Decrease In HR Research Articles

Analgesic Efficacy and Safety of Ultrasound Guided Scalp Nerve Blocks in Supratentorial Craniotomies: A Randomized Controlled Trial

Abstract Background Multimodal analgesia is considered the cornerstone in controlling intraoperative and post operative pain in patients undergoing brain surgeries. A good control of strong noxious stimulations in supratentorial craniotomies allows a maintenance of an intraoperative hemodynamic stability and a post operative pain relief. Scalp sensory nerve block is considered one of the multimodal techniques to control intra and post operative pain, preventing the increase in intracranial pressure (ICP) and hypertension, which may be harmful, especially for patients with cerebral aneurysms. Also decreasing systemic analgesia and opioid that may alter conscious level of the patients allows better assessment and examination after surgery. Objective To compare the analgesic efficacy and safety of ultrasound use in performing scalp sensory nerve block compared to blind classical infiltration technique. Methods This randomized prospective controlled trial was conducted on 40 randomly chosen patients American Society of Anesthesiologists (ASA) class I or II scheduled for elective supratentorial craniotomy (supratentorial mass lesion or aneurysm clipping) under general anesthesia in Ain Shams University Hospitals after approval of the medical ethical committee. Results Intraoperative hemodynamic monitoring showed that there was a statistically significant decrease in HR, SINBP values in SBU group at time of skin incision (SI) compared to baseline values (before performing scalp block). Also Rates of both propofol and Fentanyl consumption showed a statistically significant decrease in SBU group at all time points of concern compared to baseline values. Postoperatively, patients received ultrasound guided scalp block had significantly lower pain scores after operation, with a significant increase in time for rescue analgesia and significant decrease in total amount of morphine needed in the first 24 hr post-operative compared to patients who received blind scalp block by local infiltration. Conclusion Ultrasound use in performing scalp block, is considered of choice for maintaining patient safety, intraoperative hemodynamic control and enhancing post-operative recovery.

Implementing a Pulmonary Telerehabilitation Program for Young Adults with Post-COVID-19 Conditions: A Pilot Study.

Several studies have shown that pulmonary telerehabilitation (PTR) improves respiratory capacity. However, there is little evidence of its effectiveness in youth with post-COVID-19 conditions (PCC). This study analyzed the effects of a PTR program on young adults with PCC. Sixteen youths were randomly assigned to a control group (CG) or an experimental group (EG), with eight participants each. The EG participated in a PTR program that included twelve remote, asynchronous four-week sessions with diaphragmatic breathing and aerobic exercises. Vital signs (SpO2, HR, RR, BP), physical capacity (sit-to-stand test), cardiorespiratory capacity (6-Minute Walk Test), and perceived exertion (Borg scale) were assessed in both groups. Statistical analyses showed a significant decrease in RR and HR (p < 0.012) and an increase in SpO2 (p < 0.042), physical (p < 0.012), and respiratory (p < 0.028) capacity. Perceived effort decreased significantly in both groups (CG: p < 0.006; EG: p < 0.001) only for physical but not for cardiorespiratory capacity (p < 0.106). There were no statistical changes registered in BP (p > 0.05). The PTR program, which includes respiratory and aerobic exercises, is feasible and effective in improving physical and cardiorespiratory capacity in young people with PCC, as well as reducing HR, RR, and dyspnea.

Effect of Sacubitril / Valsartan Combination on Abnormal ECG Findings in Patients with Heart Failure with Reduced Ejection Fraction

Abstract Background The mortality rate of patients suffering from choronic heart failure is still high despite advantages in diagnosis and treatment. A new therapeutic class of agents acting on the renin angiotensin aldosterone system (RAAS) and neutral endopeptidase system has been developed, known as angiotensin receptor neprilysin inhibitors (ARNI). Recently, promising data from its administration have demonstrated a decrease in the mortality rate as compared to angiotensin receptor blocker alone. Aim of the Work The aim of this study is to asses effect of Sacubitril/Valsartan combination on abnormal ECG and ECHO parameters in patients with heart failure with reduced ejection fraction as a marker of reverse cardiac remodeling. Patients and Methods Our study was conducted at Ain Shams university hospitals and our target population was heart failure patients with reduced ejection fraction planned to initiate Sacubitril \ Valsartan combination therapy. 100 patients were collected from February 2022 to August 2022. It was an interventional study to follow up the effects of the drug on ECG parameters besides ECHO parameters 6 months after drug initiation. Results We found that in Sacubitril/Valsartan combination therapy there was significant decrease in HR, QRS width and QTc values which reflects the role of this combination to reduce ventricular arrhythmias and preventing SCD. There was significant increase in the EF which was correlated to the significant decrease in QRS width. There was significant improvement in diastolic dysfunction. There was significant decrease in the LA and LV dimensions giving an explanation of the role of the drug in reverse cardiac remodeling. There was significant improvement in NYHA class reflecting the role of the drug in improving quality of life. Conclusion HR, QRS width and QTc were significantly decreased with Sacubitril/Valsartan combination therapy through the follow up period reflecting the effect of the drug on ECG. EF, LA dimension and LVID were improving with Sacubitril/Valsartan combination therapy through the follow up period which give an explanation of the combination therapy for its role in reverse cardiac remodeling. NYHA class of our patients was improving through follow up period which means this drug improves quality of life and reduces hospitalization.

