Epinephrine Values Research Articles

Metabolic and hormonal responses to acute high-load resistance exercise in normobaric hypoxia using a saturation clamp.

We assessed metabolic and hormonal responses to high-load resistance exercise under varying normobaric hypoxia conditions with a saturation clamp. Employing a counterbalanced, crossover test design, ten well-trained men participated in three exercise trials with normoxic or hypoxic gas mixtures to maintain arterial oxygen saturation at -90% and 80% [moderate (MH) and severe (SH) hypoxia, respectively]. The resistance exercise regimen comprised five sets of 10 repetitions of barbell back squats at 70% of one repetition maximum, with 1-min rest between sets. Metabolic and hormonal responses were measured before normoxia or hypoxia exposures (Pre 1), 15min after the exposures (Pre 2), and at 0-, 15-, and 30-min post-exercises (T0, T15, and T30, respectively). Compared to Pre 2, blood lactate concentrations and growth hormone values were elevated at T0, T15, and T30 (p ≤ 0.001), while testosterone values increased at T0 in all conditions (p ≤ 0.009). Epinephrine values increased significantly from Pre 2 to T0 in SH only (p < 0.001). SH had significantly higher blood lactate concentrations (p = 0.023), growth hormone (p = 0.050), and epinephrine (p = 0.020) values at T30 compared to NM. Cortisol values were elevated above Pre 2at T15 in MH and SH, while lower testosterone values were noted at T0 and T15 for SH compared to NM and MH (all p ≤ 0.05). Severe simulated hypoxia, achieved through a saturation clamp during barbell back squats, may enhance metabolic and hormonal responses, particularly 30min post-session. Nevertheless, the acute effects of hypoxia exposure seem to be overridden by the impact of high-load resistance exercise.

Анализ содержания катехоламинов и параметров липидного обмена у аборигенного и местного европеоидного населения Арктической зоны Российской Федерации

The study of fat metabolism and the levels of sympathoadrenal hormones in the indigenous population of the Arctic presently changing their lifestyle from nomadic to sedentary is undoubtedly of practical interest. The purpose of this article was to conduct a comparative analysis of the content of catecholamines, triglycerides and saturated fatty acids in the inhabitants of the Arctic zone of the Russian Federation, depending on their lifestyle (nomadic indigenous people, sedentary indigenous people, and local Russian population), age and sex. Materials and methods. The study involved 472 subjects: men and women of the first (men: 22–35 years old; women: 21–35 years old) and second (men: 36–60 years old; women: 36–55 years old) periods of adulthood, leading different lifestyles. The following were determined in the blood serum: triglyceride concentrations using the enzymatic method; level of saturated fatty acids (ƩSFA) using gas-liquid chromatography, followed by а calculation of the content of short-, medium- and long-chain saturated fatty acids (ƩSCFA, ƩMCFA, ƩLCFA). Urine levels of adrenaline and noradrenaline were determined by means of fluorimetry. Results. Regardless of their lifestyle, adult subjects, primarily women, showed high adrenaline values, low triglyceride concentrations and elevated ƩSFA. Correlation analysis established a negative association of adrenaline with ƩLCFA and ƩSFA in sedentary indigenous women aged 21–35 years and with ƩMCFA in those aged 36–55 years. In local Russian women aged 36–55 years, on the contrary, a positive association of noradrenaline with ƩSCFA, ƩMCFA, ƩLCFA and ƩSFA was found. No statistically significant correlations were identified in nomadic indigenous women. Unlike women, men had a correlation between adrenaline content and ƩMCFA only among local Russians: negative in 22–35-year-olds and positive in 36–60-year-olds with high noradrenaline levels. On the one hand, low triglyceride values and elevated ƩSFA among residents of the Arctic zone of the Russian Federation maintain the energy homeostasis of the body. On the other hand, they lead to overweight and obesity, which increases the risk of new-onset metabolic dysfunction-associated diseases, especially in women.

The Effect of Propofol plus Remifentanil for PostoperativePain and Heart Rate Management in Patients Undergoing Abdominal Hysterectomy.

