Decrease In Arterial Blood Pressure Research Articles

Medical Constituents of Ajwain (Trachyspermum ammi) for Human Benefits

Ajwain seed analysis has revealed it to contain fiber (11.9%), carbohydrates (38.6%), tannins, glycosides, moisture (8.9%), protein (15.4%), fat (18.1%), saponins, flavone and mineral matter (7.1%) containing calcium, phosphorous, iron and nicotinic acid. Ajwain fruits yield 2% to 4% brownish essential oil, with thymol as the major constituent (35% to 60%). The non-thymol fraction (thymine) contains para-cymene, γ-terpenine, α- and β-pinenes, diketene, α-terpinene, and carvacrol. Minute amounts of camphene, myrcene, and α-3-carene also have been found in the plant. Alcoholic extracts contain a highly hygroscopic saponin. From the fruits, a yellow, crystalline flavone and a steroid-like substance has been isolated and it also contains 6-O-β-glucopyranosyloxythymol, glucoside and yields 25% oleoresin containing 12% volatile oil (thymol, γ-terpinene, para-cymene, and α- and β-pinene). The principal oil constituents of T. Ammi are carvone (46%), limonene (38%), and dillapiole (9%). Ajwain is administered for curing stomach disorders, a paste of crushed fruits is applied externally for relieving colic pains; and a hot and dry fomentation of the fruits is applied on chest for asthma. Therapeutic uses of T. Ammi fruits include; stomachic, carminative and expectorant, antiseptic and amoebiasis, antimicrobial. Seeds soaked in lemon juice with P runs Amygdalus (badan) are given in curing amenorrhea and it is also used as antipyretic, febrifugal and in the treatment of typhoid fever. The antihypertensive effect of T. Ammi administered intravenously in vivo, and the antispasmodic and bronchodilation actions in vitro showed that calcium channel blockade has been found to mediate the spasmolytic effects of plant materials and it is being considered that this mechanism contributed to their observed result and supported the traditional use of T. Ammi in hyperactive disease states of the gut such as colic and diarrhea as well as in hypertension. Ajwain seeds revealed significant reduction of cough number which may be a result of its potent antitussive effect. The bronchodilator effect of decocted extract of Ajwain on the asthmatic patients’ airways was examined in a subsequent trial study. According to the results, the extract has a relatively bronchodilator effect on asthmatic airways compared to the effect of Theophylline at concentrations used. Ajwain was attributed to have diuretic and antilithiatic activity in ethnopharmacological reports. Accordingly, a human study was performed and in which, seeds of Ajwain were decocted in milk and given orally to volunteers suffering from urinary stone for a nine days period. The results were reported satisfactory against pure ca-oxalate stone. Another activity which has been proved for Ajwain is the antihyperlipidemic property. An in vivo study revealed that Ajwain seeds powder is extensively effective on lipid profile and can decrease total cholesterol, LDL-cholesterol, triglycerides and total lipids. Moreover, organic extract of seeds reduced atherogenic index and increased the level of HDL-cholesterol in albino rabbits. Ajwain was evaluated for the potentiality of antihypertensive and antispasmodic activity. In the related investigation, the aqueous-methanolic extract of the seeds caused a dose dependent decrease in arterial blood pressure in anaesthetized animal models. Furthermore, inhibitory effect on the K+-induced contractions was seen in isolated rabbit aorta and jejunum preparations during the application of Ajwain extract. These findings prove the potential antihypertensive and antispasmodic activity of Ajwain.

Management of a child with portopulmonal hypertension due to cavernous transformation of the portal vein and sple- norenal anastomosis

A clinical case of the development of portopulmonary hypertension in a child after splenorenal anastomosis is presented. The surgical intervention was performed to correct the congenital malformation — cavernous transformation of the portal vein, which led to portal hypertension and varicose veins of the esophagus and stomach. In the long-term postoperative period, pulmonary arterial hypertension, hypersplenism with bilinear cytopenia, and moderate liver failure developed. Combined therapy provided a temporary improvement of the patient status, therefore, during subsequent surgery, the size of the anastomosis was changed. This led to a sustained decrease in pulmonary artery blood pressure and clinical improvement in the boy’s condition.

