26410
document
Deliberate hypotension in patients with intracranial arteriovenous malformations : esmolol compared with isoflurane and sodium nitroprusside . Thirty patients undergoing resection of arteriovenous malformations with deliberate hypotension were randomized to receive 1 of 3 hypotensive agents . Anesthesia was maintained with isoflurane and nitrous oxide in all patients . Mean arterial pressure was reduced 20 % to 60-65 mm Hg with use of either isoflurane ( less than or equal to 4 % ) , sodium nitroprusside ( less than or equal to 8 micrograms.kg-1.min-1 ) , or esmolol ( less than or equal to 24 mg/min ) . Esmolol was associated with a decrease in cardiac output from 6.2 +/- 1.3 to 3.8 +/- 0.8 L/min , which , because of a 22 % increase in systemic vascular resistance , far exceeded the reduction in mean arterial pressure . Systemic vascular resistance increased despite a 32 % decrease in plasma renin activity . In contrast , with sodium nitroprusside or isoflurane , the decrease in mean arterial pressure was associated with decreases in systemic vascular resistance of similar magnitude , with no change in cardiac output . Plasma renin activity levels increased 48 % with sodium nitroprusside and 126 % with isoflurane . Heart rate increased 13 % with sodium nitroprusside , remained unchanged with isoflurane , and decreased 23 % with esmolol . Although esmolol may be used as a primary hypotensive agent , the potential for marked myocardial depression must be recognized . The differences in pharmacologic properties for the different hypotensive agents suggest that combinations of these agents may provide a pharmacologic profile superior to either agent alone .
26411
Intervention_Pharmacological
esmolol
26412
Intervention_Pharmacological
isoflurane
26413
Intervention_Pharmacological
sodium nitroprusside
26414
Intervention_Pharmacological
isoflurane and nitrous oxide
26415
Intervention_Pharmacological
isoflurane
26416
Intervention_Pharmacological
sodium nitroprusside
26417
Intervention_Pharmacological
esmolol
26418
Intervention_Pharmacological
Esmolol
26419
Intervention_Pharmacological
sodium nitroprusside
26420
Intervention_Pharmacological
isoflurane
26421
Intervention_Pharmacological
sodium nitroprusside
26422
Intervention_Pharmacological
isoflurane
26423
Intervention_Pharmacological
sodium nitroprusside
26424
Intervention_Pharmacological
esmolol
26425
Intervention_Pharmacological
esmolol
26426
Outcome_Physical
Deliberate hypotension
26427
Outcome_Physical
cardiac output
26428
Outcome_Physical
systemic vascular resistance
26429
Outcome_Physical
arterial pressure
26430
Outcome_Physical
Systemic vascular resistance
26431
Outcome_Physical
plasma renin activity
26432
Outcome_Physical
mean arterial pressure
26433
Outcome_Physical
systemic vascular resistance
26434
Outcome_Physical
cardiac output
26435
Outcome_Physical
Plasma renin activity levels
26436
Outcome_Physical
Heart rate
26437
Outcome_Physical
marked myocardial depression
26438
Participant_Condition
intracranial arteriovenous malformations
26439
Participant_Sample-size
Thirty
26440
Participant_Condition
arteriovenous malformations