Purpose To explore the effect of propofol plus remifentanil for postoperative pain and heart rate management in patients undergoing abdominal hysterectomy. Methods In this prospective randomized controlled study, 96 patients who underwent abdominal hysterectomy in an affiliated hospital of Fujian Medical University from April 2016 to April 2017 were recruited and randomized into the study group (n = 48) and control group (n = 48) via the random number table method. The control group received remifentanil for anesthesia, and the study group was given propofol plus remifentanil. The postoperative pain and heart rates of patients were compared between the two groups. Results No significant difference was observed in the heart rate and adrenaline values between the two groups before anesthesia, and the study group had significantly lower adrenaline values and heart rates intraoperatively and 15 min after operation than the control group. Patients in the study group showed shorter time-lapse before independent breathing recovery, extubation, and resuscitation compared to those in the control group. The study group received less patient-controlled intravenous analgesia (PCIA) as compared to the study group within 48 h after operation. In the study group, the numeric rating scale (NRS) scores within 1 h, 2 h, 6 h, 8 h, and 12 h after operation were significantly lower than those in the control group (P < 0.001). Propofol plus remifentanil offer a viable alternative for postoperative pain management and stress alleviation after abdominal hysterectomy with a high safety profile. Further clinical trials are, however, required prior to clinical promotion.

Adrenomedullary Function in Cohort of Brazilian Pediatric Patients with Classic Congenital Adrenal Hyperplasia

Congenital Adrenal Hyperplasia is a group of autosomal recessive disorders resulting from deficiency of enzymes essential for the synthesis of cortisol. Disease of the adrenal cortex, but there may be involvement adrenomedullary. Cortisol and epinephrine are directly related to the individual’s stress response. Lower values of epinephrine in children with congenital adrenal yperplasia could be related to increased clinical complications and hospitalizations rate. We evaluated the serum values of metanephrines and normetanephrines in children and adolescents with classic congenital adrenal hyperplasia and primary hypothyroidism and possible correlations with disease and hospitalizations. Cross-sectional study involved 29 patients (10 simple virilizing and 19 salt-wasting), and control group of 28 patients with primary hypothyroidism (10 overt and 18 subclinical). There were no differences in age (p = 0.24) and metanephrine (p = 0.34) or normetanephrine values (p = 0.85) between groups.Hospitalization rate was higher in the cases than in the controls (51 x 12).We conclude the serum values of metanephrine and normetanephrine in patients with congenital adrenal hyperplasia were within the normal values of reference, with no significant difference of group with primary hypothiroidism. The number of hospitalizations in the case was high in relation to the control, mainly in salt-wasting.

395-P: N-hydroxyethyl-1-deoxynojirimycin (Miglitol) Restores the Sympathoadrenal Response to Hypoglycemia following Antecedent Hypoglycemia in Diabetic Rats

Antecedent hypoglycemia leads to a reduction in the sympathoadrenal response during subsequent hypoglycemia, i.e., HAAF. We’ve shown previously that this can be corrected in nondiabetic rats by portal vein infusion of N-hydroxyethyl-1-deoxynojirimycin (NEOH-DNJ; miglitol). In the current study we examined the efficacy of portal vein NEOH-DNJ infusion in restoring the sympathoadrenal response for diabetic animals. Diabetes was induced in rats via streptozotocin (STZ) injection (65mg/kg) 4 weeks prior to experiments. Conscious, unrestrained STZ-diabetic rats underwent hyperinsulinemic-hypoglycemic clamps on two consecutive days with a glycemic nadir of 2.6 ± 0.04 mM. On Day 2 animals received portal vein miglitol infusions (1.45 μmol/kg/min) either upstream, (PORups) or liver adjacent (PORadj), while hypoglycemic controls (HYPO) received normal saline infusion. Serial plasma samples were assayed for glucose, insulin, epinephrine (EPI) and norepinephrine (NE). On Day1 peak epinephrine (22.7 ± 2.1 nM) and norepinephrine (2.92 ± 0.3 nM) values were not significantly different between HYPO, PORups and PORadj (P&amp;gt;0.38). On Day 2, EPI values for untreated HYPO controls were suppressed by 85% relative to Day 1 (P &amp;lt; 0.0001). In contrast, EPI responses for miglitol infused groups, PORups (21.3 ± 2.2 nM) and PORadj (16.1 ± 2.01 nM) were not significantly different from Day 1 values (P = 0.75 and 0.50, respectively). NE demonstrated similar responses with HYPO suppressed by 63% on Day 2 (P&amp;lt;0.05), while miglitol treated groups, PORups and PORadj, demonstrated Day 2 NE values not significantly different from Day 1 (P&amp;gt;0.85). Conclusion: The impaired sympathoadrenal response following antecedent hypoglycemia is restored in STZ-diabetic rats by miglitol (NEOH-DNJ) treatment during subsequent hypoglycemia. As with nondiabetic rats, STZ-diabetic animals demonstrated no differences between portal miglitol infusion sites. Disclosure C. Donovan: None. A.J. Jokiaho: None. Funding JDRF (3-SRA-2017-486-S-B)

