Differences In Hemodynamic Parameters Research Articles

Invasive hemodynamic assessment of the effect of sildenafil treatment after Fontan operation

There is no pumping subpulmonary ventricle in patients with univentricular hemodynamics after Fontan type physiological correction of complex congenital heart defects (CHD). Hence the blood fl ow to the lungs is passive and depends on central venous pressure (CVP) and pulmonary vascular resistance (PVR) to provide adequate fi lling of the single ventricle. The increase in PVR leads to a reduction in ventricular fi lling and cardiac output, resulting in failure of the Fontan circulation (the so-called failing Fontan). Purpose. Invasive assessment of the hemodynamic effect of sildenafi l treatment in children with single ventricle Fontan circulation. Material and Methods. Twenty-six children (12 girls, 14 boys) with completed stages of Fontan type surgery in whom a selective pulmonary vasodilator (sildenafi l) has been administered during the follow-up have been investigated. An open-label, non-randomized, prospective invasive study of the hemodynamic effect of sildenafi l treatment in patients with completed Fontan surgery stages was performed. Results. A signifi cant decrease in the cavopulmonary pressure (from 16.58 ± 1.88 mm Hg to 13.80 ± 2.20 mm Hg; p < 0.001) and the pulmonary vascular resistance (from 2.02 ± 0.72 WU to 1.42 ± 0.41 WU; p = 0.001), increase of the pulmonary/systemic blood fl ow ratio (from 0.71 ± 0.21 to 0.83 ± 0.18; p < 0.05), as well as increase in the systemic oxygen saturation (from 85.65 ± 7.48% to 90.72 ± 4.53%; p = 0.005) were found. No signifi cant difference in hemodynamic parameters related to the ventricular morphology and the type of previous palliation was found. The only exception was the pulmonary blood fl ow after sildenafi l treatment,  which was signifi cantly higher in children with а previous systemic to pulmonary shunt compared to children with а previous banding (p < 0.05). Conclusion. Our study showed signifi cant benefi cial changes in the main hemodynamic parameters after sildenafi l treatment. The pharmacological modulation of the pulmonary vascular status is an important component of the treatment of patients with Fontan circulation.

Микроциркуляция глазного дна после реваскуляризации внутренней сонной артерии в раннем послеоперационном периоде

Purpose. To study the effect of ICA revascularization on the parameters of the fundus microvasculature in patients with clinically significant ICA stenosis in the early postoperative period. Material and methods. Thirty-two patients with hemodynamically significant stenosis (≥ 75 %) of the right or left internal carotid artery (ICA) were studied using OCT angiography. Results. According to the results of OCT angiography before the revascularization procedure, there were no significant differences in hemodynamic parameters in the eyes on the side of the stenotic and non-stenotic ICA. In the early postoperative period (3–7 days), an increase in blood flow density and vascular density at the level of the superficial and deep plexuses in the macular region was observed in the ipsilateral eyes (p ≤ 0.05). In the contralateral eyes, after ICA revascularization, there was a partial improvement in microcirculation parameters according to OCT angiography (p ≤ 0.05). Peripapillary blood flow density and vascular density did not change significantly in both eyes. Conclusion. In patients with clinically significant ICA stenosis, ICA revascularization by stenting or CAEA contributed to an effective improvement of retinal microcirculation in both eyes. Keywords: optical coherence tomography-angiography, stenting of the internal carotid artery, revascularization, eye microcirculation.

Evaluation Effect of Aspiration of 0.2 ml of Cerebrospinal Fluid After Completion of Injection 0.5% Bupivacaine and Reinjection Into Subarachnoid Space on Sensory and Motor Block in Cesarean Section: A Randomized Clinical Trial.

