Changes In Arterial Pressure Research Articles

Association of early life cardiovascular risk factors with grey matter structure in young adults in the United Kingdom: the ALSPAC study

Cumulative exposures to obesity, hypertension, and physical inactivity from midlife (40-65 years) onwards are three known cardiovascular risk factors for dementia and associated cerebral structural damage. Exactly how early in the lifespan sensitive periods for exposure to these risk factors begin is yet to be established, specifically with respect to onset of cerebral structural changes. We aimed to investigate whether cardiovascular risk across childhood and adolescence is already associated with cerebral structure in regions previously linked with dementia, during young adulthood. Participants were selected from the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK-based prospective cohort of young people, if they had participated in a neuroimaging sub-study (N=862). We entered data from repeated clinical assessments into mixed-effects models to estimate baseline and rate of change in body mass index (BMI) and mean arterial pressure (MAP) between ages 7-17 years, and physical activity (PA) between 11-15 years. Linear models assessed whether cardiovascular risk factors were associated with grey matter macrostructural indices (cortical thickness, surface area, volume) in young adulthood (∼20 years). BMI was found to be associated with grey matter macrostructure in nodes of Default Mode Network previously found to show atrophy in dementia. Baseline BMI was associated with thickness of precuneus cortex and entorhinal surface area, whilst rate of change in BMI across childhood and adolescence was associated with thickness of parahippocampal and middle temporal gyri and inferior parietal cortex in addition to entorhinal and parahippocampal surface area. Further, we identified associations between baseline MAP and PA and entorhinal surface area. Exploratory whole-brain analyses revealed associations between baseline and rate of change in these cardiovascular risk factors and the cortical thickness, surface area, and volume of broader groups of cortical and subcortical regions. Findings provide preliminary evidence that cerebral structural differences in regions linked to dementia in old age may be legacy of developmental differences associated with cardiovascular risk exposure during early life. This has relevance for lifespan models of dementia risk and timing of preventative interventions. Further work is required to generalise findings beyond this predominantly white, male, and middle-class sample to more diverse cohorts. NIHR Oxford Health BRC (NIHR203316), Wellcome Trust (203139/Z/16/Z).

Safety and efficacy of percutaneous mechanical thrombectomy in the treatment of acute medium- or high-risk pulmonary embolism: a single-center retrospective cross-sectional study.

Patients with acute and high-risk pulmonary embolism have a high mortality rate, and the optimal treatment for these patients has still not been fully established. Although anticoagulation therapy is currently the preferred treatment for pulmonary embolism, for some patients with intermediate- or high-risk pulmonary embolism, anticoagulation therapy alone has a higher probability of long-term pulmonary hypertension and also seriously worsens the quality of life of patients. This paper mainly reports the efficacy and safety of percutaneous mechanical thrombectomy (PMT) in patients with acute medium- or high-risk pulmonary embolism in Taizhou Hospital of Zhejiang Province so as to provide some clinical basis for the treatment of such patients in the future. This study mainly collected the clinical data of 43 patients who were admitted to Taizhou Hospital of Zhejiang Province from May 2018 to May 2023 due to acute medium-to-high-risk pulmonary embolism and received PMT treatment. Preoperative and postoperative blood tests, vital signs, and echocardiographic parameters were compared. The incidence of intraoperative and postoperative complications in follow-up at 1, 6, and 12 months was also recorded. Mechanical treatment included thrombus fragmentation complemented with aspiration. Among the 43 patients, 22 patients were treated with thrombus fragmentation coupled with a pigtail catheter and aspiration using a 6-F multipurpose angiographic (MPA) catheter, 11 were treated by AngioJet, and 10 were treated with an AcoStream catheter. Local thrombolysis treatment with small dose of urokinase was administered in some patients according to the patient's risk of bleeding. Among the patients, 41 patients received a successful operation, representing a surgical success rate of 95.3%. There was one patient with pulmonary infection who died after discharge. There were significant differences in vital signs between the 48-hour preoperative timepoint and the 48-hour postoperative timepoint including cardiac index, pulse, mean arterial pressure, and oxygen saturation (P<0.001). The blood test indicators of carbon dioxide partial pressure and creatinine level did not show obvious abnormalities, but differences in hemoglobin, oxygen partial pressure, and lactate level were statistically significant. In terms of cardiac ultrasound, pulmonary artery pressure and right atrial diameter change were significantly different (P<0.001). There were seven cases of local hematoma at the puncture site, three cases of infection at the puncture site, and nine cases of transient cardiac arrest during the operation. All 41 patients were followed up: one patient died after being discharged due to aggravation of pulmonary infection during hospitalization, one patient died of intracerebral hemorrhage 9 months after the operation, one patient developed recurrent pulmonary embolism, and five patients had no obvious improvement in chest tightness. PMT can be used as a safe and effective treatment option for acute medium-to-high-risk pulmonary embolism.

