Differences In Hemodynamic Parameters Research Articles

#607 Pre- and post-hemodialysis differences in heart failure diagnosis by current heart failure guidelines in patients with end-stage renal disease

Abstract Background and Aims Patients with end-stage renal disease (ESRD) who are on hemodialysis (HD) have reduced vascular compliance and are likely to develop heart failure (HF). Dialysis patients experience a volume change of ∼3–4 kg before and after HD, which can affect hemodynamic indicators, some of which are highly influenced by a patient's volume status. Therefore, depending on when echocardiography is performed, there may be differences in hemodynamic parameters. However, it is not easy to perform echocardiography in the euvolemic state in the clinical setting. This study estimated pre- and post-HD in ESRD HF diagnosis prevalence using the current guidelines. Method We prospectively investigated ESRD patients on HD using echocardiography between pre and post HD. We used structural or functional abnormality criteria of 2021 ESC guideline. Results A total of 54 patients were enrolled. The mean age was 62.6 years and 40.1% were male. Forty-five patients (83.3%) had hypertension, 28 (51.9%) had diabetes, 20 (37.0%) had ischemic heart disease. Mean NT-pro BNP level was 11959.9pg/dL. The mean ideal body weight was 59.3 kg, mean hemodialysis time was 237.4 minutes, and mean real filtration was 2.8 kg. The mean LVEF was 62.4% and mean LVEDD was 52.0 mm in pre-HD. Post-HD echocardiography showed significantly lower LAVI (33.3 ± 15.9 vs. 40.6 ± 17.1, p = 0.030), TR jet V (2.5 ± 0.4 vs. 2.8 ± 0.4 m/s, p < 0.001), and RVSP (32.1 ± 10.3 vs. 38.4 ± 11.6, p = 0.005) compared with pre-HD. There was no difference in LVEF, E/E’ ratio, or LV GLS. A total of 88.9% for pre-HD and 66.7% for post-HD had at least structural or functional abnormalities in echocardiographic parameters according to recent HF guidelines, p = 0.007). Conclusion Our data showed that the majority of patients undergoing hemodialysis satisfy the diagnostic criteria for HF according to current HF guidelines, and the difference of prevalence of HF was 22.2% between pre- and post- HD.

#3050 Hemodynamic study of hypertensive disorders in pregnancy using cardiothoracic bioimpedance

Abstract Background and Aims Hypertensive disorders in pregnancy (HDP) are a major cause of maternal and perinatal morbidity and mortality. There is still a need for the development of biomarkers for early diagnosis of the severity of the condition. Thoracic electrical bioimpedance (TEB) is a non-invasive hemodynamic technique based on the resistance to the flow of electrical current. We investigated hemodynamic changes in pregnant/postpartum women with HDP using TEB. Method A retrospective observational study was conducted in pregnant and postpartum women with hypertension monitored by TEB. Indirect changes were analyzed in: cardiac work, left cardiac work index (LCWI kg⋅m/m2) and calculated cardiac output (CO ml/min=systolic volume -SV ml- × heart rate -HR bpm-); fluid status, thoracic fluid content index (TFCI l/kOhm/m2); and resistances, systemic vascular resistance index (SVRI dyn.s.cm-5.m2). Normality of variables was assessed by Shapiro-Wilk test and correlation analysis was performed by Pearson/Spearman tests. Statistical inference between the hypertension-preeclampsia and pregnancy-postpartum groups was performed using Student's/Mann-Whitney U tests. Analysis was performed using STATA 12. Results Fifty-five patients were included with a mean age of 36.5 years (SD 4.54), 69% were older than 35 years. Pregnant women accounted for 86% of the TEB evaluations, the majority (93.6%) in the third trimester. There was chronic hypertension in 7.27% and pre-eclampsia in 18.18% of previous pregnancies. The diagnoses were: pre-eclampsia (56.36%), gestational hypertension (40%) and HELLP syndrome (3.64%). The mean blood pressure was 144/89 (SD 16/11) mmHg. Mean proteinuria was 363.2 (range: 10.3-23220) mg/g. The median values were as follow: LCWI: 5.05 (IQR: 1.4) kg⋅m/m2; CO: 6352 (IQR: 2345) ml/min; TFCI: 17.9 (IQR: 6.3) l/kOhm/m2; SVRI: 2167.63 (SD: 462.87) dyn.s.cm-5.m2. LCWI showed a weak positive correlation with systolic blood pressure (SBP) and a strong correlation with diastolic blood pressure (DBP) (Rho 0.2899 and 0.5176, respectively). There was also a positive and moderate correlation between SVRI and SBP and DBP (r 0.4265 and 0.4019, respectively). There was no correlation between CO or TFCI and SBP or DBP. No statistically significant differences in hemodynamic parameters were found between gestational hypertension and pre-eclampsia, nor between pregnant and postpartum women. Conclusion Increased blood pressure in the setting of HDP correlates with increased LCWI and systemic resistance independent of fluid retention. An increase in systemic vascular resistance measured by TEB (which decreases in normal pregnancy) may be an early diagnostic marker of HDP. These findings require further validation in a larger cohort, including a control group of pregnant women without hypertension.

