Decrease In Hemodynamic Parameters Research Articles

Invasive Hemodynamic and Vasoreactivity Testing with Inhaled Iloprost in Children with Pulmonary Arterial Hypertension Associated with Congenital Heart Defects

Objective: Invasive hemodynamic evaluation and acute vasoreactivity testing are recommended in the diagnosis of pulmonary arterial hypertension (PAH), but their clinical role in children with PAH associated with congenital heart defects (CHD) is unclear. This study aims to investigate acute hemodynamic responses to inhaled iloprost, and its role in prognosis in children with PAH-CHD. Methods: A retrospective analysis was conducted on 83 pediatric patients with PAH-CHD in whom invasive hemodynamics were evaluated before and after a single inhaled dose of iloprost at a single center between 2010 and 2022. Details of the CHD corrective operation, medical treatment, and outcome for each patient were obtained via medical records or telephone contact. A composite endpoint of all-cause death, admission for worsening heart failure during follow-up, and event-free survival was defined, and risk factors associated with this composite endpoint were analyzed. Results: The patient age was (11.3 ± 4.6) years, and 60 (72.3%) were female. Fifty-nine (71.1%) patients were diagnosed with Eisenmenger syndrome. After iloprost inhalation, mean pulmonary artery pressure decreased from (78.2 ± 11.5) to (72.3 ± 13.2) mmHg (P < 0.001), and pulmonary vascular resistance index (PVRI) decreased from (18.0 ± 7.9) to (14.5 ± 8.1) WU·m2 (P < 0.001). A total of 38 (45.8%) patients had a positive response, defined as a PVRI decrease >25% with stable systemic pressure. Thirty-seven (44.6%) patients underwent a corrective CHD operation at a median of 24 d after hemodynamic evaluation. Nine patients died, and 15 met the composite endpoint during a follow-up period of 5.4 (3.8, 8.8) years. Five-year event-free survival estimates were 96.7% (95% confidence interval: 90.3%–100%) in patients with a positive response, and 82.8% (95% confidence interval: 71.7%–94.5%) in patients with a non-positive response (log-rank P = 0.012). A positive PVRI response and higher pulmonary arterial oxygen saturation after iloprost inhalation, lower baseline brain natriuretic peptide, and PAH-targeted therapy at follow-up were significantly associated with a favorable clinical outcome. A positive acute vasoreactivity testing response and PAH-targeted therapy at follow-up were independent predictors of outcome in multivariate Cox analysis. Conclusions: Acute inhalation of iloprost can lead to a significant decrease in hemodynamic parameters. Responsiveness to inhaled iloprost is associated with better outcomes and can be a valuable predictor of outcomes.

Comparison Features of Methods of Epidural Analgesia as a Part of Combined Anesthesia in Laparoscopic Surgery

The objective: choosing the optimal method of epidural analgesia combined with general anesthesia for typical laparoscopic colorectal surgeries by comparing three different options for its implementation. Subjects and Methods. 90 patients aged 60 to 85 years were examined, they all underwent planned laparoscopic interventions for colorectal cancer under combined anesthesia (general + epidural anesthesia). Depending on the method of administration of ropivacaine to achieve an epidural block, they were randomized into three groups. In Group 1, it was administered at a concentration of 0.25% in the form of a continuous infusion at a rate of 8 m l/h during the first hour, then 6 ml/ h until the end of the operation. In Group 2, its concentration was increased to 0.375%, the rate of continuous infusion was 8 ml/ h in the first hour, then 6 m l/h . Patients of Group 3 first received ropivacaine as a bolus before the induction of general anesthesia (0.375% – 8 ml over 5 min), then continued administration continuously but at a concentration of 0.25% at a rate of 6 m l/h . Endpoints for hemodynamic assessment: upon admission to the operating room, after induction of anesthesia, after application of carboxyperitoneum, after 1 hour of laparoscopic stage, after elimination of carboxyperitoneum, after extubation, and 1 hour after transfer to the ICU . The total dose of fentanyl was recorded. The assessment of the sensory block was performed using a cold test, the severity of the pain syndrome ‒ on a visua l-a nalog scale (10 points), the density of the block ‒ on an ordinal scale, its upper and lower levels were noted. The motor block was evaluated using a modified Bromage scale. Results. The doses of fentanyl, rocuronium and the consumption of desflurane during general anesthesia, the values of the BIS index and the time of awakening of patients in all groups did not differ. The average doses of ropivacaine in the groups were different. The total volume of ropivacaine solution was the largest in Group 3, there were no significant differences in the volume of the injected local anesthetic between Group 1 and Group 2. The number of patients who needed vasopressor support with norepinephrine during anesthesia in Group 1 was less versus Groups 2 and 3. The maximum intraoperative dose of norepinephrine and duration of its use were also lower in Group 1. When applying carboxyperitoneum, the most pronounced decrease in hemodynamic parameters was revealed in patients of Group 3. At the 4th stage of the study, after 1 hour of the laparoscopic stage, hemodynamic parameters were higher in patients of Group 1. There were no significant differences in pain intensity between the groups after surgery. At the same time, the level of motor block was significantly higher in patients of Group 2, while in Groups 1 and 3, motor block did not develop in most of the patients. Conclusion: The optimal method of epidural analgesia in typical laparoscopic colorectal operations is the use of 0.25% ropivacaine concentration as a continuous infusion only due to ensuring an acceptable level of analgesia, adequate distribution of the sensory block, the minimum degree of motor block, as well as the least negative effect on hemodynamic parameters which reduces the volume of infusion therapy and doses of vasopressors.