Smarter Pregnancy coaching and maternal blood pressure

IntroductionMaternal lifestyle behaviours can affect blood pressure with consequences for maternal and offspring health. The aim of this study was to investigate the effectiveness of the Smarter Pregnancy digital lifestyle coaching program on maternal blood pressure during the first trimester. MethodsThe study was conducted on data of the Rotterdam Periconception Cohort from 2010 to 2019 (analysis completed in 2024). The intervention group included 132 pregnant women using Smarter Pregnancy for 6 to 24 weeks, within 30 months before study entry. The control group included 1,091 pregnant women that did not use Smarter Pregnancy. Outcomes included changes in systolic, diastolic and mean arterial blood pressures between baseline and first trimester. Lifestyle behaviours were tracked in the intervention group at 12 and 24 weeks of the program, using lifestyle risk score for vegetables, fruits, smoking and alcohol. ResultsUsing multivariable analysis, the intervention group showed reductions in systolic (βadj -2.34 mmHg, 95%CI -4.67 to -0.01), diastolic (βadj -2.00 mmHg, 95%CI -3.57 to -0.45) and mean arterial blood pressures (βadj -2.22 mmHg, 95%CI -3.81 to -0.52) compared with the control group. When stratifying for conception mode, reductions were observed in diastolic (βadj -2.38, 95%CI -4.20 to -0.56) and mean arterial blood pressures (βadj -2.63, 95%CI -4.61 to -0.56) only in women who underwent assisted reproduction (n=91). Smarter Pregnancy use was associated with a reduction in lifestyle risk score, indicating improved lifestyle behaviours, after 12 (β -0.84, 95%CI -1.19 to -0.49) and 24 weeks (β -1.07, 95%CI -1.44 to -0.69). The lifestyle risk score was also significantly reduced in ART and natural pregnancy subgroups. ConclusionsThe use of Smarter Pregnancy is associated with consistent but small reductions in maternal blood pressure during the first trimester, supporting further implementation in health care.

Sympathetic transduction to blood pressure in patients with chronic kidney disease.

Patients with chronic kidney disease (CKD) are more than twice as likely to die from a cardiovascular event than those with normal kidney function. Although CKD may increase resting sympathetic activity, quantification of resting sympathetic outflow alone does not account for the ensuing vasoconstriction, and blood pressure (BP) change (i.e., sympathetic transduction). Patients with CKD have been reported to exhibit elevated α-adrenergic receptor sensitivity, which may predispose this population to greater sympathetic transduction. We tested the hypothesis that patients with CKD have augmented sympathetic transduction to BP. In 16 patients with CKD, 17 bodyweight-matched (BWM) controls, and 11 lean controls of a similar age muscle sympathetic nerve activity (MSNA) and beat-to-beat BP were continuously recorded during quiet supine rest. Signal averaging was used to quantify changes in mean arterial pressure (MAP) and total vascular conductance (TVC) following spontaneous bursts of MSNA. Peak increases in MAP following MSNA bursts were not different among patients with CKD and the control groups (CKD: 2.3 ± 1.1mmHg; BWM controls: 2.1 ± 1.0mmHg; lean controls: 1.7 ± 0.9mmHg; P = 0.28). Likewise, nadir reductions in TVC following all bursts of MSNA were not different among patients with CKD and either control group (P = 0.69). Both patients with CKD and controls had graded increases in MAP and decreases in TVC with increasing burst size, which were not different among groups (all P > 0.05). In summary, these data indicate that patients with CKD do not have augmented sympathetic transduction to BP.