Action Plan to Ensure Global Availability of Adrenaline Autoinjectors.

Adrenaline (epinephrine) is the first-line treatment for anaphylaxis and, therefore, is listed as an essential medication for the treatment of anaphylaxis by the World Health Organization (WHO). However, the availability of adrenaline autoinjectors (AAI) for use as first-aid treatment is limited to only 32% of all the world's 195 countries, most of which are high-income countries. The key issues leading to the lack of availability of AAIs include cost, national regulations, lack of regional evidence on the value of epinephrine, and limited accurate data about the epidemiology of anaphylaxis. For these reasons, regional and international allergy academies support initiatives to narrow these gaps. Our WHO Collaborating Centre is deeply involved in this process. This document aims to serve as a baseline to ensure the following: (1) adequate access to affordable autoinjectors for all patients/societies; and (2) the development of disease-/patient-specific approaches. Therefore, we propose a 5-step action plan that aims to gather accurate epidemiological data on anaphylaxis and autoinjector consumption, confirm partnerships, strengthen awareness, and include AAIs in the WHO Model List of Essential Medicines. These aspects should be considered in combination. A prioritized research agenda should encapsulate all these steps within the framework a global initiative against anaphylaxis. More than calling for universal availability of autoinjectors for optimal management of anaphylaxis, we propose an action plan as the baseline for a global initiative against anaphylaxis. We strongly believe that combined efforts will ensure a strong public health and societal approach that will lead to optimal care of allergic patients and best practices in allergology.

Plasma epinephrine as a prognostic marker in traumatic brain injury

Background Traumatic brain injury is an international health problem with high morbidity and mortality. It is associated with catecholamine release (catecholamine surge).Objective The purpose of the work was to study plasma epinephrine as a prognostic marker in traumatic brain injury.Patients and methods The authors enrolled 60 adult persons of both sexes [30 patients with diagnosis of isolated traumatic brain injury with Glasgow coma score (GCS) ≤11 and 30 volunteers as a control group]. Plasma epinephrine levels were measured on admission and after 24 h. Then the patients were classified into two groups at the end of the study (3 months) according to the GOS: group I (favorable outcome; GOS IV, V) which included 11 (36.6%) patients and group II (unfavorable outcome; GOS I, II, III) which included 19 (63.3%) patients.Results Receiver operating characteristic curves were used to describe the prognostic value of plasma epinephrine on admission and after 24 h to predict unfavorable outcome and mortality. Higher levels of epinephrine on admission were associated with a higher rate of unfavorable outcome [areas under the curve (AUC)=0.921, confidence interval (CI): 0.828–1.014, P<0.001] and mortality (AUC=0.855, CI: 0.707–1.003, P=0.003). Also, higher levels of epinephrine after 24 h were associated with a higher rate of unfavorable outcome (AUC=0.971, CI: 0.912–1.030, P<0.001) and mortality (AUC=0.884, CI: 0.752–1.02, P=0.002).Conclusion Plasma epinephrine could be used as a prognostic marker in traumatic brain injury.