BackgroundSpinal anesthesia (SPA) is the most common type of anesthesia administered for cesarean section. The main aim of this study was to evaluate the effect of aspiration of CSF (0.2 mL) immediately after SPA with hyperbaric 0.5% bupivacaine on the extent of sensory and motor block.MethodsIn this clinical trial, 60 women at ≥37 weeks of gestation and aged between 18 and 46 years, candidate for cesarean delivery under spinal anesthesia were randomly allocated into two equal groups (n = 30). Group A (CSF-aspiration group) received the spinal anesthesia with 10 mg of hyperbaric 0.5% bupivacaine with aspiration of 0.2 ml of CSF. Group B (no-CSF-aspiration group) received only 10 mg of 0.5% hyperbaric bupivacaine. Pin-prick analgesia and motor block were tested during the induction.ResultsThe mean maximum level of analgesia was T6 in each group. Although the mean time to reach the maximum level of anesthesia (4.43 ± 5.14 vs. 2.76 ± 2.04, P = 0.107) and to reach T10 level (50.56 ± 11.51 vs. 49.10 ± 13.68, P = 0.665) in the CSF-aspiration group is longer than the non-CSF-aspiration group, but this differences were not significant. There were no significant between-group differences regarding sensory and motor block quality (P = 0.389) or failed SPA (four cases in CSF-aspiration group vs. two cases in no-CSF-aspiration group, P = 0.389). The incidence of bradycardia, hypotension, headache, vomiting and nausea were similar in both groups (P > 0.05). In addition, the difference in hemodynamic parameters between the two groups over times was not statistically significant.ConclusionOur finding indicated that the aspiration of 0.2 ml of CSF after injection of spinal anesthesia with hyperbaric 0.5% bupivacaine does not seem to affect the extent of sensory and motor block, success rate, or outcome after SPA in cesarean section.Clinical Trial Registration[https://www.irct.ir/search/result?query=IRCT20120915010841N25], identifier [IRCT20120915010841N25].

Comparison of intranasal and nebulized dexmedetomidine for premedication in pediatric patients: A non-inferiority randomized controlled trial.

Dexmedetomidine is a highly selective α-2 adrenoreceptor agonist and has been found to be an effective premedication agent when administered via the intranasal route. We aimed to compare the efficacy of dexmedetomidine premedication administered via intranasal route and through nebulization in pediatric patients. This non-inferiority randomized controlled trial was conducted after getting approval from institutes ethics committee and informed written parental consent. Sixty-four children aged 2-8 years scheduled for elective surgery under general anesthesia were enrolled and were divided into two groups. Group I (Intranasal, n = 33) received 2 mcg/kg dexmedetomidine via intranasal route and group N (Nebulized, n = 31) received 2 mcg/kg dexmedetomidine through nebulization. The primary outcome was number of patients with satisfactory sedation 30 minutes after premedication at separation from parent. The secondary outcome included ease of medication acceptance, anxiety at parental separation, acceptance of anesthesia mask, perioperative hemodynamics, emergence agitation during recovery and adverse effects. Data collected was analyzed using Chi-square test, Student "t" test and Mann-Whitney U test with the help of SPSS 22. A one tailed P value < 0.025 was considered significant. Demographic profile was comparable between groups. On arrival in OR 27 (81.8%) patients in group I and 21 (67.7%) patients in group N had satisfactory sedation score (P = 0.19). The median (IQR) sedation score was comparable between group I and group N (P = 0.057). Patients in Group I showed significantly better medication and mask acceptance scores (P < 0.0001, P = 0.001 respectively), parental separation anxiety score (P < 0.0001) and emergence agitation score (P = 0.001). There were no significant differences in hemodynamic parameters and adverse effects between the groups. Although nebulized dexmedetomidine is non-inferior to intranasal dexmedetomidine in providing desired level of sedation but intranasal administration had better acceptance of medication and anesthesia mask with lesser anxiety at parental separation and postoperative emergence agitation.

Abstract No.: ABS2881: Comparison of cardiac indices using two different concentrations of adrenaline wicks during endoscopic trans-sphenoidal pituitary surgery: a prospective randomised observational study

Background & Aims:Trans-nasal trans-sphenoidal approach is preferred for surgical excision of pituitary tumours. Adrenaline is a generally usedvasoconstrictor for instillation or infiltration to decrease bleeding and improve the operative field quality. We aimed to compare the cardiac indices (Flotrac guided) and hemodynamic parameters while using two different doses of adrenaline for instillationMethods:60 ASA I/II patients, aged 18-65 years, undergoing transsphenoidal surgery for pituitary tumours were enrolled and allocatedto two groups. Group 1 received 1:200,000 concentration and Group 2 receiving 1:100,000 concentration of adrenalinetopically using cotton strips for 10-15 minutes. Cardiac indices and haemodynamic parameters were noted at baseline, every 5 minutes for first hour followed by every 10 minutes till the end of the procedure. Blood loss, quality of thefield and any adverse events were notedResults:Significant reductions in cardiac indices (CO, CI) were noted in Group 2 at 60 and 70 minutes of the procedure compared to Group 1. There was no difference in haemodynamic parameters (HR, SBP, DBP, MAP, SPO2,) between the 1:100,000 and 1:200,000 adrenaline groups. However, hypertension and tachycardia were higher following instillation of 1:100,000 adrenaline concentration when compared with the baseline (p<0.005)Conclusion:1:200,000 concentrations of adrenaline for nasal decongestion was associated with lowered cardiac indices compared to1:100,000 concentration. Field quality and usage of rescue drugs were comparable in both the study groups