Comparison of Continuous Infusion of Ropivacaine and Fentanyl With Intermittent Bolus Doses of Ropivacaine and Fentanyl for Epidural Labor Analgesia: A Randomized Open-Label Study

BackgroundThe purpose of this study was to compare the efficacy of continuous epidural infusion with intermittent bolus doses for labour analgesia using ropivacaine 0.2% and opioids.MethodsIn this study, 70 primigravida patients were randomly divided into two groups of 35 each. Both groups received a loading dose of 10ml of 0.2% ropivacaine and 1μg/ml fentanyl in 5ml incremental doses while monitoring blood pressure and heart rate. Subsequently, Group I received a continuous epidural infusion of 0.2% ropivacaine with fentanyl at 10ml/hr, while Group II received 10 ml of 0.2% ropivacaine with fentanyl in bolus form every hour manually, with the first dose given after one hour of the initial loading dose. A rescue bolus dose of 5ml of 0.2% ropivacaine was given in both groups when they complained of breakthrough pain (VAS score >3). An additional 5ml bolus dose was given in both groups at the time of crowning. The blood pressure, heart rate, and severity of pain using the visual analogue scale (VAS) were assessed. Total drug volume utilized, the number of bolus doses, duration of the first and second stage of labour, rate of instrumental delivery and cesarean section, and neonatal Apgar scores were also recorded.ResultsThe total volume of drugs consumed and the number of boluses required for breakthrough pain were both significantly lower in Group II. There was a similar decrease in hemodynamic parameters (systolic blood pressure, diastolic blood pressure, and mean arterial pressure) from baseline in both the groups with no significant difference between them. The onset of analgesia was significantly faster in Group I with both groups achieving optimum analgesia (VAS ≤ 3) within 20 minutes of the loading dose. Maternal motor blockade scores, the duration of the first and second stage of labour, the rate of instrumental delivery, cesarean section, and neonatal Apgar scores, did not show any statistically significant difference between the two groups.ConclusionBoth techniques, i.e. continuous epidural infusion and intermittent epidural boluses are effective for providing labour analgesia. But consumption of drugs and episodes of breakthrough pain was higher in the continuous infusion group (Group I).