Effect of Coagulation Factor Concentrates on Markers of Endothelial Cell Damage in Experimental Hemorrhagic Shock.

Plasma-based resuscitation showed protective effects on the endothelial glycocalyx compared with crystalloid resuscitation. There is paucity of data regarding the effect of coagulation factor concentrates (CFC) on the glycocalyx in hemorrhagic shock (HS). We hypothesized that colloid-based resuscitation supplemented with CFCs offers a therapeutic value to treat endothelial damage following HS. Eighty-four rats were subjected to pressure-controlled (mean arterial pressure (MAP) 30-35 mm Hg) and lab-guided (targeted cutoff: lactate >2.2. mmol/L and base deficit > 5.5 mmol/L) HS. Animals were resuscitated with fresh frozen plasma (FFP), human albumin (HA) or Ringer's lactate (RL) and RL or HA supplemented with fibrinogen concentrate (FC) or prothrombin complex concentrate (PCC). Serum epinephrine and the following markers of endothelial damage were assessed at baseline and at the end-of-observation (120 min after shock was terminated): syndecan-1, heparan sulfate, and soluble vascular endothelial growth factor receptor 1 (sVEGFR 1). Resuscitation with FFP had no effect on sVEGFR1 compared with crystalloid-based resuscitation (FFP: 19.3 ng/mL vs. RL: 15.9 ng/mL; RL+FC: 19.7 ng/mL; RL+PCC: 18.9 ng/mL; n.s.). At the end-of-observation, syndecan-1 was similar among all groups. Interestingly, HA+FC treated animals displayed the highest syndecan-1 concentration (12.07 ng/mL). Resuscitation with FFP restored heparan sulfate back to baseline (baseline: 36 ng/mL vs. end-of-observation: 36 ng/mL). The current study revealed that plasma-based resuscitation normalized circulating heparan sulfate but not syndecan-1. Co-administration of CFC had no further effect on glycocalyx shedding suggesting a lack of its therapeutic potential. VExperimental in vivo study.

The Vagus Nerve Mediates Severe Hypoglycemia–Induced Fatal Cardiac Arrhythmias

Severe hypoglycemia causes fatal cardiac arrhythmias. The extent to which the parasympathetic nervous system regulates hypoglycemia-induced fatal arrhythmias remains unknown. To investigate the role of vagal innervation in regulating arrhythmias during severe hypoglycemia, Sprague Dawley rats underwent vagotomy (left vagus nerve transection adjacent to the carotid artery; n = 15) or sham surgery (control; n = 13). One week after surgery, all rats underwent hyperinsulinemic (0.2 U/kg/min) severe hypoglycemic (10-15 mg/dl) clamps with electrocardiogram recordings. Rats with vagotomy had increased heart rate at baseline and throughout the clamp, indicating successful vagotomy. Glucose infusion rates during hypoglycemia were increased 1.7-fold in rats with vagotomy, but epinephrine values were similar between the groups. Vagotomy resulted in fewer cardiac arrhythmias including a 12-fold decrease in 2nd degree heart block. Reduction in arrhythmias was associated with a 7-fold decrease in severe hypoglycemia-induced mortality in rats with vagotomy (7%) compared to controls (46%). In summary, vagal transection reduces mortality and cardiac arrhythmias during severe hypoglycemia. Since vagal innervation mediates severe hypoglycemia-induced sudden death, targeting the parasympathetic nervous system may be a logical approach to prevent sudden death for at-risk people with insulin treated diabetes. Disclosure C.M. Reno: None. A.J. Skinner: None. J. Bayles: None. S.J. Fisher: None.

Adrenomedullary Function in 21-Hydroxilase Deficiency. is there an Association with Adrenal Crises?

