[Effects of the fluothanechlorpromazine combination on arterial pressure, venous pressure and ophthalmic tonus].
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In patients with alcoholic cirrhosis, wedged hepatic venous pressure closely reflects portal venous pressure. This study was carried out to determine if propranolol-induced reductions in portal venous pressure are accurately evaluated by the measurement of wedged hepatic venous pressure. Hepatic venous cannulation and percutaneous transhepatic catheterization of the portal vein were simultaneously performed in 7 patients with alcoholic cirrhosis. One hour after oral administration of 40 mg of propranolol, wedged hepatic and portal venous pressures significantly decreased from 24.3 +/- 3.5 (mean +/- SD) to 19.0 +/- 3.0 mmHg, and from 24.7 +/- 3.9 to 22.4 +/- 3.6 mmHg, respectively. Although no significant difference was found between baseline wedged hepatic and portal venous pressures, a significant difference was found between these pressures after propranolol administration. We concluded that during acute administration of a drug acting on the splanchnic circulation, the measurement of wedged hepatic venous pressure may not provide a reliable estimation of the magnitude of the changes in portal venous pressure. There is, however, no evidence that the direction of the changes might not be adequately assessed by wedged hepatic venous pressure measurement.
The intraocular pressure, the ophthalmic artery pressure, and the episcleral venous pressure increased after changes from sitting to recumbent body position, whereas the subclavian artery pressure remained unchanged or decreased slightly. Changing from recumbent to sitting position was followed by a decrease in IOP, ophthalmic pressure, and subclavian artery pressure. Comparing the last measurement in the first position to the first value after change, it was found that the IOP alters by about 20%, the ophthalmic artery pressure by 15%, and the episcleral venous pressure by 50%. In all series a decrease in subclavian artery pressure was observed during the first 15 min. The mean pressure in the ophthalmic artery diminished in the series that changed from sitting to recumbent position, whereas it increased in the other series during the first 15 min. The episcleral venous pressure increased more than the corresponding IOP after changing to the recumbent position.
PURPOSE: Using peripheral venous pressure (PVP) instead of central venous pressure (CVP) as a volume monitor decreases patient risks and costs, and is convenient. This study was undertaken to determine if PVP predicts CVP in pediatric patients. METHODS: With ethical approval and informed consent, 30 pediatric patients aged neonate to 12 yr requiring a central venous line were studied prospectively in a tertiary care teaching hospital. In the supine position, PVP and CVP were simultaneously transduced. Ninety-six paired recordings of CVP and PVP were made. Correlation and Bland-Altman analysis of agreement of end-expiratory measurements were performed. RESULTS: The mean (SD; range) CVP was 10.0 mmHg (6.0; -1.0 to 27.0); the mean PVP was 13.7 mmHg (6.3; 0.0 to 33.0); offset (bias) of PVP > CVP was 3.7 mmHg with SD 2.6. The 95% confidence intervals (CI) for the bias were 3.2 to 4.1 mmHg. In the Bland-Altman analysis, lower and upper limits of agreement (LOA; CI in parentheses) were -1.5 (-2.3 to -0.7) and 8.8 (8.1 to 9.6) mmHg. Eight of 96 points were outside the limits of agreement. The correlation of PVP on CVP was r = 0.92, P < 0.0001. For a subset of ten patients (20 simultaneous recordings) with iv catheters proximal to the hand, limits of agreement were better - offset: 3.8 mmHg (+/- 1.4); lower LOA: 1.2 mmHg (0.25 to 2.1); upper LOA: 6.6 mmHg (5.7 to 7.5). CONCLUSION: Peripheral venous pressure measured from an iv catheter in the hand predicts CVP poorly in pediatric patients.