Estimation of Blood Glucose Levels And Hemodynamic Changes During Laparoscopic Cholecystectomy: A Comparison of Dexmedetomidine and Nalbuphine

Objective: To compare the effect of Dexmedetomidine and Nalbuphine premedication on changes in hemodynamics and neuroendocrine stress response under general anaesthesia by analyzing the variation of perioperative serial blood glucose levels.
 Study Design: Prospective comparative study.
 Place and Duration of Study: Services Hospital, Lahore Pakistan, from Oct to Dec 2020.
 Methodology: Total 90 patients aged between 30-and 65 years were allocated randomly into three groups. Group-D patients (n=30) were administered Dexmedetomidine 0.5 μg/kg in 100 ml normal saline, group-N (n=30) were given Nalbuphine 0.1 mg/kg in 100ml saline, and group-S received saline (100ml) throughout 15 minutes before induction of anaesthesia for laparoscopic cholecystectomy. General Anaesthesia was administered. Intra-abdominal pressure was maintained after abdominal insufflation with carbon dioxide between 12-15 mmHg. Blood glucose levels were analyzed preoperatively, 30 minutes after the beginning of surgery, at extubation and 2.5 hours postoperatively. Hemodynamic changes were recorded after premedication, 15 and 30 minutes after pneumoperitoneum and extubation.
 Results: Random mean blood sugar levels were 135.23 mg/dl with Dexmedetomidine and 123.33 mg/dl with Nalbuphine and 122.53 mg/dl in saline group (p<0.05). There was a greater decrease in hemodynamic parameters with group-D than with groups N and S (p<0.01).
 Conclusion: During laparoscopic cholecystectomy, intravenous Dexmedetomidine premedication attenuates the hemodynamic stress response better than Nalbuphine but does not suppress the neuroendocrine response as estimated by a rise in random blood glucose level.

A Comparison Between Dexmedetomidine and Clonidine as Adjuvants to Levobupivacaine in Labour Analgesia.

BackgroundThe epidural analgesia technique is effective for labor analgesia and combinations of various local anesthetics with lipophilic opioids like fentanyl are used. However, fentanyl can cause an increased incidence of pruritus, urinary retention, nausea, vomiting, giddiness, shivering, and respiratory depression. Dexmedetomidine and clonidine are selective alpha 2 agonists with analgesic properties and have been used via the neuraxial route with local anesthetics for the same without the side effects of fentanyl. Thus, the primary objective was to assess and compare the analgesic efficacy of the two-drug combinations by the visual analog scale (VAS) score.MethodsFifty-four primigravida women were randomly allocated in two groups of 27 each and were given an initial bolus of 10 mL of 0.125% levobupivacaine with dexmedetomidine 0.5 ug/kg in Group A and with clonidine 1 μg/kg in Group B. Subsequently, each patient received a background infusion rate of 10 mL/h, a bolus dose of 5 ml, and a lock-out interval of 10 min via a patient-controlled-analgesia (PCA) pump. The blood pressure, heart rate, and severity of pain using VAS were assessed. Durations of the stages of labor, rate of instrumental delivery, and cesarean section, side effects, maternal sedation, and neonatal Apgar scores were also recorded.ResultsVAS scores in both the groups progressively decreased to <3 by 15 min with significant differences at five, 10, 15, and 120 min being lower in group A. Onset of analgesia and time for maximum analgesia was significantly shorter in group A. There was a significant decrease in hemodynamic parameters from baseline in both groups. The fall in heart rate was significantly greater in Group A and at almost all the time intervals after baseline, diastolic blood pressure (DBP) was also lower in group A. Maternal motor blockade scores, the intensity of maternal sedation, the incidence of maternal complications, the duration of the first and second stage of labor, the rate of instrumental delivery and cesarean section, total analgesic dose and PCA bolus requirement, and neonatal Apgar scores did not show a significant difference between the two groups.ConclusionBoth dexmedetomidine and clonidine provide hemodynamically stable labor with a fall in heart rate and maternal blood pressure in the initial hours. Dexmedetomidine has the advantage of faster onset of analgesia and time for maximum analgesia.

Assessment of peridontal vessels hemodynamics among patients with diabetes mellitus type 1

