Changes In Cardiorespiratory Parameters Research Articles

Improvements in Cardiopulmonary Exercise Test Results in Atrial Fibrillation Patients After Radiofrequency Ablation in Kazakhstan.

This prospective study evaluates the impact of radiofrequency ablation (RFA) on cardiorespiratory indicators in patients with long-standing persistent atrial fibrillation admitted to the Heart Center UMC between January 2022 and April 2024 in Astana, Kazakhstan. The study aims to assess the functional cardiac benefits of RFA. Out of 717 registered atrial fibrillation patients, 104 were examined before and 3 months after ablation, focusing on cardiorespiratory parameters. A before-and-after analysis using linear mixed models was applied to evaluate changes in cardiorespiratory parameters post-RFA. Significant improvements were noted across various measures. VO2 max increased from 11.5 ± 4.4 mL/kg/min to 18.0 ± 4.5 mL/kg/min (p < 0.001). Oxygen uptake improved from 7.2 ± 2.6 mL/beat to 11.0 ± 3.4 mL/beat (p < 0.001). The 6-min walking test distance rose from 306 ± 82 m to 400 ± 48 m (p < 0.001). METs increased from 4.4 ± 1.6 to 8.0 ± 1.3 (p < 0.001). Heart rate at peak exercise decreased from 175.5 ± 18.6 to 147.2 ± 12.3 beats per minute (p < 0.001). NT-proBNP levels decreased from 1357 ± 1182 to 415 ± 339 pg/mL (p < 0.001). Patients with persistent atrial fibrillation undergoing RFA showed functional improvements in CPET indicators such as VO2 max, METs, O2 pulse, heart rate, and the 6-min walking test. Improvements were also seen in Nt-proBNP analysis. These results emphasize the need for longitudinal follow-up to optimize outcomes and minimize medical risks.

Cardiorespiratory dynamics during respiratory maneuver in athletes.

Introduction: The modern practice of sports medicine and medical rehabilitation requires the search for subtle criteria for the development of conditions and recovery of the body after diseases, which would have a prognostic value for the prevention of negative effects of training and rehabilitation tools, and also testify to the development and course of mechanisms for counteracting pathogenetic processes in the body. The purpose of this study was to determine the informative directions of the cardiorespiratory system parameters dynamics during the performing a maneuver with a change in breathing rate, which may indicate the body functional state violation. Methods: The results of the study of 183 healthy men aged 21.2 ± 2.3 years who regularly engaged in various sports were analyzed. The procedure for studying the cardiorespiratory system included conducting combined measurements of indicators of activity of the respiratory and cardiovascular systems in a sitting position using a spiroarteriocardiograph device. The duration of the study was 6min and involved the sequential registration of three measurements with a change in breathing rate (spontaneous breathing, breathing at 0.1 Hz and 0.25Hz). Results: Performing a breathing maneuver at breathing 0.1Hz and breathing 0.25Hz in comparison with spontaneous breathing leads to multidirectional significant changes in heart rate variability indicators-TP (ms2), LF (ms2), LFHF (ms2/ms2); of blood pressure variability indicators-TPDBP (mmHg2), LFSBP (mmHg2), LFDBP (mmHg2), HFSBP (mmHg2); of volume respiration variability indicators - LFR, (L×min-1)2; HFR, (L×min-1)2; LFHFR, (L×min-1)2/(L×min-1)2; of arterial baroreflex sensitivity indicators - BRLF (ms×mmHg-1), BRHF (ms×mmHg-1). Differences in indicators of systemic hemodynamics and indicators of cardiovascular and respiratory systems synchronization were also informative. Conclusion: According to the results of the study, it is shown that during performing a breathing maneuver with a change in the rate of breathing, there are significant changes in cardiorespiratory parameters, the analysis of which the increments made it possible to determine of the changes directions dynamics, their absolute values and informative limits regarding the possible occurrence of the cardiorespiratory interactions dysregulation.

Functional capacity testing in patients with pulmonary hypertension (PH) using the one-minute sit-to-stand test (1-min STST).