Medical Constituents of Ajwain (Trachyspermum ammi) for Human Benefits

Ajwain seed analysis has revealed it to contain fiber (11.9%), carbohydrates (38.6%), tannins, glycosides, moisture (8.9%), protein (15.4%), fat (18.1%), saponins, flavone and mineral matter (7.1%) containing calcium, phosphorous, iron and nicotinic acid. Ajwain fruits yield 2% to 4% brownish essential oil, with thymol as the major constituent (35% to 60%). The non-thymol fraction (thymene) contains para-cymene, γ-terpenine, α- and β-pinenes, dipentene, α-terpinene, and carvacrol. Minute amounts of camphene, myrcene, and α-3-carene also have been found in the plant. Alcoholic extracts contain a highly hygroscopic saponin. From the fruits, an yellow, crystalline flavone and a steroid-like substance has been isolated and it also contains 6-O-β-glucopyranosyloxythymol, glucoside and yields 25% oleoresin containing 12% volatile oil (thymol, γ-terpinene, para-cymene, and α- and β-pinene). The principal oil constituents of T. ammi are carvone (46%), limonene (38%), and dillapiole (9%). Ajwain is administered for curing stomach disorders, a paste of crushed fruits is applied externally for relieving colic pains; and a hot and dry fomentation of the fruits is applied on chest for asthma. Therapeutic uses of T. ammi fruits include; stomachic, carminative and expectorant, antiseptic and amoebiasis, antimicrobial. Seeds soaked in lemon juice with P runus amygdalus (badam) are given in curing amenhorroea and it is also used as antipyretic, febrifugal and in the treatment of typhoid fever. The antihypertensive effect of T. ammi administered intravenously in vivo, and the antispasmodic and bronchodilating actions in vitro showed that calcium channel blockade has been found to mediate the spasmolytic effects of plant materials and it is being considered that this mechanism contributed to their observed result and supported the traditional use of T. ammi in hyperactive disease states of the gut such as colic and diarrhea as well as in hypertension. Ajwain seeds revealed significant reduction of cough number which may be a result of its potent antitussive effect. The bronchodilatory effect of decocted extract of Ajwain on the asthmatic patients’ airways was examined in a subsequent trial study. According to the results, the extract has a relatively bronchodilatory effect on asthmatic airways compared to the effect of Theophylline at concentrations used. Ajwain was attributed to have diuretic and antilithiasis activity in ethnopharmacological reports. Accordingly, a human study was performed and in which, seeds of Ajwain were decocted in milk and given orally to volunteers suffering from urinary stone for a nine days period. The results were reported satisfactory against pure ca-oxalate stone. Another activity which has been proved for Ajwain is the antihyperlipidemic property. An in vivo study revealed that Ajwain seeds powder is extensively effective on lipid profile and can decrease total cholesterol, LDL-cholesterol, triglycerides and total lipids. Moreover, organic extract of seeds reduced atherogenic index and increased the level of HDL-cholesterol in albino rabbits. Ajwain was evaluated for the potentiality of antihypertensive and antispasmodic activity. In the related investigation, the aqueous-methanolic extract of the seeds caused a dose dependent decrease in arterial blood pressure in anaesthetized animal models. Furthermore, inhibitory effect on the K+-induced contractions was seen in isolated rabbit aorta and jejunum preparations during the application of Ajwain extract. These findings prove the potential antihypertensive and antispasmodic activity of Ajwain.

Lidocaine, Esmolol, and Beyond: A Comprehensive Analysis of Hemodynamic Stress during Laryngoscopy and Intubation

Aim: To evaluate the haemodynamic stress response in combination of lidocaine and esmolol versus lidocaine or esmolol alone during laryngoscopy and intubation Methods: This research comprised 60 patients who provided written permission and met the inclusion and exclusion criteria. Selected patients were randomly assigned to one of three groups based on a computer-generated random number: lignocaine 1.5 mg/kg (n=40), esmolol 2mg/kg (n=40), or lignocaine 1mg/kg and esmolol 1mg/kg (n=40). This research comprised patients aged 20 to 42 who had elective procedures under general anaesthetic and had ASA I and II. Patients with contraindications to beta blockers, such as bronchial asthma, COPD, a basal heart rate of 60 beats per minute, respiratory impairment, and documented reactions to local anaesthetics. Results: There were no significant variations in age, preoperative heart rate, or blood pressure between the groups. Males and females were approximately equally dispersed throughout all groupings. Following the delivery of the test medicines, all three groups saw a substantial drop in heart rate (Group E 61.23±3.64, Group L 73.25±5.36, Group LE 72.23±5.36) (p<0.001). Four Group E patients developed bradycardia. (HR <60). Although both Group LE and Group L showed near baseline values, Group L showed near baseline values until the third minute, whereas Group LE showed a continuous reduction in heart rate rates. After 30 minutes, all three groups' heart rates were statistically insignificant. Following induction and administration of the test medicines, systolic, diastolic, and hence mean arterial blood pressure lowers gradually in all three groups (p<0.001). (This is for systolic blood pressure.). Group E 97.36±5.69, Group L 125.39±6.36, Group LE 116.78±4.78) Group E 60.034.69, Group L 82.935.36, Group LE 72.034.78) (Group E 72.10±3.69, Group L 96.90±3.85, Group LE 86.44±2.87) Before intubation, patients in Group E experienced substantial decreases in systolic, diastolic, and mean arterial blood pressure (less than 20% of baseline). Following intubation, blood pressure levels in Group LE were near baseline until the 30th minute (p<0.001). Group E had a consistent fall in all three blood pressure readings following intubation until the fifth minute. Group E's blood pressures were likewise around baseline at the 15th and 30th minutes. Until the 15th minute, Group L had a considerable rise in all three blood pressures. Conclusion: As a result, esmolol and lidocaine together are a safe and effective strategy to minimise laryngoscopy responses to intubation and extubation, lowering myocardial oxygen consumption and the risk of myocardial ischemia under general anaesthesia.

