary infusion of these medicines and their comparison on motherly hemodynamics and are rare. METHODOLOGY:This is a randomized control study conducted on 60 cases aged between 18-35years with normal singleton gestation beyond 36 weeks of gravidity and belonging to ASAII posted for caesarean sections under spinal anesthesia are aimlessly named and distributed to either Group A- Phenylephrine and Group B- Ephedrine. (By lottery method) RESULTS Maternal blood pressure was maintained in both the groups and was not statistically significant. Bradycardia was seen in 23% of group A and nausea of 20% was seen in group A, where as there was no prevalence of any complications in group B. Neonatal assessment was done using APGAR scoring and umbilical vein ABG and was plant statistically insignificant. CONCLUSION: It was observed that maternal blood pressure was maintained well with both ephedrine as well as phenylephrine, but there was prevalence of bradycardia and nausea with phenylephrine. There was no major effects APGAR score, fetal umbilical vein ABG in both groups. KEY WORDS: alpha adrenergic, maternal hypotension, foetal distress, APGAR INTRODUCTION Maternal hypotension results in dizziness, nausea, vomiting, may also interfere with surgical procedure and can also induce fetal bradycardia (1-4) and acidosis (4-6). Many trials comparing phenylephrine and ephedrine for management of hypotension during spinal Anesthesia for Caesarean section have shown favourable results. Some of the measures taken to drop the prevalence of maternal hypotension are preloading, left uterine relegation. Administration of precautionary vasopressors, leg contraction, trendelenberg position etc.(7-9) The vasopressor of choice in pregnant women has been ephedrine. The use of alpha agonists has been avoided because of their adverse effects on uterine blood flow. However, in a quantitative, systematic review of randomized controlled trials of ephedrine versus phenylephrine for the management of hypotension during spinal anaesthesia for cesarean delivery, Lee and colleagues showed that there was no difference between ephedrine and phenylephrine in efficacy. They did find, however, that women given phenylephrine had neonates with higher umbilical cord blood pH values than women given ephedrine, although the risk of true fetal acidosis (umbilical pH value of 7.20) was similar in both groups. Because acidotic changes in the umbilical arterial pH are sensitive indicators of reduced uteroplacental perfusion, the authors concluded that their finding was indirect evidence that uterine blood flow may in fact be better with phenylephrine compared with ephedrine. Utmost of the studies are grounded on the effects of preloading (10-12) or vasopressors.(13,14) Ephedrine which has both alpha and beta agonistic activity, increases cardiac output and heart rate and therefore maintains the blood pressure. Where as phenylephrine which is an alpha agonist, rectifies the drop in systemic vascular resistance convinced by spinal Anesthesia. Rather of treating the hypotension as done generally, it is better to help the hypotension induced by spinal Anesthesia. Therefore, we have studied the effects of precautionary infusion of phenylephrine versus ephedrine on maternal hemodynamics in elective Caesarean section under spinal Anesthesia. METHODS AND MATERIALS This is a randomized control study conducted at hospitals attached to Bangalore Medical College and Research Institute, Bangalore. A total of sixty cases aged between 18-35 years with normal singleton gestation beyond 36 weeks of gravidity and belonging to ASA II posted for caesarean sections under spinal anesthesia. They were randomly allocated to two groups: A received Phenylephrine and B received Ephedrine. Cases are explained about the procedure and informed / spoken concurrence attained. Two intravenous lines are established. Cases are pre-loaded with 500ml Ringer lactate and Pre-medicated with Inj-Pantoprazole 40mg I.V and Inj-Metaclopromide 10mg I.V 15 minutes after pre-medication, baseline parameters -Heart rate, saturation, blood pressure and ECG, monitored using pulseoximetry, Noninvasive blood pressure and ECG monitor. [ABSTRACT FROM AUTHOR]

Psychosocial stress promotes cancer pathogenesis involving angiogenesis through alterations in neuroendocrine-immune functions that may involve adrenoceptor (AR)-dependent signaling mechanisms in the brain, lymphoid organs, and cancerous cells. Various concentrations of α1- and α2- AR-specific agonists and antagonists were incubated in vitro with estrogen receptor-positive (ER +) MCF-7, and ER (-) MDA MB-231 cells to examine the secretions of VEGF-A, VEGF-C, and nitric oxide (NO), and expression of signaling molecules- p-ERK, p-CREB, and p-Akt on the proliferation of breast cancer cell lines. Cellular proliferation, VEGF-A and NO secretion, expression of p-ERK, p-CREB, and p-Akt were enhanced in MCF-7 cells treated with α1-AR agonist while VEGF-C secretion alone was enhanced in MDA MB-231 cells. Treatment of MCF-7 and MDA MB-231 cells with α2- AR agonist similarly enhanced proliferation and decreased NO production and p-CREB expression while VEGF-C secretion was decreased in MCF-7 cells and p-Akt expression was decreased in MDA MB-231 cells. α1-AR inhibition reversed cellular proliferation and VEGF-A secretion by MCF-7 cells while α2-AR inhibition reversed the proliferation of MCF-7 and MDA MB-231 cells and VEGF-C secretion by MCF-7 cells. Taken together, breast cancer pathogenesis may be influenced by distinct α-AR-mediated signaling mechanisms on angiogenesis and lymphangiogenesis that are dependent on estrogen receptor status. [ABSTRACT FROM AUTHOR]