Relevance. Processes of disturbance of regional hemodynamics, tissue blood flow, insufficiency of transcapillary metabolism and antioxidant system caused by dysfunction of periodontal vascular endothelium among patients with diabetes type 1 directly lead to diabetic microangiopathy accompanied by decrease of level of microcirculation and perfusion of periodontal tissues among patients with absolute insulin insufficiency. The reduction of linear and volumetric blood flow rates in periodontal vessels among patients with type 1 diabetes compared to values obtained by ultrasonic dopplerography in healthy patients can be considered as distinctive features of the manifestation of this systemic disease on microcirculation of periodontal tissues.Purpose. To evaluate the hemodynamics of periodontal vessels among patients with diabetes mellitus type 1 and without diabetes before and after conservative periodontal therapy.Materials and methods. 40 patients at the age 20-30 years were surveyed: 20 patients with diabetes mellitus type 1 and 20 patients without diabetes. All subjects underwent dental examination. To study the state of microcirculation of periodontal tissues patients of both groups underwent high-frequency ultrasound Doppler “Minimax-doppler-k”. Further was conducted professional oral hygiene complex with training in rules of individual oral hygiene. Reexamination was scheduled after 4 weeks. Results. During the conduction have been registered average baseline of the linear (Vam) and volumetric (Qam) blood flow in periodontal vessels in patients with diabetes mellitus type 1 and without diabetes. Average linear (Vam) and volumetric (Qam) blood flow before the conduction of professional oral hygiene complex were considerably lower compared to patients without diabetes. This points reduction of microcirculation and perfusion of periodontal tissues in patients with diabetes mellitus type 1 and without diabetes. Reassessment of blood flow in periodontal tissues in 4 weeks after professional oral hygiene revealed an increase in rate of microcirculation in periodontal tissues among patients with diabetes mellitus type 1 and without diabetes. Conclusion. Our study confirms the theory of hemodynamic impairment and local hemostasis in patients with type 1 diabetes, which is reflected in the appearance of trophic disorders of an inflammatory-dystrophic nature and a decrease in hemodynamic parameters. After conservative periodontal therapy, we revealed positive changes in hemodynamics of periodontal vessels, which was recorded using ultrasound dopplerography. Our results will allow us to select the optimal algorithms for the timely diagnosis, prevention and treatment of dental diseases in patients with type 1 diabetes in future.

The Effect of Age on the Indicator of Individual Norm of Intraocular Pressure

The screening method for determination of individual norm of IOP proved the efficiency for early glaucoma diagnosis and for the treatment and monitoring of a disease. Purpose: definition of compliance of IOP to individual norm or tolerant IOP (TIOP) in different age groups Patients and methods. 4212 women (65.6%) and 2205 men (34.4%) aged from 22 up to 80 years participated in a research. In total 12820 examinations were analyzed. At each patient the result of compliance of settlement TIOP to the available real oftalmotonus was estimated. Patients with excess of an oftalmotonus concerning TVGD up to 15% were carried to group with low risk of disease developing, with excess from 15 to 25% — with average risk, by more than 25% — with high risk of glaucoma development. All patients were divided into 3 groups depending on age: younger 40 years, with average age of 35 years (620 eyes); from 40 to 60 years, with middle age 54 years (2724 eyes); 60 years, with middle age are more senior 73 years. Results. The regularity consisting in decrease in an indicator of lack of risk of glaucoma with age and in increase in high risk of a disease in the senior age groups was revealed. For patients who entered into risk group, morfofunctional monitoring for the glaucoma exception, dynamic observation with the subsequent analysis of the received results through certain time was recommended. The obtained data confirm decrease in hemodynamic parameters of eyes with increase in age, and assessment of indicators of microcirculation of an eye with calculation of TIOP can be one of important diagnostic criteria for glaucoma diagnostics and monitoring.

Fermented ginseng, GBCK25, ameliorates hemodynamic function on experimentally induced myocardial injury

In the present study, we investigated whether treatment with GBCK25 facilitated the recovery of hemodynamic parameters, left ventricle systolic pressure, left ventricular developed pressure, and electrocardiographic changes. GBCK25 significantly prevented the decrease in hemodynamic parameters and ameliorated the electrocardiographic abnormality. These results indicate that GBCK25 has distinct cardioprotective effects in rat heart.

The effect of puberty on diurnal sodium regulation.