Transcutaneous vagal nerve stimulation during lower body negative pressure

BackgroundPara-sympathetic vagal activation has profound influence on heart rate and other cardiovascular parameters. We tested the hypothesis that transcutaneous Vagal Nerve Stimulation (tVNS) through the auricular branch of the vagus nerve would attenuate the normal sympathetic response to central blood volume reduction by lower body negative pressure (LBNP). Method10 healthy volunteers (6 female; age 21 ± 2 years; weight 62 ± 13 kg; height 167 ± 12 cm) were included in this cross-over design trial. After 15 min rest in supine position, subjects underwent three 15-min periods of 30 mmHg LBNP intervention with and without cyclic tVNS stimulation. Continuous cardiovascular parameters (Nexfin) were recorded. ResultsOverall tVNS did not convincingly attenuate sympathetic response to central hypovolemia. Deactivation of the tVNS during LBNP resulted in increased MAP at 2.3 ± 0.5 mmHg (P < 0.001). Comparing the cyclic actual active stimulation periods to periods with pause during tVNS intervention showed a decrease in HR by 72.9 ± 11.2 to 70.2 ± 11.6 bpm (mean ± SD; P < 0.05), and concomitant increases in SV (86.0 ± 12.1 to 87.2 ± 12.6 mL; P < 0.05), MAP (82.9 ± 6.3 to 84.0 ± 6.2 mmHg; P < 0.05) and TPR (1116.0 ± 111.1 to 1153 ± 104.8 dyn*s/cm5; P < 0.05). ConclusiontVNS in 30 s cycles during LBNP can selectively attenuate HR, prompting a compensatory augmented sympathetic response. It would appear the method used in this study at least, has an isolated cardiac inhibitory effect probably mediated by augmented vagal activity on the sinoatrial or atrio-ventricular node, possibly in combination with reduced activity in the sympathetic cardiac nerve.

Cardiovascular Autonomic Control During Hibernation in American Black Bears

The dramatic early decrease in HR upon entry into torpor in small hibernators has recently been shown to be associated with a marked increase in cardiac parasympathetic activity as indicated by increased short term beat to beat heart rate variability (RMSSD) normalized to average R-R interval (RMDSSD/RR, Zanetti et al 2023). At steady state torpor, as their body temperature drop to ~2°C, small hibernators benefit from the Q10 effect on cardiac pacemaker cells in maintaining a low HR with a reduced parasympathetic activity. Black bears in hibernation maintain body temperatures between 30-35°C while suppressing metabolism by 75% and with a marked decrease in HR from non-hibernating 55 bpm to hibernating 6-12 bpm including extreme respiratory sinus arrhythmia (Tøien et al 2011). As hibernating bears would not significantly benefit from the Q10 effect on cardiac pacemaker cells to sustain a low HR, we hypothesized that an elevated cardiac parasympathetic tone is needed to suppress HR. Continuous electrocardiogram (ECG) and blood pressure (BP) were recorded with implantable telemetry transmitters (DSI D70-CCP/EET and Konigsberg T28F-14B) in American black bears. A Pan-Tomkins algorithm modified for R-wave detection with long R-R intervals followed by visual inspection was used for the analysis. RMDSSD/RR for a 2 hour period in mid hibernation with no activity was 3 times higher than that during the resting phase in non-hibernation (0.68 vs. 0.23, n=10 and 7 respectively, p&lt;0.001), confirming the presence of a high parasympathetic tone during hibernation. HR decreased from 68.3 ± 5.8 bpm to 12.9 ± 0.9 bpm (±SE, p&lt;0.0001). RMSSD/RR during a 10 min period recovering from anesthesia (Telazol with supplemental Ketamin) during hibernation in mid March was only 0.019 ± 0.008 vs 0.58 ± 0.14 during a 10 min period before disturbance to induce anesthesia and HR 87.0 ± 8.7 b/min vs. 16.3 ± 1.4 b/min, demonstrating a parasympatholytic effect (n=6, p&lt; 0.0006). The longest R-R intervals during extreme sinus arrhythmia detected in mid hibernation ranged from 11.8 to 33.0 s (Mean 19.0 ± 2.7, n=21). BP typically increased to above 200 mmHg during periods of rapid heart beats, and decayed slowly to 50-60 mmHg at the end of the longest R-R intervals. Analysis of data from a single bear from 2 hour periods at 2 week intervals throughout hibernation and recovery indicates that a high parasympathetic activity is maintained throughout hibernation and strongly correlated to the maximum observed R-R interval. We conclude that opposed to small hibernators, hibernating bears sustain low HR in hibernation with high parasympathetic activity controlling the extreme sinus arrhythmia. We suggest that BP is maintained during long R-R intervals by peripheral vasoconstriction. Supported by NIH COBRE grant number [P20GM130443]. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Abstract P299: Alteration of Cardiac Autonomic Function Through Inhalation of Biogenic Volatile Organic Compounds