Background: Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency is characterized by impairment in normal steroid production. Patients with the most severe forms also have decreased adrenomedullary function. However, the clinical implications of epinephrine deficiency are not clear. Objective: Evaluate the adrenomedullary function in children with salt-wasting congenital adrenal hyperplasia (SW CAH) and assess its relationship to the number of hospitalizations due to adrenal crises. We compare the clinical, analytical and genotypic characteristics and the therapeutic needs of patients with and without adrenomedullary disfunction. Methods: We measured 24-hours urine catecholamine levels (epinephrine, norepinephrine, and dopamine) and 21-hydroxylase genotype in 21 SW CAH. Results: 11 SW CAH had adrenomedullary disfunction characterized by undetectable urine epinephrine, and interestingly, had &gt;8 adrenal crises during infanthood. Other 10 SW CAH had normal values of urine epinephrine and had less than 4 adrenal crises during infanthood. There were no significant differences in hydrocortisone (16.08 ± 3.4 mg/m2/day vs 16.98 ± 5.01 mg/m2/day) and 9fluorohydroxortisone (0.072 ± 0.06 mg/m2/day vs 0,101 ± 0.12 mg/m2 /day) doses, although the mean value of 17-OHP (0.04 ng/ml (0.1-1.3) vs 26.7 ng/ml (0.1-79)); ATCH (45pg/ml (30.9-122)vs 71 pg/ml (34-271)), aldosterone (50 pg/ml (50-50) vs 50 pg/ml (50-244)), and androstenedione(0 ng/ml (0-0,4) vs 2,6 ng/ml (0-5.3)) was lower in patients with undetectable urine epinephrine. 11 SW CAH with urinary epinephrine deficiency had most severe genotype. Conclusion: SW CAH with undetectable epinephrine in urine had several crises during infanthood. The measurement of urine epinephrine is well correlated with the clinical severity of the disease and the expected activity of 21-hydroxilase.

Public Access Defibrillation: Is This Making Any Difference? Controversial Issues in Resuscitation from Cardiac Arrest.

Public access defibrillation is particularly valuable in witnessed cardiac arrests that occur in public places. Bystander and police use of automated external defibrillators (AEDs) has increased over the past 15years, resulting in improved survival with normal or near-normal neurologic function. There is great promise for increasing bystander use of defibrillators as the technology is applied to linking patients with shockable arrests to volunteers committed to bringing AEDs to the patients. There continues to be controversy as to the value of epinephrine, antiarrhythmic drugs, hypothermia, and mechanical chest compression in resuscitative efforts.

Risk factors for prolonged hypotension in patients with pheochromocytoma undergoing laparoscopic adrenalectomy: a single-center retrospective study

Prolonged hypotension during pheochromocytoma resection is a significant complication. We sought to investigate the predictors of prolonged hypotension in patients with pheochromocytoma undergoing laparoscopic adrenalectomy (LA). Patients with pheochromocytoma who underwent LA between 2012 and 2015 were surveyed. Patients were considered to have prolonged hypotension if they had a mean arterial blood pressure <60 mmHg or required ≥30 consecutive minutes of catecholamine support intraoperatively. Among 123 patients, 54 (43.9%) developed prolonged hypotension requiring ≥30 consecutive minutes of catecholamine support. Compared with patients with nonprolonged hypotension, those with prolonged hypotension had higher levels of urinary norepinephrine (P = 0.011), epinephrine (P < 0.001), and dopamine (P = 0.019) preoperatively, and a higher incidence of vital organ injury postoperatively (P = 0.039). Multivariate logistic analysis showed that independent predictors for prolonged hypotension were multiples of the normal reference upper limit value of urinary epinephrine (odds ratio, 1.180; 95% confidence interval, 1.035–1.345) and dopamine (odds ratio, 4.375; 95% confidence interval, 1.207–15.855). The levels of preoperative urinary epinephrine and dopamine are clinical predictors for prolonged hypotension in patients with pheochromocytoma undergoing LA. Using these parameters, clinicians can assess and manage this patient population more effectively.