The aim of this study was to investigate the impact of sex and puberty stage on circadian changes in sodium excretion, sodium-regulating hormones, and hemodynamics. Thirty-nine healthy volunteers (9 prepuberty boys, 10 prepuberty girls, 10 puberty boys, and 10 puberty girls) were included. They all underwent a 24-h circadian in-patient study under standardized conditions regarding activity, diet, and fluid intake. Blood samples were drawn every 4 h, and the urine was collected in fractions. Blood pressure and heart rate were noninvasively monitored. Atrial natriuretic peptide (ANP), angiotensin II, aldosterone, and renin were measured in blood. Children in puberty had lower plasma levels of renin (P<0.05) and angiotensin II (P<0.05) and a 26% reduction in filtered sodium without changes in sodium excretion compared with prepuberty children. A circadian rhythm in sodium excretion, the renin-angiotensin system, ANP, and blood pressure was found with a midnight ANP peak (P<0.001), a nighttime decrease in hemodynamic parameters (P<0.001), an increase in plasma renin (P<0.001) and angiotensin II (P<0.001), and a decrease in sodium excretion (P<0.001) mainly on the basis of increased sodium reabsorption (P<0.001). The timing of the changes did not depend on sex or puberty group. There is a circadian rhythm of sodium excretion and sodium regulation in 7- to 15-yr-old children. This rhythm is similar in boys and girls. As an important new finding, puberty changes the plasma levels of renin and angiotensin II without changing the amount of sodium excreted or the day to night sodium excretion ratio.

Cardiopulmonary Arrest and Resuscitation in Severe Sepsis and Septic Shock: A Research Model.

Cardiopulmonary resuscitation in patients with severe sepsis and septic shock is challenging and usually unsuccessful. The aim of the present study is to describe our swine model of cardiac arrest and resuscitation in severe sepsis and septic shock. In this prospective randomized animal study, 10 healthy female Landrace-Large White pigs with an average weight of 20 ± 1 kg (aged 19 - 21 weeks) were the study subjects. Septicemia was induced by an intravenous infusion of a bolus of 20-mL bacterial suspension in 2 min, followed by a continuous infusion during the rest of the experiment. After septic shock was confirmed, the animals were left untreated until cardiac arrest occurred. All animals developed pulseless electrical activity between the fifth and sixth hours of septicemia, whereas five (50%) of 10 animals were successfully resuscitated. Coronary perfusion pressure was statistically significantly different between surviving and nonsurviving animals. We found a statistically significant correlation between mean arterial pressure and unsuccessful resuscitation (P = 0.046), whereas there was no difference in end-tidal carbon dioxide (23.05 ± 1.73 vs. 23.56 ± 1.70; P = 0.735) between animals with return of spontaneous circulation and nonsurviving animals. During the 45-min postresuscitation monitoring, we noted a significant decrease in hemodynamic parameters, although oxygenation indices and lactate clearance were constantly increased (P = 0.001). This successful basic swine model was for the first time developed and may prove extremely useful in future studies on the periarrest period in severe sepsis and septic shock.

Effect of naringin on hemodynamic changes and left ventricular function in renal artery occluded renovascular hypertension in rats.

Background:Renal artery occlusion (RAO) induced hypertension is a major health problem associated with structural and functional variations of the renal and cardiac vasculature. Naringin a flavanone glycoside derived possesses metal-chelating, antioxidant and free radical scavenging properties.Objective:The objective of this study was to investigate the antihypertensive activity of naringin in RAO induced hypertension in rats.Material and Methods:Male Wistar rats (180-200 g) were divided into five groups Sham, RAO, naringin (20, 40 and 80 mg/kg). Animals were pretreated with naringin (20, 40 and 80 mg/kg p.o) for 4 weeks. On the last day of the experiment, left renal artery was occluded with renal bulldog clamp for 4 h. After assessment of hemodynamic and left ventricular function various biochemical (superoxide dismutase [SOD], glutathione [GSH] and malondialdehyde [MDA]) and histological parameters were determined in the kidney.Results:RAO group significantly (P < 0.001) increased hemodynamic parameters at 15, 30 and 45 min of clamp removal. Naringin (40 and 80 mg/kg) treated groups showed a significant decrease in hemodynamic parameters at 15 min. after clamp removal that remained sustained for 60 min. Naringin (40 and 80 mg/kg) treated groups showed significant improvement in left ventricular function at 15, 30 and 45 min after clamp removal. Alteration in level of SOD, GSH and MDA was significantly restored by naringin (40 and 80 mg/kg) treatment. It also reduced histological aberration induced in kidney by RAO.Conclusion:It is concluded that the antihypertensive activity of naringin may result through inhibition of oxidative stress.

