Epidural morphine decreases postoperative hypertension by attenuating sympathetic nervous system hyperactivity

Article Abstract:

Patients undergoing surgery may develop high blood pressure after the operation (postoperative hypertension). In order to test how postoperative hypertension may be caused by the sympathetic (or autonomic) nervous system, the portion of the nervous system that regulates the activity of the heart muscle, the smooth muscles and the glands, a group of patients undergoing abdominal aortic surgery received an epidural injection into the spinal canal, either of morphine or of a solution of no pharmacological value. Patients receiving the morphine injection required fewer pain killers in the 24 hours following surgery, had lower pain scores and had significantly lower blood levels of norepinephrine, a hormone which acts as a vasopressor to raise blood pressure by stimulating the contraction of capillaries and arteries, than patients who had not received the drug. Morphine injections did not affect the levels of epinephrine in the blood. Epinephrine, a hormone secreted by the adrenal gland, stimulates the sympathetic nervous system, accelerating the heart rate and increasing blood pressure. Patients who had received an epidural morphine injection had lower blood pressure readings in the 24 hours after surgery than the group which did not. The results indicate that it is the activity of the sympathetic nervous system, rather than the adrenal epinephrine or pituitary gland secretion of arginine vasopressin, that is responsible for postoperative hypertension following aortic surgery. In addition, epidural narcotic drugs such as morphine may reduce postoperative hypertension.

Analysis, Hypertension, Dosage and administration, Epinephrine, Blood chemical analysis, Morphine, Postoperative period, Vasopressin, Vasopressins, blood, Abdominal aorta

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Should normothermia be maintained during major surgery?

Article Abstract:

Keeping patients warm during surgery has benefits but it could have a negative impact on medical research. Most surgical patients experience a drop in body temperature, or hypothermia, due to the use of anesthetics and cold intravenous fluids. A 1997 study found that keeping patients warm to prevent hypothermia reduced the risk of serious complications such as heart attack by 55%. Maintaining body temperature is inexpensive and could be adopted as a standard by anesthesiologists. However, it would then be more difficult to study the health effects of hypothermia.

Care and treatment, Editorial, Patients, Patient care

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Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events: a randomized clinical trial

Article Abstract:

Keeping surgical patients with coronary artery disease warm during the operation may reduce their risk of a post-operative cardiac complication. Researchers randomly assigned 270 cardiac patients who were having non-cardiac surgery to receive standard operative care or methods to keep their body warm during surgery. The warming resulted in a 55% drop in the risk of post-operative complications such as unstable angina, heart attack of cardiac arrest. Anesthetics and open body cavities are primarily responsible for the hypothermia that occurs during operations.

Evaluation, Thermotherapy

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