Gender differences in cardiogenic shock: characteristics and prognosis

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Hospital Clinico San Carlos. Background Cardiogenic shock (CS) is a life-threatening condition caused by severe heart dysfunction. While significant advances have been made in the management and treatment of cardiogenic shock, there is growing recognition of the importance of considering gender-specific differences in the presentation and outcomes of this condition. Recent research highlights gender-related variations in how the condition is presented, managed, and its outcomes. Understanding these differences is crucial for tailored and effective treatment. Our goal is to identify potential gender differences in terms of the characteristics and prognosis of CS. Methods From 2013 to 2023, 142 consecutive patients diagnosed with CS in and admitted to an Acute Cardiac Care Unit in a tertiary care hospital were recruited. Demographic, clinical, and analytical variables were retrospectively collected. Patient were followed-up to November-2023 and clinical events were also recorded. For purposes of analysis, patients were classified in woman (N=95) and men (N=47). Success, in terms of IABP use, was defined as patient’s survival to the index event. Failure of IABP was defined as in-hospital death. A multivariate logistic regression analysis was performed to identify potential predictors of success. A descriptive analysis of clinical, analytical, and demographic parameters was performed in both groups, followed by a survival curve analysis to assess differences in prognosis between both sexes. Results Mean age was 67.3±12.2 years and 67.0% were females. There were no significant differences in cardiovascular risk factor and comorbidities between groups: hypertension (61.2% vs 38.8%, p 0.077), diabetes (65.9% vs 34.1%, p 0.866), chronic kidney disease (75% vs 25%, p 0.465), previous stroke (61.5% vs 38.5%, p 0.666) in woman vs men group respectively. STEMI was the most frequent cause of CS requiring an IABP in men (33.7%) but NSTEMI was in women (67.7%). Regarding the CS classification, both groups had a similar distribution of the severity and complexity of the shock (Figure 1). There were also no differences in hemodynamic parameters, analytical results, complete revascularization, and left ventricular ejection fraction (LVEF) between men and women (Figure 1). There were also no differences in hemodynamic parameters, analytical results, complete revascularization, and left ventricular ejection fraction (LVEF) between men and women (Figure 1). The complications, mortality (Figure 2), and long-term mortality were also similar in both groups. Conclusions In our observational study, there were no differences between genders in terms of characteristics, shock complexity, and prognosis.

Application of 4D flow MRI for exploring factors affecting haemodynamics of iliac veins in asymptomatic population.

Haemodynamics plays an important role in the development of vascular disease. There is currently a lack of studies evaluating the characteristics and affecting factors of the iliac vein haemodynamics in clinical practice. The goal of this study was to use 4D flow MRI to explore the haemodynamic characteristics of iliac veins and its affecting factors in an asymptomatic population. Thirty consecutive volunteers without venous-related symptoms or signs underwent four-dimensional postprocessing of their MRI images. Relevant parameters, the demographic data, common iliac vein-inferior vena cava angle, iliac vein area, tortuosity, iliac vein mean flow, mean velocity was computed and analysed. T tests and Spearman's tests were used for analysing. A P value of 0.05 or less was considered significant. Height and iliac vein area were positively correlated with flow, while degree of stenosis, and common iliac-inferior vena cava angle were negatively correlated with that. Degree of stenosis was positively correlated with velocity, but the common iliac-inferior vena cava angle and iliac vein tortuosity were negatively correlated with that. The mean flow and velocity of iliac veins in females were lower than males. The mean flow and velocity of the left iliac veins were lower than those of the right. The height, gender, tortuosity, degree of stenosis, common iliac vein-inferior vena cava angle of the iliac vein are important factors that affect flow and velocity of the iliac veins. There were differences in haemodynamic parameters of the bilateral iliac veins.