Abstract No.: ABS1828: A prospective randomised double blinded study to compare the analgesic efficacy of USG guided bilateral suprazygomatic maxillary nerve block(SMB) with 0.25% bupivacaineand 0.25% bupivacaine with dexmedetomidine in children undergoing cleft palate(CP)repair

Background & Aims:The aim of this study was to assess the analgesic efficacy of dexmedetomidine as an additive to bupivacaine in childrenundergoing cleft palate (CP) repair with regional nerve block. OFC is one of the most common birth defects in India.Methods:Suprazygomatic maxillary nerve block (SMB) is a simple technique providing effective analgesia with decreased perioperative opioid consumption and complications. • 46 children fulfilling the inclusion criteria planned for CP repair with ultrasound guided (USG) SMB were randomised into Group A and B with comparable demographics and received 0.25% bupivacaine with saline and 0.25% bupivacaine with 1 µg/kg dexmedetomidine respectively. Postoperatively, pain was assessed by Children and Infants Postoperative Pain Scale (CHIPPS) score every 30 minutes for 2 hours and then every 2 hours until 24 hours. The pain control was considered insufficient if CHIPPS score was >3 for which Inj. fentanyl 0.5 µg/kg during first 2 hours and after 2 hours until 24 hours Inj. paracetamol 15 mg/kg were administered respectively and recorded.Results:The CHIPPS score was significantly lower in Group B than Group-A with p-value < 0.05. None of the children in Group-Brequired rescue fentanyl compared to 6 children in Group-A which was statistically significant (p value 0.032). 65.2% children in Group-A required rescue Paracetamol with more frequent administrations compared to only 26% in Group-B which wasstatistically significant (p value 0.048). No significant differences in haemodynamic parameters were noted between the groups intraoperatively.Conclusion:Dexmedetomidine when used as an adjuvant to 0.25% bupivacaine increased the duration of analgesia, reduced postoperative pain and need for rescue analgesics. It also provided stable haemodynamics throughout the intraoperative period with nil complications.

Comparison of Pain Scale, Hemodynamics, and Side Effects of Percutaneous and Intravenous Fentanyl in Post Sectio Caesaria Patients at Bunda Hospital

This is novel research about comparison pain scale, hemodynamics, and side effects of percutaneous and intravenous fentanyl in post sectio cesarean patients. Sectio cesarean is a method of delivering a fetus through an incision in the abdominal wall (laparotomy) and the uterus wall. This method induces pain in the incision, so patients feel complicated or afraid to mobilize. Fentanyl is one of the opioid analgesics, which is the main choice in section caesarian surgery because safe for breastfeeding, is more potent than morphine, and acts as balanced anesthesia—comparing the use of percutaneous fentanyl with intravenous fentanyl with pain scale parameters, hemodynamics, and side effects in sectio caesarian patients at Bunda Mother and Child Hospital Jakarta. Before conducting this research, an observational study first makes an ethical approval. Data were taken prospectively and collected simultaneously to compare percutaneous and intravenous fentanyl performed on post sectio cesarean patients with the physical status of the American Society of Anesthesiologists (ASA) I–II at Bunda Mother and Child Hospital Jakarta from September to November 2020. Comparative data observed were pain scale parameters, hemodynamics, and side effects after percutaneous fentanyl therapy or intravenous fentanyl therapy. Data were processed using SPSS 22 version and Microsoft Excell 2016. In conclusion, intravenous fentanyl is more effective in reducing pain scale and has more minor side effects than percutaneous fentanyl. There is no significant difference in hemodynamic parameters (p-value &gt;0.05).

Segmental thoracic spinal anesthesia versus general anesthesia for breast cancer surgery: A prospective randomized-controlled open-label trial.

Breast surgery is associated with moderate-to-severe postoperative pain, nausea, and vomiting. For this, neuraxial anesthesia might be a better alternative to general anesthesia (GA), providing superior analgesia, with higher patient satisfaction and lesser incidence of nausea vomiting. This randomized-controlled open-label trial was done to compare segmental spinal and GA for breast cancer surgery. The present study enrolled 56 female patients scheduled to undergo breast cancer surgery. They were randomly divided into two groups, group G (received standard GA) and group TS (received segmental thoracic spinal anesthesia with 0.5% isobaric levobupi vacaine at T5-T6 inter spaces). The primary objective of this study was patient satisfaction with the anesthetic technique, while secondary objectives were hemodynamic changes, perioperative complications, time of first rescue analgesic, total opioid consumption in first 24 h, and surgeon satisfaction score. Data were expressed as mean (SD) or number (%) as indicated and were compared using Chi-square, Fisher's exact, or Student's ttest as appropriate. Patient in group TS had significantly higher satisfaction score median 5 (IQR 1) compared to patients in group G median 4 (IQR 3.5) (P = 0.0001). Nausea and vomiting were significantly higher in group G compared to group TS (P = 0.01). Mean time to rescue analgesia was 33.21 ± 7.48 min in group G as compared to 338.57 ± 40.70 in group TS and opioid consumption was also significantly lower in group TS (70.00 ± 27.38) as compared to group G (366.07 ± 59.40). There was no significant difference in hemodynamic parameters (except significantly lower heart rate at 15 min in group TS (P = 0.001) and surgeon satisfaction score between groups. Quality of postoperative analgesia was better in group TS. Segmental thoracic spinal anesthesia technique provides better satisfaction with superior postoperative analgesia and fewer complications in patients undergoing breast cancer surgery compared to GA.