Effect of aspirin on biomarker profile in women at high-risk for preeclampsia

There is limited evidence in the literature regarding the temporal changes of preeclampsia-related biomarkers during pregnancy in high-risk women who develop preeclampsia despite the administration of aspirin prophylaxis. To compare the temporal changes in mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), placental growth factor (PlGF), and soluble fms-like tyrosine kinase-1 (sFlt-1) across gestation in women screened high-risk for preterm preeclampsia receiving aspirin prophylaxis and low-risk women without aspirin treatment. This was a prospective longitudinal nested case-control study of 2007 women with singleton pregnancies who participated in the first-trimester screen-and-prevent program for preeclampsia at the Prince of Wales Hospital, Hong Kong SAR, China, between January 2020 and May 2023. The risk of developing preterm preeclampsia was determined using the Fetal Medicine Foundation triple test (maternal factors, MAP, UtA-PI and PlGF). High-risk women (adjusted risk ≥1:100) were administered a daily dose of aspirin at either 100 or 160 mg according to maternal weight, starting before 16 weeks until 36 weeks or until delivery or the onset of preeclampsia before 36 weeks. Low-risk women were matched based on maternal age, weight, and the date of the scan. The participants were followed up at 12-15+6, 20-24+6 and 30-37+6 weeks to measure MAP, UtA-PI, PlGF and sFlt-1 at each visit. The level of biomarker was expressed as multiple of median (MoM). Log10 transformation was applied to make the data Gaussian distribution prior to statistical analysis. A linear mixed-effects analysis was performed to compare the longitudinal changes of these biomarkers across gestation between the study groups. Our study involved 403 low-risk women without preeclampsia, 1471 high-risk women without preeclampsia, and 133 high-risk women who developed preeclampsia. The low-risk group had significantly lower estimated marginal mean log10 MAP MoM, log10 UtA-PI MoM, log10 sFlt-1 MoM and higher estimated marginal mean log10 PlGF MoM across gestation than the high-risk groups (p values <0.001). Among high-risk women, those who developed preeclampsia experienced a significantly higher estimated marginal mean log10 MAP MoM (0.06378 vs 0.02985; p<0.001), log10 UtA-PI MoM (0.08651 vs 0.02226; p<0.001), log10 sFlt-1 MoM (0.13204 vs 0.01234; p<0.001) and lower estimated marginal mean log10 PlGF MoM (-0.33504 vs -0.16388; p<0.001) across gestation in comparison to those without preeclampsia. In the individual gestational timepoint analysis, compared to high-risk women without preeclampsia, those who developed preeclampsia experienced higher log10 MAP MoM in all three trimesters, higher log10 UtA-PI MoM and lower log10 PlGF MoM in the second- and third-trimesters, and higher log10 sFlt-1 MoM in the third-trimester. The study has demonstrated that high-risk women who develop preeclampsia experience consistently high MAP level from the first-trimester and remain unchanged during pregnancy, high UtA-PI level and low PlGF level starting from the second-trimester, and high sFlt-1 level in the third-trimester compared to those who do not develop preeclampsia despite the administration of low-dose aspirin. These findings underscore the role of these biomarkers in further risk stratification for the development of preeclampsia among high-risk women following aspirin administration.

Ciprofol versus propofol for anesthesia induction in cardiac surgery: a randomized double-blind controlled clinical trial

BackgroundCiprofol, a novel intravenous general anesthetic with a chemical structure similar to propofol, exhibits significantly enhanced potency. It offers a rapid onset, reduced incidence of injection pain, and has comparable effects on heart rate and blood pressure to propofol. However, clinical data on its use for anesthesia induction in cardiac surgery remain limited.MethodsSeventy-eight patients undergoing coronary artery bypass grafting or valve replacement surgery were randomly assigned to receive either ciprofol (N = 40) or propofol (N = 38) for anesthesia induction. Variables recorded included changes in mean arterial pressure and heart rate during anesthesia, alterations in the oxygenation index and lactic acid concentration before and 10 min after anesthesia induction, and the incidence of adverse events such as bradycardia, hypotension, and injection pain.ResultsThe incidence of anesthesia-induced injection pain was significantly lower in the ciprofol group compared to the propofol group (3% vs. 18%, P < 0.05). The incidence of other adverse events was similar between the groups. No significant differences in hemodynamics or oxygenation index were observed during anesthesia induction between ciprofol and propofol.ConclusionsCiprofol demonstrated a significantly lower incidence of injection pain compared to propofol, potentially improving patient comfort during anesthesia induction. Additionally, ciprofol showed comparable circulatory stability to propofol during anesthesia induction in cardiac surgery, suggesting it may be a suitable alternative to propofol for this application.Trial registrationThe trial was registered at the ClinicalTrials.gov on 03/10/2024 (NCT06312345).

