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- W2032808414 abstract "Baroreceptor (BR) reactivity was studied in 16 patients scheduled for carotid artery surgery performed under cervical epidural anesthesia with 0.375% bupivacaine (15 mL). In the first seven patients, BR reactivity was assessed by measurement of the slopes of the linear relationship between systolic arterial pressure (SAP) and the RR interval on the electrocardiogram. Alterations of blood pressure (BP) were produced using sequential intravenous (IV) doses of nitroglycerin (NTG; 100 to 200 μg) or phenylephrine (PHE: 100 to 200 μg), before and 30 minutes after epidural anesthesia. The changes in SAP and heart rate (HR) determined during the four phases of a Valsalva maneuver were evaluated in a second set of measurements before and after cervical epidural blockade. In nine additional patients, a third set of measurements studying BR reactivity after carotid clamping and unclamping was performed in order to assess the effect of carotid handling on BP control. Cervical epidural anesthesia induced moderate decreases in BP (SAP, 150 ± 18 mmHg before cervical block, 143 ± 27 mmHg after cervical block, P < 0.05) and HR (RR, 812 ± 120 ms before cervical block, 938 ± 130 ms after cervical block, P < 0.05). Cervical epidural anesthesia depressed BR reactivity during deactivation as assessed by the decrease in the BR slope after PHE injection (6.6 ± 4.4 ms/mmHg before cervical block v 2.5 ± 1.8 ms/mmHg after cervical block, P < 0.01) and activation as assessed by the changes in SAP and HR during phases II and IV of the Valsalva maneuver. However, the BR slope after NTG injection was unchanged after cervical block (2.8 ± 1.8 ms/mmHg before cervical block v 2.9 ± 2.1 ms/mmHg after cervical block). Carotid artery clamping further depressed BR reactivity as assessed by the decrease in the BR slope after NTG injection (4.2 ± 2.0 after cervical block v 1.9 ± 1.5 ms/mmHg after carotid clamping, P < 0.05). No significant changes in BR slopes were observed after carotid artery unclamping. In conclusion, blockade of cardiac sympathetic innervation induced by cervical epidural anesthesia reduced the BR reactivity in patients undergoing carotid artery surgery without complete abolition of the reflex. Therefore, changes in BP during carotid artery surgery should still be expected under epidural anesthesia." @default.
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- W2032808414 title "Baroreceptor control after cervical epidural anesthesia in patients undergoing carotid artery surgery" @default.
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- W2032808414 doi "https://doi.org/10.1016/s0888-6296(89)97411-5" @default.
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