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Norepinephrine

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1. Early Norepinephrine Administration in Septic Shock

Early Norepinephrine Administration in Septic Shock Early Norepinephrine Administration in Septic Shock | Emergency Medicine | Washington University in St. Louis Open Menu Back Close Menu Search for: Loading... Welcome Our Team Sections Education Alumni Research ECRC Journal Club Events Jermyn Lectures Open Search Vignette You are working an overnight shift in TCC one evening when you get the following page: “Triage patient to 3L.” No other information is provided, but when the patient finally (...) , but while ordering this, you wonder if you should also initiate vasopressors. while your attending instructs you to wait and see how she responds to the fluid bolus, you remember reading an article in one of the “throw away” journals you receive suggesting that there was a benefit to early norepinephrine administration in sepsis, initiated concomitant with fluid resuscitation. After the patient’s fluid bolus, she remains hypotensive (MAP 59) and a norepinephrine is initiated. As the patient

2019 Washington University Emergency Medicine Journal Club

2. Esketamine (Spravato) - In combination with a selective serotonin reuptake inhibitor (SSRI) or serotonin–norepinephrine reuptake inhibitor (SNRI), for adults with treatment-resistant major depressive disorder, who have not responded to at least two differ

Esketamine (Spravato) - In combination with a selective serotonin reuptake inhibitor (SSRI) or serotonin–norepinephrine reuptake inhibitor (SNRI), for adults with treatment-resistant major depressive disorder, who have not responded to at least two differ 1 Published 7 September 2020 SMC2258 esketamine 28mg nasal spray, solution (Spravato®) Janssen-Cilag Ltd 7 August 2020 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises NHS Boards and Area (...) Drug and Therapeutic Committees (ADTCs) on its use in NHSScotland. The advice is summarised as follows: ADVICE: following a full submission esketamine (Spravato®) is accepted for use within NHSScotland. Indication under review: In combination with a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI), for adults with treatment-resistant Major Depressive Disorder, who have not responded to at least two different treatments with antidepressants

2020 Scottish Medicines Consortium

3. Selective serotonin-norepinephrine reuptake inhibitor (SNRI) toxicity - emergency management

Selective serotonin-norepinephrine reuptake inhibitor (SNRI) toxicity - emergency management

2017 DynaMed Plus

4. Effect of Early Vasopressin vs Norepinephrine on Kidney Failure in Patients With Septic Shock: The VANISH Randomized Clinical Trial

Effect of Early Vasopressin vs Norepinephrine on Kidney Failure in Patients With Septic Shock: The VANISH Randomized Clinical Trial PEDSCCM.org Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?

2017 PedsCCM Evidence-Based Journal Club

6. Prothrombotic response to norepinephrine infusion, mimicking norepinephrine stress-reactivity effects, is partly mediated by α-adrenergic mechanisms. (Abstract)

Prothrombotic response to norepinephrine infusion, mimicking norepinephrine stress-reactivity effects, is partly mediated by α-adrenergic mechanisms. Stress-induced prothrombotic changes are mediated by the sympathetic nervous system and critically involved in mental triggering of acute coronary syndromes, but the underlying psychobiology is not fully understood. We tested the hypothesis that a norepinephrine (NE) infusion to mimic effects of stress-induced NE release on blood coagulation

2018 Psychoneuroendocrinology Controlled trial quality: uncertain

7. Prospective, open-label trial of early, concomitant vasopressin and norepinephrine therapy versus initial norepinephrine monotherapy in septic shock. (Abstract)

Prospective, open-label trial of early, concomitant vasopressin and norepinephrine therapy versus initial norepinephrine monotherapy in septic shock. Delays in achieving target mean arterial pressure (MAP) are associated with increased morbidity and mortality in patients with septic shock. This trial was conducted to test the hypothesis that early concomitant treatment with vasopressin and norepinephrine reduces the time to achieve and maintain target MAP compared with initial norepinephrine (...) monotherapy.A single-center prospective open-label trial was conducted in patients with septic shock between November 2015 and June 2016 at a medical intensive care unit in an academic medical center. Initial norepinephrine monotherapy was initiated between November 2015 and February 2016. Between March and June 2016, vasopressin was initiated within 4 hours of norepinephrine. The primary outcome was time to achieving and maintaining MAP of 65 mm Hg for at least 4 hours that was compared between groups