Comparative efficacy of ciprofol and propofol in reducing respiratory depression during ERCP anesthesia: a randomized controlled trial

BackgroundPropofol is one of the important drug causes of respiratory depression in endoscopic retrograde cholangiopancreatography (ERCP) anesthesia. This study aims to clarify whether Ciprofol in ERCP anesthesia reduces the respiratory depression rate.MethodsIn this randomized controlled trial performed at the Surgical Endoscopy Center, the First Hospital of Lanzhou University between Jun 01, 2022 and Feb 20, 2024, patients undergoing ERCP anesthesia were randomly assigned into ciprofol (study group) or propofol (control group). Primary outcomes included respiratory depression rate during anesthesia, and secondary outcomes included body movement and hypoxemia, awakening time, mean arterial pressure and heart rate changes at key points during surgery.Results20 of the 306 patients had respiratory depression (6.5%). The frequency of respiratory depression was 3.3% in the group C and 9.8% in the group P, with a difference of 6.5% between the two groups (P = 0.035). Ciprofol anesthesia decreased the hyoxemia, injection pain, and circulation and heart rate fluctuations. Multivariable logistic regression analyses showed that Propofol (OR 1.970; 95% CI, 1.121–3.461, P = 0.018), mallampati classification>II (OR 1.594; 95% CI, 1.129–2.249, P = 0.008), and fasting time>10.5 h (OR 3.184; 95% CI, 1.531–6.621, P = 0.002) were independent risk factors for incidence of respiratory depression in ERCP anesthesia.ConclusionsFor patients undergoing anesthesia for ERCP, Ciprofol, compared to Propofol, has been shown to effectively reduce the incidence of intraoperative respiratory depression, thereby enhancing the safety of the anesthesia process.Trial registrationThis study was registered in the Chinese Clinical Trial Registry on 15/01/2022 (ChiCTR2200055629).

The hemodynamic effects of protamine in pediatric patients undergoing pulmonary artery reconstruction and unifocalization surgery: A Pilot Study.: Hemodynamic effects of protamine in children.

ObjectivesTo determine protamine administration increases pulmonary artery pressures in patients undergoing unifocalization or pulmonary artery reconstruction surgeries. Design: Retrospective database study. SettingA large pediatric heart center within an academic quaternary care facility. ParticipantsAll patients undergoing pulmonary artery reconstruction or unifocalization procedure identifiable within the data warehouse. InterventionsWe collected data from Stanford University's data repository, formatted it, and analyzed it using RStudio (v 2023.06.1+524). Measurements and Main ResultsOur primary outcome is the change in pulmonary artery pressure (PAP) after an administration of protamine. Secondary outcomes include changes in the mean arterial pressure, the ratio of systolic pulmonary artery to systemic artery pressure, right sided filling pressure, and left atrial pressure. After a protamine bolus, we found a difference in PAP (Friedman X2 = 49.46, p <0.001). When compared to two minutes before its administration, the PAP was higher at two minutes (29.00 mmHg versus 25.00 mmHg, p <0.001), five minutes (30.00 mmHg versus 25.00 mmHg, p <0.001) and ten minutes (31 mmHg versus 25 mmHg, p < 0.001). When co-administered with calcium, there was also a significant increase in PAP (Friedman X2 = 28.11, p < 0.001), with a higher PAP ten minutes after calcium administration when compared to two minutes before (32 mmHg versus 26 mmHg, p < 0.001) Conclusions: Protamine administration led to a small increase in PAP after separation from cardiopulmonary bypass in patients undergoing pulmonary artery reconstruction or unifocalization surgeries. Calcium co-administration did not lead to a greater increase in PAP.

Predialysis central arterial waveform and blood pressure changes during hemodialysis

To investigate the predictive value of the central arterial waveform for intradialytic blood pressure (BP) change, a total of 152 hemodialysis patients (mean age 68 years) on a thrice-weekly hemodialysis schedule were enrolled, and at both the first and second session of the week, BP and central arterial waveform were measured every 30 min during hemodialysis. In both sessions, a 1-standard deviation increase in baseline subendocardial viability ratio (SEVR), an index of subendocardial perfusion, as well as in baseline systolic BP (SBP) was an independent predictor of maximum SBP decrease ≥ 30 mmHg during hemodialysis. When divided into four groups based on the respective median level of SEVR in the SBP ≥ median and SBP < median groups, intradialytic SBP change was different among the subgroups. Multiple logistic regression analysis revealed that, compared with the SBP < median; low SEVR group, the SBP < median; high SEVR group had lower risk, and the SBP ≥ median; low SEVR group had higher risk of SBP decrease ≥ 30 mmHg, but the risk did not differ from that in the SBP ≥ median; high SEVR group. Predialysis subendocardial perfusion evaluated by SEVR was associated with the maximum intradialytic BP decrease, and evaluation of the central arterial waveform could be used as complementary screening for intradialytic BP change.