Background: There is an inverse relationship between exposure to greenspaces and prevalence of cardiovascular disease and cardiovascular disease risk factors. More specifically, green exposure is associated with electrocardiogram (ECG) changes, suggesting a potential alteration of cardiac autonomic balance. One proposed mechanism by which cardiac autonomic balance may be altered is a direct physiologic effect of inhalable plant derived compounds, or biogenic volatile organic compounds (bVOCs), including limonene, α- and β-pinene which are commonly released from vegetation. Therefore, we examined the relationship between acute exposure of isolated bVOCs and cardiac autonomic tone. Hypothesis: We hypothesize that controlled exposure to isolated individual bVOCs will decrease cardiac sympathetic tone. Methods: Under controlled conditions after a bVOC washout period, healthy adults ages 18-70 were exposed to limonene (n=32), α-pinene (n=24), β-pinene (n=17), and a control (room air, n=9). Exposure consisted of one inhalation every 30 seconds for a total of 5 minutes (10 inhalations total). Pre- and post-exposure measurements of supine heart rate variability (HRV) were conducted following a 10-minute rest period. HRV was analyzed using a clean, 5-minute epoch with &gt;95% effective data length. Statistical analysis was performed using paired t-tests to determine changes in HR and HRV. Significance level was set at p&lt;0.05, a priori . Results: Our population was primarily female (56%, 18 of 32), white (53%, 17 of 32), high income (47%, 15 of 32), and had an education higher than a 4-year degree (62.5%, 20 of 32). There were significant decreases in HR when exposed to limonene (pre: 64.87±9.86bpm vs. post: 63.26±9.10bpm, p&lt;.001) and α-pinene (pre: 63.98±9.32bpm vs. post: 61.64±9.72bpm, p=.008), along with trends seen in β-pinene (pre: 65.78±10.60bpm vs. post: 63.74±9.65bpm, p=.066). Control exposure showed no difference (pre: 65.40±8.38bpm vs. post: 64.14±9.35bpm, p=.301). Normalized low- (LF) and high-frequency (HF) HRV parameters showed no change across isolated bVOCs, however the LF/HF ratio scores decreased significantly following β-pinene exposure (pre: 1.62±1.69 vs. post: 0.96±0.96, p=.039). HRV time-domain parameters RMSSD and SDNN did not change following isolate exposure. Conclusions: Post-exposure decreases in HR and LFHF ratios indicate the potential for cardiovascular disease risk reduction from bVOC exposure leading to decreased sympathetic tone. Additional work is required to determine the mechanism of exposure-related changes.

Comparison of esketamine versus dexmedetomidine for attenuation of cardiovascular stress response to double-lumen tracheal tube intubation: a randomized controlled trial.

The insertion of a double-lumen tracheal tube may cause a transient but more intense sympathetic response. We examined the effects of esketamine vs. dexmedetomidine as an adjuvant to anesthesia induction to blunt double lumen tracheal (DLT) intubation induced cardiovascular stress response. In a randomized, double-blind trial, 78 adult patients scheduled for elective thoracotomy under general anesthesia requiring DLT intubation were enrolled. The patients were randomly divided into three groups: each group received one of the following drugs prior to induction of anesthesia: dexmedetomidine 0.8 µg/kg (Group A), esketamine 0.5 mg/kg (Group B), or normal saline (group C). The primary outcome was the incidence of a DLT intubation-related cardiovascular stress response, defined as an increase in mean arterial pressure or heart rate of >30% above the baseline values. The secondary outcomes were changes in hemodynamic and cardiac function. The incidence of the response to cardiovascular stress was 23.1%, 30.8%, and 65.4% in groups A, B, and C, respectively. There was a significant decrease in intubation response in groups A and B in comparison with group C (P < 0.01); however, there was no significant difference between group A and group B (P > 0.05). Following the drug infusion and the induction of anesthesia, there was a significant decrease in HR and cardiac output in group A compared with group B. In contrast, no significant differences were observed in the left ventricular ejection fraction or in stroke volume between the three groups during induction of anesthesia. Esketamine 0.5 mg/kg and dexmedetomidine 0.8 µg/kg attenuate cardiovascular stress responses related to DLT intubation. As adjuvants to etomidate induction, they do not impair cardiac function (ChiCTR1900028030).

The Effect of Udenafil on Heart Rate and Blood Pressure in Adolescents With the Fontan Circulation

The Fontan Udenafil Exercise Longitudinal (FUEL) trial showed that treatment with udenafil was associated with improved exercise performance at the ventilatory anaerobic threshold in children with Fontan physiology. However, it is not known how the initiation of phosphodiesterase 5 inhibitor therapy affects heart rate and blood pressure in this population. These data may help inform patient selection and monitoring after the initiation of udenafil therapy. The purpose of this study is to evaluate the effects of udenafil on vital signs in the cohort of patients enrolled in the FUEL trial. This international, multicenter, randomized, double-blind, placebo-controlled trial of udenafil included adolescents with single ventricle congenital heart disease who had undergone Fontan palliation. Changes in vital signs (heart rate [HR], systolic [SBP] and diastolic blood pressure [DBP]) were compared both to subject baseline and between the treatment and the placebo groups. Additional exploratory analyses were performed to evaluate changes in vital signs for prespecified subpopulations believed to be most sensitive to udenafil initiation. Baseline characteristics were similar between the treatment and placebo cohorts (n=200 for each). The groups demonstrated a decrease in HR, SBP, and DBP 2 hours after drug/placebo administration, except SBP in the placebo group. There was an increase in SBP from baseline to after 6-min walk test in the treatment and placebo groups, and the treatment group showed an increase in HR (87.4 ± 15.0 to 93.1 ± 19.4 beats/min, p <0.01) after exercise. When comparing changes from baseline to the 26-week study visit, small decreases in both SBP (-1.9 ± 12.3 mm Hg, p=0.03) and DBP (-3.0 ± 9.6 mm Hg, p <0.01) were seen in the treatment group. There were no clinically significant differences between treatment and placebo group in change in HR or blood pressure in the youngest age quartile, lightest weight quartile, or those on afterload-reducing agents. In conclusion, initiation of treatment with udenafil in patients with Fontan circulation was not associated with clinically significant changes in vital signs, implying that for patients similar to those enrolled in the FUEL trial, udenafil can be started without the requirement for additional monitoring after initial administration.