The one-minute sit-to-stand-test (1-min STST) is a quick, space saving test to evaluate functional capacity. Exercise testing plays an important role in the long-term follow-up of pulmonary hypertension (PH) patients and is currently evaluated using the six-minute-walk-test (6MWT). The aim of the study was to assess the convergent validity of the 1-min STST in patients with PH and its association with markers of PH severity. We evaluated 106 PH patients with the 1-min-STST and 6MWT and measured cardiorespiratory parameters (heart rate, blood pressure, oxygen saturation) before and after test conduction. N-terminal pro brain-type natriuretic peptide (NT-proBNP), WHO functional class (WHO-FC) and mean pulmonary artery pressure (mPAP) were defined as markers of PH severity. Strong correlation was found between performances of 1-min STST and 6MWT (r = .711, p < .001), indicating convergent validity. Both tests were inversely associated with NT-proBNP (STST: r = -.405, p < .001; 6MWT: r = -.358, p < .001), WHO-FC (STST: r = -.591, p < .001; 6MWT: r = -.643, p < .001) and mPAP (STST: r = -.280, p < .001; 6MWT: r = -.250, p < .001). Significant changes in cardiorespiratory parameters were observed in both tests (all p < 0.001). Further the post-exercise cardiorespiratory parameters correlated strongly between the 1-min STST and 6MWT (all r ≥ .651, all p < .001). The 1-min STST demonstrated good convergent validity with the 6MWT and was associated with markers of PH severity. Furthermore, both exercise tests caused similar cardiorespiratory responses.

Remodeling in the AV block dog is essential for tolerating moderate treadmill activity.

A preclinical model standardized at different remodeling stages after AV block induction in awake state is suitable for the evaluation of improved cardiac devices. We studied exercise-induced cardiorespiratory parameters at three different timepoints after inducing AV block in dogs. Mongrel dogs (n=12) were placed on a treadmill with a 10% incline and performed a moderate exercise protocol (10-minute run at 6km/h). Dogs ran at sinus rhythm (SR), at two days (AVB2d, initiation of remodeling), three weeks (CAVB3) and six weeks (CAVB6, completed remodeling) after AV block. All dogs completed the exercise protocol at SR, CAVB3 and CAVB6, while 6/12 dogs at AVB2d failed to complete the exercise protocol. The atrial rate was higher at all AV block timepoints (126±20 to 141±19bpm at rest and 221±10 to 231±13bpm during exercise) compared to SR (100±29bpm at rest and 162±28bpm during exercise, p<0.05). Upon exercise, stroke volume increased from 66±15ml at SR, to 96±21ml at AVB2d (p<0.05), 91±13ml at CAVB3 (p<0.05) and 85±24ml at CAVB6 but failed to compensate for the AV block-induced bradycardia. Therefore, cardiac output was lower after AV block compared to SR. Exercising dogs at AVB2d showed most arrhythmic events, lowest VO2, and signs of desaturation and acidification in venous blood. Dogs with limited remodeling after AV block have a reduced exercise tolerance, which is reflected in changes in cardiorespiratory parameters.

Timed Up and Go Test: An Underutilized Tool in Patients with Chronic Respiratory Disease

Background: Patients admitted with chronic respiratory diseases (CRDs) find it difficult to return to their day-to-day activities postdischarge due to muscle dysfunction and cardiorespiratory load. The Timed Up and Go (TUG) test is extensively used for predicting falls; however, it is underutilized to assess the cardiorespiratory load. The study was designed to assess the time in seconds, the cardiorespiratory load including desaturation with TUG, and also the correlation if any between TUG time in seconds with oxygen saturation (SpO2) and Barthel Index score. Materials and Methods: Hundred and twenty-eight patients admitted with CRDs in the age range of 40–70 years were included. Activities of daily living were scored on Barthel Index. TUG was carried out and changes in cardiorespiratory parameters, i.e., heart rate (HR), blood pressure (BP), respiratory rate (RR), and SpO2 were noted. Results: All cardiorespiratory parameters HR, BP, and RR showed a statistically significant change (P < 0.0001). There was a significant drop in SpO2 (mean 9%) post TUG. There was a significant but weak inverse correlation (r = 0.5069) observed between TUG in seconds and SpO2 at rest. There was no correlation between TUG and Barthel score. The mean time for TUG was 16.73 ± 3.11 s indicating a moderate risk of fall. Conclusions: TUG leads to a significant change in cardiorespiratory parameters including SpO2. It can be used as a test to assess activity tolerance and the need for oxygen supplementation.

