Hemodynamic Response In Patients Research Articles

Perioperative infusion of magnesium sulfate versus dexmedetomidine on the hemodynamic responses in patients undergoing laparoscopic cholecystectomy: A randomized controlled trial

Background: Laparoscopic cholecystectomy is associated with less post-operative pain, shorter hospitalization, and a faster functional recovery as compared to the open procedure. However, like any other surgery, a stress response is induced. Anesthesia interventions such as direct laryngoscopy, tracheal intubation, and extubation involve severe sympathetic stimulation. Magnesium can block the release of catecholamines from both the adrenal gland and adrenergic nerve terminals by inhibiting of activation of membrane Ca²⁺-ATPase and Na⁺-K⁺-ATPase. Aims and Objectives: Both magnesium sulfate and dexmedetomidine decrease the release of catecholamines and attenuate pressor responses to anesthesia and surgery. Materials and Methods: Eighty-four ASA I/II patients were randomly allocated to two groups. Group D received dexmedetomidine 1 μg/kg followed by 0.4 μg/kg/h and Group M received 2 g MgSO₄ followed by 15 mg/kg/h. hemodynamic variables were recorded as T0 (after loading dose of study drug), just before (T1) and 1, 2, and 3 min after ProSeal laryngeal mask airway (PLMA) insertion (T2 [i] [ii] [iii]), before and after peritoneal insufflation (T3 and T4), before and after table tilt (T5 and T6), after resuming flat position (T7), peritoneal deflation (T8), PLMA removal (T9), and on post-anesthesia care unit admission (T10). Data were collected and analyzed using SPSS 17 statistical software. Results: The demographic profile was comparable. After the study drug administration, there was a fall in mean arterial pressure (MAP) in both groups (Group D > Group M) and no pressor response to PLMA insertion. At peritoneal insufflation, the MAP increase was significantly more in Group M at T6, T7, and T8 (31.9%, 27.9%, and 35.6% above baseline, respectively). Although there was a fall in systolic blood pressure (SBP) from the baseline throughout the procedure in both groups, SBP was significantly higher at most times in Group M as compared to Group D (P<0.05). In both groups, there was a similar rise in diastolic blood pressure after peritoneal insufflation. The mean heart rate was significantly lower in Group D at all time points. Conclusion: Dexmedetomidine seemed to be superior to MgSO₄ for ameliorating hemodynamic responses in patients undergoing laparoscopic cholecystectomy.

Attenuated frontotemporal brain activation during cognitive tasks is associated with lower succinate dehydrogenase protein levels in patients with major depressive disorder

BackgroundPrevious studies have shown a lower hemodynamic response in patients with major depressive disorder (MDD) during cognitive tasks. However, the mechanism underlying impaired hemodynamic and neural responses to cognitive tasks in MDD patients remains unclear. Succinate dehydrogenase (SDH) is a key biomarker of mitochondrial energy generation, and it can affect the hemodynamic response via the neurovascular coupling effect. In the current study, cerebral hemodynamic responses were detected during verbal fluency tasks (VFTs) via functional near-infrared spectroscopy (fNIRS) and SDH protein levels were examined in serum from MDD patients to quickly identify whether these hemodynamic alterations were related to mitochondrial energy metabolism. MethodsFifty patients with first-episode drug-naïve MDD and 42 healthy controls (HCs) were recruited according to inclusion and exclusion criteria. The 17-item Hamilton Depression Rating Scale (17-HDRS), Hamilton Anxiety Rating Scale (HAMA) and Inventory of Depressive Symptomatology-Self Report (IDS-SR) were used to assess the clinical symptoms of the patients. All participants underwent fNIRS measurements to evaluate cerebral hemodynamic responses in the frontal and temporal cortex during VFTs; moreover, SDH protein levels were measured using an enzyme-linked immunosorbent assay. ResultsActivation in the frontal-temporal brain region during the VFTs was lower in patients with MDD than in HCs. The SDH level in the serum of MDD patients was also significantly lower than that in HCs (p = 0.003), which significantly affected right lateral frontal (p = 0.025) and right temporal (p = 0.022) lobe activation. Both attenuated frontal-temporal activation during the VFTs (OR = 1.531) and lower SDH levels (OR = 1.038) were risk factors for MDD. ConclusionsMDD patients had lower cerebral hemodynamic responses to VFTs; this was associated with mitochondrial dysfunction, as indicated by SDH protein levels. Furthermore, attenuated hemodynamic responses in frontotemporal regions and lower SDH levels increased the risk for MDD. LimitationsThe sample size is relatively small. SDH protein levels in peripheral blood may not necessarily reflect mitochondrial energy generation in the central nervous system.