Perioperative advanced haemodynamic monitoring of patients undergoing multivisceral debulking surgery: an observational pilot study

BackgroundPatients undergoing high-risk surgery show haemodynamic instability and an increased risk of morbidity. However, most of the available data concentrate on the intraoperative period. This study aims to characterise patients with advanced haemodynamic monitoring throughout the whole perioperative period using electrical cardiometry.MethodsIn a prospective, observational, monocentric pilot study, electrical cardiometry measurements were obtained using an Osypka ICON™ monitor before surgery, during surgery, and repeatedly throughout the hospital stay for 30 patients with primary ovarian cancer undergoing multivisceral cytoreductive surgery. Severe postoperative complications according to the Clavien–Dindo classification were used as a grouping criterion.ResultsThe relative change from the baseline to the first intraoperative timepoint showed a reduced heart rate (HR, median – 19 [25-quartile − 26%; 75-quartile − 10%]%, p < 0.0001), stroke volume index (SVI, − 9.5 [− 15.3; 3.2]%, p = 0.0038), cardiac index (CI, − 24.5 [− 32; − 13]%, p < 0.0001) and index of contractility (− 17.5 [− 35.3; − 0.8]%, p < 0.0001). Throughout the perioperative course, patients had intraoperatively a reduced HR and CI (both p < 0.0001) and postoperatively an increased HR (p < 0.0001) and CI (p = 0.016), whereas SVI was unchanged. Thoracic fluid volume increased continuously versus preoperative values and did not normalise up to the day of discharge. Patients having postoperative complications showed a lower index of contractility (p = 0.0435) and a higher systolic time ratio (p = 0.0008) over the perioperative course in comparison to patients without complications, whereas the CI (p = 0.3337) was comparable between groups. One patient had to be excluded from data analysis for not receiving the planned surgery.ConclusionsSubstantial decreases in HR, SVI, CI, and index of contractility occurred from the day before surgery to the first intraoperative timepoint. HR and CI were altered throughout the perioperative course. Patients with postoperative complications differed from patients without complications in the markers of cardiac function, a lower index of contractility and a lower SVI. The analyses of trends over the whole perioperative time course by using non-invasive technologies like EC seem to be useful to identify patients with altered haemodynamic parameters and therefore at an increased risk for postoperative complications after major surgery.

Phenylephrine and norepinephrine increase blood pressure through opposing physiologic mechanisms in isoflurane-anesthetized dogs receiving acepromazine.

To elucidate the cardiovascular effects of escalating doses of phenylephrine and norepinephrine in dogs receiving acepromazine and isoflurane. 8 beagles aged 1 to 2 years (7.4 to 11.2 kg). All dogs received acepromazine 0.01 mg/kg, propofol 4 to 5 mg/kg, and isoflurane and were mechanically ventilated. Mean arterial pressure (MAP) from a femoral artery catheter and continuous electrocardiogram were recorded. Cardiac output (CO) was measured with transpulmonary thermodilution. Systemic vascular resistance (SVR), global end-diastolic volume (GEDV), and global ejection fraction (GEF) were subsequently calculated. Phenylephrine and norepinephrine were infused in random order at 0.07, 0.3, 0.7, and 1.0 μg/kg/min. All variables were measured after 15 minutes of each infusion rate. The effects of dose, agent, and their interaction on the change of each variable were evaluated with mixed-effect models. A P < .05 was used for significance. Atrial premature complexes occurred in 3 dogs during norepinephrine infusion at doses of 0.3, 0.7, and 1 μg/kg/min; no dysrhythmias were seen with phenylephrine administration. MAP increased during dose escalation (P < .0001) within each agent and did not differ between agents (P = .6). The decrease in HR was greater for phenylephrine (P < .0001). Phenylephrine decreased CO and GEF and increased GEDV and SVR (all P < .03). Norepinephrine decreased the SVR and increased CO, GEDV, and GEF (all P < .03). Our results confirm that phenylephrine increases arterial pressures mainly through vasoconstriction in acepromazine-premedicated dogs while norepinephrine, historically considered a vasopressor, does so primarily through an increase in inotropism.