Effect of Left Ventricular Diastolic Dysfunction on the Cardiopulmonary Exercise Test in Patients With Cardiovascular Disease

Left ventricular diastolic dysfunction exists in patients with heart failure with reduced ejection fraction and causes activity restriction and a poor prognosis, but there have been few reports about exercise tolerance in patients with diastolic dysfunction, regardless of left ventricular ejection fraction (LVEF). In this study, 294 cardiovascular disease patients who performed a cardiopulmonary exercise test (CPX) with an adequate examination by echocardiography at Fukuoka University Hospital from 2011 to 2020 were investigated. Patients were divided into groups with grade I and grade II or III diastolic dysfunction according to diagnostic criteria, regardless of LVEF, by echocardiography. After adjusting for age, gender, body mass index, smoking, and LVEF by propensity score matching, we compared the results of CPX between the grade I and grade II/III groups. There were no significant differences in hemodynamic parameters, or in the respiratory exchange ratio, oxygen uptake per body weight, oxygen uptake per heart rate, or parameters of ventilatory volume. Ventilatory equivalents per oxygen uptake and per carbon dioxide output were significantly worse in the grade II/III group from the rest to peak periods during CPX. In conclusion, left ventricular diastolic dysfunction worsens ventilatory efficacy during CPX. This effect potentially contributes to a poor prognosis in left ventricular diastolic dysfunction.

Augmented pressor responses to mental stress in females with spontaneous coronary artery dissection

Background: Spontaneous coronary artery dissection (SCAD) causes acute coronary syndrome or sudden cardiac death due to a separation of arterial wall layers. The majority of patients with SCAD are females (>80%) with few to no traditional cardiovascular risk factors. Though the physiological mechanisms that predispose to SCAD are unknown, common triggers for SCAD events include sympathoexcitatory stimuli, such as mental and emotional stress. Additionally, studies report high prevalence of depression and anxiety among patients with SCAD. Our study aimed to investigate cardiovascular responses to mental stress in patients with SCAD. We hypothesized that patients with SCAD would have exaggerated cardiovascular responses to mental stress compared to healthy controls. Methods: Four female patients with SCAD were age-, and BMI-matched with 4 healthy females. Participants underwent 2 minutes of baseline quiet rest, a 5-minute Stroop Color Word Test to induce mental stress, followed by 2 minutes of recovery. Continuous beat-to-beat blood pressure (BP, finger photoplethysmography) and heart rate (HR, 3-lead ECG) were recorded. Venous occlusion plethysmography was used to measure forearm blood flow (FBF). Forearm vascular conductance (FVC) was calculated as FBF/mean BP×100. Data are presented as change from baseline (Δmean±SD). Group data were compared using independent samples t-tests. Results: Resting hemodynamic parameters (Systolic [SBP], Diastolic [DBP], and Mean BP [MBP], Pulse pressure [PP], and HR) and FVC were similar between groups. Patients with SCAD had greater increases in DBP (Δ12±5 vs. Δ1±5 mmHg, p=0.02) and PP (Δ5±3 vs. Δ-7±8 mmHg, p=0.04) during the last minute of mental stress test compared to controls. Although, there were no differences in the changes of SBP (Δ17±7 vs. Δ-1±13 mmHg, p=0.05), MBP (Δ13±6 vs. Δ3±8 mmHg, p=0.08), HR (Δ8±0 vs. Δ10±2 bpm, p=0.12), or FVC (Δ1.5±1.2 vs. Δ1.8±1.3 ml/min/100 mmHg, p=0.80) between groups. During the last minute of recovery, there were no differences in hemodynamic parameters (SBP: Δ6±9 vs. Δ-4±10 mmHg, p=0.23; DBP: Δ2±7 vs. Δ-3±2 mmHg, p=0.22; MBP: Δ3±7 vs. Δ-3±5 mmHg, p=0.22; PP: Δ4±5 vs. Δ-1±8 mmHg, p= 0.35; HR: Δ-1±3 vs. Δ0±3 bpm, p=0.64), or FVC (Δ1.3±1.7 vs. Δ0.5±0.3 ml/min/100 mmHg, p= 0.35) between groups. Conclusion: These preliminary data suggest that patients with SCAD have greater increases in DBP and PP in response to mental stress compared to healthy controls. These exaggerated pressor responses might have implications for the pathophysiology of SCAD. NIH K23 HL155506, T32 DK07352, K01 HL148144, UL1 TR0022377, and AHA 898649. 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.