The Comparison of the Effectiveness of Respiratory Physiotherapy Plus Myofascial Release Therapy Versus Respiratory Physiotherapy Alone on Cardiorespiratory Parameters in Patients With COVID-19.

BackgroundRespiratory involvement is a common consequence of COVID-19; changes in cardiorespiratory parameters of these patients during respiratory rehabilitation program are very important. Previous studies showed that myofascial release therapy (MFRT) could affect the respiratory muscle and adjunct fascia.PurposeThe aim of this study was to evaluate the effects of MFRT techniques and respiratory physiotherapy, in comparison with respiratory physiotherapy alone, on improving cardiorespiratory parameter in patients with COVID-19.SettingA hospital affiliated to Tehran University of Medical Sciences in Tehran, Iran, from February to July 2021.ParticipantsFifty patients with COVID-19 participated in this study.Research DesignA single-blind, randomized control design.InterventionThe patients with COVID-19 randomly assigned to an intervention group who received respiratory physiotherapy combined with MFRT or a control group receiving respiratory physiotherapy alone.Main Outcome Measure(s)Heart rate, systolic and diastolic blood pressure, respiration rate, oxygen saturation, chest expansion, and ease of breathing were assessed at baseline and after the first and third session of treatment. Dyspnea and fatigue perception and 6-minute walking were assessed at baseline and at the end of treatment. Patient’s thoughts about the treatment were examined through the 4-point Likert scale.ResultsThe ANOVAs found significant time effect for ease of breathing, dyspnea perception (F = 32.33, p < .01 and F = 11.72, p < .01, respectively). Also significant time by group interaction was found for chest expansion at xiphoid level (F = 4.02, p = .02).ConclusionsThe present study provided evidence that both programs could result in improving ease of breathing and dyspnea perception, although the inclusion of MFR techniques into a respiratory physiotherapy program did not result in better outcomes in cardiorespiratory function of patients with COVID-19.

Spacecraft launch and re-entry: Effects of simulated +Gx acceleration on cardiorespiratory parameters

Introduction: In the spaceflight, during launch and re-entry, the crew is exposed to acceleration ranging from +4Gx to +8Gx in nominal conditions. This study was conducted to assess the changes in cardiorespiratory parameters, namely, heart rate (HR), electrocardiogram (ECG), respiratory rate (RR), and SpO2 on exposure to simulated +Gx acceleration. Material and Methods: Fifteen randomly selected healthy male volunteers participated in the study. They were exposed to a simulated acceleration profile consisting of two peaks in the high-performance human centrifuge; first peak of +4Gx for 30 s and second peak of+8Gx for 30 s. The cardiorespiratory parameters were monitored and recorded during the acceleration exposure. The data were compiled and analyzed using one-way repeated measures ANOVA. Results: Significant increase in HR was observed on exposure to +4Gx (110.4 ± 16.7 bpm; P &lt; 0.001) in comparison to the baseline value (80.5 ± 7.5 bpm). However, the changes in the HR at +8Gx were not significant in comparison to baseline as well as +4Gx values. On the other hand, RR indicated a significant increase on exposure to +8Gx (25.2 ± 5.8 breaths/min) in comparison to the baseline (15.1 ± 1.6 breaths/min; P = 0.001) and +4Gx (19.0 ± 6.1 breaths/min; P = 0.009) values. SpO2 showed a significant reduction at +8Gx (94.2 ± 3.8%) in comparison to baseline (98.9 ± 0.3%; P = 0.004) and +4Gx (96.9 ± 1.5%; P = 0.003). ECG did not show any evidence of arrhythmia during the exposure to +Gx acceleration. Conclusion: The insignificant changes in the HR at peak of +8Gx indicate less pronounced effects on the smaller hydrostatic gradient in +Gx acceleration unlike +Gz acceleration. However, the findings of the study point towards a significant increase in respiratory rate and reduction in SpO2 at +8Gx.