Effect of anticonvulsant therapy for absence epilepsy on heart function.

Monitoring of the heart status during increasing stress-induced load allowed us to evaluate heart function after treatment of absence epilepsy with anticonvulsants of various types of action. Functional load against the background of treatment with lamotrigine or convulex had different effects on the dynamics of heart rate variability, hemodynamic parameters of the heart, and risk of life-threatening arrhythmias. The decrease in hemodynamic parameters and ischemic changes in the myocardium after convulex therapy occurred at a lower functional load associated with more pronounced reduction in parasympathetic tone and heart rate variability than after lamotrigine therapy. This suggests that the heart of animals treated with convulex has lower functional capacities and, therefore, stress-induced decompensation and prenosological status developed earlier.

Patient Controlled Epidural Labour Analgesia (PCEA): A Comparison Between Ropivacaine, Ropivacaine-Fentanyl and Ropivacaine-Clonidine.

Feeling of pain is one of the most important emotional determinants which dominate the perception of females who undergo the process of labour and delivery. Patient controlled epidural labour analgesia (PCEA) is convenient and safer technique for this purpose. Very few studies compared clonidine and fentanyl with ropivacaine in labour analgesia in past. This study was undertaken to compare fentanyl and clonidine in PCEA. To compare low concentration ropivacaine with or without fentanyl or clonidine for labour analgesia and its effect on maternal and foetal safety. Prospective, double blind, randomized, comparative study. Ninety primegravida in labour were divided into three groups (n=30) and patient controlled epidural labour analgesia was given to them: Initial bolus of 10ml of ropivacaine 0.125% in Group I; with fentanyl 2 μg/ml in Group II and with clonidine 1μg/kg in Group III. Subsequently each group received ropivacaine 0.125% through patient controlled epidural analgesia (PCEA) as background infusion of 5 ml/hr with lockout interval time of 10min and subsequent bolus of 5ml. Hemodynamic parameters, sensory level, motor block and pain relief were noted. Total analgesic dose of local anaesthetic and feto-maternal adverse effects were also recorded. At baseline, groups were matched demographically, hemodynamically as well as for intensity of pain. There was a statistically significant decrease in hemodynamic parameters from baseline in all groups with maximum reduction in group III. A significant difference among groups in VAS was observed at zero min and from 120min till 240min intervals and lowest values were in Group III. No significant difference was observed among the groups for mode of delivery and expulsive efforts. Total analgesic dose and PCA bolus requirement was maximum in Group I and minimum in Group III and the difference was statistically significant among groups. Six (20%) patients had shivering in Group II and hypotension was recorded in only 1 (3.3%) patient of Group III. Ropivacaine 0.125% was effective in decreasing labour pain without any motor blockade. Clonidine 1μg/kg was superior to fentanyl 2μg/ml as an adjuvant in PCEA for labour without any significant feto-maternal adverse effects.

Ginsenoside-Re ameliorates ischemia and reperfusion injury in the heart: a hemodynamics approach

Ginsenosides are divided into two groups based on the types of the panaxadiol group (e.g., ginsenoside-Rb1 and -Rc) and the panaxatriol group (e.g., ginsenoside-Rg1 and -Re). Among them, ginsenoside-Re (G-Re) is one of the compounds with the highest content in Panax ginseng and is responsible for pharmacological effects. However, it is not yet well reported if G-Re increases the hemodynamics functions on ischemia (30 min)/reperfusion (120 min) (I/R) induction. Therefore, in the present study, we investigated whether treatment of G-Re facilitated the recovery of hemodynamic parameters (heart rate, perfusion pressure, aortic flow, coronary flow, and cardiac output) and left ventricular developed pressure (±dp/dtmax). This research is designed to study the effects of G-Re by studying electrocardiographic changes such as QRS interval, QT interval and R-R interval, and inflammatory marker such as tissue necrosis factor-α (TNF-α) in heart tissue in I/R-induced heart. From the results, I/R induction gave a significant increase in QRS interval, QT interval and R-R interval, but showed decrease in all hemodynamic parameters. I/R induction resulted in increased TNF-α level. Treatment of G-Re at 30 and 100 μM doses before I/R induction significantly prevented the decrease in hemodynamic parameters, ameliorated the electrocardiographic abnormality, and inhibited TNF-α level. In this study, G-Re at 100 μM dose exerted more beneficial effects on cardiac function and preservation of myocardium in I/R injury than 30 μM. Collectively, these results indicate that G-Re has distinct cardioprotectective effects in I/R induced rat heart.