Evaluation of the Effects of Magnesium Sulphate versus Normal Saline on Hemodynamics in Patients Undergoing Laparoscopic Cholecystectomy

Introduction: Numerous studies have shown that giving magnesium sulphate intravenously before carbon dioxide pneumoperitoneum is produced reduces the adverse hemodynamic response in patients undergoing elective laparoscopic cholecystectomy. 
 Objective: To examine the effects on hemodynamics in patients undergoing laparoscopic cholecystectomy between magnesium sulphate and normal saline.
 Methodology:The Department of Anaesthesia at the Pakistan Institute of Medical Sciences, SZABMU, Islamabad, conducted a Randomised Clinical Trial. The study involved the enrolment of 108 adult patients, regardless of gender, who were admitted for elective laparoscopic cholecystectomy and ranged in age from 18 to 65. Every patient who was enrolled was in ΑSΑ classes I and II. Patients were randomised equally to Group M, which received an IV slow bolus of magnesium sulphate (28 mg/kg) over a 20-minute period, and Group N, which received a 0.9% normal saline solution. The patient was tilted right and up by 15 degrees.
 Results:Both groups' baseline characteristics were comparable. The mean age of groups M and N was 42.2 years ± 7.6SD and 40.5 years ± 8.4SD, respectively (Ρ-value t-test=0.258). 22 (40.7%) men and 32 (59.3%) women made up group M, while 20 (37.0%) men and 34 (63.0%) women made up group N (Ρ-value chi-square = 0.693). Both groups' baseline and pre-pneumoperitoneum hemodyanamic parameters (HR, Systolic, BΡ, Diastolic BΡ, and MAΡ) were similar (Ρ-value t-test > 0.05).
 Conclusions:The adverse hemodynamic response caused by pneumoperitoneum was significantly attenuated by pretreatment with intravenous magnesium sulphate. Heart rate, systolic blood pressure, diastolic blood pressure, and MTH were all significantly lower than baseline. Significant hypotension and bradycardia, however, were not seen.

Intraperitoneal local anesthetic instillation as a method to attenuate pneumoperitoneum induced hemodynamic response during laparoscopic surgeries: A randomized placebo controlled study

Laparoscopy is associated with significant hemodynamic changes due to pneumoperitoneum creation. We sought to study the effectiveness of intraperitoneal local anesthetic instillation in attenuating pneumoperitoneum-mediated hemodynamic response in patients undergoing laparoscopic cholecystectomy. This randomized study was conducted after approval from the institutional ethics committee, and 100 patients were randomly assigned to either group R (40 mL of 0.2% Ropivacaine intraperitoneally) or group N (40 mL of 0.9% normal saline intraperitoneally). Data analysis was performed using SPSS version 23. Independent Samples T test was used to compare hemodynamic variables between groups at regular intervals. Statistical significance was set less than 0.05.: Heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure were significantly lower in Group R than in Group N at 15,30, 45,60,75, and 90 min (P<0.05).: Intra peritoneal instillation of 0.2% Ropivacaine in laparoscopic cholecystectomy attenuates intra operative hemodynamic changes associated with pneumoperitoneum.

A COMPARATIVE STUDY TO EVALUATE HEMODYNAMIC CHANGES BETWEEN ENDOTRACHEAL INTUBATION AND PROSEAL LARYNGEAL MASK AIRWAY INSERTION IN PATIENTS UNDERGOING GENERAL ANAESTHESIA