Abstract 088: Modulatory Effects Of The Gut Microbiota-derived Short Chain Fatty Acids On Heart Rate And Vascular Tone In Larval Zebrafish

Introduction: Short chain fatty acids (SCFAs), such as acetic, propionic, and butyric acid, areproduced by fermentation of dietary fibers by the gut bacteria. Deregulation in production andhandling of SCFAs is associated with cardiovascular dysfunction in humans and rodents.However, limited studies have investigated the effect of SCFAs on cardiovascular parameters inthe zebrafish (ZF), an increasingly popular model in cardiovascular and gut microbiota research. Methods: Bacterial 16s sequencing and GC-MS were performed in adult male and female Tg(NFkB:EGFP) ZF fecal samples for analysis of the gut microbiota and SCFAs respectively. Inanaesthetized ZF larvae (7-9 dpf; MS-222, 0.3mM), measurements of heart rate (HR, bpm) andvascular tone (width of dorsal aorta, pixels) were performed every 10 minutes for an hour usinglive imaging (Nikon, 4x magnification) following administration of physiologic concentrations ofacetate (27.4 μM), butyrate (2.2 μM) and propionate (1.7 μM; pH=7.5) via immersion. Results: Relative proportions of SCFAs in the ZF were similar to those previously reported in rats andhumans, with highest levels of acetic acid (27.43 μM) followed by butyric (2.19 μM) and propionic(1.65 μM) acid. At the phylum level, the observed abundances of Proteobacteria, Firmicutes, andFusobacteria were similar to those reported in rodents and humans. Administration of selectSCFAs resulted in a ~20% decrease in HR at all time points following administration of butyrate(P&lt;0.0001), and at 40-60min following administration of acetate (P&lt;0.05), with no effect ofpropionate. In addition, a ~25% decrease in the width of the dorsal aorta was observed at 60 minfollowing administration of butyrate (P&lt;0.05), with no effect of acetate or propionate. Conclusion: We report a similar composition and abundances of the gut microbiota and SCFAs between ZF,rodents and humans. In addition, both butyrate and acetate produced a bradycardia in the ZF,while the observed butyrate-dependent decrease in the vascular tone may be compensatory tobradycardia. Our findings demonstrate the potential for ZF as a model to study host-microbiotainteractions in regulation of cardiovascular function.

A prospective randomized comparative analysis between opioid based anaesthesia vs opioid free anaesthesia on depth of anaesthesia and intraoperative hemodynamics in patients undergoing elective laparoscopic surgeries lasting less than 3 hours

To avoid the adverse effects of opioid usage, an opioid-free multimodal approach for analgesia can be applied. This study was conducted with an aim to compare the effect of opioid-free anesthesia (dexmedetomidine, lignocaine, dexamethasone and ketamine) and opioid-based anesthesia (fentanyl) on maintaining depth of anaesthesia and intraoperative hemodynamic stability in patients scheduled for Laparoscopic surgeries. We conducted a prospective randomized comparative study on ASA Grade 1 – 2 patients admitted for laparoscopic abdominal surgeries sampling by block Randomization technique with sample size of 60 (30 in each group). In opioid based group, anaesthesia was induced with Inj. Fentanyl 2 mcg/kg before induction while in opioid-free group loading dose of Inj. Dexmedetomidine 1 mcg/kg over 10 min, infusion 0.5 mcg/kg/hr, Inj. Lignocaine 1.5 mg/kg, infusion of 1.5 mg/kg/hr after loading dose, Inj. Dexamethasone 8 mg, Inj. Ketamine 0.5 mg/kg was given. Intraoperatively, the hemodynamic stability and depth of anaesthesia was assessed by measuring the heart rate, blood pressure and BIS values.In the opioid-free group we had few significant decreases in HR and increases in MAP. The depth of anaesthesia was adequate and comparable to the opioid-based group. Hemodynamically, overall heart rates did not vary much between the two groups and the MAP values were higher in the opioid-free group closer to intubation and extubationOpioid-free, multimodal approach can safely replace the single opioid-based approach of anaesthesia management in the conduct of general anaesthesia.

Effects of dexmedetomidine at different dosages on perioperative haemodynamics and postoperative recovery quality in elderly patients undergoing hip replacement surgery under general anaesthesia: a randomized controlled trial