Background: Anesthesia for spinal muscular atrophy (SMA) patients undergoing spinal deformity surgery is challenging. We report an unusual case of an SMA girl who developed severe intraoperative hypoxemia and hypotension during posterior spinal fusion related with surgical positioning. Case presentation: A 13-yr-old girl diagnosed with SMA type 2, severe kyphoscoliosis and thoracic deformity was scheduled for elective posterior spinal fusion. She developed severe hypoxemia and profound hypotension intraoperatively in the prone position with surgical table tilted 45° to the right. Though transesophageal echocardiography (TEE) could not be performed due to limited mouth opening, her preoperative computed tomography revealed a severely distorted thoracic cavity with much reduced volume of the right side. A reasonable explanation was when the surgeons performed surgical procedure with the tilted surgical table, the pressure was directly put on the shortest diameter of the significantly deformed thoracic cavity, causing severe compression of the pulmonary artery, resulting in both hypoxemia and hypotension. The patient stabilized when the surgical table was tilted back and successfully went through the surgery in the leveled prone position. Conclusions: Spinal fusion surgery is beneficial for SMA patients in preventing scoliosis progression and improving ventilation. However, severe scoliosis and thoracic deformities put them at risk of both hemodynamic and respiratory instability during surgical positioning. When advanced monitoring like TEE is not practical intraoperatively, preoperative imaging may help with differential diagnosis, and guide the surgical positioning to minimize mechanical compression of the thoracic cavity, thereby helping the patient complete the surgery safely. [ABSTRACT FROM AUTHOR]

Norepinephrine or phenylephrine administration to prevent and treat hypotension during spinal anesthesia for cesarean section has been a significant topic of discussion. This meta-analysis aimed to update existing evidence and provide further insights into neonatal and maternal outcomes associated with norepinephrine and phenylephrine. Review of randomized controlled trials (RCTs) was performed to assess the effectiveness of norepinephrine and phenylephrine in managing maternal hypotension during cesarean delivery under spinal anesthesia. Neonatal umbilical cord blood pH and maternal hypotension were the primary outcomes. Based on the analysis of 26 RCTs with 2984 participants, we found no significant difference between the norepinephrine and phenylephrine groups in umbilical artery pH in neonates (mean difference (MD) 0.00; 95% confidence interval (CI) -0.00 to 0.01, p = 0.20). Neonates Apgar scores did not differ between both groups. Norepinephrine was associated with lower incidences of bradycardia (risk ratio (RR) 0.44; 95% CI 0.37 to 0.51, p < 0.001) and reactive hypertension (RR 0.53; 95% CI 0.39 to 0.72, p < 0.001) in parturient women than phenylephrine. In neither group did umbilical cord blood levels of partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2) and base excess (BE) levels of neonates differ significantly, nor did maternal hypotension, nausea or vomiting incidence during delivery. For maternal hypotension after spinal anesthesia, norepinephrine and phenylephrine did not significantly differ in neonatal acidemia. Despite similarities to phenylephrine in managing hypotension and maintaining maternal hemodynamic stability, norepinephrine is a promising alternative. [ABSTRACT FROM AUTHOR]

Improvement to anesthesia medication safety is a useful and worthwhile area of research. Anesthesia is one of the few healthcare professions to have immediate access to compounding and label high-hazard medications at the bedside. There is a need to assess the perceptions of anesthesia medication safety and this relationship with pharmacopeia's updated recommendations for anesthesia to improve medication safety and prevent adverse drug events. Certified registered nurse anesthetist (CRNA) perceptions of medication safety climate in Florida were measured utilizing a validated Likert-scale that merged the Attitudes Questionnaire themes of teamwork, climate, safety climate, job satisfaction, stress recognition, perceptions of management, and working. The Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture themes utilized were organizational learning, error communication, and support for patient safety. The overall email invitations delivered 5,890, 524 participants voluntarily started, and 401 completed the questionnaire resulting in a 77% completion rate. The overall response rate was 8.896% and 6.8% overall completion rate. The findings demonstrate a correlation between themes related to supportive organizational learning, stress reduction, positive changes, and creating anesthesia medication quality improvements. CRNAs' openness in adopting new pharmacopeia best practice recommendations can improve anesthesia medication safety delivery. The survey indicated clinical noteworthiness that supports the importance of additional examination of frontline providers' perceptions regarding anesthesia medication safety, buy-in, and adoption of updated pharmacopeia recommendations. [ABSTRACT FROM AUTHOR]