Background: Hemodynamic stability is an important aspect to the anesthesiologist for patients. Laryngoscopy and endotracheal intubation can cause striking changes in Hemodynamics as result of intense stimulation of sympathetic nervous system. ProSeal LMA (PLMA)minimizes this response without compromising the airway. The aim of this study was to compare PLMA and Endotracheal tube with respect to intra-operative hemodynamic responses in patients undergoing general anaesthesia. Material and Methods: This prospective observational study was conducted on 30 patients of either sex, age group of 18-60 years, ASA (I or II), Mallam Pati (I or II) posted for elective surgery under general anaesthesia. They were randomly divided into two group 15 each. For group A, airway was secured with laryngoscopy and intubation with appropriate size endotracheal tube and for group B, appropriate size PLMA was inserted to secure airway. The hemodynamic responses like Heart rate and Blood pressure were recorded at base line, at insertion, after 1st min, 3rd min, 5th min and after extubation. Mean increase was statistically more after endotracheal intubation than PLMA insertion. The elevation in theseResults: hemodynamic parameters signicantly persisted for a longer period of time in the ETT group, where it returned to the baseline value by 5 minutes as compared to the PLMA group where it returned by 3 minutes. The hemodynamic response produced when PLMA was used forConclusion: securing airway was less than the laryngoscopy and endotracheal intubation. Thus, PLMA proved to be a suitable alternative to endotracheal tube for airway management with stable hemodynamic.

Near Infrared Spectroscopy For Cerebral Hemodynamic Monitoring During Carotid Endarterectomy Under General Anesthesia

Background:Near infrared spectroscopy (NIRS) is a noninvasive method for continuous monitoring of cerebral oxygenation.Objective:To describe the intraoperative behavior of NIRS variables used to evaluate hemodynamic response in patients with atherosclerotic disease undergoing carotid endarterectomy under general anesthesia.Methods:Fifteen volunteers with atherosclerotic carotid disease with indications for endarterectomy were evaluated. After selection of patients, carotid stenosis was confirmed by appropriate diagnostic methods. NIRS was used for intraoperative monitoring. The variables total hemoglobin (Hb), oxygenated hemoglobin (O2Hb), deoxygenated hemoglobin (HHb), and regional oxygen saturation (rSO2) were evaluated at three intraoperative time points: before, during, and after carotid clamping.Results and Discussion:Measurements recorded by NIRS showed that, during the first 5 min of clamp time, patients experienced a decline in O2Hb levels, an increase in HHb levels, and a marked decrease in rSO2. Hb remained constant throughout the procedure. At the post-clamping time point, HHb, O2Hb, and rSO2returned to patterns similar to those observed before clamping.Conclusion:NIRS was able to reliably and accurately identify the three stages of carotid endarterectomy and may predict the risk of cerebral hypoxia during carotid clamping under general anesthesia.

Ultrasound-guided paravertebral nerve block anesthesia on the stress response and hemodynamics among lung cancer patients.

BACKGROUNDThoracic surgery for radical resection of lung tumor requires deep anesthesia which can lead to an adverse inflammatory response, loss of hemodynamic stability, and decreased immune function. Herein, we evaluated the feasibility and benefits of ultrasound-guided paravertebral nerve block anesthesia, in combination with general anesthesia, for thoracic surgery for lung cancer. The block was performed by diffusion of anesthetic drugs along the paravertebral space to achieve unilateral multi-segment intercostal nerve and dorsal branch nerve block. AIMTo evaluate the application of ultrasound-guided paravertebral nerve block anesthesia for lung cancer surgery to inform practice. METHODSThe analysis was based on 140 patients who underwent thoracic surgery for lung cancer at our hospital between January 2018 and May 2020. Patients were randomly allocated to the peripheral + general anesthesia (observation) group (n = 74) or to the general anesthesia (control) group (n = 66). Patients in the observation group received ultrasound-guided paravertebral nerve block anesthesia combined with general anesthesia, with those in the control group receiving an epidural block combined with general anesthesia. Measured outcomes included the operative and anesthesia times, as well as the mean arterial pressure (MAP), heart rate (HR), and blood oxygen saturation (SpO2) measured before surgery, 15 min after anesthesia (T1), after intubation, 5 min after skin incision, and before extubation (T4).RESULTSThe dose of intra-operative use of remifentanil and propofol and the postoperative use of sufentanil was lower in the observation group (1.48 ± 0.43 mg, 760.50 ± 92.28 mg, and 72.50 ± 16.62 mg, respectively) than control group (P < 0.05). At the four time points of measurement (T1 through T4), MAP and HR values were higher in the observation than control group (MAP, 90.20 ± 9.15 mmHg, 85.50 ± 7.22 mmHg, 88.59 ± 8.15 mmHg, and 90.02 ± 10.02 mmHg, respectively; and HR, 72.39 ± 8.22 beats/min, 69.03 ± 9.03 beats/min, 70.12 ± 8.11 beats/min, and 71.24 ± 9.01 beats/min, respectively; P < 0.05). There was no difference in SpO2 between the two groups (P > 0.05). Postoperative levels of epinephrine, norepinephrine, and dopamine used were significantly lower in the observation than control group (210.20 ± 40.41 pg/mL, 230.30 ± 65.58 pg/mL, and 54.49 ± 13.32 pg/mL, respectively; P < 0.05). Similarly, the postoperative tumor necrosis factor-α and interleukin-6 levels were lower in the observation (2.43 ± 0.44 pg/mL and 170.03 ± 35.54 pg/mL, respectively) than control group (P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P > 0.05).CONCLUSIONUltrasound-guided paravertebral nerve block anesthesia improved the stress and hemodynamic response in patients undergoing thoracic surgery for lung cancer, with no increase in the rate of adverse events.