Topical pharyngeal anesthesia with articaine for gastroscopy: a double-blinded, randomized cross-over study in healthy volunteers

Objectives The benefits of topical pharyngeal anesthesia for gastroscopy remain under debate. Articaine, a local anesthetic with fast onset and offset of action as well as low systemic toxicity, could be a promising choice for topical anesthesia. The objective of this study was to assess whether topical pharyngeal anesthesia with articaine is beneficial in sedated gastroscopy. Materials and methods This randomized double-blinded cross-over study included nine volunteers who underwent two gastroscopies under conscious sedation. One was performed with topical pharyngeal anesthesia with articaine and the other with placebo. Hemodynamic parameters including autonomic nervous system state were recorded prior to and during the endoscopic procedure. The endoscopist and the volunteer assessed the endoscopy after the examination. Results Topical pharyngeal anesthesia with articaine resulted in less discomfort during esophageal intubation and higher patient satisfaction with the procedure. Topical pharyngeal anesthesia with articaine did not increase satisfaction or facilitate the procedure as rated by the endoscopist. There were no clinically relevant differences in hemodynamic parameters. Conclusion The use of articaine for topical pharyngeal anesthesia results in less intubation-related discomfort and better satisfaction.

Effectiveness of Dexmedetomidine vs Propofol in Post-Open Heart Surgery Patients: A Prospective, Randomized, Double-Blind Study at the PLA Army Central Hospital in Beijing, China

Introduction: Dexmedetomidine and propofol are sedation drugs commonly used in patients after open heart surgery. The aim of this study was to compare the effectiveness of dexmedetomidine and propofol in patients after open heart surgery in terms of sleep quality, delirium, and hemodynamics.
 Methods: A prospective, randomized, double-blind study was conducted on 120 patients after open heart surgery at the PLA Army Central Hospital in Beijing, China. Patients were randomized to receive dexmedetomidine (n = 60) or propofol (n = 60). Sleep quality was measured using the Pittsburgh Sleep Quality Scale (PSQI), delirium was measured using the confusion assessment method for the intensive care unit (CAM-ICU), and hemodynamics were monitored continuously.
 Results: Patients receiving dexmedetomidine had lower PSQI scores (p < 0.05) and a lower incidence of delirium (p < 0.05) compared with patients receiving propofol. There were no significant differences in hemodynamic parameters between the two groups.
 Conclusion: Dexmedetomidine is more effective than propofol in improving sleep quality and reducing delirium in patients after open heart surgery.

Use of the USCOM® noninvasive cardiac output measurement system to predict the development of pre-eclampsia in hypertensive pregnancies

ABSTRACT Objectives To assess the ability of the USCOM® (USCOM), using measurements of cardiac output (CO) and systemic vascular resistance (SVR), to predict the development of pre-eclampsia (PE) and severe PE in hypertensive pregnancies. Study design Prospective cohort study of women in the second or third trimester recruited at a tertiary center in Sydney, Australia. Demographic data and hemodynamic measurements using the USCOM were taken for all study participants at recruitment. Pregnancy outcome, including development of PE and severe PE, was tracked. Data were analyzed using ANOVA testing, pair-wise comparison testing, and Student’s t-testing. Results Recruitment included 65 normotensive controls, 34 women with chronic hypertension (CH), 51 with gestational hypertension (GH), and 21 with PE. Significantly higher weight, body surface area, and blood pressure measurements were found in the hypertensive, compared with the normotensive control and pregnancies. There were no observed differences in USCOM-measured CO, cardiac index, SVR, or systemic vascular resistance index between hypertensive women who did versus did not develop PE or severe PE in later pregnancy. Analysis of the CH and GH subgroups, as well as only unmedicated hypertensive women (n = 24), also showed no significant difference in hemodynamic parameters between those who did or did not develop PE or severe PE. Conclusions Our group was unable to successfully predict the onset of PE or severe PE based on hemodynamic parameters measured with the USCOM. It is possible this relates to the high proportion of women on antihypertensive medication at recruitment.

Research on the classification of early-stage brain edema by combining intrinsic optical signal imaging and laser speckle contrast imaging.

The early detection and pathological classification of brain edema are very important for symptomatic treatment. The dual-optical imaging system (DOIS) consists of intrinsic optical signal imaging (IOSI) and laser speckle contrast imaging (LSCI), which can acquire cerebral hemodynamic parameters of mice in real-time, including changes of oxygenated hemoglobin concentration ( ), deoxyhemoglobin concentration (ΔCHbR) and relative cerebral blood flow (rCBF) within the field of view. The slope sum of , ΔCHbR and rCBF was proposed to classify vasogenic edema (VE) and cytotoxic edema (CE). The slope sum values in the VE and CE group remain statistically different and the classification results provide higher accuracy of more than 93% for early brain edema detection. In conclusion, the differences of hemodynamic parameters between VE and CE in the early stage were revealed and the method helps in the classification of early brain edema.