BackgroundDexmedetomidine could provide some advantages to prevent postoperative complications in elderly patients undergoing under general anaesthesia. However, dexmedetomidine inhibits haemodynamics to some extent due to its sympathetic inhibition.ObjectiveTo evaluate the effects of different doses of dexmedetomidine on haemodynamics during surgery and recovery after general anaesthesia in elderly patients undergoing hip replacement.MethodsThis was a prospective randomized double-blind controlled clinical trial. Eligible patients were randomly allocated into comparative groups (normal saline (NS) and midazolam (MD), n = 30) and dexmedetomidine groups at different doses (D0.25/D0.5/D0.75, n = 30). In the D0.25/D0.5/D0.75 groups, dexmedetomidine was administered at different initial loading doses (0.25/0.5/0.75 μg/kg for 15 min) following 0.5 μg/kg/h continuous infusion until the end of the operation. In the MD group, patients were administered 0.03 mg/kg midazolam at the beginning of anaesthesia induction.ResultsCompared to the MD and NS groups, there were significant decreases in MAP in the D0.5 and D0.75 groups at many time points, such as skin incision, end of operation, and from extubation until 30 min after extubation (P < 0.05); there were also significant decreases in HR in the D0.5 and D0.75 groups at time points including anaesthesia induction, end of operation, and from extubation to 2 h after operation (P < 0.05). In the D0.25 group, there were few differences in the changes in MAP and HR compared to the MD and NS groups during the entire perioperative period (P > 0.05). Moreover, the percentage of patients whose MAP and HR decreased > 20% of baseline was higher in the D0.75 and D0.5 groups than that in all other groups. Compared to the NS group, from the beginning to the end of the operation, the 95% confidence interval (CI) of RR for MAP below > 20% of baseline in the D0.5 and D0.75 groups was greater than 1. In particular, the CI of the RR in the D0.75 group was greater than 1 until the patient awoke from general anaesthesia (P < 0.05). In addition, the CI of the RR for HR below > 20% of baseline in the D0.5 group was greater than 1 compared to the NS group at the time of induction and extubation (P < 0.05). There was no significant difference in the possibility of developing hypotension or bradycardia in the MD or D0.25 groups compared to the NS group (P > 0.05). The recovery quality of patients during the post-anaesthesia period was also observed. No differences were observed among all the groups in the time to awakening or extubation after general anaesthesia (P > 0.05). According to the Riker Sedation-agitated Scale, dexmedetomidine significantly alleviated emergency agitation or delirium compared to NS (P < 0.05). In addition, the scores in the D0.5 and D0.75 groups were lower than those in the D0.25 group (P < 0.05).ConclusionDexmedetomidine could alleviate the agitation of elderly patients undergoing hip replacement after intravenous general anaesthesia combined with inhaled sevoflurane without delayed recovery. However, it is necessary to be vigilant about the haemodynamic inhibition of the drug at high dosages throughout the perioperative period. Dexmedetomidine 0.25–0.5 μg/kg as the initial loading dose followed by 0.5 μg/kg/h continuous infusion might provide comfortable recovery after general anaesthesia with slight haemodynamic inhibition.Trail registrationClinicalTrial.gov, No. NCT05567523. Registered 05 October 2022, https://clinicaltrials.gov/ct2/show/NCT05567523?term=NCT05567523&draw=2&rank=1.

Effect of chair yoga on heart rate variability, perceived stress, and sleep quality among nursing professionals from a tertiary care hospital

Introduction and Aim: Health care professionals that provide treatment to individuals most prone to experience sadness and anxiety are experiencing public health difficulties due to the linked elevated death rate brought on by the COVID epidemic. The purpose of this study was to determine how Chair Yoga affected nursing professionals' Heart Rate Variability (HRV), a measure of autonomic functioning, stress level, and sleep quality index. Materials and Methods: The randomized controlled trial was conducted among 60 Nursing professionals in a tertiary care hospital aged &gt;=23 years for a period of 2 months and they were divided into two groups: control (n=30) and intervention (n=30) groups. A set of chair yoga sessions was taught by a professional yoga trainer to the intervention group for a duration of 20 minutes, 5 days a week for two months. Both groups' sleep quality and HRV were measured using the PHYSIOPAC-PP4 (MEDICAID SYSTEMS, Chandigarh) software, as well as their levels of stress using the Perceived Stress Scale. Results: After training of Chair yoga for 2 months, a significant decrease in HR, MAP and a significant increase in Mean RR, SDNN and PNN50 and a significant increase in TP and HFnu and a significant decrease in LFnu and LF/HF ratio in the intervention group was found. After doing chair yoga at work, the intervention group's stress levels dropped and their quality of sleep increased. Conclusion: The findings of the study concluded that the Chair yoga practice in Nursing professionals led to the improvement in parasympathetic activity. It is also beneficial for stress reduction and improvement of sleep quality in nursing professionals.

Brief periods of transcutaneous auricular vagus nerve stimulation improve autonomic balance and alter circulating monocytes and endothelial cells in patients with metabolic syndrome: a pilot study

BackgroundThere is emerging evidence that the nervous system regulates immune and metabolic alterations mediating Metabolic syndrome (MetS) pathogenesis via the vagus nerve. This study evaluated the effects of transcutaneous auricular vagus nerve stimulation (TAVNS) on key cardiovascular and inflammatory components of MetS.MethodsWe conducted an open label, randomized (2:1), two-arm, parallel-group controlled trial in MetS patients. Subjects in the treatment group (n = 20) received 30 min of TAVNS with a NEMOS® device placed on the cymba conchae of the left ear, once weekly. Patients in the control group (n = 10) received no stimulation. Hemodynamic, heart rate variability (HRV), biochemical parameters, and monocytes, progenitor endothelial cells, circulating endothelial cells, and endothelial micro particles were evaluated at randomization, after the first TAVNS treatment, and again after 8 weeks of follow-up.ResultsAn improvement in sympathovagal balance (HRV analysis) was observed after the first TAVNS session. Only patients treated with TAVNS for 8 weeks had a significant decrease in office BP and HR, a further improvement in sympathovagal balance, with a shift of circulating monocytes towards an anti-inflammatory phenotype and endothelial cells to a reparative vascular profile.ConclusionThese results are of interest for further study of TAVNS as treatment of MetS.

Heart Rate as a Correlate for the Emotional Processing of Body Stimuli in Anorexia Nervosa.

