Head Injury
T.M. Craft, P.M. Upton in Key Topics In Anaesthesia, 2021
Head injury accounts for approximately a third of all trauma deaths and is the leading cause of death and disability in young adults. Anaesthetists may be involved in the assessment and resuscitation of those with brain injuries, providing perioperative care to those undergoing surgery following such trauma, and the provision of critical care aimed at reducing the impact of secondary brain injury. A rapid neurological assessment, including response to commands and any focal signs should be made before any sedative/paralysing drugs are given. All head injured patients requiring intubation will need ventilatory support. Ventilation should be monitored by arterial blood gas analysis and capnography. Haemorrhage should be controlled by whatever means is required. Severely head-injured patients should not be moved or transferred until life-threatening injuries are stable and an adequate mean arterial pressure has been achieved.
Control of Mean Arterial Pressure by Sodium Nitroprusside Injection
Robert B. Northrop in Endogenous and Exogenous Regulation and Control of Physiological Systems, 2020
The human arterial blood pressure waveform (ABP(t)) varies with the site of measurement, e.g., the ascending aorta, the brachial artery, etc. In general, ABP(t) becomes lower in amplitude and more rounded as the measurement site becomes more distal to the heart. Since nearly all clinical, noninvasive measurements of systolic and diastolic blood pressures are made by sphygmomanometer cuff and stethoscope (or microphone) on the upper arm’s brachial artery, this chapter notes that brachial artery pressure is used in defining mean arterial pressure (MAP). A short-term fix for elevated MAP is to decrease systemic peripheral vascular resistance. A drug that has been widely used for this purpose is sodium nitroprusside (SNP). The chapter discusses the pharmacology and pharmacokinetics of SNP and describes several controllers (fixed and self-tuning) for the administration of intravenous (IV) SNP in order to reduce and manage postoperative MAP.
Noninvasive Measurement of Blood Pressure
Robert B. Northrop in Non-Invasive Instrumentation and Measurement in Medical Diagnosis, 2017
The "gold standard" for blood pressure (BP) measurement is the invasive measurement done by inserting a large bore hypodermic needle into the desired artery or vein, and coupling this needle with a saline-filled catheter to a physiological BP sensor, generally of the unbonded strain gauge type. BP monitoring under clinical circumstances can either be by catheter/transducer, or be performed noninvasively by a caregiver with a sphygmomanometer and stethoscope, or by a calibrated plethysmographic device that sends its output data to a nursing station. BP is sometimes given as mean arterial pressure (MAP), which is simply the time average of BP(t) measured with an invasive sensor. This chapter describes how the sphygmomanometer works, and how finger plethysmographs can be used to continuously monitor BP. Another approach to BP measurement with the pressure cuff that avoids listening for Korotkow sounds is oscillometry .
The effect of hemodynamic parameters in patient-based coronary artery models with serial stenoses: normal and hypertension cases
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
K. E. Hoque, M. Ferdows, S. Sawall, E. E. Tzirtzilakis
The purpose of this study is to investigate the hemodynamic significance of various degrees of coronary area of stenosis (AS) and multiple sequential stenoses (MSS) in normal and hypertension pressure conditions. MSS in a single branch coronary artery pose challenges to determine the physiological assessment in the prevalent invasive intervention. The hemodynamic parameters of each stenosis are influenced by other stenoses in the single branch of MSS coronary artery. In this study, we entirely use open source tools and techniques for coronary computed tomography angiography (CCTA) image segmentation, 3D reconstruction, grid generation and hemodynamic simulations. The results yield different hemodynamic parameters such as velocity magnitude, mean arterial pressure difference, flow-pressure linear relation, wall shear stress (WSS) and eventually virtual fractional flow reserve (vFFR) allowing for the prediction and the assessment of lumen area severity conditions in MSS coronaries.
Maternal serum sestrin 2 levels in preeclampsia and their relationship with the severity of the disease
Published in Hypertension in Pregnancy, 2019
Ahter Tanay Tayyar, Ahmet Tayyar, Sukran Kozali, Resul Karakus, Ahmet Eser, Cigdem Abide Yayla, Emel Tugce Yalcin, Ismail Dag, Mustafa Eroglu
Objective: To investigate sestrin 2 (SESN2) levels in preeclampsia (PE) cases and uncomplicated pregnancies. Methods: Cross-sectional study including 26 pregnant women with PE, 24 with severe-PE, and 30 randomly selected healthy pregnant women. Results: The mean arterial pressure, severe proteinuria, number of HELLP syndrome cases, and serum SESN2 levels in the severe PE group were significantly higher than those in the other groups (p
Hypertension, inflammation and T lymphocytes are increased in a rat model of HELLP syndrome
Published in Hypertension in Pregnancy, 2014
Kedra Wallace, Rachael Morris, Patrick B. Kyle, Denise Cornelius, Marie Darby, Jeremy Scott, Janae Moseley, Krystal Chatman, Babbette LaMarca
Objective: An animal model of hemolysis, elevated liver enzymes, low platelet count (HELLP) was used to determine if T lymphocytes accompany hypertension and increased inflammatory cytokines. Methods: sFlt-1 (4.7 µg/kg/day) and sEndoglin (7 µg/kg/day) were infused into normal pregnant rats (HELLP rats) for 8 days. Results: HELLP was associated with increased mean arterial pressure (p = 0.0001), hemolysis (p = 0.044), elevated liver enzymes (p = 0.027), and reduced platelets (p = 0.035). HELLP rats had increased plasma levels of TNFα (p = 0.039), IL-6 (p = 0.038) and IL-17 (p = 0.04). CD4+ and CD8+ T lymphocytes were increased. Conclusion: These data support the hypothesis that T cells are associated with hypertension and inflammation.