Static autoregulation in humans.

The process by which cerebral blood flow (CBF) remains approximately constant in response to short-term variations in arterial blood pressure (ABP) is known as cerebral autoregulation. This classic view, that it remains constant over a wide range of ABP, has however been challenged by a growing number of studies. To provide an updated understanding of the static cerebral pressure-flow relationship and to characterise the autoregulation curve more rigorously, we conducted a comprehensive literature research. Results were based on 143 studies in healthy individuals aged 18 to 65 years. The mean sensitivities of CBF to changes in ABP were found to be 1.47 ± 0.71%/% for decreased ABP and 0.37 ± 0.38%/% for increased ABP. The significant difference in CBF directional sensitivity suggests that cerebral autoregulation appears to be more effective in buffering increases in ABP than decreases in ABP. Regression analysis of absolute CBF and ABP identified an autoregulatory plateau of approximately 20 mmHg (ABP between 80 and 100 mmHg), which is much smaller than the widely accepted classical view. Age and sex were found to have no effect on autoregulation strength. This data-driven approach provides a quantitative method of analysing static autoregulation that can be easily updated as more experimental data become available.

Association of infraclavicular axillary vein diameter and collapsibility index with general anesthesia-induced hypotension in elderly patients undergoing gastrointestinal surgery: an observational study

BackgroundThe collapse index of inferior Vena Cava (IVC) and its diameter are important predictive tools for fluid responsiveness in patients, especially critically ones. The collapsibility of infraclavicular axillary vein (AXV) can be used as an alternative to the collapsibility of IVC (IVC-CI) to assess the patient’s blood volume.MethodsA total of 188 elderly patients aged between 65 and 85 years were recruited for gastrointestinal surgery under general anesthesia. Ultrasound measurements AXV and IVC were performed before induction of general anesthesia. Patients were grouped in accordance to the hypotension after induction. ROC curves were used to analyze the predictive value of ultrasound measurements of AXV and IVC for hypotension after induction of anesthesia. Pearson linear correlation was used to assess the correlation of ultrasound measurements and decrease in mean arterial blood pressure (MAP).ResultsThe maximum diameter of AXV(dAXVmax) and the maximum diameter of IVC (dIVCmax) were not related to the percentage decrease in MAP; the collapsibility of AXV (AXV-CI) and IVC-CI were positively correlated with MAP changes (correlation coefficients:0.475, 0.577, respectively, p < 0.001). The areas under the curve (AUC) was 0.824 (0.759–0.889) for AXV-CI, and 0.874 (0.820–0.928) for IVC-CI. The optimal threshold for AXV-CI was 31.25% (sensitivity 71.7%, specificity 90.1%), while for IVC-CI was 36.60% (sensitivity 85.9%, specificity 79.0%). Hypotension and down-regulation of MAP during induction can be accurately predicted by AXV-Cl after correction for confounding variables.ConclusionInfraclavicular axillary vein diameter has no significant correlation with postanesthesia hypotension, whereas AXV-CI may predict postanesthesia hypotension during gastrointestinal surgery of the elderly.Trial registrationThis study was registered in the Clinical Trial Registry of China on 05/06/2022 (ChiCTR2200060596).

Sevoflurane-induced hypotension causes cognitive dysfunction and hippocampal inflammation in mice

Sevoflurane commonly adopted for anesthetic in clinical practice, however, its influences on cerebral blood flow and cognitive function remain controversial. Herein, the sevoflurane-induced hypotension on arterial blood pressure, cerebral blood flow, cognitive function, and hippocampal inflammation was investigated in mice. A significant decrease in arterial blood pressure and cerebral blood flow was indicated by the sevoflurane anesthesia treatment. Moreover, sevoflurane-induced hypotension was associated with the impaired cognitive function and the increased levels of NLRP3 inflammasome activation and oxidative stress in hippocampus. These findings suggest that sevoflurane-induced hypotension may lead to the cognitive dysfunction and hippocampal inflammation.

Critical power is a key threshold determining the magnitude of post-exercise hypotension in non-hypertensive young males.

