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Norepinephrine

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21. Dopamine versus norepinephrine in the treatment of septic shock: A meta-analysis

Dopamine versus norepinephrine in the treatment of septic shock: A meta-analysis PEDSCCM.org Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?

2014 PedsCCM Evidence-Based Journal Club

22. Risk of Major Complications After Perioperative Norepinephrine Infusion Through Peripheral Intravenous Lines in a Multicenter Study. (Abstract)

Risk of Major Complications After Perioperative Norepinephrine Infusion Through Peripheral Intravenous Lines in a Multicenter Study. Continuous infusions of norepinephrine to treat perioperative hypotension are typically administered through a central venous line rather than a peripheral venous catheter to avoid the risk of localized tissue necrosis in case of drug extravasation. There is limited literature to estimate the risk of skin necrosis when peripheral norepinephrine is used (...) to counteract anesthesia-associated hypotension in elective surgical cases. This study aimed to estimate the rate of occurrence of drug-related adverse effects, including skin necrosis requiring surgical management when norepinephrine peripheral extravasation occurs.This retrospective cohort study used the perioperative databases of the University Hospitals in Amsterdam and Utrecht, the Netherlands, to identify surgical patients who received norepinephrine peripheral intravenous infusions (20 µg/mL) between

2019 Anesthesia and Analgesia

23. Impact of norepinephrine on right ventricular afterload and function in septic shock-a strain echocardiography study. (Abstract)

Impact of norepinephrine on right ventricular afterload and function in septic shock-a strain echocardiography study. In this observational study, the effects of norepinephrine-induced changes in mean arterial pressure (MAP) on right ventricular (RV) systolic function, afterload and pulmonary haemodynamics were studied in septic shock patients. We hypothesised that RV systolic function improves at higher doses of norepinephrine/MAP levels.Eleven patients with septic shock requiring (...) norepinephrine after fluid resuscitation were included <24 hours after ICU arrival. Study enrolment and insertion of a pulmonary artery catheter was performed after written informed consent from the next of kin. Norepinephrine infusion was titrated to target mean arterial pressures (MAP) of 60, 75 and 90 mmHg in a random sequential order. At each target MAP, strain-and conventional echocardiographic-and pulmonary haemodynamic variables were measured. RV afterload was assessed as effective pulmonary arterial

2019 Acta Anaesthesiologica Scandinavica

24. Norepinephrine versus phenylephrine infusion for prophylaxis against post-spinal anaesthesia hypotension during elective caesarean delivery: A randomised controlled trial. (Abstract)

Norepinephrine versus phenylephrine infusion for prophylaxis against post-spinal anaesthesia hypotension during elective caesarean delivery: A randomised controlled trial. Prophylactic vasopressors are fundamental during caesarean delivery under spinal anaesthesia. The aim of this work is to compare the efficacy and safety of phenylephrine and norepinephrine when used in variable infusion rate during caesarean delivery.A randomised, double-blinded, controlled trial was conducted including (...) mothers scheduled for elective caesarean delivery under spinal anaesthesia. Participants were allocated to two groups norepinephrine group (n = 60), and phenylephrine group (n = 63). Participants received prophylactic vasopressors after spinal block at rate started at 0.05 mcg/kg/min and 0.75 mcg/kg/min respectively. The rate of vasopressor infusion was manually adjusted according to maternal systolic blood pressure. Both groups were compared according to incidence of post-spinal hypotension

2019 Anaesthesia, critical care & pain medicine Controlled trial quality: predicted high

25. Ultrafine particles and ozone perturb norepinephrine clearance rather than centrally generated sympathetic activity in humans. Full Text available with Trip Pro