A Comparative Study of Hemodynamic Parameters Following Subarachnoid Block in Patients With and Without Hypertension.

BackgroundHypotension is common in patients receiving a subarachnoid block (SAB) and can decrease vital organ perfusion, causing increased morbidity and mortality. Patients may receive intraoperative intravenous (IV) fluids and rescue medications to avoid these adverse effects and maintain adequate hemodynamic parameters. We conducted this study to compare the hemodynamic parameters and heart rate following spinal anesthesia on patients receiving antihypertensive medications (e.g., calcium channel blockers with or without beta-blockers) with those without hypertension during surgical procedures requiring SAB.MethodsWe conducted this two-year, single-center, prospective observational study in patients with hypertension and blood pressure within reference ranges receiving elective surgical procedures that do not require a definitive airway. All participants were from the American Society of Anesthesiologists physical status I and II. We assigned patients into three groups. Group 1 consisted of patients with hypertension receiving calcium channel blockers. Group 2 consisted of patients with hypertension receiving calcium channel blockers with beta-blockers. Patients whose blood pressure was within reference range were assigned to group 3. We collected patient ages and body weights, and we compared heart rate (HR), systolic and diastolic blood pressure (SBP; DBP), and mean arterial pressure (MAP) between the groups. We also compared the use of intraoperative rescue medications, IV fluid administration, and patient outcomes. We used Epi Info version 7.1 (Atlanta, GA: Centers for Disease Control and Prevention) public domain software for statistical analysis.ResultsSeventy-eight patients were included in the study (41 men, 37 women); group 1, HR, SBP, DBP, and MAP significantly declined over time in all groups, but there were no significant differences when comparing parameters between groups. Hypotension occurred in significantly more patients in group 1 (p=0.02) than groups 2 and 3. Bradycardia was experienced by significantly more patients in group 2 (p<0.05) than group 1 and group 3. Twenty-four patients in group 3, 17 patients in group 1, and 14 patients in group 2 required IV fluid in the first 20 minutes of the procedure, and the differences between the groups were not significant. Likewise, 15 patients in group 3, 14 in group 1, and 10 in group 2 required ephedrine, but the differences were not significant.ConclusionsWe compared intraoperative hemodynamic parameters following spinal anesthesia on patients receiving antihypertensive medications with patients without hypertension following SAB. Our results showed no meaningful differences in hemodynamic parameters between patients receiving antihypertensive drugs (calcium channel blockers without or in combination with beta-blockers) and those not receiving antihypertensive drugs after SAB. Therefore, calcium channel blockers alone or in combination with beta-blockers can be used to control patient blood pressure prior to surgery.

Соматотипологические особенности вегетативной регуляции у девочек подросткового возраста г. Красноярска

Introduction. The decrease in physical health parameters of children and adolescents in our country justifies the need to develop programs aimed at correcting this situation, in particular, conducting research in the field of anthropology, studying the autonomic balance and the influence of the body’s individual morphological features on it. Aim. Identification of the relationship between autonomic status and morphofunctional parameters of the cardiovascular system depending on the somatotype in adolescent girls of the city of Krasnoyarsk. Materials and methods. The study involved 158 adolescent girls (from 13 to 15 years old) living in Krasnoyarsk. An anthropometric examination was carried out with the further determination of the somatotype according to the Rees-Eysenck body index. Some indicators of the cardiovascular system (systolic and diastolic blood pressure (SBP and DBP), heart rate (HR)) and the tone of the autonomic nervous system were assessed according to the Kerdo’s index. Results. According to the results of anthropometry, the participants were distributed as follows: ectomorphy – 65 people, mesomorphy – 51 people, endomorphy – 42 people. A statistically significant increase in SBP and DBP was found as body strength increased in all three groups. In ectomorphic body type girls, there was a decrease in SBP values in combination with higher HR. The predominance of sympathicotonia was found in the ectomorphy and endomorphy groups (65.2 and 52.8%, respectively). The largest number of girls with the excitation-inhibition balance of the autonomic nervous system was among mesomorphy (53.3%) and slightly less among endomophy girls (39.6%), both of these indicators were significantly higher than among the ectomorphic body type girls (30.4%). At the same time, in the latter, the parasympathicotonia predominates less often (4.3%) than in mesomorphy (6.7%) and endomorphy (7.5%) (p &lt; 0.05). Conclusion. The obtained data on the difference in hemodynamic parameters and autonomic status in girls aged 13–15, depending on the body type, must be considered when choosing sports activities and realization of medical and preventive work in a secondary school.