Central venous pressure (CVP), portal pressure (PP), and heart rate (HR) were monitored in 6 female, sexually intact, middle-age Beagles during temporary portal vein obstruction, anesthetic recovery, abdominal bandaging, and propranolol administration. Intraoperative baseline PP was 7.3 mm of Hg (+/- 1.7 SD). Portal pressure was significantly increased throughout portal vein occlusion, but returned to baseline values 2 minutes after release of the ligature. Central venous pressure was significantly decreased throughout portal vein occlusion, but did not differ significantly from baseline values 3 minutes after release of the portal vein ligature. Portal pressure increased significantly (8 +/- 3.3 mm of Hg) over baseline values after application of an abdominal bandage; however, CVP did not change significantly. During postoperative monitoring, CVP and PP did not change significantly from respective 18-hour mean postoperative values in resting dogs. At 60 and 75 minutes after surgery, heart rate was significantly increased over the 18-hour mean. Portal pressure and CVP, respectively, were significantly increased over intraoperative baseline values in the first hour and the first 8 hours after surgery. Postoperative CVP and HR were significantly correlated. Individual measurements of PP in dogs that were abdominal pressing during barking or defecation were significantly increased (9 +/- 3 mm of Hg) above measurements taken after cessation of abdominal press. Portal pressure measurements in standing dogs decreased 7.5 +/- 2 mm of Hg, compared with measurements of the same dog in lateral recumbency. Central venous pressure was inaccurate in dogs performing abdominal press. Portal pressure did not decrease significantly from baseline after injection of propranolol (2 mg/kg, IV).(ABSTRACT TRUNCATED AT 250 WORDS)
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Venous bleeding during transsphenoidal surgery for resection of pituitary tumors is a common problem that interferes with the performance of the surgical procedure. In this study, data were collected prospectively from 50 patients to determine whether there were pre- or intraoperative factors (e.g., patient demographics, type and grade of pituitary tumor, intraoperative hemodynamics) associated with venous bleeding which might be used to predict its occurrence. In addition, central venous pressure (CVP), and cavernous sinus pressure (CSP) were measured in 13 patients to evaluate the relationship of these pressures to each other and to the severity of venous bleeding. During resection of the pituitary tumor, the severity of venous bleeding was graded as minimal, moderate, or severe, the latter two grades requiring therapeutic intervention. Moderate bleeding requiring intervention occurred in 15 of the 50 patients, and resolved in all cases. Moderate bleeding was not related to CSP or CVP, and no specific associated factor was observed. CSP was not correlated with CVP, and was higher than that predicted from the CVP and the position of the patient or the hydrostatic gravitational pressure gradient. These results suggest that it is not possible to predict in advance which patients will have problems with venous bleeding, but that simple therapeutic maneuvers are effective.
OBJECTIVE: To determine the degree of agreement between central venous pressure (CVP) and peripheral venous pressure (PVP) in surgical patients. DESIGN: Prospective study. SETTING: University hospital. PARTICIPANTS: Patients without cardiac dysfunction undergoing major elective noncardiac surgery (n = 150). MEASUREMENTS AND MAIN RESULTS: Simultaneous CVP and PVP measurements were obtained at random points in mechanically ventilated patients during surgery (n = 100) and in spontaneously ventilating patients in the postanesthesia care unit (n = 50). In a subset of 10 intraoperative patients, measurements were made before and after a 2-L fluid challenge. During surgery, PVP correlated highly to CVP (r = 0.86), and the bias (mean difference between CVP and PVP) was -1.6 +/- 1.7 mmHg (mean +/- SD). In the postanesthesia care unit, PVP also correlated highly to CVP (r = 0.88), and the bias was -2.2 +/- 1.9 (mean +/- SD). When adjusted by the average bias of -2, PVP predicted the observed CVP to within +/-3 mmHg in both populations of patients with 95% probability. In patients receiving a fluid challenge, PVP and CVP increased similarly from 6 +/- 2 to 11 +/- 2 mmHg and 4 +/- 2 to 9 +/- 2 mmHg. CONCLUSION: Under the conditions of this study, PVP showed a consistent and high degree of agreement with CVP in the perioperative period in patients without significant cardiac dysfunction. PVP -2 was useful in predicting CVP over common clinical ranges of CVP. PVP is a rapid noninvasive tool to estimate volume status in surgical patients.
Amitriptyline and imipramine given in the single dose insignificantly depressed the arterial blood pressure but significantly elevated the central venous pressure, prolonged the PQ interval and widened the QRS complex. After a prolonged daily treatment, the subsequent 21st dose of either antidepressant significantly depressed the arterial blood pressure; amitriptyline also depressed the central venous pressure. When given chronically, amitriptyline induced rhythm disturbances and the flattening of T-wave, while imipramine caused the widening of the QRS complex, block of the left bundle branch, changes in the T-wave amplitude, elevation in the ST interval. An intravenous infusion of ethanol potentiated those changes. The impairment of atrioventricular conduction occurred more frequently after administration of ethanol jointly with amitriptyline than with imipramine. Physostigmine salicylate elevated the depressed arterial blood pressure, aggravated the impairment of conduction and potentiated rhythm disturbances caused by the interaction of ethanol with antidepressants. In the above interactions with ethanol imipramine was less toxic than amitriptyline.
Hepatic venous catheterization is widely used to assess portal pressure. However, it remains unclear whether wedged hepatic venous pressure is a close indicator of portal venous pressure during vasoactive drug administration in nonalcoholic cirrhosis. To address this issue, we analyzed the data from our previous published studies. Forty patients with nonalcoholic cirrhosis (HBV infection in five, HCV infection in 28, and cryptogenic in seven) were available in this analysis. A vasoconstrictor (N = 14), vasodilator (N = 10), or combination (N = 16) was administered. The agreement of the changes between portal and wedged hepatic venous pressures during pharmacological manipulation was assessed by an intraclass correlation coefficient. The intraclass correlation coefficient in each subgroup was more than 0.60 (0.62 in vasoconstrictor group, 0.87 in vasodilator group, and 0.73 in combination group). When the analysis was performed according to the cause of liver disease, the values were 0.67 in HBV infection, 0.73 in HCV infection, and 0.74 in cryptogenic cirrhosis. These results suggest that wedged hepatic venous pressure reflects portal venous pressure during vasoactive drug administration in patients with nonalcoholic cirrhosis.