Ultrafine particles and ozone perturb norepinephrine clearance rather than centrally generated sympathetic activity in humans. Cardiovascular risk rapidly increased following exposure to air pollution. Changes in human autonomic regulation have been implicated based on epidemiological associations between exposure estimates and indirect autonomic nervous system measurements. We conducted a mechanistic study to test the hypothesis that, in healthy older individuals, well-defined experimental (...) deep breathing, and during a Valsalva manoeuvre. Catechols and inflammatory marker levels were measured in venous blood samples. Induced sputum was obtained 3.5 h after exposure. Combined exposure to UFP + O3 but not UFP alone, caused a significant increase in sputum neutrophils and circulating leucocytes. Norepinephrine was modestly increased while the ratio between plasma dihydroxyphenylglycol (DHPG) and norepinephrine levels, a marker for norepinephrine clearance, was reduced with UFP + O3

2019 Scientific reports Controlled trial quality: uncertain

26. Feasibility of closed-loop titration of norepinephrine infusion in patients undergoing moderate- and high-risk surgery. (Abstract)

Feasibility of closed-loop titration of norepinephrine infusion in patients undergoing moderate- and high-risk surgery. Vasopressor agents are used to prevent intraoperative hypotension and ensure adequate perfusion. Vasopressors are usually administered as intermittent boluses or manually adjusted infusions, but this practice requires considerable time and attention. We have developed a closed-loop vasopressor (CLV) controller to correct hypotension more efficiently. Here, we conducted a proof (...) -of-concept study to assess the feasibility and performance of CLV control in surgical patients.Twenty patients scheduled for elective surgical procedures were included in this study. The goal of the CLV system was to maintain MAP within 5 mm Hg of the target MAP by automatically adjusting the rate of a norepinephrine infusion using MAP values recorded continuously from an arterial catheter. The primary outcome was the percentage of time that patients were hypotensive, as defined by a MAP of 5 mm Hg below

2019 British Journal of Anaesthesia

27. Norepinephrine pressor infusion withdrawal in a National Health Service hospice. (Abstract)

Norepinephrine pressor infusion withdrawal in a National Health Service hospice. Norepinephrine (NE) is a peripheral vasoconstrictor used as an emergency measure to restore blood pressure secondary to acute hypotension. NE must be administered centrally as a continuous infusion and requires intensive monitoring. Consequently, its use is restricted to critical care environments. We discuss the withdrawal of NE in a hospice for a patient with advanced malignancy and profound hypotension from

2019 BMJ Supportive & Palliative Care

28. Terlipressin versus norepinephrine to prevent milrinone-induced systemic vascular hypotension in cardiac surgery patient with pulmonary hypertension. Full Text available with Trip Pro

Terlipressin versus norepinephrine to prevent milrinone-induced systemic vascular hypotension in cardiac surgery patient with pulmonary hypertension. Milrinone at inotropic doses requires the addition of a vasoconstrictive drug. We hypothesized that terlipressin use could selectively recover the systemic vascular hypotension induced by milrinone without increasing the pulmonary vascular resistance (PVR) and mean pulmonary artery pressure (MPAP) as norepinephrine in cardiac surgery (...) patients.Patients with pulmonary hypertension were enrolled in this study. At the start of rewarming a milrinone 25 μg/kg bolus over 10 min followed by infusion at the rate of 0.25 μg/kg/min. Just after the loading dose of milrinone, the patients were randomized to receive norepinephrine infusion at a dose of 0.1 μg/kg/min (norepinephrine group) or terlipressin infusion at a dose of 2 μg/kg/h (terlipressin group). Heart rate, mean arterial blood pressure (MAP), central venous pressure, MPAP, systemic vascular

2019 Annals of cardiac anaesthesia Controlled trial quality: uncertain

29. Dexmedetomidine reduces norepinephrine requirements and preserves renal oxygenation and function in ovine septic acute kidney injury. (Abstract)