Comparison of effect of etomidate with propofol on hemodynamics during modified electroconvulsive therapy.

Background and Aims:Studies comparing the effect of propofol and etomidate on hemodynamic parameters during electroconvulsive therapy (ECT) have shown ambiguous results. Although some studies observed a larger increase in blood pressure and heart rate during the use of etomidate than propofol in ECT, whereas some studies have shown no difference in hemodynamic parameters with the use of etomidate or propofol. Most of the studies done to compare the hemodynamic effects of etomidate and propofol were limited by small sample size or retrospective in nature. Therefore, we conducted a prospective randomized trial to compare the effects of etomidate and propofol on hemodynamics during ECT.Material and Methods:A prospective randomized crossover study was conducted on 30 patients with American Society of Anesthesiologist physical status I and II, between age 18 and 65 years, suffering from a mental disorder as per International Classification of Diseases-10 and requiring bilateral ECT as per clinical decision of consultant psychiatrist. They were randomized to receive both the drugs for their successive ECT sessions and were subjected to evaluation after clubbing together the ECT sessions of propofol or etomidate as anesthetic agent.Results:Duration of motor seizures was significantly more in patients receiving etomidate, whereas patients receiving propofol had more stable hemodynamics.Conclusion:Though propofol maintains stable hemodynamics during MECT, yet clinical applicability of etomidate outstrips it by a reasonable margin due to its better effect on seizure parameters.

Ocular microcirculation after revascularization of the internal carotid artery in the early postoperative period

To study the impact of CEA and CAS interventions on ocular blood flow in patients with clinically significant ICA stenosis in the early postoperative period. Thirty-two patients with hemodynamically significant stenosis (≥75%) of the left or right ICA were examined using optical coherence tomography angiography (OCT-A) and flowmetry before and after CEA or CAS in order to assess the changes in ocular blood flow parameters. There were no significant differences in hemodynamic parameters in the eyes on the side of the stenotic and non-stenotic ICA before revascularization. In the early postoperative period (3-7 days) in the ipsilateral eyes, there was an increase in blood flow density and vascular density at the level of the superficial and deep plexuses in the macular area (p≤0.05), as well as an increase in the ocular blood flow volume, the level of tolerated intraocular pressure (p≤0.05) and a decrease in intraocular pressure (p≤0.05) bilaterally. In the contralateral eyes, after ICA revascularization there was a partial improvement in microcirculation parameters according to OCT-A (p≤0.05). Peripapillary blood flow density and peripapillary vessel density did not change significantly either on the ipsilateral or the contralateral side. In patients with clinically significant ICA stenosis, ICA revascularization by stenting or endarterectomy contributed to an improvement in retinal microcirculation and retrobulbar blood flow in both eyes. OCT-A and flowmetry allow non-invasive assessment of retinal microvessels and retrobulbar blood flow, and the measurements provided by these methods can serve as valuable biomarkers for predicting and monitoring hemodynamic changes in patients who undergo CEA and CAS surgeries.

THE EFFECT OF EPIDURAL VOLUME EXTENSION ON SPINAL BLOCK WITH 0.5% HEAVY BUPIVACAINE IN TOTALABDOMINAL HYSTERECTOMY - A RANDOMISED CONTROLLED STUDY