B-PO05-020 REMODELING IMPROVES EXERCISE CAPACITY IN DOGS WITH AV BLOCK

Children with congenital complete atrioventricular block (AVB) do not often report exercise intolerance due to compensatory mechanisms. The effect of cardiac remodeling being absent and present after AV block on exercise capacity has not yet been reported. We studied the cardiorespiratory changes due to exercise at three different timepoints after inducing AV block in dogs. Mongrel dogs (n=8) were placed on a treadmill with a 10% incline in a custom-build closed chamber and performed a moderate exercise protocol (10 minutes at a speed of 6 km/h). Dogs ran at sinus rhythm (SR), at two days after AV block (AVB2d) lacking cardiac remodeling, and at three and six weeks of chronic AV block (CAVB) remodeling (CAVB3 and CAVB6, respectively). ECG tracings were recorded via electrodes on the back. Stroke volume and cardiac output were recorded via a thoracic electrical bioimpedance-based device (PhysioFlow®). pO2, pCO2, SpO2 and pH levels were determined from venous blood samples. O2 consumption (VO2) and CO2 production (VCO2) were measured within the chamber. All dogs completed the exercise protocol at SR, CAVB3 and CAVB6, but 5/8 dogs failed at AVB2d (average run duration: 7min23sec, SD: 2min38sec), due to ventricular tachycardia and/or staggering. Changes in heart rate, stroke volume and cardiac output upon exercise were not different between the timepoints after AV block. At AVB2d, pO2 was lower (3.3±1.1 vs. 5.2±0.7 kPa (SR), p<0.01), the SpO2 was decreased (31±16 vs. 67±7 % (SR), p<0.001), the pCO2 was higher (7.3±1.4 vs. 5.5±0.3 kPa (SR), p<0.01), and the pH was decreased (7.23±0.06 vs. 7.36±0.02 (SR), p<0.001) at 2min exercise. Similar values were found at 5min exercise e.g., for pCO2 (6.8±1.8 vs. 5.1±1.3 kPa (SR), p<0.05) and pH (7.22±0.08 vs. 7.37±0.03 (SR), p<0.001). Venous blood parameters were not different between SR, CAVB3 and CAVB6 at rest and during exercise. At the end of the run (at steady state), VO2 and VCO2 are lowest at AVB2d with a 10% and 5% decrease, respectively, compared to SR (p=0.05 and 0.33). Dogs without remodeling after AV block have a reduced exercise capacity, which seems to be reflected in changes in cardiorespiratory parameters. Remodeling after chronic AV block improves the exercise capacity in dogs.

Dynamics of changes in cardiorespiratory capabilities among the students of the Faculty of Biology and Chemistry, depending on the season of the year

The scientific article presents the changes in cardiorespiratory parameters among the students of the Chechen Republic in the autumn and spring periods. During the examination of the students’ health, we found that as the air temperature decreases, the physiological state deteriorates (SBP, heart rate, Kerdoe's Vegetative Index increase). With an increase in ambient temperature, VC, respiration rate, Shtange and Genchi’s tests increase; according to adaptation indicators, the adaptive capacity of cardiovascular activity rises.

Acquisition of cardiovascular kinetics via treadmill exercise – A tool to monitor physical fitness during space missions