The effect of different exercise intensities on the magnitude of post-exercise hypotension has not been rigorously clarified with respect to the metabolic thresholds that partition discrete exercise intensity domains (i.e., critical power and the gas exchange threshold (GET)). We hypothesized that the magnitude of post-exercise hypotension would be greater following isocaloric exercise performed above versus below critical power. Twelve non-hypertensive men completed a ramp incremental exercise test to determine maximal oxygen uptake and the GET, followed by five exhaustive constant load trials to determine critical power and W' (work available above critical power). Subsequently, criterion trials were performed at four discrete intensities matched for total work performed (i.e., isocaloric) to determine the impact of exercise intensity on post-exercise hypotension: 10% above critical power (10%>CP), 10% below critical power (10%<CP), 10% above GET (10%>GET) and 10% below GET (10%<GET). The post-exercise decrease (i.e., the minimum post-exercise values) in mean arterial (10%>CP: -12.7±8.3 vs. 10%<CP: v3.5±2.9mmHg), diastolic (10%>CP: -9.6±9.8 vs. 10%<CP: -1.4±5.0mmHg) and systolic (10%>CP: -23.8±7.0 vs. 10%<CP: -9.9±4.3mmHg) blood pressures were greater following exercise performed 10%>CP compared to all other trials (all P<0.01). No effects of exercise intensity on the magnitude of post-exercise hypotension were observed during exercise performed below critical power (all P>0.05). Critical power represents a threshold above which the magnitude of post-exercise hypotension is greatly augmented. NEW FINDINGS: What is the central questions of this study? What is the influence of exercise intensity on the magnitude of post-exercise hypotension with respect to metabolic thresholds? What is the main finding and its importance? The magnitude of post-exercise hypotension is greatly increased following exercise performed above critical power. However, below critical power, there was no clear effect of exercise intensity on the magnitude of post-exercise hypotension.

Identification and characterization of the new generation soluble guanylate cyclase stimulator BAY-747 designed for the treatment of resistant hypertension.

First-generation soluble guanylate cyclase (sGC) stimulators have shown clinical benefit in pulmonary hypertension (riociguat) and chronic heart failure (vericiguat). However, given the broad therapeutic opportunities for sGC stimulators, tailored molecules for distinct indications are required. We report the high-throughput screening (HTS)-based discovery of a second generation of sGC stimulators from a novel imidazo[1,2-a]pyridine lead series. An intense medicinal chemistry programme resulted in the discovery of the sGC stimulator BAY 1165747 (BAY-747). The pharmacokinetic profile of BAY-747 was determined in different species, and it was broadly characterized in pharmacological model systems relevant for vasodilatation and hypertension. BAY-747 is a highly potent sGC stimulator in vitro. In addition, BAY-747 showed an excellent pharmacokinetic profile with long half-life and low peak-to-trough ratio. BAY-747 was investigated in experimental in vivo models of malignant and resistant hypertension (rHT). In spontaneously hypertensive (SH) rats, BAY-747 caused a dose-related and long-lasting decrease in mean arterial blood pressure (MAP). Oral treatment over 12 days resulted in a persistent decrease. BAY-747 provided additional benefit when dosed on top of losartan, amlodipine or spironolactone and even on top of triple combinations of frequently used antihypertensive drugs. In a new canine model of rHT, BAY-747 caused a dose-related and long-lasting (>6 h) MAP decrease. BAY-747 is a potent, orally available sGC stimulator. BAY-747 shows long-acting pharmacodynamic effects with a very low peak-to-trough ratio. BAY-747 could be a treatment alternative for patients with hypertension, especially those not responding to standard-of-care therapy.

An abrupt decrease in arterial blood pressure may predict a high level carbon dioxide embolism in retroperitoneoscopic surgery: case report and a literature review

BackgroundCarbon dioxide (CO2) embolism is the primary suspect in most cases of intraoperative “cardiovascular” collapse. However, there are few reports about CO2 embolism in retroperitoneal laparoscopy.Case presentationAn abrupt decrease in arterial blood pressure was noted in time of retroperitoneoscopic adrenalectomy in a 40 years old male patient with adrenal adenoma. The end-tidal carbon dioxide (EtCO2) and saturation of oxygen were stable with normal cardiography until anesthesiologists found the change of resistant of peripheral circulation, then they gave us a hint of hemorrhage. However, the blood pressure had no reaction to one bolus of epinephrine administration when trying to improve the circulation. Five minutes later, a sudden fall of blood pressure was noted, and then we stopped the processing of cutting tissue and trying to coagulate any bleeding in the operation field. Further vasopressor support proved to be completely ineffective. With the help of transesophageal echocardiography, we found the bubbles in the right atrium, which confirmed the diagnosis of an intraoperative gas embolism (Grade IV). We stopped the carbon dioxide insufflation and deflated the retroperitoneal cavity. All the bubbles in the right atrium totally disappeared and the blood pressure, resistance of peripheral circulation and cardiac output returned to normal 20 min later. We continued the operation and completed it in 40 min with the 10 mmHg air pressure.ConclusionCO2 embolism may occour during retroperitoneoscopic adrenalectomy, and an acute decrease in arterial blood pressure should alert both the urologists and anesthesiologists to this rare and fatal complication.