Introduction: One of the indication of total abdominal hysterectomy and bilateral salpingo -oophorectomy is the patient is suffering from menometrorrhagia, excessive or irregular menstrual bleeding that occurs between or during a female's menstrual cycle. Menometrorrhagia is a indication of urogenital malignancy (such as cervical malignancy), uterine broids, hormonal discripancies and endometriosis. Other possible indications for TAHBSO are pelvic inammatory disease,ovarian cyst, cancer of overies, uterus and or cervix. If remains untreated this can lead to anemia. Aims And Objectives: Compare maximum sensory block level in each group (Smax), Period when Smax was rst achieved, Period for 2 segment regression of sensory block from its highest level, Period for block regression to level of T10 dermatome e. Maximum motor blockade achieved, Time to attain maximum motor block, Time for complete regression of motor block(modied Bromage score=6),To compare any difference in haemodynamic parameters(Spo2,mean blood pressure). Materials And Methods Study Setting:This study will be conducted in the gynaecology OTComplex of IPGME&amp;R. Study Period: March 2017-August 2018 Definition Of Problem: Comparative evaluation of the effect of epidural volume extension on spinal block with 0.5% heavy bupivacaine for total abdominal hysterectomy such as Results And Analyses: Our study showed that the distribution of body weight between Group E and Group S. Body weight was normally distributed, it was found that there was no statistical signicance difference between the groups (p=0.4054). Distribution of ASAstatus in groups, In group E 25patient were. Summary And Conclusion: This technique is, however, not without its disadvantages, which draws special attention from an anesthesiologist such as rapid rise of spinal block, accidental migration of catheter in intravascular and intrathecal space along with an increased incidence of meningitis. In future We in subsequent case series will try to highlight the efcacy of this novel technique in patients of different setting with compromised cardiac functional status.

Comparison of the Effect of Propofol and Dexmedetomidine on Hemodynamic Parameters and Stress Response Hormones During Laparoscopic Cholecystectomy Surgery.

BackgroundGeneral anesthesia induces endocrine, immunologic, and metabolic responses. Anesthetic drugs affect the endocrine system by changing the level of stress hormones and hemodynamic variables of the patient.ObjectivesThe purpose of this study was to compare the effects of propofol and dexmedetomidine on hemodynamic parameters and stress-induced hormones in laparoscopic cholecystectomy (LC) surgery.MethodsSeventy patients of elective LC were included in this study. The patients were randomly assigned into two equal groups of propofol (75 µg/kg/min) and dexmedetomidine (0.5 µg/kg/hour) as anesthesia maintenance. Hemodynamic parameters (heart rate and mean atrial pressure), blood sugar, and serum epinephrine level were monitored and recorded from pre-anesthesia period to 10 min after entry to post-anesthesia care unit (PACU) according to a planned method.ResultsHeart rate and mean atrial pressure changes were significantly lower in dexmedetomidine group in all stages compared to propofol group (P < 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 < 0.001).ConclusionsAnesthesia 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.

Pulmonary and Systemic Hemodynamics following Multielectrode Radiofrequency Catheter Renal Denervation in Acutely Induced Pulmonary Arterial Hypertension in Swine.

Objective We aimed to assess the effects of renal denervation (RDN) on systemic and pulmonary hemodynamics in a swine model of thromboxane A2- (TXA2-) induced pulmonary arterial hypertension (PAH). Methods The study protocol comprised two PAH inductions with a target mean pulmonary artery pressure (PAP) of 40 mmHg at baseline and following either the RDN or sham procedure. Ten Landrace pigs underwent the first PAH induction; then, nine animals were randomly allocated in 1 : 1 ratio to RDN or sham procedure; the second PAH induction was performed in eight animals (one animal died of pulmonary embolism during the first PAH induction, and one animal died after RDN). In the RDN group, ablation was performed in all available renal arteries, and balloon inflation within artery branches was performed in controls. An autopsy study of the renal arteries was performed. Results At baseline, the target mean PAP was achieved in all animals with 25.0 [20.1; 25.2] mcg of TXA2. The second PAH induction required the same mean TXA2 dose and infusion time. There was no statistically significant difference in the mean PAP at second PAH induction between the groups (39.0 ± 5.3 vs. 39.75 ± 0.5 mmHg, P > 0.05). In the RDN group, the second PAH induction resulted in a numerical but insignificant trend toward a decrease in the mean systemic blood pressure and systemic vascular resistance, when compared with the baseline induction (74 ± 18.7 vs. 90.25 ± 28.1 mmHg and 1995.3 ± 494.3 vs. 2433.7 ± 1176.7 dyn∗sec∗cm−5, P > 0.05, respectively). No difference in hemodynamic parameters was noted in the sham group between the first and second PAH induction. Autopsy demonstrated artery damage in both groups, but RDN resulted in more severe lesions. Conclusions According to our results, RDN does not result in significant acute pulmonary or systemic hemodynamic changes in the TXA2-induced PAH model. The potential chronic effects of RDN on PAH require further research.

The Use of Laparoscopy for Suspected Postpartum Uterine Rupture: Changing the Paradigm.