Higher critical closing pressure is independently associated with enlarged basal ganglia perivascular spaces.

This study aimed to explore the association between cerebral hemodynamic parameters focused on the critical closing pressure (CCP) and enlarged perivascular spaces (EPVS). Cerebral blood velocity in the middle cerebral artery (MCAv) and non-invasive continuous blood pressure (NIBP) were measured using a transcranial Doppler (TCD) and Finometer, followed by the calculation of cerebral hemodynamic parameters including CCP, resistance area product (RAP), pulsatility index (PI), and pulse pressure (PP). EPVS were graded separately in the basal ganglia (BG) and centrum semiovale (CSO), using a visual semiquantitative ordinal scale. Patients with EPVS >10 were classified into the severe BG-EPVS group and severe CSO-EPVS group, and the remainder into the mild BG-EPVS group and the mild CSO-EPVS group. Spearman's correlation and binary logistic regression analysis were performed to analyze the relationship between hemodynamic parameters and BG-EPVS and CSO-EPVS, respectively. Overall, 107 patients were enrolled. The severe BG-EPVS group had higher CCP, mean arterial blood pressure (MABP), systolic blood pressure (SBP), and diastolic blood pressure (DBP) than that in the mild BG-EPVS group (p < 0.05). There was no statistical difference in hemodynamic parameters between the severe CSO-EPVS group and the mild CSO-EPVS group. Spearman's correlation analysis showed that CCP was positively associated with BG-EPVS (rho = 0.331, p < 0.001) and CSO-EPVS (rho = 0.154, p = 0.044). The binary logistic regression analysis showed that CCP was independently associated with severe BG-EPVS (p < 0.05) and not with CSO-EPVS (p > 0.05) after adjusting for confounders. CCP representing cerebrovascular tension was independently associated with BG-EPVS.

In-silico enhanced animal study of pulmonary artery pressure sensors: assessing hemodynamics using computational fluid dynamics.

To assess whether in-silico models can be used to predict the risk of thrombus formation in pulmonary artery pressure sensors (PAPS), a chronic animal study using pigs was conducted. Computed tomography (CT) data was acquired before and immediately after implantation, as well as one and three months after the implantation. Devices were implanted into 10 pigs, each one in the left and right pulmonary artery (PA), to reduce the required number of animal experiments. The implantation procedure aimed at facilitating optimal and non-optimal positioning of the devices to increase chances of thrombus formation. Eight devices were positioned non-optimally. Three devices were positioned in the main PA instead of the left and right PA. Pre-interventional PA geometries were reconstructed from the respective CT images, and the devices were virtually implanted at the exact sites and orientations indicated by the follow-up CT after one month. Transient intra-arterial hemodynamics were calculated using computational fluid dynamics. Volume flow rates were modelled specifically matching the animals body weights. Wall shear stresses (WSS) and oscillatory shear indices (OSI) before and after device implantation were compared. Simulations revealed no relevant changes in any investigated hemodynamic parameters due to device implantation. Even in cases, where devices were implanted in a non-optimal manner, no marked differences in hemodynamic parameters compared to devices implanted in an optimal position were found. Before implantation time and surface-averaged WSS was Pa, whereas OSI was , respectively. Areas affected by low WSS magnitudes were cm, whereas the areas affected by high OSI were cm. After device implantation, WSS and OSI were Pa and , respectively. Surface areas affected by low WSS and high OSI were cm, and cm, respectively. This in-silico study indicates that no clinically relevant differences in intra-arterial hemodynamics are occurring after device implantation, even at non-optimal positioning of the sensor. Simultaneously, no embolic events were observed, suggesting that the risk for thrombus formation after device implantation is low and independent of the sensor position.

Myeloid Hif2α is not essential to maintain systemic iron homeostasis

Dietary consumption serves as the primary source of iron uptake, and erythropoiesis acts as a major regulator of systemic iron demand. In addition to intestinal iron absorption, macrophages play a crucial role in recycling iron from senescent red blood cells. The kidneys are responsible for the production of erythropoietin (Epo), which stimulates erythropoiesis, whereas the liver plays a central role in producing the iron-regulatory hormone hepcidin. The transcriptional regulator hypoxia-inducible factor (HIF)2α has a central role in the regulation of Epo, hepcidin, and intestinal iron absorption and therefore plays a crucial role in coordinating the tissue crosstalk to maintain systemic iron demands. However, the precise involvement of Hif2α in macrophages in terms of iron homeostasis remains uncertain. Our study demonstrates that deleting Hif2α in macrophages does not disrupt the expression of iron transporters or basal erythropoiesis. Mice lacking Hif2α in myeloid cells exhibited no discernible differences in hemodynamic parameters, including hemoglobin concentrations and erythrocyte count, when compared with littermate controls. This similarity was observed under conditions of both dietary iron deficiency and acute erythropoietic demand. Notably, we observed a significant increase in the expression of iron transporters in the duodenum during iron deficiency, indicating heightened iron absorption. Therefore, our findings suggest that the disruption of Hif2α in myeloid cells does not significantly impact systemic iron homeostasis under normal physiologic conditions. However, its disruption induces adaptive physiologic changes in response to elevated iron demand, potentially serving as a mechanism to sustain increased erythropoietic demand.