Cardio-Protective Effect of the Leaf Extract of Andrographis paniculata in Isoproterenol-Induced Myocardial Infarction

Background: Nowadays, myocardial infarction has been regarded as one of the chronic diseases with increasing mortality rate worldwide. The use of medicinal plants in the treatment of this chronic disease is gaining wide acceptance globally.&#x0D; Materials and Methods: This study was carried out to evaluate the cardio-protective effect of the leaf extract of A. paniculata in isoproterenol-induced myocardial infarction. Fresh green leaves of A paniculata were collected from the Faculty of Agriculture farmland, Nnamdi Azikiwe University, Awka, Nigeria. The plant was identified and authenticated at the Department of Botany, Nnamdi Azikiwe University and a voucher specimen was deposited at the herbarium accordingly. The shredded, air-dried sample was then pulverized and weighed. Solvent-solvent (ethanol and water) (7:3) was used for extraction via maceration for 72 hr. The filtrate was evaporated to dryness to obtain the ethanol extract which was used for further bioassay study. The bioactive constituents of the plant extract were quantitatively analyzed by Gas chromatography mass spectrometry (GC-MS). The animals were administered with the extract of A. paniculata orally for seven days at a divided dose of 100 mg/kg, 200 mg/kg and 400 mg/kg body weights. On the eight day, myocardial infarction was induced through subcutaneous administration of isoproterenol at a dose of 150 mg/kg/day diluted in 2 ml of saline on two consecutive days. Subsequently, the blood pressures were monitored and blood collected for bioassay studies.&#x0D; Results: The results of the study showed that the leaf extract of A. paniculata was rich in 2,5-Octadecadiynoic acid, methyl ester (28.21%); 1,2,3,5-Cyclohexanetetrol,(1à,2á,3à,5á)- (15.10 %) and 10-12-Pentacosadiynoic acid (13.05%). The findings also showed a significant decrease (p&gt;0.05) in the Mean arterial blood pressure, heart rate, aspartate transaminase, alanine transaminase, creatinine kinase and lactate dehydrogenase activities of the treatment group compared with the untreated control group while the antioxidant (superoxide dismutase, catalase and glutathione) activities were significantly increased in the treatment group, compared with the untreated control group.&#x0D; Conclusion: The findings of this work have shown that leaf of A. paniculata was rich in bioactive compounds which could be synthesized to produce plant based products to combat cardiovascular diseases especially myocardial infarction.

Establishment of Deep Hypothermic Circulatory Arrest in Rats

Deep hypothermic circulatory arrest (DHCA) is routinely applied during surgeries for complex congenital heart disease and aortic arch disease. The present study aims to provide a method for establishing DHCA in rats. To evaluate the impact of the DHCA process on vital signs, a normal temperature cardiopulmonary bypass (CPB) rat model without circulatory arrest was used as a control. As expected, DHCA led to a significant decrease in body temperature and mean arterial blood pressure. The blood gas analysis indicated that DHCA increased lactic acid levels but did not influence the blood pH and the concentrations of hemoglobin, hematocrit, Na+, Cl-, K+, and glucose. Furthermore, compared with the normal temperature CPB rats, the results of the transmission electron microscopy showed a mild increase in hippocampal autophagosomes in the DHCA rats.

The optimal PEEP after alveolar recruitment maneuver assessed by electrical impedance tomography in healthy horses.