Acute impact of autoregulation of applied blood flow restriction pressures on bilateral single-joint upper limb resistance exercise

ABSTRACT To investigate the acute effects of 4 sets of autoregulated (AR-BFR) versus non-autoregulated (NAR-BFR) applied pressures during blood flow restriction (BFR) resistance exercise to volitional failure compared with low-load exercise without BFR. A randomized crossover design study was conducted on 32 healthy adults (20.8 ± 2.3 years; 11 females). Outcome measures were as follows: (1) arterial stiffness, (2) peak perceptual responses and likelihood to perform again, and (3) performance. Results: Post-exercise changes in central and brachial diastolic blood pressure were decreased in all groups. Post-exercise supine systolic blood pressure in no-BFR increased (mean difference (MD) = 4 ± 1 mmHg, 95% CI (1–7), p = 0.003, η2 = 0.13). Total repetitions performed and volume workload were similar between BFR conditions but less than no-BFR. AR-BFR reported significantly higher exertion (MD = 0.53 ± 0.2, 95% CI (0.04–1.0), p = 0.03, η2 = 0.19) than other conditions, and induced greater discomfort (MD = 2.50 ± 0.36, 95% CI (1.63–3.37), p < 0.001, η2 = 0.28) than no-BFR. Conclusion: Biceps curl exercise to volitional failure appears to induce negligible arterial stiffness or blood pressure changes regardless of the application of autoregulation, yet autoregulation appears to enhance the perceptual response to BFR exercise compared to NAR-BFR without impacting exercise performance.

A Comparison of Remimazolam versus Propofol on Blood Pressure Changes During Therapeutic Endoscopic Retrograde Cholangiopancreatography: A Randomized Controlled Trial.

Intraoperative hypotension is the most common adverse event in endoscopic retrograde cholangiopancreatography (ERCP) and is usually attributed to the vasodilatory effect of the anesthetic. The aim of this randomized controlled trial was to evaluate the impact of remimazolam versus propofol on blood pressure changes during the therapeutic ERCP procedure. Adult patients scheduled for elective therapeutic ERCP were randomized to receive either remimazolam or propofol anesthesia (40 patients in each group). The primary outcomes included the change in mean arterial pressure (MAP) during induction and the area under the baseline (AUB), calculated as the blood pressure below baseline multiplied by the duration, throughout the procedure. These measures, respectively, indicated the severity of blood pressure decrease during anesthesia induction and the overall impact of blood pressure changes throughout the procedure. Any incidences of hypotension, defined as MAP <65 mm Hg for at least 1 minute, were recorded. The recovery time and any adverse events were also reported. The change in MAP after induction was smaller in the remimazolam group compared to the propofol group (-7.5 [-14.0 to 0] mm Hg vs -25.0 [-33.8 to -14.3] mm Hg), with a median difference of 17.0 mm Hg (95% confidence interval [CI], 12.0-22.0; P <.001). The AUB in the remimazolam group was less than in the propofol group (-373 [-82 to -854] mm Hg·min vs -705 [-272 to -1100] mm Hg·min), with a median difference of 255 mm Hg·min (95% CI, 29-477; P =.021). The incidence of hypotension was significantly lower for remimazolam than propofol (5% vs 30%; P =.006). There were no serious adverse events in either group. Remimazolam may be considered as an alternative to propofol for general anesthesia during therapeutic ERCP procedures, with the potential advantage of stable hemodynamics.

Endothelial Dysfunction Does Not Occur after Acute, Elevated Homocysteine Exposure of the Lumen of the Iliac Artery of the Anaesthetised Pig

Introduction: Elevated luminal homocysteine has been linked with cardiovascular disease; however, whether there is a direct effect of homocysteine on blood vessel endothelium is not clear. In this study, the acute effect of luminal homocysteine on iliac artery endothelial function was assessed in the anaesthetised pig. Methods: Hyperhomocysteinaemic blood was injected into an occluded segment of the iliac in the anaesthetised pig for 20 min, and the effect on atrial diameter during the occlusion and during the reactive hyperaemia assessed. Results: No significant changes in arterial diameter or pressure were observed during the incubation period at homocysteine concentrations of 10, 20, 40 and 100 µM. There was also no difference in the magnitude of the iliac diameter increase in the response to reactive hyperaemia when the incubation period was completed. Conclusion: There is no evidence of endothelial dysfunction in response to an acute 20-min elevation in homocysteine in an intact conduit artery.

Accuracy of oscillometric blood pressure measurement using a Cardell Touch multiparameter monitor in anesthetized pigs.