<h3>Study Objective</h3> To investigate the feasibility of laparoscopy as both diagnostic and operative tool in patients with suspected postpartum uterine rupture. <h3>Design</h3> Case series. <h3>Setting</h3> Tertiary university-affiliated hospital. <h3>Patients or Participants</h3> Sixteen women who were diagnosed with postpartum uterine rupture Between November 2012 and April 2021. <h3>Interventions</h3> Emergent laparoscopy or laparotomy in women with suspected post-partum uterine rupture. <h3>Measurements and Main Results</h3> Clinical and demographic data were retrospectively collected and analyzed. During the study period 7 women (43.7%) underwent laparoscopy and 9 women (56.2%) laparotomy for suspected postpartum uterine rupture. There where five cases of uterine rupture in the laparoscopy group and 9 cases in the laparotomy group all of which had the uterine defect sutured. There was no difference in hemodynamic parameters between the two groups. The median time interval from delivery to surgery was 66(IQR 39.5-187.5) minutes in the laparotomy group and 202(IQR 70-485) minutes in the laparoscopy group. The median operative time for laparoscopic surgery was 80(IQR 60-114) minutes and 73(IQR 58-101.5) minutes for the laparotomy group. Three women who underwent laparotomy (33.3%) and one who underwent laparoscopy (14.2%) were admitted to the intensive care unit following surgery. Blood transfusion was required in five women who had laparotomy (55.5%) and one who had laparoscopy (14.2%). Hospitalization period was longer in women who had laparotomy (median (IQR) of 5(4-5) days vs. 3(3-4)). There were no conversions to laparotomy in the laparoscopy group. <h3>Conclusion</h3> In careful patient selection and surgical expertise laparoscopic surgery for suspected postpartum uterine rupture is feasible and safe. It has the benefit of shorter recovery and early mobilization which is paramount important in women following delivery.

Abdominal hemodynamics in patients with visceroptosis

Abstract Background Abdominal circulation plays the important physiological role for structure and function of the digestive system, maintenance of nutrient homeostasis. Purpose To study the features of abdominal hemodynamics in patients with visceroptosis. Methods We studied 69 patients (mean age 22.28±3.7 years) with splanchnoptosis (visceroptosis) and 52 age- and sex- matched patients without splanchnoptosis (controls). Exclusion criteria: a history of digestive system surgery of taking blood circulation activating drugs. Doppler ultrasonography of the common hepatic artery, splenic artery, superior mesenteric artery, portal vein was performed on an empty stomach and 30 minutes after a food sample (standardized for proteins (14 g), fats (10 g) and carbohydrates (45 g)) using the Sonoace-8000 ultrasound scanner (Medison, South Korea). The data were analyzed using the Statistica-6 packages. Results There were no differences in hemodynamic parameters of fasting abdominal blood flow (ABF). After a food testing, in the postprandial period the ABF in all vessels in patients with splanchnoptosis was lower than in controls: the portal vein blood flow (BF) 1124,0 [1030,0–1419,0] ml/min vs 1373,0 [1136,0–1567,5] ml/min respectively (U=433,5; Z=−2,1; p=0,0342); the common hepatic artery BF 341,0 [295,0–394,0] ml/min vs 412,0 [331,0–521,0] ml/min respectively (U=335,0; Z=−2,3; p=0,0218); the splenic artery BF 396,0 [292,0–538,0] ml/min vs 502,0 [394,0–594,0] ml/min respectively (U=328,0; Z=−2,1; p=0,0399); the superior mesenteric artery BF 988,0 [837,0–1272,0] ml/min vs 1136,5 [992,0–1465,0] ml/min respectively (U=1625,5; Z=−2,2; p=0,0314). Changes in ABF were correlated with splanchnoptosis: the portal vein BF with any ptosis (rs=−0,21; p&amp;lt;0.05), the common hepatic artery BF with gastroptosis (rs=−0,38; p&amp;lt;0.05), the superior mesenteric artery BF with colonoptosis (rs=−0,86; p&amp;lt;0.05). The peripheral vascular resistance was correlated with the common hepatic artery BF (rs=−0,46; p&amp;lt;0.05), with the splenic artery BF (rs=−0,33; p&amp;lt;0.05) and with the superior mesenteric artery BF (rs=−0.79; p&amp;lt;0.05). Conclusions Patients with splanchnoptosis in the postprandial period have low volumetric BF in abdominal aorta vessels. This can be associated with the length of the mesenteric vessels, which undergoes the greatest changes in splanchnoptosis. Food testing reveals latent BF deficit in patients with splanchnoptosis. Funding Acknowledgement Type of funding sources: None.