2018 Pharmacotherapy

8. Ketamine influences the locus coeruleus norepinephrine network, with a dependency on norepinephrine transporter genotype – a placebo controlled fMRI study Full Text available with Trip Pro

Ketamine influences the locus coeruleus norepinephrine network, with a dependency on norepinephrine transporter genotype – a placebo controlled fMRI study Ketamine is receiving increasing attention as a rapid-onset antidepressant in patients suffering from major depressive disorder (MDD) with treatment resistance or severe suicidal ideation. Ketamine modulates several neurotransmitter systems, including norepinephrine via the norepinephrine transporter (NET), both peripherally and centrally (...) in [T] carriers.We demonstrated acute rs-fc changes after ketamine administration in the central node of the norepinephrine pathway. These findings may contribute to understanding the antidepressant effect of ketamine at the system level, supporting modes of action on networks subserving aberrant arousal regulation in depression.Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

2018 NeuroImage : Clinical Controlled trial quality: uncertain

9. Depletion of cardiac catecholamine stores impairs cardiac norepinephrine re-uptake by downregulation of the norepinephrine transporter. Full Text available with Trip Pro

Depletion of cardiac catecholamine stores impairs cardiac norepinephrine re-uptake by downregulation of the norepinephrine transporter. In heart failure (HF), a disturbed cardiac norepinephrine (NE) homeostasis is characterized by depleted cardiac NE stores, impairment of the cardiac NE re-uptake by the neuronal norepinephrine transporter (NET) and enhanced cardiac NE net release. Reduced cardiac NE content appears to be caused by enhanced cardiac NE net release from sympathetic neurons in HF

2017 PLoS ONE

10. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER). A Randomized Trial (Abstract)

Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER). A Randomized Trial Rationale: Recent retrospective evidence suggests the efficacy of early norepinephrine administration during resuscitation; however, prospective data to support this assertion are scarce. Objectives: To conduct a phase II trial evaluating the hypothesis that early low-dose norepinephrine in adults with sepsis with hypotension increases shock control by 6 hours compared with standard care. Methods: This single (...) -center, randomized, double-blind, placebo-controlled clinical trial was conducted at Siriraj Hospital, Bangkok, Thailand. The study enrolled 310 adults diagnosed with sepsis with hypotension. The patients were randomly divided into two groups: early norepinephrine (n = 155) and standard treatment (n = 155). The primary outcome was shock control rate (defined as achievement of mean arterial blood pressure ≥65 mm Hg, with urine flow ≥0.5 ml/kg/h for 2 consecutive hours, or decreased serum lactate ≥10

2019 EvidenceUpdates

11. Norepinephrine vs Norepinephrine and Dobutamine in Cardiogenic Shock

Norepinephrine vs Norepinephrine and Dobutamine in Cardiogenic Shock Norepinephrine vs Norepinephrine and Dobutamine in Cardiogenic Shock - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Norepinephrine vs (...) Norepinephrine and Dobutamine in Cardiogenic Shock (SHOCK-NORDOB) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. of clinical studies and talk to your health care provider before participating. Read our for details. ClinicalTrials.gov Identifier: NCT03340779 Recruitment Status : Not yet recruiting First Posted : November 14, 2017 Last Update Posted : November 14

2017 Clinical Trials

12. Epinephrine Versus Norepinephrine for Cardiogenic Shock After Acute Myocardial Infarction Full Text available with Trip Pro

Epinephrine Versus Norepinephrine for Cardiogenic Shock After Acute Myocardial Infarction Vasopressor agents could have certain specific effects in patients with cardiogenic shock (CS) after myocardial infarction, which may influence outcome. Although norepinephrine and epinephrine are currently the most commonly used agents, no randomized trial has compared their effects, and intervention data are lacking.The goal of this paper was to compare in a prospective, double-blind, multicenter (...) , randomized study, the efficacy and safety of epinephrine and norepinephrine in patients with CS after acute myocardial infarction.The primary efficacy outcome was cardiac index evolution, and the primary safety outcome was the occurrence of refractory CS. Refractory CS was defined as CS with sustained hypotension, end-organ hypoperfusion and hyperlactatemia, and high inotrope and vasopressor doses.Fifty-seven patients were randomized into 2 study arms, epinephrine and norepinephrine. For the primary