Effect of a Multi-Nutrient Over-the-Counter Supplement on Changes in Metabolic Rate and Markers of Lipolysis

ABSTRACTUsing a prospective, randomized, double-blind, crossover study design, fifteen healthy male (n = 8) and female (n = 7) participants (mean ± standard deviation (SD): 28.3 ± 6.1 yr, 176.3 ± 11.4 cm, 89.8 ± 21.7 kg, 28.5 ± 4.8 kg/m2) completed this study. Two testing sessions occurred after an overnight fast and refraining from physical exercise. Prior to and 60, 120, and 180 minutes after single dose ingestion of placebo (PLA) or a Thermogenic Supplement (TS), visual analog scales (VAS), resting metabolic rate (VO2), and venous blood were collected. Resting heart rate and blood pressures were collected before, and 30, 60, 90, 120, 150 and 180 minutes after PLA or TS ingestion. Significant group × time interactions were found for VO2 with TS experiencing significant (p < 0.05) increases 60 and 120 minutes after ingestion. Respiratory quotient values tended to be lower 180 minutes (p = 0.07) after TS ingestion. TS group reported increased energy 60 minutes (p < 0.05) after ingestion. No interactions were reported for resting heart rate or blood pressure. Significant within-group reductions in systolic blood pressure were noted for PLA, while resting heart rates were significantly lower in TS 30 and 60 minutes after ingestion. An interaction for epinephrine (p = 0.02) was found, while no changes were reported for norepinephrine and dopamine. Dependent t-tests using area under the curve calculations revealed higher AUC values for epinephrine in TS compared to PLA (p = 0.001). In conclusion, ingestion of a single dose of TS increased oxygen consumption, epinephrine and energy levels, while substrate oxidation tended to change in comparison to a placebo. No adverse responses were reported.

The effects of a roundtrip trans-American jet travel on physiological stress, neuromuscular performance, and recovery.

The purpose was to examine the effects of a round trip trans-American jet travel on performance, hormonal alterations, and recovery. Ten matched pairs of recreationally trained men were randomized to either a compression group (COMP) (n = 10; age: 23.1 ± 2.4 yr; height: 174.8 ± 5.3 cm; body mass: 84.9 ± 10.16 kg; body fat: 15.3 ± 6.0%) or control group (CONT) (n = 9; age: 23.2 ± 2.3 yr; height: 177.5 ± 6.3 cm; weight: 84.3 ± 8.99 kg; body fat: 15.1 ± 6.4%). Subjects flew directly from Hartford, CT to Los Angeles, CA 1 day before a simulated sport competition (SSC) designed to create muscle damage and returned the next morning on an overnight flight back home. Both groups demonstrated jet lag symptoms and associated decreases in sleep quality at all time points. Melatonin significantly (P < 0.05) increased over the first 2 days and then remained constant until after the SSC. Epinephrine, testosterone, and cortisol values significantly increased above resting values before and after the SSC with norepinephrine increases only after the SSC. Physical performances significantly decreased from control values on each day for the CONT group with COMP group exhibiting no significant declines. Muscle damage markers were significantly elevated following the SSC with the COMP group having significantly lower values while maintaining neuromuscular performance measures that were not different from baseline testing. Trans-American jet travel has a significant impact on parameters related to jet lag, sleep quality, hormonal responses, muscle tissue damage markers, and physical performance with an attenuation observed with extended wear compression garments.

Effect of space allowance during transport and fasting or non-fasting during lairage on welfare indicators in Merino lambs

A total of 72 male lambs of Merina breed were sampled in a 3×2 factorial design, testing three different space allowances treatment (SA) during transport [0.16 m2/animal (SAL; n=24); 0.20 m2/animal (SAM; n=24) and 0.30 m2/animal (SAH; n=24)] and two lairage treatments (TL) during 18 h previous slaughter [fasting (FAST; n=36) vs feeding (FEED; n=36)] on welfare physiological indicators. After transport, glucose and lactate dehydrogenase (LDH) were highest in SAM group and lowest in SAH one (p&lt;0.05). SAL showed intermediate values for both parameters. SA did not affect the rest of the blood parameters studied. TL-FAST treatment decreased glucose values (p&lt;0.001) while increased LDH (p&lt;0.001). Fasting caused an increase (p&lt;0.05) of Red Blood Cell Count values in SAM group. Feed deprivation did not affect cortisol or adrenaline values. Noradrenaline value was higher (p&lt;0.001) in TL-FAST groups than in TL-FEED. In conclusion, under the conditions of this study, a range of space allowance during transport between 0.16 and 0.30 m2/lamb could be recommended without showing major changes on welfare physiological indicators; and feeding could be more appropriate than fasting during lairage.