To assess the accuracy of an oscillometric monitor in anesthetized pigs and its ability to track changes in mean arterial pressure (MAP) and to detect arterial hypotension and hypertension in reference to direct measurements. Mean arterial pressure was measured simultaneously from a catheter in a femoral artery and with an oscillometric cuff placed over the metatarsus in 9 anesthetized pigs (∼6 months old, 35 to 55 kg). Pigs were subjected to maneuvers to alter MAP. Paired values for invasive and noninvasive MAP (iMAP and NiMAP) were recorded every 2 minutes. Bland-Altman plots with bias, limits of agreement, and percentage error were constructed using each pair and the average of 5 consecutive values. Concordance was calculated using changes in MAP at 20-minute intervals. Receiver operating characteristics (ROC) curves were constructed to test NiMAP for detection of hypotension (< 70 mm Hg) and hypertension (≥ 120 mm Hg). Bias of NiMAP was -8.59 mm Hg for consecutive pairs and -8.85 mm Hg for averaged pairs, relative to iMAP. Limits of agreement and percentage error were reduced for averages (19%) over individual pairs (26%). Concordance was 82%. The area under the ROC curve for detecting hypotension with NiMAP was 0.936, with a best cutoff value of 63 mm Hg NiMAP. The area under the ROC curve for hypertension was 0.940, with a best cutoff value of 101 mm Hg NiMAP. Averaging several consecutive values improves the accuracy of NiMAP measurements. This device correctly tracked changes in MAP approximately 80% of the time and appears reliable for diagnosing arterial hypotension.

Evaluation of Macular Perfusion Analyzed by Optical Coherence Tomography Angiography after Uncomplicated Phacoemulsification

Abstract Background Age related cataract is one of the commonest causes of diminution of vision worldwide. Phacoemulsification is one of the most common surgical procedures in the world1. Changes in arterial blood pressure, position of blood vessels, venous return of blood and CO2 levels all influence eye perfusion during cataract surgery. The exact impact of phacoemulsification on macular perfusion is unknown2&amp;3. Purpose To investigate the changes of macular perfusion parameters after uncomplicated phacoemulsification using an optical coherence tomography angiography (OCT-A). Subjects and Methods Thirty eyes of 30 cataractous patients, who had uneventful phacoemulsification with implantation of IOL in the bag, were enrolled in this cohort study. Participants underwent a complete ophthalmologic assessment and measurement of macular perfusion parameters using optical coherence tomography angiography preoperatively and one week, one month, and three months postoperatively. Results There was statistically significant increase in the level of parafoveal retinal thickness and perifoveal retinal thickness in postoperative visits than preoperative visits. We have also found statistically significant increase in the level of grid central vessel density in both superficial and deep capillary plexuses in postoperative visits than preoperative visits. Conclusion Phacoemulsification positively increases retinal thickness particularly at parafovea and increases vascularity in the center of fovea which makes phacoemulsification beneficial even beyond visual restoration.

Association of dynamic changes in arterial partial pressure of carbon dioxide with neurological outcomes in aneurysmal subarachnoid hemorrhage

BackgroundCerebral blood flow (CBF) is closely regulated by carbon dioxide (CO2). In patients with aneurysmal subarachnoid hemorrhage (aSAH), abnormal arterial partial pressure of CO2 (PaCO2) might deteriorate brain injuries. Nevertheless, the impact of dynamic PaCO2 fluctuations on neurological outcomes in aSAH patients has not been extensively studied. Our study aimed to investigate the association between dynamic PaCO2 levels and unfavorable neurological outcomes in aSAH patients. MethodsIn this retrospective observational study, we consecutively enrolled 159 aSAH patients from December 2019 to July 2021. Arterial blood gas measurements within 10 days after intensive care unit (ICU) admission for each patient were recorded to calculate the time-weighted average (TWA)-PaCO2, an indicator representing the dynamic changes in PaCO2 levels. For the association between TWA-PaCO2 levels and unfavorable neurological outcomes in aSAH patients, multivariable logistic analysis was used to explore TWA-PaCO2 levels as categorical variables, and restricted cubic spline (RCS) was used to explore TWA-PaCO2 levels as continuous variables. ResultsIn multivariable logistic analysis, after adjusting confounders, when TWA-PaCO2 35–45 mmHg was as a reference, TWA-PaCO2 < 35 mmHg (odds ratio [OR] 2.15, 95 % confidence interval [CI] 0.83–5.55, P = 0.113) and TWA-PaCO2 > 45 mmHg (OR 8.31, 95 % CI 0.72–96.14, P = 0.090) were not independently associated with unfavorable neurological outcomes (modified Rankin score of 3–6). The RCS shows a “U” shape curve between TWA-PaCO2 levels and unfavorable neurological outcomes, with a nonlinear P-value of 0.023. The lowest ORs of unfavorable neurological outcomes were within PaCO2 32.8–38.1 mmHg. ConclusionsBoth lower and higher PaCO2 levels are harmful to aSAH patients. PaCO2 in the range of 32.8–38.1 mmHg is associated with lowest unfavorable neurological outcomes.