IntroductionThe aim of the preliminary presentation of results of the ongoing project onboard the International Space Station (ISS) is to evaluate whether the application of a kinetics test protocol with pseudo randomized changes of moderate walking speeds on a treadmill is feasible on board the ISS, and whether potential changes in cardiorespiratory parameters can be tracked. MethodsOverall, 5 male cosmonauts (47 ± 3 yrs) were tested before and after the space mission on a treadmill, applying pseudo randomized changes in speed until subjective exhaustion. Of these, 3 cosmonauts were also tested during space flight. Oxygen uptake (only pre/post) and heart rate (HR) were measured and time series analysis was used to obtain kinetics information. Higher maxima of the cross-correlation functions (CCFmax) between the applied velocity and the respective parameter indicate faster kinetics. ResultsPeak treadmill velocity (pre vs. post: 13.9 ± 1.7 vs. 12.4 ± 1.9 km/h; p = 0.043) was significantly slower after space flight. Average HR values during rest (69 ± 5 vs. 79 ± 10 beats/min, p = 0.043), 6 km/h (102 ± 14 vs. 113 ± 16 beats/min, p = 0.043) and 10 km/h (129 ± 9 vs. 138 ± 11 beats/min, p = 0.043) were higher, and HR kinetics (0.68 ± 0.08 vs. 0.44 ± 0.08, p = 0.043) were significantly slower after space flight. DiscussionThe kinetics test with pseudo randomized, moderate work rate (WR) changes on a treadmill is applicable in the exercise test setting onboard the ISS. Cardiorespiratory kinetics were slowed after the long duration space flight, which provides important information about the underlying mechanisms of decreases in physical fitness.

Cardiorespiratory safety of respiratory muscle training using NU_spiroBreathe in healthy subjects

Objectives This study investigated responses of cardiorespiratory parameters of healthy subjects from respiratory muscle training using a NU_spiroBreathe device. Methods Nine healthy female subjects with sedentary lifestyles were asked to perform respiratory muscle training using a NU_spiroBreathe device with 10 cmH2O resistance (10 repetitions/set, 3 sets). Cardiorespiratory parameters (blood pressure; pulse rate; oxygen saturation) were assessed before and during respiratory muscle training sessions and after a 30-minute recovery period. The data were analyzed using the k-related sample Friedman test. Results There were no significant changes in cardiorespiratory parameters before, during or after a 30-minutes recovery period from respiratory muscle training using NU_spiroBreathe device (p &gt; 0.05). Conclusions Respiratory muscle training using an NU_spiroBreathe device does not change cardio-respiratory parameters and is safe for use by healthy subjects. Chiang Mai Medical Journal 2021; 60(1):53-62. doi 10.12982/CMUMEDJ.2021.05

Quipazine Elicits Swallowing in the Arterially Perfused Rat Preparation: A Role for Medullary Raphe Nuclei?

Pharmacological neuromodulation of swallowing may represent a promising therapeutic option to treat dysphagia. Previous studies suggested a serotonergic control of swallowing, but mechanisms remain poorly understood. Here, we investigated the effects of the serotonergic agonist quipazine on swallowing, using the arterially perfused working heart-brainstem (in situ) preparation in rats. Systemic injection of quipazine produced single swallows with motor patterns and swallow-breathing coordination similar to spontaneous swallows, and increased swallow rate with moderate changes in cardiorespiratory functions. Methysergide, a 5-HT2 receptor antagonist, blocked the excitatory effect of quipazine on swallowing, but had no effect on spontaneous swallow rate. Microinjections of quipazine in the nucleus of the solitary tract were without effect. In contrast, similar injections in caudal medullary raphe nuclei increased swallow rate without changes in cardiorespiratory parameters. Thus, quipazine may exert an excitatory effect on raphe neurons via stimulation of 5-HT2A receptors, leading to increased excitability of the swallowing network. In conclusion, we suggest that pharmacological stimulation of swallowing by quipazine in situ represents a valuable model for experimental studies. This work paves the way for future investigations on brainstem serotonergic modulation, and further identification of neural populations and mechanisms involved in swallowing and/or swallow-breathing interaction.

Cardiorespiratory parameters in newborns during sedation with chloral hydrate.