Development of an automatic device performing chest compression and external defibrillation: An animal-based pilot study.

Automatic chest compression devices (ACCDs) can promote high-quality cardiopulmonary resuscitation (CPR) and are widely used worldwide. Early application of automated external defibrillators (AEDs) along with high-quality CPR is crucial for favorable outcomes in patients with cardiac arrest. Here, we developed an automated CPR (A-CPR) apparatus that combines ACCD and AED and evaluated its performance in a pilot animal-based study. Eleven pigs (n = 5, A-CPR group; n = 6, ACCD CPR and AED [conventional CPR (C-CPR)] group) were enrolled in this study. After 2 min observation without any treatment following ventricular fibrillation induction, CPR with a 30:2 compression/ventilation ratio was performed for 6 min, mimicking basic life support (BLS). A-CPR or C-CPR was applied immediately after BLS, and resuscitation including chest compression and defibrillation, was performed following a voice prompt from the A-CPR device or AED. Hemodynamic parameters, including aortic pressure, right atrial pressure, coronary perfusion pressure, carotid blood flow, and end-tidal carbon dioxide, were monitored during resuscitation. Time variables, including time to start rhythm analysis, time to charge, time to defibrillate, and time to subsequent chest compression, were also measured. There were no differences in baseline characteristics, except for arterial carbon dioxide pressure (39 in A-CPR vs. 33 in C-CPR, p = 0.034), between the two groups. There were no differences in hemodynamic parameters between the groups. However, time to charge (28.9 ± 5.6 s, A-CPR group; 47.2 ± 12.4 s, C-CPR group), time to defibrillate (29.1 ± 7.2 s, A-CPR group; 50.5 ± 12.3 s, C-CPR group), and time to subsequent chest compression (32.4 ± 6.3 s, A-CPR group; 56.3 ± 10.7 s, C-CPR group) were shorter in the A-CPR group than in the C-CPR group (p = 0.015, 0.034 and 0.02 respectively). A-CPR can provide effective chest compressions and defibrillation, thereby shortening the time required for defibrillation.

Characteristics of left ventricular and cardiac hemodynamic remodeling after on-pump or off-pump coronary artery bypass grafting

Aim. To study the comparative dynamics of left ventricular (LV) remodeling after on-pump and off-pump coronary artery bypass grafting.Materials and methods. The study included 129 patients with verified coronary artery disease (CAD) who underwent coronary artery bypass grafting (CABG) with cardiopulmonary bypass (on-pump CABF) or beating heart surgery (off-pump CABG). All patients underwent transthoracic echocardiography (TTE) and volumetric compression oscillometry (VCO) before surgery, as well as one week and four months after it. The results were compared in groups divided according to the surgical technique and the presence of previous myocardial infarction using variation series, the Tukey’s post-hoc test, the Pearson correlation coefficient, and the Spearman’s rank correlation coefficient.Results. According to TTE data, no difference in hemodynamic parameters between the groups in the postoperative period was noted. According to VCO data, a significant difference was revealed in the off-pump group without previous MI one week after surgery: an increase in cardiac output (CO) (p &lt; 0.001), an increase in stroke volume (SV) and stroke index (SI) (p = 0.005), LV power (LVP) (p = 0.015), and also a rise in cardiac index and LVP four months after the surgery. In the on-pump group of patients with previous MI a week after CABG, a decrease in the LVP (p &lt; 0.001) and dynamic changes of energy expenditure (p &lt; 0.001) were observed. The correlation analysis revealed moderate correlations between the inotropic parameters of cardiac hemodynamics SV, SI, CO, LVP and blood pressure (BP) (rπ = 0.33–0.47; p &lt; 0.001) and strong correlations between SV, SI, CO, LVP and ejection fraction (EF) (rπ = 0.63–0.68; p &lt; 0.001).Conclusion. Seven days after the off-pump CABG, an improvement in some hemodynamic parameters and all inotropic parameters of the heart was revealed compared with the on-pump group. Four months after the off-pump surgery, positive hemodynamic remodeling was observed compared with the postoperative period after the onpump CABG.