Dexmedetomidine Causes Increased Hypotension in Older Adults When Used for Cataract Surgery Compared to Propofol

Purpose: This study evaluated the hemodynamic effects, suitability and safety of dexmedetomidine (DEX) compared with propofol (PRO) in older adults having outpatient cataract surgery under monitored anesthesia care. The patients, surgeon and the anesthesia staff evaluated satisfaction for both drugs.Method: This prospective, single blind, randomized study was conducted using forty-seven patients ≥55 years old undergoing cataract surgery. The two patient groups received either i.v. dexmedetomidine 1 μg/kg over 10 min; followed by maintenance i.v. infusion at 0.2 -0.7 μg/kg/hr (DEX group, N = 24), or propofol infused between 25 -120 μg/kg/min (PRO group, N = 23). Both agents were titrated to patient comfort. Results: Patients’ mean arterial pressures (SEM) at baseline were 104.7 (2.6) and 107.5 (2.7) mmHg for the DEX and PRO groups, respectively (p = 0.45). At discharge the pressures were 78.1 (2.5) and 98.1 (2.6) mmHg in DEX and PRO groups, respectively (p 0.05). Patients’ heart rates (SEM) at baseline were 74.8 (3.0) for the DEX group and 73.2 (2.8) bpm for the PRO groups (p = 0.71). At the time of discharge following surgery, the mean heart rate for the DEX group was 61.5 (2.2) bpm vs. 69.1 (2.3) bpm (p 0.05) for the PRO group. Three patients in the DEX group developed complications precluding discharge or requiring readmission while none of the patience in the PRO group had complications (p = 0.08). Patient and surgeon satisfaction scores were similar between the groups. Conclusion: Dexmedetomidine is a less suitable sedative compared with propofol use in older patients undergoing cataract surgery due to the decrease in hemodynamic parameters and noted increases in complication rates.

Autonomic Response During Bladder Hydrodistention in Patients with Bladder Pain Syndrome

We determined whether patients with bladder pain syndrome who have typical interstitial cystitis endoscopic findings, including glomerulations and/or Hunner ulcer, have a distinct autonomic response during bladder hydrodistention. Included in the study were 50 consecutive patients (40 females and 10 males) who met International Society for the Study of BPS recommendations. All patients underwent the same clinical evaluation, consisting of medical history, physical examination, urine and blood tests, urine cytology and culture, urinary tract ultrasound and urodynamics. Bladder hydrodistention and biopsies were performed using general anesthesia. Systolic and diastolic blood pressure, and heart rate were recorded after the induction of general anesthesia and at the end of the filling phase. Patients were divided into 2 groups, including patients with and without typical endoscopic findings, respectively. Clinical, histological and urodynamic variables, and autonomic parameters were compared between the 2 groups. No significant differences in demographics, symptoms, pain severity, comorbidities, previous surgery, urodynamic variables, anesthetic bladder capacity or histological findings were found between the 2 groups. In patients with endoscopic findings average ± SD systolic and diastolic blood pressure increased by 25 ± 19 and 21 ± 12 mm Hg, respectively, and average heart rate increased by 12 ± 11 beats per minute. All hemodynamic changes were statistically significant (p <0.001). In patients without endoscopic findings a minor decrease in hemodynamic parameters was observed. Patients with bladder pain syndrome who have typical interstitial cystitis findings on endoscopy show a marked autonomic response during bladder hydrodistention, consisting of an increase in heart rate, and systolic and diastolic blood pressure.