2018 EvidenceUpdates

13. Norepinephrine Infusion for Preventing Postspinal Anesthesia Hypotension during Cesarean Delivery: A Randomized Dose-finding Trial (Abstract)

Norepinephrine Infusion for Preventing Postspinal Anesthesia Hypotension during Cesarean Delivery: A Randomized Dose-finding Trial Norepinephrine has been recently introduced for prophylaxis against postspinal hypotension during cesarean delivery; however, no data are available regarding its optimum dose. The objective of this study is to compare three infusion rates of norepinephrine for prophylaxis against postspinal hypotension during cesarean delivery.The authors conducted a double-blinded (...) , randomized, controlled study including full-term pregnant women scheduled for cesarean delivery. Norepinephrine infusion was commenced after subarachnoid block. Patients were randomized into three groups, which received norepinephrine with starting infusion rates of 0.025 μg · kg(-1) · min(-1), 0.050 μg · kg(-1) · min(-1), and 0.075 μg · kg(-1) · min(-1). Infusion was stopped when intraoperative hypertension occurred. The primary outcome was the frequency of postspinal hypotension (defined as decreased

2018 EvidenceUpdates

14. Age-dependent association of polymorphisms in the promoter and 5'-untranslated region of the norepinephrine transporter gene with generalized anxiety disorder. (Abstract)

Age-dependent association of polymorphisms in the promoter and 5'-untranslated region of the norepinephrine transporter gene with generalized anxiety disorder. Norepinephrine transporter (NET), which regulates synaptic norepinephrine for noradrenergic signaling, is involved in the pathogenesis of anxiety, while expression of the NET gene differs at different ages. Here, we examine whether genetic variants in the NET gene are associated, in an age-specific manner, with increased risk

2020 Journal of Affective Disorders

15. Alkaline Phosphatase Activity Is a Key Determinant of Vascular Responsiveness to Norepinephrine. (Abstract)

Alkaline Phosphatase Activity Is a Key Determinant of Vascular Responsiveness to Norepinephrine. Here, we tested the hypothesis that TNAP (tissue nonspecific alkaline phosphatase) modulates vascular responsiveness to norepinephrine. In the isolated, Tyrode's-perfused rat mesentery, 50 µmol/L of L-p-bromotetramisole (L-p-BT; selective TNAP inhibitor, Ki=56 µmol/L) significantly reduced TNAP activity and caused a significant 9.0-fold rightward-shift in the norepinephrine concentration versus (...) vasoconstriction relationship. At 100 µmol/L, L-p-BT further reduced mesenteric TNAP activity and caused an additional significant right-shift of the norepinephrine concentration versus vasoconstriction relationship. A higher concentration (200 µmol/L) of L-p-BT had no further effect on either mesenteric TNAP activity or norepinephrine-induced vasoconstriction. L-p-BT did not alter vascular responses to vasopressin, thus ruling-out nonspecific suppression of vascular reactivity. Since in the rat mesenteric

2020 Hypertension

16. Urinary Norepinephrine Is a Metabolic Determinant of 24-Hour Energy Expenditure and Sleeping Metabolic Rate in Adult Humans. (Abstract)

Urinary Norepinephrine Is a Metabolic Determinant of 24-Hour Energy Expenditure and Sleeping Metabolic Rate in Adult Humans. Interindividual variability in 24-hour energy expenditure (24EE) during energy-balance conditions is mainly determined by differences in body composition and demographic factors. Previous studies suggested that 24EE might also be influenced by sympathetic nervous system activity via catecholamine (norepinephrine, epinephrine) secretion. Therefore, we analyzed (...) physical activity (SPA). Urine samples were collected, and 24-h urinary epinephrine and norepinephrine excretion rates were assessed by high-performance liquid chromatography.Both catecholamines were associated with 24EE and SMR (norepinephrine: +27 and +19 kcal/d per 10 μg/24h; epinephrine: +18 and +10 kcal/d per 1 μg/24h) in separate analyses after adjustment for age, sex, ethnicity, fat mass, fat-free mass, calorimeter room, temperature, and physical activity. In a multivariate model including both