Investigations into the Potential of Using Open Source CFD to Analyze the Differences in Hemodynamic Parameters for Aortic Dissections (Healthy versus Stanford Type A and B)

The objective of this study was to develop a method to evaluate the effects of an aortic dissection on hemodynamic parameters by conducting a comparison with that of a healthy (nondissected) aorta. Open-source software will be implemented, no proprietary software/application will be used to ensure accessorily and repeatability, in all the data analysis and processing. Computed tomography (CT) images of aortic dissection are used for the model geometry segmentation. Boundary conditions from literature are implemented to computational fluid dynamics (CFD) to analyze the hemodynamic parameters. A numerical simulation model was created by obtaining accurate 3-dimensional geometries of aortae from CT images. In this study, CT images of 8 cases of aortic dissection (Stanford type-A and type-B) and 3 cases of healthy aortae are used for the actual aorta model geometry segmentation. These models were exported into an open-source CFD software, OpenFOAM, where a simplified pulsating flow was simulated by controlling the flow pressure. Ten cycles of the pulsatile flow (0.50 sec/cycle) conditions, totaling 5 sec, were calculated. The pressure distribution, wall shear stress (WSS) and flow velocity streamlines within the aorta and the false lumen were calculated and visualized. It was found that the flow velocity and WSS had a high correlation in high WSS areas of the intermittent layer between the true and false lumen. Most of the Stanford type-A dissections in the study showed high WSS, over 38 Pa, at the systole phase. This indicates that the arterial walls in type-A dissections are more likely to be damaged with pulsatile flow. Using CFD to estimate localized high WSS areas may help in deciding to treat a type-A or B dissection with a stent graft to prevent a potential rupture.

Combatting ischemia reperfusion injury from resuscitative endovascular balloon occlusion of the aorta using adenosine, lidocaine and magnesium: A pilot study.

Resuscitative endovascular balloon occlusion of the aorta (REBOA), a minimally invasive alternative to resuscitative thoracotomy, has been associated with significant ischemia reperfusion injury (IRI). Resuscitation strategies using adenosine, lidocaine, and magnesium (ALM) have been shown to mitigate similar inflammatory responses in hemorrhagic and septic shock models. This study examined the effects of ALM on REBOA-associated IRI using a porcine model. Animals underwent a 20% controlled hemorrhage followed by 30 minutes of supraceliac balloon occlusion. They were assigned to one of four groups: control (n = 5), 4-hour ALM infusion starting at occlusion, 2-hour (n = 5) and 4-hour (n = 5) interventional ALM infusions starting at reperfusion. Adenosine, lidocaine, and magnesium cohorts received a posthemorrhage ALM bolus followed by their respective ALM infusion. Primary outcomes for the study assessed physiologic and hemodynamic parameters. Adenosine, lidocaine, and magnesium infusion after reperfusion cohorts demonstrated a significant improvement in lactate, base deficit, and pH in the first hour following systemic reperfusion. At study endpoint, continuous ALM infusion initiated after reperfusion over 4 hours resulted in an overall improved lactate clearance when compared with the 2-hour and control cohorts. No differences in hemodynamic parameters were noted between ALM cohorts and controls. Adenosine, lidocaine, and magnesium may prove beneficial in mitigating the inflammatory response seen from REBOA-associated IRI as evidenced by physiologic improvements early during resuscitation. Despite this, further refinement should be sought to optimize treatment strategies.

Severe Myocardial Dysfunction after Non-Ischemic Cardiac Arrest: Effectiveness of Percutaneous Assist Devices.

Introduction: Despite the improvements in standardized cardiopulmonary resuscitation, survival remains low, mainly due to initial myocardial dysfunction and hemodynamic instability. Our goal was to compare the efficacy of two left ventricular assist devices on resuscitation and hemodynamic supply in a porcine model of ventricular fibrillation (VF) cardiac arrest. Methods: Seventeen anaesthetized pigs had 12 min of untreated VF followed by 6 min of chest compression and boluses of epinephrine. Next, a first defibrillation was attempted and pigs were randomized to any of the three groups: control (n = 5), implantation of an percutaneous left ventricular assist device (Impella, n = 5) or extracorporeal membrane oxygenation (ECMO, n = 7). Hemodynamic and myocardial functions were evaluated invasively at baseline, at return of spontaneous circulation (ROSC), after 10–30–60–120–240 min post-resuscitation. The primary endpoint was the rate of ROSC. Results: Only one of 5 pigs in the control group, 5 of 5 pigs in the Impella group, and 5 of 7 pigs in the ECMO group had ROSC (p < 0.05). Left ventricular ejection fraction at 240 min post-resuscitation was 37.5 ± 6.2% in the ECMO group vs. 23 ± 3% in the Impella group (p = 0.06). No significant difference in hemodynamic parameters was observed between the two ventricular assist devices. Conclusion: Early mechanical circulatory support appeared to improve resuscitation rates in a shockable rhythm model of cardiac arrest. This approach appears promising and should be further evaluated.