Electrical impedance tomography (EIT) has been an essential tool for assessing pulmonary ventilation in several situations, such as the alveolar recruitment maneuver (ARM) in PEEP titration to maintain the lungs open after atelectasis reversion. In the same way as in humans and dogs, in horses, this tool has been widely used to assess pulmonary aeration undergoing anesthesia, mechanical ventilation, recruitment maneuver, standing horses, or specific procedures. The present study aimed to evaluate the distribution of regional ventilation during ARM based on lung monitoring assessment by EIT, with a focus on better recruitment associated with less or no overdistention. Fourteen horses of 306 ± 21 kg undergoing isoflurane anesthesia in dorsal recumbency were used. The animals were mechanically ventilated with a tidal volume of 14 ml kg-1 and a respiratory rate of 7-9. An alveolar recruitment maneuver was instituted, increasing the PEEP by five cmH2O every 5 min until 32 cmH2O and decreasing it by five cmH2O every 5 min to 7 cmH2O. At each step of PEEP, arterial blood samples were collected for blood gas analysis, EIT images, hemodynamic, and respiratory mechanics. Associated with the CoV-DV increase, there was a significant decrease in the DSS during the ARM and a significant increase in the NSS when PEEP was applied above 12 cmH2O compared to baseline. The ComplROI showed a significant increase in the dependent area and a significant decrease in the non-dependent area during ARM, and both were compared to their baseline values. The driving pressure decreased significantly during the ARM, and Cst, PaO2, and PaO2/FiO2 ratio increased significantly. The VD/VT decreased significantly at DEPEEP17 and DEPEEP12. There was an HR increase at INPEEP27, INPEEP 32, and DEPEEP17 (p < 0.0001; p < 0.0001; and p < 0.05, respectively), those values being above the normal reference range for the species. The SAP, MAP, DAP, CI, and DO2I significantly decreased INPEEP32 (p < 0.05). The ARM by PEEP titration applied in the present study showed better ventilation distribution associated with better aeration in the dependent lung areas, with minimal overdistention between PEEP 17 and 12 cmH2O decreasing step. Those changes were also followed by improvements in static and regional compliance associated with increased oxygenation and pulmonary ventilation. ARM promoted a transitory decrease in arterial blood pressure and depression in CI with a concomitant drop in oxygen delivery, which should be best investigated before its routine use in clinical cases.

ROLE OF ULTRASONOGRAPHIC INFERIOR VENACAVAL ASSESSMENT IN SURGERIES CONDUCTED UNDER GENERAL ANAESTHESIA-A PROSPECTIVE OBSERVATIONAL STUDY

Background: One of the most frequent side effects following the induction of general anaesthesia during surgery is hypotension. The goal of our study was to determine if there was a connection between the maximum inferior vena cava (IVC) diameter prior to induction, the collapsibility index (CI), and the post-induction decrease in mean arterial blood pressure in patients undergoing operations under general anaesthesia. Materials and Methods: Eighty patients who underwent procedures under general anaesthesia at Gandhi Medical College Bhopal and associated tertiary care hospital were included in a prospective observational research. Prior to starting general anaesthesia, the IVC was evaluated. For each surgical patient, the maximum and minimum IVC diameters (IVCD max and IVCD min) as well as the CI were assessed. Results: According to the criteria of hypotension as defined, 31(38.75%) of the patients developed post-induction hypotension. Four patients had MAP &lt;60 mmHg after induction of anesthesia. Post-induction hypotension was seen in patients with increased age. Patients with smaller IVCD max (P = 0.02), smaller IVCD min (P = 0.003), and higher CI% (P = 0.004) developed hypotension after induction of anesthesia. Percentage drop in MAP was 33.7 ± 4.48% (P = 0.002) in patients who developed post-induction hypotension. Conclusion: Predicting post-induction hypotension caused by hypovolemia in surgical patients with IVC measurement using ultrasound is a reliable strategy.

Short-pulsed micro-magnetic stimulation of the vagus nerve.

Vagus nerve stimulation (VNS) is commonly used to treat drug-resistant epilepsy and depression. The therapeutic effect of VNS depends on stimulating the afferent vagal fibers. However, the vagus is a mixed nerve containing afferent and efferent fibers, and the stimulation of cardiac efferent fibers during VNS may produce a rare but severe risk of bradyarrhythmia. This side effect is challenging to mitigate since VNS, via electrical stimulation technology used in clinical practice, requires unique electrode design and pulse optimization for selective stimulation of only the afferent fibers. Here we describe a method of VNS using micro-magnetic stimulation (µMS), which may be an alternative technique to induce a focal stimulation, enabling a selective fiber stimulation. Micro-coils were implanted into the cervical vagus nerve in adult male Wistar rats. For comparison, the physiological responses were recorded continuously before, during, and after stimulation with arterial blood pressure (ABP), respiration rate (RR), and heart rate (HR). The electrical VNS caused a decrease in ABP, RR, and HR, whereas µM-VNS only caused a transient reduction in RR. The absence of an HR modulation indicated that µM-VNS might provide an alternative technology to VNS with fewer heart-related side effects, such as bradyarrhythmia. Numerical electromagnetic simulations helped estimate the optimal coil orientation with respect to the nerve to provide information on the electric field’s spatial distribution and strength. Furthermore, a transmission emission microscope provided very high-resolution images of the cervical vagus nerve in rats, which identified two different populations of nerve fibers categorized as large and small myelinated fibers.

Histamine induced high mobility group box-1 release from vascular endothelial cells through H1 receptor.