We commonly use chloral hydrate sedation in newborns, though its cardiorespiratory side effects have not yet been fully investigated. Our study aimed to analyze the impact of chloral hydrate on cardiorespiratory parameters in term newborns. We performed a prospective, pre-post single-arm interventional study in 42 term, respiratorily and hemodynamically stable newborns. Oxygen saturation (SpO2), end-tidal CO2 (ETCO2), the apnea-hypopnea index and the respiratory and heart rates were recorded by polygraphy, starting 0.5-1 hour before oral administration of chloral hydrate at a dose of 40 mg/kg and ceasing 4 hours post-administration. After administration of chloral hydrate, the mean basal SpO2 dropped by 2.0% (from 97.1% to 95.1%; p < 0.001) and the mean basal ETCO2 increased by 3.9 mmHg (25.6 to 29.5 mmHg; p < 0.001). We found a significant decrease in the minimal SpO2 values (p < 0.001) and an increase in the percentage of time spent with SpO2 < 95% and < 90% (p < 0.001). The mean increase in the estimated apnea-hypopnea index was 3.5 events per hour (p < 0.001). The mean respiratory and heart rates were significantly lower 150 min after the administration of chloral hydrate when compared with pre-sedation values (51/min and 127/min versus 61/min and 138/min respectively; p < 0.001). A considerable number of patients exhibited changes in cardiorespiratory parameters that differed considerably from the normal ranges. In conclusion, SpO2, ETCO2, the estimated apnea-hypopnea index and the respiratory and heart rates changed after the administration of chloral hydrate. They remained within normal limits in most newborns, but the inter-individual variability was high in the studied population.

Changes in Cardiorespiratory Parameters during the Management of status Epilepticus in Children: A Prospective Randomized Controlled Study

Changes in Cardiorespiratory Parameters during the Management of status Epilepticus in Children: A Prospective Randomized Controlled Study

High continuous positive airway pressure in neonates: A physiological study.

We sought to evaluate physiological cardiorespiratory implications of high pressures (>8 cmH2 O) on continuous positive airway pressure (CPAP) in preterm neonates. Fifteen preterm neonates at postmenstrual age ≥32 weeks on CPAP 5 cmH2 O were enrolled. Pressures were increased by 2 cmH 2 O increments until 13 cmH 2 O. At each increment, cardiac output, electrical diaphragmatic (Edi) activity, and clinical cardiorespiratory parameters were measured. Predefined cut-off values for changes in cardiorespiratory parameters were used as termination criteria. Data, presented as mean (SD), were compared using repeated measures analysis of variance. The mean GA, age at study, and weight of subjects were 27.4 (2.6) weeks, 58.5 (35.5) days, and 2.3 (0.6) kg, respectively. The median (IQR) time at each CPAP increment was 10 (5, 20) min. Cardiac output (mL/kg/min) at 5, 7, 9, 11, and 13 cmH 2 O were not different at 295 (75), 290 (66), 281 (69), 286 (73), and 292 (58), respectively (P = 0.99). Edi values demonstrated a trend towards decline at 9 cmH 2 O before rising again. No other cardiorespiratory parameter was different across CPAP levels; no subject met termination criteria. High CPAP levels were well tolerated for short durations. Further physiological and clinical research is required on safety/efficacy in neonates with more severe lung disease, as well as its impact over longer durations.

IMPACT OF HIGH LEVELS OF CONTINUOUS POSITIVE AIRWAY PRESSURE ON CARDIAC OUTPUT IN PRETERM NEONATES: A PROSPECTIVE PHYSIOLOGICAL STUDY