Dipping in Ambulatory Blood Pressure Monitoring Correlates With Overnight Urinary Excretion of Catecholamines and Sodium.

Nondipping blood pressure (BP) is associated with increased morbidity and mortality. This study examines the relationship of "dipping" in 24-hour ambulatory BP monitoring (ABPM) with awake and sleeping urinary norepinephrine (NE) and epinephrine (EPI), and that of urinary NE and EPI with urinary sodium (UNa). Fifty nondippers and 65 dippers were included in the present study. Collected data included age, sex, body mass index, history of hypertension, current antihypertensive treatment, ABPM data, and NE, EPI, and UNa values. Hierarchical multiple regression analysis with the night-to-day ratio (NDR) of systolic BP as a dependent variable showed that the composite term of the NDRs of urinary NE and EPI was a significant predictor for dipping. Results also show a differential role of NE and EPI in circadian UNa excretion in dippers and nondippers. These results indicate that the sympathetic nervous system is involved in the regulation of circadian BP variations and UNa excretion.

Clinical predictors of prolonged postresection hypotension after laparoscopic adrenalectomy for pheochromocytoma

Although the perioperative management of patients with pheochromocytoma has been improving recently, severe hypotensive episodes can occur that require postoperative catecholamine support and are challenging to manage. Our aim was to identify the clinical factors that predict prolonged postresection hypotension in patients after laparoscopic adrenalectomy for pheochromocytoma. The records of 73 Japanese patients who underwent unilateral laparoscopic adrenalectomy for pheochromocytoma were surveyed retrospectively. Patients were divided into 2 groups according to whether catecholamine support was needed after postoperatively. Clinical and biochemical data were evaluated at baseline and after operation. Thirty-four of 73 patients (47%) required continuous infusion of catecholamine to maintain systolic blood pressure >90 mm Hg at the end of the operation. The median duration of postoperative catecholamine support was 17 hours (range, 3-130) in these 34 patients. On multivariate analysis, tumor size >60 mm, urinary epinephrine levels >200 μg/day, and urinary norepinephrine levels >600 μg/day were independent predictors of prolonged hypotension requiring postoperative catecholamine support. Tumor size and urinary norepinephrine levels were significantly correlated with the duration of postoperative catecholamine support. Larger tumor size and greater values of urinary epinephrine and norepinephrine levels were significant predictors of prolonged hypotension requiring postoperative catecholamine support. Moreover, tumor size and urinary norepinephrine levels were positively correlated with the duration of postoperative catecholamine support. Clinicians can identify and manage patients more effectively with a greater risk of prolonged hypotension after tumor resection using these preoperative clinical variables.

Impact of Acute Training Stress on Moral Decision Making Following Marine Corps Martial Arts Training