Dexmedetomidine reduces norepinephrine requirements and preserves renal oxygenation and function in ovine septic acute kidney injury. Norepinephrine exacerbates renal medullary hypoxia in experimental septic acute kidney injury. Here we examined whether dexmedetomidine, an α2-adrenergic agonist, can restore vasopressor responsiveness, decrease the requirement for norepinephrine and attenuate medullary hypoxia in ovine gram-negative sepsis. Sheep were instrumented with pulmonary and renal artery (...) flow probes, and laser Doppler and oxygen-sensing probes in the renal cortex and medulla. Conscious sheep received an infusion of live Escherichia coli for 30 hours. Eight sheep in each group were randomized to receive norepinephrine, norepinephrine with dexmedetomidine, dexmedetomidine alone or saline vehicle, from 24-30 hours of sepsis. Sepsis significantly reduced the average mean arterial pressure (84 to 67 mmHg), average renal medullary perfusion (1250 to 730 perfusion units), average

2019 Kidney International

30. Norepinephrine versus Ephedrine to Maintain Arterial Blood Pressure during Spinal Anesthesia for Cesarean Delivery: A Prospective Double-blinded Trial. Full Text available with Trip Pro

Norepinephrine versus Ephedrine to Maintain Arterial Blood Pressure during Spinal Anesthesia for Cesarean Delivery: A Prospective Double-blinded Trial. Ephedrine was conventionally regarded as the first-choice drug to maintain maternal blood pressure during spinal anesthesia for cesarean delivery, due to its stimulant activity on α- and β-adrenergic receptors. Norepinephrine is a weak β-adrenergic and potent α-adrenergic receptor agonist. Therefore, it may be suitable for maintaining blood (...) pressure with less chronotropic effects compared to ephedrine.One hundred and forty healthy patients having cesarean delivery under spinal anesthesia were randomized to Group N (n = 61) who received a prophylactic bolus of norepinephrine 5 μg intravenous (i.v.) at the time of intrathecal block or Group E (n = 61) who received a prophylactic bolus of i.v. ephedrine 10 mg. Rescue i.v. bolus interventions of norepinephrine 5 μg or ephedrine 10 mg were given as required to maintain systolic blood pressure

2019 Anesthesia, essays and researches Controlled trial quality: uncertain

31. The effects of repeated binge drinking on arterial stiffness and urinary norepinephrine levels in young adults. (Abstract)

The effects of repeated binge drinking on arterial stiffness and urinary norepinephrine levels in young adults. The aim of this study was to investigate the effect of repeated binge drinking and moderate alcohol consumption in young adults on arterial stiffness and sympathetic activity.We enrolled 49 healthy young adults, free of cardiovascular diseases (25 men; age: 23.5 ± 0.4 years; BMI: 23.4 ± 0.4 kg/m; mean ± S.E). Individuals included were those with a history of repeated binge drinking (...) (>2 years duration; n = 20), drank at moderate levels (MODs, >5 years duration; n = 16) and abstained from alcohol (last 2-3 years; n = 13). Arterial stiffness was assessed using carotid to femoral pulse wave velocity (cfPWV) and sympathetic activity was assessed using 24-h urinary norepinephrine levels. Also measured was aortic SBP and augmentation index (AIx), a measure of wave reflection.Binge drinkers and MODs had higher cfPWV than alcohol abstainers (0.6 and 0.5 m/s, respectively; P ≤ 0.04

2019 Journal of Hypertension

32. The contribution of the locus coeruleus-norepinephrine system in the emergence of defeat-induced inflammatory priming. (Abstract)

The contribution of the locus coeruleus-norepinephrine system in the emergence of defeat-induced inflammatory priming. Exposure to psychosocial stress is known to precipitate the emergence of stress related psychiatric disorders such as depression and anxiety. While mechanisms by which this occurs remain largely unclear, recent evidence points towards a causative role for inflammation. Neurotransmitters, such as norepinephrine (NE), are capable of regulating expression of proinflammatory (...) cytokines and thus may contribute to the emergence of stress-related disorders. The locus coeruleus (LC) is the major source of norepinephrine (NE) to the brain and therefore the current study utilized N-(2-chloroethyl)-N-ethyl-2-bromobenzylamine (DSP-4), an LC selective noradrenergic neurotoxin, to determine the discrete involvement of the LC-NE system in social defeat-induced inflammation in LC projection regions including the central amygdala (CeA), dorsal raphe (DR) and plasma. In the current study