In anorexia nervosa, aberrant emotional reactions toward body stimuli have been discussed. We investigated heart rate as a physiological marker when viewing body stimuli and hypothesized altered HR reactions toward those highly significant and emotional stimuli in anorexia nervosa. In total, 37 anorexia nervosa patients and 43 control participants viewed pictures of women of five different weight categories, while their cardiac activity was recorded. R-R intervals following picture onset were determined, and means were calculated for three distinct time periods. The overall change in HR relative to baseline across all picture categories was greater in the patient group than in the control group (significant effect of "group", p = 0.002, partial η2 = 0.120). A significant decrease in HR 2 to 8 s after picture presentation was found for pictures of women of extreme weight in both participant groups (significant "category ∗ time segment interaction", p = 0.01, partial η2 = 0.037) and correlated with scores of sociocultural attitudes toward the appearance for the extremely underweight category (r = -0.33, p = 0.005). Therefore, differential HR reactions for anorexia nervosa patients and control participants were found for body stimuli in general. The highest HR decelerations in response to pictures of strongly underweight and overweight women may reflect emotional processes such as anxiety due to social comparison.

PECULIARITIES OF TREATMENT OF CORONARY ARTERY DISEASE WITH CONCOMITANT TYPE 2 DIABETES MELLITUS WITH ANGIOTENSIN RECEPTOR BLOCKERS

Introduction: the relevance of determining peculiarities of treatment of coronary artery disease with concomitant type 2 diabetes mellitus is high, as it solves several important medical, social and economic problems of society.&#x0D; The aim: of research was to evaluate state of heart function (development of heart failure) and changes in glucose metabolism in patients with CAD with concomitant type II DM depending on diabetes stage and treatments with telmisartan and valsartan.&#x0D; Materials and methods: Study included 106 patients with coronary artery diseases and type II DM with mean age 68.8±8.9 years; mean age of males (46.2 %) was 65.2±9.0 years and females (53.8 %) — 71.6±7.8 years. All patients were treated in cardiology department of CME “City clinical hospital № 27” of Kharkiv city government, which is clinical base of Departments of internal medicine № 2, clinical immunology and allergology of L. T. Malaya of Kharkiv National Medical University. All patients were divided into 4 groups depending on stage of diabetes. First group included patients with CAD and with no concomitant DM (n=36; mean age = 66.4±10.1 years); second — CAD and mild course of DM (n=21; mean age = 71.9±9.4 years); third group included patients with CAD and moderate DM (n=28; mean age = 69.7±8.0 years); and fourth group — patients with CAD and severe DM (n=21; mean age = 67.9±6.5 years).&#x0D; Results: After treatment with valsartan and telmisartan no difference was observed in SBP, DBP and HR in both valsartan and telmisartan patients. However, it is obvious that levels of described variables mostly normalized, which suggests on high effectiveness of performed treatment.&#x0D; Comparison of initial and post-treatment data showed significant changes observed both in heart function and glucose metabolism. It was found that valsartan users showed significant decrease in SBP, DBP and HR in patients with CAD only and CAD with moderate T2DM.&#x0D; In all patients suggest that valsartan users will show decrease of HbA1c independently on DM stage, while telmisartan provides normalization of HbA1c only in moderate to severe DM patients.&#x0D; This suggests that telmisartan acts as protective and repairing medication in patients with concomitant CAD and T2DM, predominantly in moderate to severe stages of DM; valsartan increases cardiac function mostly in CAD only patients and in mild to severe DM, but influence on systolic and diastolic function was not found.&#x0D; Conclusions: Our study demonstrates strong connection between glucose metabolism and heart function. It was shown that stage of T2DM significantly influence indices of morphological state of heart with effects on development of systolic and, predominantly, diastolic dysfunction, which further leads to development of heart failure. Moreover, it was shown, that treatments of patients with CAD with concomitant T2DM of different stages with ARBs (valsartan and telmisartan) provides protective effects on heart muscle and glucose metabolism. Study found significant correlations between levels of blood pressure, systolic and diastolic function and levels of glucose and HbA1c in patients with different stages of T2DM.

Effect of Exercise on ECG Components and their Correlation with Body Mass Index among Young Asymptomatic Obese and Non-obese Individuals: A Cross-sectional Study

Introduction: The worldwide higher prevalence of obesity is currently one of the most important reasons for the occurrence of several health disorders, along with an increased risk of mortality and morbidity. However, the magnitude of the effect of sub-maximal aerobic exercise on cardiac autonomic and electrical function among Indian obese individuals has yet to be established. Aim: To evaluate the effect of exercise on ECG components and their correlation with Body Mass Index (BMI) among young asymptomatic obese and non-obese individuals, in order to assess the risk for developing Cardiovascular Diseases (CVD) in the future. Materials and Methods: An observational cross-sectional study was conducted at the Autonomic Research Laboratory of the Physiology Department at RG Kar Medical College and Hospital, Kolkata, between January 2017 to December 2017. Two hundred healthy medicos were divided into two groups: Obese (BMI ≥25 kg/m²; n=88) and non-obese (BMI ≥18.5 to ≤23 kg/m²; n=112). Resting Blood Pressure (BP) was manually recorded, followed by the recording of long lead-II ECG in the supine posture both at rest and ten minutes after submaximal (50% VO2 max) aerobic exercise on a treadmill using the modified Bruce protocol and following the Astrand-Rhyming nomogram. The HR, QT interval, and RR interval were recorded from the lead-II ECG. The measured QT interval was corrected using Bazett’s formula (QTC=QT/√RR). The results were analysed using both unpaired and paired t-tests and the Pearson correlation coefficient in Graphpad-Quickcalc software. Results: Significant prolongation of the QTc interval both at rest (p-value: 0.019) and after exercise (p-value: 0.044), along with delayed Heart Rate Recovery (HRR) (p-value: 0.001), were observed among the obese compared to the non-obese population. Additionally, a significantly positive linear correlation was observed between BMI and ECG components at rest (BMIRHR: r:+0.293; p: 0.005 and BMI-QTc Interval: r:+0.226; p-value: 0.034) and during the recovery state (BMI-HRR: r:+0.42; p-value: 0.00004 and BMI-QTc Interval: r:+0.365; p-value: 0.0004), only among the obese. Conclusion: At rest, obese individuals had an elevated QTc, which could be due to alterations in cardiac autonomic function, along with a significant positive correlation between BMI and RHR, indicating lower aerobic fitness in this population. Prolongation of the QTc interval, delayed decrease in HR, and a significant positive correlation with BMI after exercise in obese individuals indicated myocardial repolarisation instability, autonomic dysfunction, and an increased risk of out-of-hospital sudden cardiac events in these individuals.