Abstract BACKGROUND Many NICUs employ high (&gt;8 cmH2O) positive end-expiratory pressures (PEEP) on nasal continuous positive airway pressure (NCPAP) to prevent intubation and associated ventilator-induced lung injury, despite limited safety/efficacy data. OBJECTIVES This study sought to evaluate the physiological impact of high NCPAP PEEP. DESIGN/METHODS Fifteen preterm neonates at postmenstrual age ≥32 weeks (without congenital anomalies or acute intercurrent illness) on NCPAP PEEP of 5 cmH2O were enrolled. PEEP was increased by 2 cmH2O increments until 13 cmH2O. At each increment, following 5 minutes washout, cardiac output (aortic velocity-time integral x heart rate) and cardiorespiratory parameters including blood pressure, heart rate, respiratory rate were measured over 10 minutes. Predefined cut-off values for changes in cardiorespiratory parameters were used as termination criteria. Data are presented as mean (SD), and were compared using one-way ANOVA. RESULTS The mean GA, age at study, and weight of subjects were 27.4 (2.6) weeks, 58.5 (35.5) days, and 2.3 (0.6) kg, respectively. Cardiac output (mL/kg/min) at PEEPs of 5, 7, 9, 11, and 13 cmH2O were not different at 295 (75), 290 (66), 281 (69), 286 (73), and 292 (58), respectively (P=0.986), as shown in Figure 1a. Importantly there were also no differences in either aortic velocity-time integral or heart rate over these PEEP ranges (Figures 1b and 1c). There were no significant differences in cardiorespiratory parameters; no subjects met cut-off criteria. Data collection was terminated in 2 subjects after PEEP 9 cmH2O due to lung over-distension subjectively noted on echocardiogram. CONCLUSION High levels of NCPAP PEEP were well tolerated for short durations. Further physiological and clinical research is required on safety/efficacy in neonates with more severe lung disease, as well as its impact over longer durations.

IV Levetiracetam versus IV Phenytoin in Childhood Seizures: A Randomized Controlled Trial.

Objectives:To compare the efficacy of IV phenytoin and IV levetiracetam in acute seizures.Design:Randomized controlled trial.Setting:Tertiary care hospital, November 2012 to April 2014.Patients:100 children aged 3–12 yrs of age presenting with acute seizures.Intervention:Participants randomly received either IV phenytoin 20 mg/kg (n = 50) or IV levetiracetam 30 mg/kg (n = 50). Patients who were had seizures at presentation received IV diazepam prior to these drugs.Outcome Measures:Primary: Absence of seizure activity within next 24 hrs.Secondary: Stopping of clinical seizure activity within 20 mins of first intervention, change in cardiorespiratory parameters, and achievement of therapeutic drug levels.Results:Two groups were comparable in patient characteristics and seizure type (P > 0.05). Of the 100 children, 3 in levetiracetam and 2 in phenytoin group had a repeat seizure in 24 hrs, efficacy was comparable (94% vs 96%, P > 0.05). Of these, 18 (36%) in phenytoin and 12 (24%) in levetiracetam group received diazepam. Sedation time was 178.80 ±97.534 mins in phenytoin and 145.50 ±105.208 mins in levetiracetam group (P = 0.346). Changes in cardiorespiratory parameters were similar in both groups except a lower diastolic blood pressure with phenytoin (P = 0.023). Therapeutic drug levels were achieved in 38 (76%) children both at 4 and 24 hrs with phenytoin, compared to 50 (100%) and 48 (98%) at 1 and 24 hrs with levetiracetam (P < 0.05).Conclusion:Intravenous levetiracetam and phenytoin have similar efficacy in preventing seizure recurrences for 24 hrs in children 3–12 years presenting with acute seizures.

Anesthetic considerations for patients with esophageal achalasia undergoing peroral endoscopic myotomy: a retrospective case series review.