2020 Journal of Clinical Endocrinology and Metabolism

17. Utilization and extravasation of peripheral norepinephrine in the emergency department. (Abstract)

Utilization and extravasation of peripheral norepinephrine in the emergency department. Vasopressors are typically administered through central venous catheters (CVC) due to a historical risk of extravasation with peripheral administration. However, CVC insertion is a time-consuming process that may delay vasopressor administration and is associated with complications. The Virginia Commonwealth University Health System (VCUHS) Emergency Department (ED) implemented a protocol that recommends (...) peripheral norepinephrine (pNE) be administered through an 18 gauge or larger at or above the antecubital fossa or the external jugular vein with a maximum dose of 20 μg/min. This study characterizes the use and incidence of extravasation in all adult patients who received pNE initiated in the VCUHS ED.This was an observational, retrospective cohort study in adult patients from March 2016 to March 2019. Of the 331 patients that were screened, 177 met inclusion criteria. Data were analyzed using

2020 American Journal of Emergency Medicine

18. Norepinephrine or phenylephrine during spinal anaesthesia for Caesarean delivery: a randomised double-blind pragmatic non-inferiority study of neonatal outcome. (Abstract)

Norepinephrine or phenylephrine during spinal anaesthesia for Caesarean delivery: a randomised double-blind pragmatic non-inferiority study of neonatal outcome. Norepinephrine is an effective vasopressor during spinal anaesthesia for Caesarean delivery. However, before it can be fully recommended, possible adverse effects on neonatal outcome should be excluded. We aimed to test the hypothesis that umbilical arterial cord pH is at least as good (non-inferior) when norepinephrine is used compared (...) with phenylephrine for treatment of hypotension.We enrolled 668 subjects having elective and non-elective Caesarean delivery under spinal or combined spinal-epidural anaesthesia in this randomised, double-blind, two-arm parallel, non-inferiority clinical trial. Arterial blood pressure was maintained using norepinephrine 6 μg ml-1 or phenylephrine 100 μg ml-1 according to the practice of the anaesthetist, either prophylactically or therapeutically, as an infusion or bolus. The primary outcome was umbilical

2020 British Journal of Anaesthesia

19. Minimising haemodynamic lability during changeover of syringes infusing norepinephrine in adult critical care patients: a multicentre randomised controlled trial. (Abstract)

Minimising haemodynamic lability during changeover of syringes infusing norepinephrine in adult critical care patients: a multicentre randomised controlled trial. Arterial pressure lability is common during the process of replacing syringes used for norepinephrine infusions in critically ill patients. It is unclear if there is an optimal approach to minimise arterial pressure instability during this procedures. We investigated whether 'double pumping' changeover (DPC) or automated changeover (...) (AC) reduced blood pressure lability in critically ill adults compared with quick syringe changeover (QC).Patients requiring a norepinephrine infusion syringe change were randomised in a non-blinded trial undertaken in six ICUs. Randomisation was minimised by norepinephrine flow rate at inclusion and centre. The primary outcome was the frequency of increased/decreased mean arterial pressure (defined by 15 mm Hg from baseline measurements) within 15 min of switching the syringe compared

2020 British Journal of Anaesthesia

20. Impact of high-dose norepinephrine during intra-hospital damage control resuscitation of traumatic haemorrhagic shock: A propensity-score analysis. (Abstract)

Impact of high-dose norepinephrine during intra-hospital damage control resuscitation of traumatic haemorrhagic shock: A propensity-score analysis. The use of norepinephrine (NE) during uncontrolled haemorrhagic shock (HS) has mostly been investigated in experimental studies. Clinical data including norepinephrine dose and its impact on fluid resuscitation and organ function are scarce. We hypothesized that there is great variability in NE use and that high doses of NE could lead to increased (...) organ dysfunction as measured by the sequential organ failure assessment (SOFA).We included patients with HS (systolic blood pressure < 90 mmHg in severely injured patients) who required haemostasis surgery and a transfusion of more than 4 packed red blood cells (PRBC) in the first 6 h of admission and the used of norepinephrine infusion to maintain the blood pressure goal, between admission and the end of haemostasis surgery in a prospective trauma database. A ROC curve determined that, using

2020 Injury

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