Efficacy of Ketamine as an Adjuvant to Scalp Block for Hemodynamic Stability in Patients Undergoing Elective Craniotomy for Supratentorial Glioma: A Prospective Randomized Controlled Trial.

Introduction Scalp nerve block (SNB) attenuates the hemodynamic response to pin insertion and delivers excellent postoperative analgesia. This study aimed to evaluate the efficacy of SNB using ketamine as an adjuvant to bupivacaine on perioperative hemodynamic responses and postoperative pain in patients undergoing craniotomy for supratentorial glioma. Materials and Methods Sixty patients were randomized into two groups. They were given scalp nerve block either with bupivacaine and saline (group S) or bupivacaine and ketamine (group K). Primary outcome was to compare the change in mean arterial pressure (MAP) and heart rate (HR) at defined time points from baseline. Secondary outcomes included time to request for first analgesia, total analgesic consumption in intraoperative and postoperative periods till 24 hours, and numeric rating scale pain score at various time points in postoperative period till 24 hours. Results Fifty-seven patients were included in analysis. HR and MAP were comparable intraoperatively till closure. As soon as closure began, a significant increase in HR (group K vs. group S, 69.76 ± 9.03 vs. 93.96 ± 9.98, p -value = < 0.0001) and MAP (group K vs. group S, 79.4 ± 4.12 vs. 87.17 ± 12.67, p -value = 0.002) was noted in group S patients. This increase persisted in the postoperative period as well. The median total opioid consumed during intraoperative period in group K was 200 mcg versus 300 mcg in group S, p -value < 0.0001. Conclusion Adding ketamine as an adjuvant to bupivacaine for SNB not only provides significant hemodynamic stability but also reduces both intra- and postoperative analgesic consumption.

Effects of bilateral renal denervation on open-loop baroreflex function and urine excretion in spontaneously hypertensive rats.

Bilateral renal denervation (RDN) decreases arterial pressure (AP) or delays the development of hypertension in spontaneously hypertensive rats (SHR), but whether bilateral RDN significantly modifies urine output function during baroreflex-mediated acute AP changes remains unknown. We quantified the relationship between AP and normalized urine flow (nUF) in SHR that underwent bilateral RDN (n = 9) and compared the results with those in sham-operated SHR (n = 9). Moreover, we examined the acute effect of an angiotensin II type 1 receptor blocker telmisartan (2.5 mg/kg) on the AP-nUF relationship. Bilateral RDN significantly decreased AP by narrowing the response range of the total arc of the carotid sinus baroreflex. The slopes of nUF versus the mean AP (in μL·min-1·kg-1·mmHg-1) in the sham and RDN groups under baseline conditions were 0.076 ± 0.045 and 0.188 ± 0.039, respectively; and those after telmisartan administration were 0.285 ± 0.034 and 0.416 ± 0.078, respectively. The effect of RDN on the nUF slope was marginally significant (P = 0.059), which may have improved the controllability of urine output in the RDN group. The effect of telmisartan on the nUF slope was significant (P < 0.001) in the sham and RDN groups, signifying the contribution of circulating or locally produced angiotensin II to determining urine output function regardless of ongoing renal sympathetic nerve activity.

Evaluation of the effect of fluid management on intracranial pressure in patients undergoing laparoscopic gynaecological surgery based on the ratio of the optic nerve sheath diameter to the eyeball transverse diameter as measured by ultrasound: a randomised controlled trial