Study of haemodynamic changes during robotic urological surgeries: Comparison of dexmedetomidine and propofol

Background: General anesthesia induces endocrine, immunologic, and metabolic responses. Certain anesthetic drugs affect the hemodynamic variables of the patient by various mechanism. The purpose of this study was to compare the effects of propofol and dexmedetomidine on hemodynamic parameters in robotic renal transplant surgery. Methods: This was a prospective comparative study performed in a tertiary care center. After local ethics committee approval and written informed consent, a total of fifty-two patients of ASA physical status 3 of either sex were randomly selected for this study. They were scheduled for elective robotic urological procedures of around three hours under general anaesthesia and divided into two groups (each group containing 26 patients). According to the haemodynamic requirement inj. dexmedetomidine maintainence(0.2 – 0.7mcg/kg/min) infusion and propofol(25 -75 mcg/kg/min) infusion started and maintained respectively. The measurements were taken on the same arm throughout the study at the following times: baseline,after loading dose,after intubation, after 20 min after the pneumoperitoneum, after 60 minutes of the pneumoperitoneum, after infusion stopped, after extubation. Results: Heart rate and mean atrial pressure changes were significantly lower in dexmedetomidine group in all stages compared to propofol group (P &lt; 0.001). Also, the rises in blood glucose and serum epinephrine levels in the dexmedetomidine group were significantly higher than in the propofol group (P &lt; 0.001). Conclusions: Anesthesia maintenance by dexmedetomidine showed a significant difference in hemodynamic parameters in comparison with propofol. While dexmedetomidine had better effects on controlling hemodynamic parameters, propofol showed better effects on decreasing stress hormones, and it can be suggested for LC surgery.

Sevoflurane and isoflurane anesthesia induce redox imbalance, but only sevoflurane impairs vascular contraction.

Volatile anesthetics may cause vascular dysfunction; however, underlying effects are unclear. The aim of the present study was to investigate whether sevoflurane and isoflurane affect vascular function, nitric oxide (NO) bioavailability, and biomarkers of oxidative stress and inflammation. Wistar rats were divided into three experimental groups: Not anesthetized (control group) or submitted to anesthesia with isoflurane (Iso group) or sevoflurane (Sevo group). Hemodynamic parameters were monitored during anesthesia, and blood gas values and biochemical determinants were analyzed. Isometric contractions were recorded in aortic rings. Vasoconstriction induced by potassium chloride (KCl) and phenylephrine (Phe) were measured. No differences in hemodynamic parameters and blood gasses variables were observed. Impaired KCl and Phe-induced contractions were observed in endothelium-intact aorta of Sevo compared to Iso and Control groups. Redox imbalance was found in Sevo and Iso groups. Reduced NO bioavailability and increased activity of matrix metalloproteinase 2 (MMP-2) were observed in Sevo, but not in the Iso group. While reduced IL-10 and IL-1β were observed in Sevo, increases in IL-1β in the Iso group were found. Sevoflurane, but not isoflurane, anesthesia impairs vasocontraction, and reduced NO and cytokines and increased MMP-2 activity may be involved in vascular dysfunction after sevoflurane anesthesia.

COMPARATIVE STUDY OF CLONIDINE AND FENTANYLAS ADJUVANTS TO INTRATHECAL ROPIVACAINE TO ASSESS THE DURATION OF ANALGESIA IN LOWER LIMB SURGERIES.