BackgroundSystemic allergic reaction is characterized by vasodilation and vascular leakage, which causes a rapid, precipitous and sustained decrease in arterial blood pressure with a concomitant decrease of cardiac output. Histamine is a major mediator released by mast cells in allergic inflammation and response. It causes a cascade of inflammation and strongly increases vascular permeability within minutes through its four G-protein-coupled receptors (GPCRs) on endothelial cells. High mobility group box-1 (HMGB1), a nonhistone chromatin-binding nuclear protein, can be actively secreted into the extracellular space by endothelial cells. HMGB1 has been reported to exert pro-inflammatory effects on endothelial cells and to increase vascular endothelial permeability. However, the relationship between histamine and HMGB1-mediated signaling in vascular endothelial cells and the role of HMGB1 in anaphylactic-induced hypotension have never been studied.Methods and resultsEA.hy 926 cells were treated with different concentrations of histamine for the indicated periods. The results showed that histamine induced HMGB1 translocation and release from the endothelial cells in a concentration- and time-dependent manner. These effects of histamine were concentration-dependently inhibited by d-chlorpheniramine, a specific H1 receptor antagonist, but not by H2 or H3/4 receptor antagonists. Moreover, an H1-specific agonist, 2-pyridylethylamine, mimicked the effects of histamine, whereas an H2-receptor agonist, 4-methylhistamine, did not. Adrenaline and noradrenaline, which are commonly used in the clinical treatment of anaphylactic shock, also inhibited the histamine-induced HMGB1 translocation in endothelial cells. We therefore established a rat model of allergic shock by i.v. injection of compound 48/80, a potent histamine-releasing agent. The plasma HMGB1 levels in compound 48/80-injected rats were higher than those in controls. Moreover, the treatment with anti-HMGB1 antibody successfully facilitated the recovery from compound 48/80-induced hypotension.ConclusionHistamine induces HMGB1 release from vascular endothelial cells solely through H1 receptor stimulation. Anti-HMGB1 therapy may provide a novel treatment for life-threatening systemic anaphylaxis.

Rocuronium versus Cisatracurium for Rapid Sequence Induction of Anesthesia in Morbidly Obese Patients

Introduction and Aim: Obesity is a challenging problem for anesthetists. Difficult airway with risk of aspiration and regurgitation increases with obesity. Therefore, the need for effective and safe drug for rapid induction of anesthesia is crucial to ensure fast good intubation condition. The aim of this study is to assess Rocuronium versus Cisatracurium for rapid sequence induction of anesthesia in morbidly obese patients.&#x0D; Patients and methods: This study included 60 patients with ASA physical status II, aged 21-40 years, BMI 35-40 kg/m2 and scheduled for elective surgery under general anesthesia. Patients were classified into two equal groups: Group (R): received Rocuronium bromide (Esmeron) in a dose of 0.9 mg/kg (lean body mass) for intubation; Group (C): received Cisatracurium besylate (Nimbex) in a dose of 0.15 mg/kg (LBM) for intubation. Timing of intubation in seconds, intubation score (excellent, good, poor, or inadequate), and hemodynamic variables before induction (baseline), after induction and before injection of Neuro-muscular blocker (NMB), after injection of NMB and before endotracheal intubation and just after intubation were assessed and measured.&#x0D; Results: There was statistically significant decrease in the timing of intubation in R group (84.0 ± 18.50) as compared to C group (96.0 ± 13.29). However, there was no statistically significant difference in the intubation score among the two groups. There was significant decrease in heart rate and mean arterial blood pressure after the induction of anaesthesia as compared to the baseline in both groups; Heart rate and mean arterial blood pressure changes were comparable among the two groups all of the time.&#x0D; Conclusion: Rocuronium for rapid sequence induction in morbidly obese patients is associated with faster onset compared with cisatracurium, with comparable intubation condition and hemodynamic variables. We recommend further studies to be conducted for evaluation of both drugs with different doses.

S-nitroso-L-cysteine stereoselectively blunts the adverse effects of morphine on breathing and arterial blood gas chemistry while promoting analgesia

S-nitrosothiols exert multiple effects on neural processes in the central and peripheral nervous system. This study shows that intravenous infusion of S-nitroso-L-cysteine (SNO-L-CYS, 1 μmol/kg/min) in anesthetized male Sprague Dawley rats elicits (a) sustained increases in minute ventilation, via increases in frequency of breathing and tidal volume, (b) a decrease in Alveolar-arterial (A-a) gradient, thus improving alveolar gas-exchange, (c) concomitant changes in arterial blood-gas chemistry, such as an increase in pO2 and a decrease in pCO2, (d) a decrease in mean arterial blood pressure (MAP), and (e) an increase in tail-flick (TF) latency (antinociception). Infusion of S-nitroso-D-cysteine (SNO-D-CYS, 1 μmol/kg/min, IV), did not elicit similar responses, except for a sustained decrease in MAP equivalent to that elicited by SNO-L-CYS. A bolus injection of morphine (2 mg/kg, IV) in rats receiving an infusion of vehicle elicited (a) sustained decreases in frequency of breathing tidal volume, and therefore minute ventilation, (b) a sustained decrease in MAP, (c) sustained decreases in pH, pO2 and maximal sO2 with sustained increases in pCO2 and A-a gradient, and (d) a sustained increase in TF latency. In rats receiving SNO-L-CYS infusion, morphine elicited markedly smaller changes in minute ventilation, arterial blood gas chemistry, A-a gradient and MAP. In contrast, the antinociceptive effects of morphine were enhanced in rats receiving the infusion of SNO-L-CYS. The morphine-induced responses in rats receiving SNO-D-CYS infusion were similar to vehicle-infused rats. These data are the first to demonstrate that infusion of an S-nitrosothiol, such as SNO-L-CYS, can stereoselectively ameliorate the adverse effects of morphine on breathing and alveolar gas exchange while promoting antinociception.