Military training involves rapid decision making during periods of intense stress. Often these decisions have a profound impact on the moral and tactical growth of military personnel in training. PURPOSE: Map the trajectory of the endocrine response and quantify variation in measures of moral judgment (MJ) and intention (MI) following Marine Corps Martial Arts training. METHODS: 10 male Marines participated in this study and were observed 3 times during a 9-week period. Blood samples for cortisol, norepinephrine (NE) and epinephrine (EPI) were collected before training (Baseline) and during the recovery period (Immediate Post (IP), 15, 30, 45 and 60min). Components of the Ethical and Moral Index were assessed over the same times. Blood markers were quantified using summary measures and analyzed with rm-ANOVA. Hierarchical regression was used to analyze emotional and cognitive variables. RESULTS: There were no significant differences across visits for the summary or baseline blood markers. EPI (69±46.5pcg/ml, 70.6±46.1pcg/ml, 58.5±42.6pcg/ml) and NE (880.3±670pcg/ml, 886.4±353.2pcg/ml, 874.1±578.1pcg/ml) values peaked at IP. Times to peak for cortisol (22.0±6.7mcg/dl, 20.9±5.9mcg/dl, 19.7±3.9mcg/dl) are interpreted as peaks between 15-30min for Visit 1 and between 0-15min for Visits 2-3. At baseline, MJ was predicted positively by moral justification (β=.67, t(24)=2.39, p<.05) and national identity (β=.59, t(24)=2.22, p<.05). At IP, national identity (β=.77, t(24)=2.27, p<.05) predicted MI - the higher the individual identified with America, the more likely they were to intend to commit unethical acts on the battlefield. Over the 15-45 min recovery moral identity predicted MJ (β=-.61, t(24)=-2.72, p<.05) and MI (β=-.57, t(24)=-2.70, p<.05). CONCLUSION: The lack of significant differences across visits suggests the acute endocrine response to training stress is not attenuated with repeated exposure. Changes in moral predictors over the recovery period indicate moral decision making is informed differently immediately following an acute stressor. Future research quantifying the interplay between physiological responses to acute stress and moral decision making may aid the development of training strategies for military personnel. Supported by a grant through the Office of Naval Research.

Effect of electroacupuncture at Zusanli (ST36) and Sanyinjiao (SP6) acupoints on adrenocortical function in etomidate anesthesia patients

BackgroundWe aimed to investigate the effect of electroacupuncture at Zusanli (ST36) and Sanyinjiao (SP6) on adrenocortical function in patients with etomidate anesthesia.Material/MethodsWe randomly divided 80 patients who underwent elective surgery into 4 groups: group etomidate (ETO), group etomidate + electroacupuncture (ETO+EA), group etomidate + sham acupuncture (ETO+SEA), and group propofol (PRO). The patients in group ETO, ETO+EA, and ETO+SEA were induced with etomidate and sufentanil and maintained with intravenous infusion of etomidate and remifentanil. Group PRO was induced with propofol and sufentanil and maintained with propofol and remifentanil. Group ETO+EA received electro-acupuncture stimulation at Zusanli and Sanyinjiao throughout the operation, while group ETO+SEA received electro-acupuncture stimulation at non-acupoints. We recorded the values of MAP, HR, BIS, CVP, cortisol, ACTH, epinephrine, norepinephrine, and arterial blood gas during the perioperative period.ResultsCortisol concentrations were significantly higher at all times except T0 in group ETO+EA compared with group ETO. The ACTH concentrations were lower in group ETO+EA than that in group ETO at point T3.ConclusionsElectroacupuncture at ST 36 and SP 6 can mitigate the adrenal cortical inhibition induced by etomidate and can reduce the secretion of catecholamines during surgery.

Comparison of Epidural and Systemic Tramadol for Analgesia Following Ovariohysterectomy

The objective of the study was to compare epidural and systemic tramadol for postoperative analgesia in bitches undergoing ovariohysterectomy. Twenty animals, randomly divided into two groups, received either epidural (EPI) or intramuscular (IM) tramadol (2 mg/kg) 30 min before anesthetic induction. Analgesia, sedation, cardiorespiratory parameters, end-tidal isoflurane, blood catecholamines and cortisol, and arterial blood gases were measured at different time points up to 24 hr after agent administration. There were no differences between the two groups regarding cardiorespiratory parameters, end-tidal isoflurane, and pain scores. Two dogs in the IM and one in the EPI group required supplemental analgesia. Cortisol was increased (P<0.05) at 120 min (3.59 μg/dL and 3.27 μg/dL in the IM and EPI groups, respectively) and 240 min (2.45 μg/dL and 2.54 μg/dL in the IM and EPI groups, respectively) compared to baseline. Norepinephrine was also increased (P<0.05) at 120 min in both groups compared to baseline values. Epinephrine values were higher (P<0.05) in the IM group compared with the EPI group at 50 min, 120 min, and 1,440 min after tramadol administration. Epidural tramadol is a safe analgesic, but does not appear to have improved analgesic effects compared with IM administration.