Amelioration of cardio-respiratory perturbations following Mesobuthus eupeus envenomation in anesthetized rabbits with commercial polyvalent F(ab′)2 antivenom

Immunotherapy is the only specific treatment for scorpion sting. In the present study, protective effects of polyvalent antivenom against hemodynamic disturbances, biomarkers (troponin T, creatinine kinase isoenzyme MB, Lactate dehydrogenase) changes, electrocardiogram abnormalities and histopathological complications in heart and lung induced by Mesobuthus eupeus scorpion venom was investigated in anesthetized rabbits. Twenty four rabbits were randomized into four equal groups: six rabbits in control group received 1 ml ultra-pure water subcutaneously (group 1). Group two received LD50 of venom (4.5 mg/kg). In the third and fourth groups, 5 ml of scorpion antivenom was administrated intravenously simultaneous with venom injection and 60 min following envenomation, respectively. Results of the present study indicate significant decrease in hemodynamic parameters following envenomation in the second group of animals. Venom injection caused edema, myocytolysis, coagulation necrosis, hemorrhage in heart as well as edema, hemorrhage and vascular thrombus in lungs. Although envenomed rabbits presented rises in LDH and TnT but no alteration in CK-MB was observed. Electrocardiogram monitoring of rabbits showed ST elevation and inverted T waves. Simultaneous administration of antivenom and venom prevented entirely the clinical signs, hemodynamic disturbances, markers changes, ECG abnormalities and histopathological damages. Delayed immunotherapy gradually ameliorated clinical signs, hemodynamic disturbances and markers changes related to envenomation. Histopathological evaluation showed slight alterations such as mild myocytolysis in heart and mild edema in lung following delayed immunotherapy. In conclusion, scorpion antivenom administration has preventive, neutralizing and curative properties for M. eupeus scorpion envenomation, if it would be applied at optimum time, dose and route.

Hemodynamic and hormonal changes during pneumoperitoneum and trendelenburg positioning for operative gynecologic laparoscopy surgery

Objective: The number and types of surgical procedures being preformed using laparoscopic technique is increasing due to technological advances. Recent studies suggest the carbon dioxide pneumoperitoneum and patient positioning causes hemodynamic alterations, respiratory acidosis, and a release of stress hormones. However, to date, no studies have investigated the physiological effect of laparoscopic procedures lasting more than 60 minutes on the stress response and the effect of Trendelenburg positioning. The purpose of this study was to identify the physiological effect of pneumoperitoneum and positioning during prolonged laparoscopy on hemodynamic (cardiac index, mean arterial pressure, heart rate, systemic vascular resistance, and stroke volume), metabolic (arterial blood gases), and hormone (arginine vasopressin, aldosterone, and plasma renin activity) parameters. We hypothesized that pneumoperitoneum and patient positioning will alter the hemodynamic, hormone, and metabolic parameters. Methods: The study was longitudinal in design and sampled a total of 31 healthy subjects having a gynecologic oncologic laparoscopic procedure at Hurley Medical Center, Flint, Michigan. The subjects were randomly assigned one of three groups receiving an initial insufflation pressure of either 10, 15, or 18 mmHg. After obtaining informed consent hemodynamic, metabolic, and hormone measurements were obtained at the following times: 1) pre-induction, 2) post-induction, 3) post-insufflation, 4) post-Trendelenburg 5 minutes and at 30, 60, 90, and 120 minutes post-insufflation. The results were analyzed using multivariate analysis of variance for repeated measures with a P < .05. A power of 0.9 was obtained to identify changes over time. Results: During the time course of the study the hemodynamic, metabolic, and hormonal parameters showed significant alterations. The most dramatic hemodynamic changes occurred post-insufflation characterized by a decrease in cardiac index and stroke volume with a concurrent increase in systemic vascular resistance. The metabolic parameters showed a significant decrease in pH and corresponding increase in Pa co 2. However, the pH and Pa co 2 remained within normal limits through the study. As part of the study’s protocol the investigators increased minute volume to control for a rise in Pa co 2 during the procedure. A significant increase was noted in aldosterone and arginine vasopressin at post-insufflation and Trendelenburg positioning. Plasma renin activity showed a dramatic increase following post-insufflation. None of the subjects developed any post anesthetic complications. Conclusion: Our study demonstrated that pneumoperitoneum and Trendelenburg positioning cause statistically significant elevations in the stress hormones and concurrently cause a decrease in hemodynamic parameters. A healthy patient may tolerate these changes but a patient with cardiovascular disease or pulmonary problems may not be able to compensate as efficiently.