Blood Pressure Changes During Mechanical Thrombectomy for Acute Ischemic Stroke Are Associated With Serious Early Treatment Complications: Symptomatic Intracerebral Hemorrhage and Malignant Brain Edema.

BackgroundSymptomatic intracranial hemorrhage (sICH) and malignant brain edema (MBE) are well-known deleterious endovascular treatment (EVT) complications that some studies found to be associated with postprocedural blood pressure (BP) variability. We aimed to evaluate their association with periprocedural BP changes, including its intraprocedural decrease.MethodsWe retrospectively analyzed the data of 132 consecutive patients that underwent EVT between 1 December 2018 and 31 December 2019, for anterior circulation ischemic stroke. Analyzed predictors of sICH and MBE included non-invasively obtained BP before and 5-min after treatment, intraprocedural relative decreases of BP from baseline, and its post-treatment increases. SICH was defined in accordance with the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) criteria and MBE as brain edema with midline shift on the follow-up imaging. We used binary logistic regression analysis to investigate the association of BP parameters and the incidence of sICH and MBE.ResultsAmong the included patients, 11 (8.3%) developed sICH and 31 (23.5%) MBE. The intraprocedural decrease of mean arterial blood pressure (MAP) was independently associated with MBE occurrence (aOR per 10 mmHg drop from baseline 1.27; 95% CI 1.01–1.60; P = 0.040). Over 40% MAP drop was associated with a higher risk of sICH in the entire cohort (aOR 4.24; 95% CI 1.33–13.51; P = 0.015), but not in the subgroup with successful reperfusion (aOR 2.81; 95% CI 0.64–12.23; P = 0.169). Post-treatment systolic blood pressure (SBP) and MAP elevation above their minimal values during MT are significantly associated with the development of sICH (aOR per 10 mmHg SBP increase 1.78; 95% CI 1.15–2.76; P = 0.010 and aOR per 10 mmHg MAP increase 1.78; 95% CI 1.04–3.03; P = 0.035).ConclusionsIn the anterior circulation ischemic stroke patients relative MAP decrease during EVT is associated with a higher risk of MBE occurrence, and over 40% MAP drop with a higher incidence of both MBE and sICH. Post-treatment elevation of SBP and MAP increased the risk of sICH.

Cardiovascular Protection Associated With Cilostazol, Colchicine, and Target of Rapamycin Inhibitors.

An alteration in extracellular matrix (ECM) production by vascular smooth muscle cells is a crucial event in the pathogenesis of vascular diseases such as aging-related, atherosclerosis and allograft vasculopathy. The human target of rapamycin (TOR) is involved in the synthesis of ECM by vascular smooth muscle cells. TOR inhibitors reduce arterial stiffness, blood pressure, and left ventricle hypertrophy and decrease cardiovascular risk in kidney graft recipients and patients with coronary artery disease and heart allograft vasculopathy. Other drugs that modulate ECM production such as cilostazol and colchicine have also demonstrated a beneficial cardiovascular effect. Clinical studies have consistently shown that cilostazol confers cardiovascular protection in peripheral vascular disease, coronary artery disease, and cerebrovascular disease. In patients with type 2 diabetes, cilostazol prevents the progression of subclinical coronary atherosclerosis. Colchicine reduces arterial stiffness in patients with familial Mediterranean fever and patients with coronary artery disease. Pathophysiological mechanisms underlying the cardioprotective effect of these drugs may be related to interactions between the cytoskeleton, TOR signaling, and cyclic adenosine monophosphate (cAMP) synthesis that remain to be fully elucidated. Adult vascular smooth muscle cells exhibit a contractile phenotype and produce little ECM. Conditions that upregulate ECM synthesis induce a phenotypic switch toward a synthetic phenotype. TOR inhibition with rapamycin reduces ECM production by promoting the change to the contractile phenotype. Cilostazol increases the cytosolic level of cAMP, which in turn leads to a reduction in ECM synthesis. Colchicine is a microtubule-destabilizing agent that may enhance the synthesis of cAMP.