Objective: Ropivacaine has the benet of providing appropriate intraoperative anaesthesia and effective postoperative analgesia when used for lower limb procedures under spinal anaesthesia, but some patients still experience pain after the medication has taken its full course of action. Adjuvants added to local anaesthetics have the advantage of extending the sensory-motor block's duration and lowering the overall dose necessary.4 This study compared Clonidine and Fentanyl as adjuvants to intrathecal ropivacaine in enhancing the quality of anaesthesia by postponing the requirement for analgesics. Methods: 100 Patients who were undergoing lower limb surgeries were selected for the study and divided into two groups of 50 each. Patients were randomly allocated to one of the two groups using envelope method for blinding the investigator. GROUP A patients received 2.5ml 0.75% Ropivacaine(18.75mg) + Clonidine(60μg) 0.2ml, GROUP B patients received 2.5ml 0.75% ropivacaine(18.75mg) +Fentanyl (20mcg) 0.2ml. The following parameters were noted: Time of injection of subarachnoid block, Time of onset of sensory block at T10 level, Time of onset of motor block, Duration of motor block, Degree of sedation. Results and discussion: No difference in the onset of sensory and motor blockade between the two groups. There was statistically signicant prolongation in the duration of motor blockade in clonidine group 195.6 minutes when compared with fentanyl group 157.8 minutes (p &lt; 0.001). Analgesic duration was signicantly higher in clonidine group 321.70 ± 48.93 min when compared with fentanyl group 273.60 min (p = &lt; 0.001).The difference in haemodynamic parameters – heart rate, systolic &amp; diastolic blood pressure, mean arterial pressure (except for systolic blood pressure at 150 minutes) were statistically insignicant between both the groups. Sedation was slightly higher in the fentanyl group when compared to clonidine group but was statistically insignicant. None of the patients required supplemental oxygen, analgesia, or anxiolysis intraoperatively. No signicant difference in the incidence of complications like bradycardia, hypotension, respiratory depression etc between the two groups. Conclusion: In our study subarachnoid block with 0.75% isobaric ropivacaine (2.5ml) for lower limb surgeries with addition of clonidine 60mcg as anaesthetic adjuvant has advantage over fentanyl 20 mcg, as it increases the duration of spinal anaesthesia and increases postoperative analgesic duration. No signicant complications were recorded in both study groups

Effect of Adding Dexmedetomidine to Lidocaine in the Supraclavicular Block Technique in Patients Candidate for Upper Extremity Surgery: A Randomized Controlled Clinical Trial

Background: Various drugs are used as adjuvants to improve the quality of supraclavicular block method. Objective: This study aims to investigate the effect of adding dexmedetomidine to lidocaine in the supraclavicular block method in patients candidate for upper extremity surgery. Methods: This double-blind randomized controlled clinical trial was conducted on 61 patients candidate for upper extremity fracture surgery receiving the supraclavicular block method from 2017 to 2018. They were randomly divided into two groups of lidocaine-normal saline (30 mL of 1.5% lidocaine plus normal saline) and lidocaine-dexmedetomidine (30 mL of 1.5% lidocaine plus 1 μg/kg of dexmedetomidine). The supraclavicular block characteristics and intraoperative hemodynamic changes were measured. Results: There was no statistically significant difference between the two groups regarding the demographic factors. The mean age of patients was 43.09±10.92 years, and most of them were male. The mean onset time of sensory-motor blockade was faster and the duration of sensory-motor blockade and analgesia were longer in the lidocaine-dexmedetomidine group than in the other group. These differences were statistically significant. There was significant differences in hemodynamic parameters among nine assessment times in each group and between the two groups. Conclusion: Adding dexmedetomidine to lidocaine in the supraclavicular block method accelerates the blockade onset and increases the duration of blockade and analgesia after surgery without causing any considerable side effects.

The Effect of Preoperative Combined with Intravenous Lidocaine and Ketamine vs. Intravenous Ketamine on Pediatric Patients Undergoing Upper Gastrointestinal Endoscopy.

Ketamine is widely used in pediatric sedation. New studies have recommended combination therapy to reduce the side effects of ketamine. This study investigated the effect of adding intravenous (IV) lidocaine to ketamine on hemodynamic parameters, endoscopist satisfaction, and recovery time of children undergoing gastrointestinal endoscopy. This triple-blind, randomized, controlled clinical trial was conducted in Isfahan, Iran (2021). One hundred twenty children between the ages of 1 and 6 were enrolled. Patients were divided into 2 groups. The intervention group received 1.0 mg/kg of IV lidocaine and 1.0 mg/kg of IV ketamine, and the placebo group received 1.0 mg/kg of IV ketamine and placebo 2 minutes before entering the endoscopic room. Patients in both groups were sedated with 1.0 mg/kg of propofol, 0.1 mg/kg of midazolam, and 2.0 ug/kg of fentanyl for the procedure. The pulse rate, mean arterial pressure (MAP), respiratory rate, and oxygen saturation were recorded 1 minute before injection and every 5 minutes afterward. The mean (SD) ages of the intervention and control groups were 3.4 (1.5) and 3.4 (1.7), respectively. The mean difference in hemodynamic parameters between the 2 groups was insignificant during the investigation (P > 0.05). Furthermore, no significant differences were found regarding endoscopist satisfaction scores and length of recovery room stay (P > 0.05). Adding low-dose IV lidocaine to ketamine for pediatric sedation does not significantly affect the hemodynamic status, endoscopist satisfaction, and recovery time.