BackgroundDuring gynecological laparoscopic surgery, pneumoperitoneum and the Trendelenburg position (TP) can lead to increased intracranial pressure (ICP). However, it remains unclear whether perioperative fluid therapy impacts ICP. The purpose of this research was to evaluate the impact of restrictive fluid (RF) therapy versus conventional fluid (CF) therapy on ICP in gynecological laparoscopic surgery patients by measuring the ratio of the optic nerve sheath diameter (ONSD) to the eyeball transverse diameter (ETD) using ultrasound.MethodsSixty-four patients who were scheduled for laparoscopic gynecological surgery were randomly assigned to the CF group or the RF group. The main outcomes were differences in the ONSD/ETD ratios between the groups at predetermined time points. The secondary outcomes were intraoperative circulatory parameters (including mean arterial pressure, heart rate, and urine volume changes) and postoperative recovery indicators (including extubation time, length of post-anaesthesia care unit stay, postoperative complications, and length of hospital stay).ResultsThere were no statistically significant differences in the ONSD/ETD ratio and the ONSD over time between the two groups (all p > 0.05). From T2 to T4, the ONSD/ETD ratio and the ONSD in both groups were higher than T1 (all p < 0.001). From T1 to T2, the ONSD/ETD ratio in both groups increased by 14.3%. However, the extubation time in the RF group was shorter than in the CF group [median difference (95% CI) -11(-21 to -2) min, p = 0.027]. There were no differences in the other secondary outcomes.ConclusionIn patients undergoing laparoscopic gynecological surgery, RF did not significantly lower the ONSD/ETD ratio but did shorten the tracheal extubation time, when compared to CF.Trial registrationChiCTR2300079284. Registered on December 29, 2023.

Abstract P206: Renal hemodynamic and transcriptomic changes in response to salt in Dahl salt-sensitive rats

Introduction: Continuous measurements (24/7) of arterial pressure (AP) and renal blood flow (RBF), along with intermittent sampling of arterial and renal venous blood and urine in freely moving rats, have enabled the determination of sequential changes in global substrate metabolism and their association with physiological responses in the kidney. It was found that salt loading in Sprague-Dawley (SD) rats resulted in an increase in RBF and renal O 2 consumption with minimal changes in AP. At the same time, TCA cycle pathway was downregulated with reduced metabolism of free fatty acids and amino acids, while glycolysis was upregulated, in the kidney cortex (Cx). In contrast, no significant changes were observed in metabolism-related pathways in the outer medulla (OM). (PMID: 37575482). Here, we report transcriptomic responses of Dahl salt-sensitive (SS) rats to the HS diet as compared to the salt-resistant SD rats. Method: Male SS rats were fed a 0.4% NaCl (LS) diet. At 8 weeks of age, the rats were implanted with an RBF probe together with an arterial and a renal venous catheter. RBF and AP were measured continuously, and arterial and renal venous blood and urine were sampled when rats were fed the LS and on days 7, 14, and 21 after switching to the 4.0% NaCl (HS) diet. From separate groups of rats subjected to the same protocol, Cx and OM were removed for mRNAseq analysis (Novogene, Inc). Results: When switching to the HS diet, mean AP of SS rats rose from 122 ± 2 to 164 ± 5 mmHg by HS21. RBF (mL/min/g kidney weight) fell significantly over the 3 weeks of the HS diet averaging 7.2 ± 0.6 (LS) to 4.6 ± 0.7 (HS21). The gene set enrichment analysis (GSEA) of the mRNAseq data revealed that only a few metabolic pathways were enriched in HS7 in Cx such as glycosphingolipid biosynthesis, while metabolic pathways such as linolenic acid and arachidonic acid metabolism and glycosphingolipid biosynthesis were enriched in OM. Downregulation of the lysine degradation and glutathione metabolic pathways was observed in both Cx and OM in HS21. In general, fewer metabolic pathways responded to HS in SS rats compared to SD in Cx (22 in SD vs 7 in SS). Conclusion: The Cx of SS rats appear less capable of adjusting to the increased metabolic needs imposed by a HS diet compared to SD rats in contrast to the OM. The functional implications of this are being examined and the metabolomic analysis of blood, tissue and urine samples is currently in progress at the JAX lab.

Reductive stress in mitochondria isolated from the carotid body of type 1 diabetic male Wistar rats.

The carotid body (CB) senses changes in arterial O2 partial pressure (pO2) and glucose levels; therefore, it is key for the detection of hypoxia and hypoglycemia. The CB has been suggested to detect pO2 through an increase in reactive oxygen species (ROS) in the mitochondria. However, the mechanism protecting the chemoreceptor cells and their mitochondria from ROS and hyperglycemia is poorly understood. Here we measured glutathione levels in CB mitochondria of control and in streptozotocin (STZ)-induced type 1 diabetic male Wistar rats. We found a dramatic reduction in total glutathione from 11.45 ± 1.30 μmol/mg protein in control rats to 1.45 ± 0.31 μmol/mg protein in diabetic rats. However, the ratio of reduced to oxidized glutathione, a measure of the redox index, was increased in diabetic rats compared to controls. We conclude that the mitochondria of CB chemoreceptor cells in type 1 diabetic male Wistar rats were likely under glutathione-reducing stress.