Background Research comparing the efficacy of phenylephrine and norepinephrine in managing post spinal hypotension among pregnant patients is limited. Objective To assess the effectiveness of phenylephrine and norepinephrine bolus doses in treating hypotension during elective cesarean section under spinal anesthesia in pregnant females hypothesizing similar neonatal outcomes. Materials and Methods: The present randomized controlled study is a single-centre, tertiary care hospital based study conducted on 90 pregnant women with singleton pregnancies experiencing postspinal hypotension during cesarean section. Patients received intravenous phenylephrine (50 µg) or norepinephrine (4 µg) for hypotension treatment, defined as = 20% drop in baseline systolic BP or absolute value < 100 mmHg. Primary outcome measure was umbilical artery pH while secondary measures were Apgar scores, hypotensive episodes, vasopressor requirements, cardiac complications, maternal outcomes. Results: Umbilical artery pH did not differ between phenylephrine and norepinephrine groups (8.26 ± 0.06 vs. 8.27 ± 0.06, respectively; P = 0.93). Median hypotensive episodes were higher with norepinephrine (2[1to3] vs.1 [1to2], P=0.014). Apgarscores, va so press ordoses, BP trends, and maternal complications were similar. Phenylephrine group had lower heart rates (P = 0.026); one had bradycardia (HR < 50 bpm) vs. none with norepinephrine (P = 1.000). Conclusions In pregnant women undergoing elective cesarean section, phenylephrine (50 µg) and norepinephrine (4 µg) bolus doses for spinal anesthesia-induced hypotension are equally effective with similar neonatal and maternal outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Phenylephrine is considered the vasopressor of choice in hypotension associated with obstetric spinal anesthesia. But the dose and mode of administration that is effective yet safe in mother as well as fetus remains controversial. We studied the hemodynamics of parturients who received prophylactic infusion of phenylephrine 50µg/min following spinal anesthesia. Methods: Patients posted for elective cesarean section received a prophylactic phenylephrine infusion of 50µg/min immediately after spinal anesthesia for 30 minutes. Parturients were also co-loaded with lactated Ringer's solution 1 litre. Blood pressure and heart rate was monitored at an interval of 3min initially and after the delivery of baby interval was increased to 5min. Episodes of hypotension, reactive hypertension and bradycardia in mother were recorded. Neonatal APGAR score at 1 and 5min was also recorded. Results: One hundred and forty parturients were included in the study. Twenty patients (14.28%) developed hypotension. Out of 20 patients who developed hypotension, 3 patients (15%) had a single episode, 11 patients (55%) had 2 episodes and 6 patients (30%) had 3 episodes of hypotension. Three patients (2.14%) had reactive hypertension. None of the patients had bradycardia. There was no episode of hypotension induced nausea vomiting. Mean APGAR score at 1min and 5min was 8 and 9 respectively. Conclusion: The prevalence of hypotension with prophylactic phenylephrine infusion was low. We found minimal episodes of reactive hypertension, no episodes of bradycardia and no adverse effect on fetus. It can be regarded a safe means to minimize hypotension in obstetric spinal anesthesia. [ABSTRACT FROM AUTHOR]

Background and Aims: There is limited data on the effects of norepinephrine on neonatal outcomes and maternal complications relative to other vasopressors. The study aimed to compare neonatal outcomes and maternal complications after bolus intravenous doses of phenylephrine and norepinephrine for post-spinal hypotension in elective caesarean section women. Methods: This randomised study was done on 100 elective caesarean section women under spinal anaesthesia. Block randomisation divided women into two groups to receive intravenous phenylephrine 50 µg bolus (Group A) or norepinephrine 5 µg bolus (Group B) following post-spinal hypotension. Groups were evaluated and compared for umbilical arterial blood gas analysis, birth weight, APGAR (appearance, pulse, grimace, activity, and respiration) score, maternal haemodynamics, and complications. Kolmogorov-Smirnov and Shapiro-Wilk tests were used to verify data normality. Independent samples t-test or Mann-Whitney U test was employed to compare continuous variables based on data normality, and the Chi-square test was used to determine categorical variable associations. Results: Demographic characteristics of women were found to be comparable between groups. Umbilical arterial potential of hydrogen, partial pressure of oxygen, partial pressure of carbon dioxide, base excess, bicarbonate, birth weight, and APGAR scores were comparable across groups, showing no significant differences (P > 0.05). Groups had similar maternal haemodynamic characteristics and episodes of nausea, vomiting, and chest pain across groups without statistical significance (P > 0.05). Conclusion: No notable distinction was found between neonatal outcomes and maternal complications between phenylephrine and norepinephrine bolus regimens. Norepinephrine can be used as an alternative to phenylephrine post-spinal hypotension in women undergoing elective caesarean section. [ABSTRACT FROM AUTHOR]