Continuous Invasive Blood Pressure and Cardiac Output Monitoring during Cesarean Delivery: A Randomized, Double-Blind Comparison of Low-dose versus High-dose Spinal Anesthesia with Intravenous Phenylephrine or Placebo Infusion

2010 ◽  
Vol 2010 ◽  
pp. 302-303
Author(s):  
D.H. Chestnut
Keyword(s):  
Blood Pressure ◽  
Cardiac Output ◽  
Low Dose ◽  
Cardiac Output Monitoring ◽  
High Dose ◽  
Double Blind ◽  
Invasive Blood Pressure ◽  
Output Monitoring ◽  
Blind Comparison ◽  
Placebo Infusion

scholarly journals Carbidopa for Afferent Baroreflex Failure in Familial Dysautonomia

Hypertension ◽  
2020 ◽  
Vol 76 (3) ◽  
pp. 724-731
Author(s):  
Lucy Norcliffe-Kaufmann ◽  
Jose-Alberto Palma ◽  
Jose Martinez ◽  
Horacio Kaufmann
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Variability ◽  
Low Dose ◽  
Familial Dysautonomia ◽  
Reduce Blood Pressure ◽  
Catecholamine Release ◽  
High Dose ◽  
Double Blind ◽  
Adequate Treatment ◽  
Baroreflex Failure

Afferent lesions of the arterial baroreflex occur in familial dysautonomia. This leads to excessive blood pressure variability with falls and frequent surges that damage the organs. These hypertensive surges are the result of excess peripheral catecholamine release and have no adequate treatment. Carbidopa is a selective DOPA-decarboxylase inhibitor that suppresses catecholamines production outside the brain. To learn whether carbidopa can inhibit catecholamine-induced hypertensive surges in patients with severe afferent baroreflex failure, we conducted a double-blind randomized crossover trial in which patients with familial dysautonomia received high dose carbidopa (600 mg/day), low-dose carbidopa (300 mg/day), or matching placebo in 3 4-week treatment periods. Among the 22 patients enrolled (13 females/8 males), the median age was 26 (range, 12–59 years). At enrollment, patients had hypertensive peaks to 164/116 (range, 144/92 to 213/150 mm Hg). Twenty-four hour urinary norepinephrine excretion, a marker of peripheral catecholamine release, was significantly suppressed on both high dose and low dose carbidopa, compared with placebo ( P =0.0075). The 2 co-primary end points of the trial were met. The SD of systolic BP variability was reduced at both carbidopa doses (low dose: 17±4; high dose: 18±5 mm Hg) compared with placebo (23±7 mm Hg; P =0.0013), and there was a significant reduction in the systolic BP peaks on active treatment ( P =0.0015). High- and low-dose carbidopa were similarly effective and well tolerated. This study provides class Ib evidence that carbidopa can reduce blood pressure variability in patients with congenital afferent baroreflex failure. Similar beneficial effects are observed in patients with acquired baroreflex lesions.

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