2019 Brain, behavior, and immunity

33. Norepinephrine-Induced Stimulation of Kir4.1/Kir5.1 Is Required for the Activation of NaCl Transporter in Distal Convoluted Tubule. Full Text available with Trip Pro

Norepinephrine-Induced Stimulation of Kir4.1/Kir5.1 Is Required for the Activation of NaCl Transporter in Distal Convoluted Tubule. The stimulation of β-adrenergic receptor increases thiazide-sensitive NaCl cotransporter (NCC), an effect contributing to salt-sensitive hypertension by sympathetic stimulation. We now test whether the stimulation of β-adrenergic receptor-induced activation of NCC is achieved through activating basolateral Kir4.1 in the distal convoluted tubule (DCT). Application (...) of norepinephrine increased the basolateral 40 pS K+ channel (Kir4.1/Kir5.1 heterotetramer) in the DCT. The stimulatory effect of norepinephrine on the K+ channel was mimicked by cAMP analogue but abolished by inhibiting PKA (protein kinase A). Also, the effect of norepinephrine on the K+ channel in the DCT was recapitulated by isoproterenol but not by α-adrenergic agonist and blocked by propranolol, suggesting that norepinephrine effect on the K+ channel was mediated by β-adrenergic receptor. The whole-cell

2019 Hypertension

34. Persistence with selective serotonin (norepinephrine) reuptake inhibitors in Germany-A retrospective database analysis. (Abstract)

Persistence with selective serotonin (norepinephrine) reuptake inhibitors in Germany-A retrospective database analysis. Selective serotonin (norepinephrine) reuptake inhibitors (SS(N)RIs) are used in the treatment of depression. The aim of this study was to assess the persistence with SS(N)RIs in outpatients treated by general practitioners (GP) or psychiatrists (PSY) in Germany, and to investigate the association between persistence and the following factors: age, gender, specialty

2019 Journal of Affective Disorders

35. Correction to: Norepinephrine in septic shock. Full Text available with Trip Pro

Correction to: Norepinephrine in septic shock. The original version of this article unfortunately contained a mistake.

2019 Intensive Care Medicine

36. Association Between US Norepinephrine Shortage and Mortality Among Patients With Septic Shock. (Abstract)

Association Between US Norepinephrine Shortage and Mortality Among Patients With Septic Shock. Drug shortages in the United States are common, but their effect on patient care and outcomes has rarely been reported.To assess changes to patient care and outcomes associated with a 2011 national shortage of norepinephrine, the first-line vasopressor for septic shock.Retrospective cohort study of 26 US hospitals in the Premier Healthcare Database with a baseline rate of norepinephrine use (...) of at least 60% for patients with septic shock. The cohort included adults with septic shock admitted to study hospitals between July 1, 2008, and June 30, 2013 (n = 27 835).Hospital-level norepinephrine shortage was defined as any quarterly (3-month) interval in 2011 during which the hospital rate of norepinephrine use decreased by more than 20% from baseline.Use of alternative vasopressors was assessed and a multilevel mixed-effects logistic regression model was used to evaluate the association between

2017 JAMA

37. A randomized double-blind study comparing prophylactic norepinephrine and ephedrine infusion for preventing maternal spinal hypotension during elective cesarean section under spinal anesthesia: A CONSORT-compliant article. Full Text available with Trip Pro

A randomized double-blind study comparing prophylactic norepinephrine and ephedrine infusion for preventing maternal spinal hypotension during elective cesarean section under spinal anesthesia: A CONSORT-compliant article. Studies have shown the efficacy of norepinephrine in the treatment of maternal hypotension during cesarean section by comparing it to treatment with phenylephrine. However, few studies have compared the efficacy of norepinephrine to ephedrine.Ninety-seven women undergoing (...) elective cesarean section were administered norepinephrine at 4 μg/minute (group N; n = 48) or ephedrine at 4 mg/minute (group E; n = 49) immediately postspinal anesthesia, with an on-off titration to maintain systolic blood pressure (SBP) at 80% to 120% of baseline. A rescue bolus of 8 μg norepinephrine was given whenever SBP reached the predefined lower limit. Our primary outcome was the incidence of tachycardia. Secondary outcomes included the incidence of bradycardia, hypertension, hypotension