Peroral endoscopic myotomy (POEM) is a novel technique for treating esophageal achalasia. During POEM, carbon dioxide (CO2) is insufflated to aid surgical dissection, but it may inadvertently track into surrounding tissues, causing systemic CO2 uptake and tension capnoperitoneum. This in turn may affect cardiorespiratory function. This study quantified these cardiorespiratory effects and treatment by hyperventilation and percutaneous abdominal needle decompression (PND). One hundred and seventy-three consecutive patients who underwent POEM were included in this four-year retrospective study. Procedure-related changes in peak inspiratory pressure (pmax), end-tidal CO2 levels (etCO2), minute ventilation (MV), mean arterial pressure (MAP), and heart rate (HR) were analyzed. We also quantified the impact of PND on these cardiorespiratory parameters. During the endoscopic procedure, cardiorespiratory parameters increased from baseline: pmax 15.1 (4.5) vs 19.8 (4.7) cm H2O; etCO2 4.5 (0.4) vs 5.5 (0.9) kPa [34.0 (2.9) vs 41.6 (6.9) mmHg]; MAP73.9 (9.7) vs 99.3 (15.2) mmHg; HR 67.6 (12.4) vs 85.3 (16.4) min-1 (P < 0.001 for each). Hyperventilation [MV 5.9 (1.2) vs 9.0 (1.8) L·min-1, P < 0.001] was applied to counteract iatrogenic hypercapnia. Individuals with tension capnoperitoneum treated with PND (n = 55) had higher peak pmax values [22.8 (5.7) vs 18.4 (3.3) cm H2O, P < 0.001] than patients who did not require PND. After PND, pmax [22.8 (5.7) vs 19.9 (4.3) cm H2O, P = 0.045] and MAP [98.2 (16.3) vs 88.6 (11.8) mmHg, P = 0.013] decreased. Adverse events included pneumothorax (n = 1), transient myocardial ischemia (n = 1), and subcutaneous emphysema (n = 49). The latter precluded immediate extubation in eight cases. Postanesthesia care unit (PACU) stay was longer in individuals with subcutaneous emphysema than in those without [74.9 min (34.5) vs 61.5 (26.8 min), P = 0.007]. Carbon dioxide insufflation during POEM produces systemic CO2 uptake and increased intra-abdominal pressure. Changes in cardiorespiratory parameters include increased pmax, etCO2, MAP, and HR. Hyperventilation and PND help mitigate some of these changes. Subcutaneous emphysema is common and may delay extubation and prolong PACU stay.

Effect of propofol anesthesia on resting state brain functional connectivity in Indian population with chronic back pain.

Functional magnetic resonance imaging (fMRI) studies in healthy volunteers have shown alterations in brain connectivity following anesthesia as compared to the awake state. It is not known if the anesthesia-induced changes in brain connectivity are different in a pathological state. This study aims to evaluate changes in the resting state functional connectivity in the brain, after propofol anesthesia, in patients with chronic back pain (CBP). Fourteen adults with CBP were included in this prospective study over 6 months. After excluding structural brain pathology, a resting state fMRI was performed in the awake state, and the sequences were repeated after propofol anesthesia. The primary outcome measure was change in resting state connectivity after propofol. Student's t-test was performed between the pre and post-propofol sedation data of all patients with total brain volume as covariates of interest. A repeated measures analysis of variance was used to compare pre- and post-propofol changes in cardiorespiratory parameters. There were 8 male and 6 female patients in the study, and the mean age of the study population was 46.9 ± 11.3 years. Propofol sedation resulted in an increased strength of functional connectivity between the posterior cingulate cortex (PCC) and thalamus in patients with CBP, whereas there was a generalized decrease in functional integration within the large scale brain networks. The changes in cardiorespiratory parameters before and after propofol administration were not statistically significant. Strengthening of functional connectivity was seen between PCC and thalamus with decrease in large scale brain networks following propofol anesthesia in patients with CBP. These changes are similar to those previously described in normal volunteers.

Venous blood gases and cardiorespiratory parameters during aerobic exercise with different pre-exercise diet and hydration

Summary Objective To monitor and evaluate venous blood gases before and during cycle ergometer activity for one hour after three breakfast nutritional procedures offered 30 minutes before in the attempt to establish correlations between possible changes in cardiorespiratory parameters of volunteers. Methods Twelve healthy male practitioners of regular physical activity performance four sessions of continuous exercise on an cycle ergometer (60 to 70% of VO 2MaxEx ) for one hour after breakfast offered or not 30 minutes before the exercise. The sessions differed by pre-exercise meal and hydration, as follows: high glycemic index/water, low glycemic index/water, in fasting state/water and in fasting state/carbohydrate beverage (60 g/L). Statistical analysis used Analysis of Variance, Pearson correlation test, and significance level 5%. Results No significant difference was observed in the cardiorespiratory parameters of participants among the four experimental procedures, since the venous blood gases parameters showed significant differences for pH and pO 2 . The moment that showed the most significant correlations between venous blood gases and cardiorespiratory parameters was at 40 minutes of exercise. Significant negative correlation between lactate levels and base excess (BE) was observed at 20 minutes of exercise ( r = –0.31, P = 0.04).