During the open-heart surgery, haemodilution is performed before extracorporeal circulation is started by the sampling of autologous blood and substituting an electrolyte solution. Following extracorporeal circulation, first the machine-blood and then the autologous blood is reinfused. The haemodilution and reinfusion procedures lead to alterations in blood osmolality and tissue fluid distribution, initiating changes in arterial blood pressure, central venous pressure, intracranial and intraocular pressures. These changes were studied in pigs. It is believed that these potentially hazardous pressure alterations can be minimized through proper handling of the procedure. This study presents some of the mechanisms involved.
BACKGROUND AND OBJECTIVE: Previous studies in adults have demonstrated a clinically useful correlation between central venous pressure (CVP) and peripheral venous pressure (PVP). The current study prospectively compared CVP measurements from a central versus a peripheral catheter in kidney recipients during renal transplantation. METHODS: With ethics committee approval and informed consent, 30 consecutive kidney recipients were included in the study. We excluded patients who had significant valvular disease or clinically apparent left ventricular failure. For each of 30 patients, CVP and PVP were measured on five different occasions. The pressure tubing of the transducer system was connected to the distal lumen of the central or to the peripheral venous catheter for measurements following induction of anesthesia, after induction, 1 hour after induction, reperfusion of the kidney, and the end of the operation, yielding 150 hemodynamic data points. Each hemodynamic measurement included heart rate, mean arterial pressure, mean CVP, and mean PVP determined at end-expiration. RESULTS: The mean PVP was 13.5 +/- 1.8 mm Hg and the mean CVP was 11.0 +/- 1.5 mm Hg during surgery. The mean difference was 2.5 +/- 0.5 (P < .01). Repeated-measures analysis of variance indicated a highly significant relationship between PVP and CVP (P < .01) with a Pearson correlation coefficient of 0.97. CONCLUSION: Under the conditions of this study, PVP showed a consistently high agreement with CVP in the perioperative period among patients without significant cardiac dysfunction.
A scheme for automatic regulation of the venous pressure and venous blood outflow during extracorporeal circulation is proposed. The system consists of a photoelectric sensor placed on a tube led out of the major venous trunkline, a converter and an electromechanical eccentric clamp that compresses the venous trunkline, all of which secures stabilization of the controlled values.
We have addressed the hypothesis that varicocele-related infertility is caused in part by a pressure-induced disturbance of testicular convective transport that upsets the testicular hormonal environment and thus impairs spermatogenesis. The left testis of the hamster [pentobarbital sodium (Nembutal), 70 mg/kg ip] was prepared for microcirculatory observations. Testicular venous pressure was acutely elevated by ligating collateral routes of venous outflow and partially occluding, via a snare, the main venous outflow distal to the pampiniform plexus. Simultaneous direct pressure measurements (servo-null method) were made to monitor venous pressure elevation and quantify resulting pressure and diameter changes in the arterial feed to the testis and in postcapillary venules. The data show that over 90% of the venous pressure elevation (VPE) was transmitted to the postcapillary venules. VPE affected intravascular pressures throughout the testis microvasculature; on average, capsular artery pressure increased by 83% of the VPE, although part of this increase was due to a rise in systemic arterial pressure. Vasoconstriction helped to buffer the pressure rise in the capsular artery, probably at the expense of flow amplitude. Yet the vasoconstriction was ineffective in preventing a rise in exchange vessel pressure. These data suggest that microvascular fluid exchange may be dramatically altered in varicocele, upsetting the hormonal and paracrine environment of the testis, and hence, impairing physiological regulation of gametogenesis.
Experimental brain lesions were created in the left parietooccipital cortex of the albino rabbit through the intact dura mater with high radiating carbon dioxide laser energy (40-watt impacts of 0.5-second duration for a total of 4 seconds on a 12.5-mm surface). Behavior, intracranial pressure (ICP), systolic arterial pressure (SAP), central venous pressure (CVP), electroencephalography (EEG), and gross pathology were studied at 2, 6, and 24 hours after the insult at a constant PaCO2 (38-42 torr). Disruption of the blood-brain barrier (Evans blue extravasation) was uniformly seen extending from the impact crater into the surrounding white matter in all groups. The ICP was elevated in sham-operated animals at 2 hours after the impact, and it remained elevated at 6 and 24 hours. The EEG revealed severe slowing with high voltage waves in the insulted left hemisphere. There was no change in mean SAP or CVP when compared to the sham-operated group. In the dexamethasone-pretreated group, there was a reduction of ICP when compared to the untreated group at 24 hours after the insult (P less than 0.005), but no changes in the gross pathology were noted.