Comparative features of the immediate impact of manual therapy traction manipulations on the cardiorespiratory system of men and women

Purpose: the aim of this study was to determine the principal differences of changes in the cardiorespiratory system activity under the influence of traction manipulations in the thoracic spine of men and women. Material &amp; Methods: the 26 adults were involved in the study, including 18 women aged 39.6±12.1 years and 8 men aged 36.3±8.3 years. All patients were diagnosed with osteochondrosis of the thoracic spine, which was confirmed by radiographic examination. The study of the cardiorespiratory system was conducted in the first procedure of SMT before and after the use of traction manipulations directly in the physician office. The integrated method of studying the cardiorespiratory system defined as spiroarteriocardiorhythmography (SACR) was used. It simultaneously records the heart rate, rhythms of systolic and diastolic pressure at each heartbeat and respiratory rhythms, which provides significant time savings to determine the functional state of the heart, vessels and respiration, as well as to identify the important parameters of their interaction. Results: characterizing the changes in the cardiorespiratory system as a whole under the influence of traction manipulations on the thoracic spine, it should be noted that men and women had some significant unidirectional changes in HR (min–1), CO (dm3), CI (dm3/m2), IH (n. u.), which are determined primarily by the decrease in HR (min–1) under the influence of traction manipulations. As to the men, the significant effects were more related to the impact on the contractile function of the heart, which was confirmed by the improvement of the electrical systole of the ventricles (QTC, s), the increase in the activity of the effects of the parasympathetic branch of the ANS on the cardiac rhythm (HF, ms2) and a certain increase in the stroke index within the normative values (SI, cm3/m2), then to the women the significant effects were more related to the influence on the breathing pattern and vascular tone. Thus, characteristic and positive effects in women can be considered a decrease in the variability of diastolic blood pressure in the very-low-frequency range (VLFDBP, mmHg2), which is combined with a decrease in the total power of diastolic pressure variability (TPDBP, mmHg2) and an increase in the total peripheral vascular resistance (GPVR, dyn/s/cm−5). Conclusions: summarizing the results of the impact of traction manipulations in the thoracic spine on the cardiorespiratory system of men and women, it can be stated that their effect is different and has features associated with the use of different mechanisms. For men, the predominant effect is on the heart contractile function, and for women it is on the respiratory system and autonomous regulation of vascular tone.

The place of diltiazem in the treatment of patients with stable angina in concomitant bronchial asthma

Introduction. In the treatment of stable angina in patients with concomitant bronchial asthma (BA), the bronchopulmonary system may be adversely affected by a number of drugs. Diltiazem may be the drug of choice when antianginal therapy with a pulseslowing effect is required, but β-blockers are contraindicated.Aim of the study. To compare the antianginal, pulse-slowing and vasoprotective effects of the calcium antagonist (CA) diltiazem, the calcium antagonist verapamil and the cardioselective beta-adrenoblocker (BAB) bisoprolol in the treatment of stable angina (SA) patients with concomitant BA.Materials and methods. The study included 60 patients with stable angina II-III FC with concomitant mild or moderate persistent BA. The patients were divided into three groups of 20 patients depending on antianginal drugs: Group 1 received betaadrenoblocker bisoprolol, Group 2 – calcium antagonist verapamil, Group 3 – calcium antagonist diltiazem. All patients underwent cardiography (Doppler EchoCG), external respiration function (ERF), endothelium-dependent vasodilation (EDVD) study at baseline and after 2, 4, 6 weeks of treatment.Results. No negative dynamics of FEV1 was found in patients of all groups during the study of ERF after 6 weeks of treatment. There was a statistically significant increase in FEV1 after 6 weeks of treatment in group 3 patients receiving diltiazem (p = 0.032). There was a statistically significant decrease in HR in all three groups during treatment, but in group 2 the dynamics were significantly lower when treated with verapamil. Analysis of mPAP of patients showed that it decreased in all groups after 6 weeks of treatment, but significant dynamics was noted only in Group 3. EDVD test after 6 weeks of treatment revealed positive dynamics, with a statistically significant increase in the index registered in patients of groups 1 and 3.Conclusions. In treatment of patients with stable angina with mild and intermediate persistent disease without exacerbation, antianginal therapy with the calcium antagonist diltiazem has marked antianginal, pulse-slowing action, has vasoprotective effect on the small and large circulatory vessels, improves the parameters of bronchial permeability.