2019 Medicine

38. Is the Addition of Vasopressin to Norepinephrine Beneficial for the Treatment of Septic Shock?

Is the Addition of Vasopressin to Norepinephrine Beneficial for the Treatment of Septic Shock? SystematicReviewSnapshot TAKE-HOME MESSAGE The addition of low-dose vasopressin to norepinephrine may not signi?cantly reduce mortality in adult patients with septic shock. METHODS DATA SOURCES MEDLINE (1966 to 2011) and CENTRAL (1800 to 2011) data- bases were searched and ab- stracts from recent major confer- ences were reviewed by 3 of the authors. STUDY SELECTION Randomized controlled trials evalu (...) was calculated with a ?xed-effect model and was represented with forest plots; heterogeneity was evaluated with a 2 test. Subgroup analysis of just patients with sepsis was per- formed. Individual study investiga- tors were contacted as necessary for clari?cation after data were extracted. Study quality was Is the Addition of Vasopressin to Norepinephrine Bene?cial for the Treatment of Septic Shock? EBEM Commentators John P. Sandifer, MD Alan E. Jones, MD Department of Emergency Medicine University

2013 Annals of Emergency Medicine Systematic Review Snapshots

39. Dopamine versus Norepinephrine For the Treatment of Septic Shock

Dopamine versus Norepinephrine For the Treatment of Septic Shock SystematicReviewSnapshot TAKE-HOME MESSAGE Dopamine administration is associated with a higher incidence of arrhythmias and increased risk of death compared with norepinephrine in the treatment of septic shock. METHODS DATA SOURCES The search included MEDLINE, EMBASE, Scopus databases, and the Cochrane registry of clinical trials (through June 30, 2011). Google Scholar, clinical trials.org, controlled-trials.com, and ab- stracts (...) of major congresses (2005 to 2010) were also searched. STUDY SELECTION Studies providing outcome data on the use of dopamine com- pared with norepinephrine in the treatment of septic shock were included; observational and ran- domized controlled trials were evaluated separately. Animal trials, pediatric trials, and crossover de- sign trials were excluded. DATA EXTRACTION AND SYNTHESIS Two authors independently ex- tracted data from all studies, and the Cochrane risk of bias tool was used. Twenty-eight

2012 Annals of Emergency Medicine Systematic Review Snapshots

40. Serotonin norepinephrine re-uptake inhibitor (SNRI)-, selective norepinephrine reuptake inhibitor (S-NRI)-, and exogenously administered norepinephrine-induced takotsubo syndrome: Analysis of published cases. (Abstract)

Serotonin norepinephrine re-uptake inhibitor (SNRI)-, selective norepinephrine reuptake inhibitor (S-NRI)-, and exogenously administered norepinephrine-induced takotsubo syndrome: Analysis of published cases. Takotsubo syndrome (TS) may be triggered by numerous physical stress factors including exogenous Norepinephrine administration. The aim of this study is to report on the clinical features and outcome of serotonin-norepinephrine reuptake inhibitor (SNRI)-, selective NRI (S-NRI (...) )-, and exogenously administered norepinephrine-induced TS in a largest possible cohort of published cases.A computer assisted search of the electronic data base Pubmed was performed from 1990 to August 2016. All cases deemed to have SNRI-, S-NRI-, and norepinephrine-induced TS were retrieved.Twenty two cases of SNRI-, S-NRI-, and norepinephrine-induced TS were retrieved from the literature. At presentation, the 22 patients with TS were 11 to 82years of age (mean age 49.9±20years). Seventeen of 21 (81

2016 International journal of cardiology

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