Effectiveness of Angiotensin II for Catecholamine Refractory Septic or Distributive Shock on Mortality: A Propensity Score Weighted Analysis of Real-World Experience in the Medical ICU.

This study examined ATII as a third-line vasopressor based on institutional approval. Retrospective observational cohort study. Medical ICU at an academic tertiary care medical center. Adult patients requiring 3 or more vasopressor agents for septic shock or other forms of distributed shock from September 1, 2018, to January 31, 2020. Effect of ATII after norepinephrine and vasopressin on mortality and mean arterial blood pressure response after 3 hours of administration. One-hundred forty-seven patients, 56 receiving ATII and 91 receiving another vasopressor (non-ATII), were enrolled. Patients in the ATII group had higher mortality compared to the non-ATII group, and more required 5 or greater vasopressor agents (p < 0.01). After propensity score weighting, there remains a trend in higher mortality in the ATII compared to non-ATII group, but not statistically significant (86.0% vs 71.0%, p = 0.16). More patients in the ATII group continued to require 5 or greater vasopressor agents compared to the non-ATII group after propensity score weighting (45.9% vs 12.5%, p < 0.01). SOFA score was the only variable associated with mortality (OR = 1.25, 95% CI, 1.05-1.49; p = 0.01). Patients were considered a "responder" if mean arterial pressure greater than 65 mm Hg at 3 hours after the third vasopressor was initiated. Among the ATII group, 37.5% patients were responders compared to 45.1% responders in the non-ATII group (relative risk = 1.07, 95% CI, 0.6-1.93; p = 0.81). Although previous data support the use of ATII due to its favorable hemodynamic response in patients with distributive shock, there was no observed benefit in mortality or hemodynamic response with ATII as a third-line vasopressor in our study of real-world patients.

A randomized control trial to study the effect of bilateral Gow-gates block on visibility of surgical field and hemodynamic response in patients with carcinoma tongue

Background and AimsRegional anesthesia in oncosurgery is a current research topic. The use of nerve blocks near the surgical site gives good analgesia, surgical field visibility and hemodynamic profile. Our aim was to evaluate the effect of the Gow gate mandibular nerve block in tongue surgeries. MethodsASA 1 & 2 patients posted for surgery for carcinoma of tongue were included in the study. After randomization Bilateral Gowgates block was given to Group G. Group M received IV Morphine only. The investigator B who was blinded to which group the patient belonged conducted the anesthesia and did the outcome assessment. The hemodynamic response to surgical manipulation was noted. The visibility of the surgical field was assessed by the surgeon using Surgical visibility scale. Postoperative pain was assessed by assessing dose requirement of opioids and paracetamol. The mean difference between the two groups were tested using student's t-test for normally distributed variables and Mann-Whitney U test for non-normal variables. ResultsHemodynamic stress response during surgical stimulation was significantly lower in group G. Surgical field visibility score was better in the group G (p0.002). The use of morphine intraoperatively in group G was less (p= 0.001) ConclusionBilateral Gow gates block improves visibility of surgical field and hemodynamic response in patients undergoing surgery for carcinoma tongue.

Comparative Evaluation of King Vision Video Laryngoscope, McCoy and Macintosh Laryngoscopes in Patients Scheduled for Mucormycosis Surgery: A Randomised Clinical Trial

Introduction: Mucormycosis, an aggressive fungal infection may result in a difficult airway owing to its inflammation. King Vision Video Laryngoscope (KVVL) is a useful addition to a difficult airway armamentarium. McCoy laryngoscope with hinged tip is well-known equipment of difficult airway cart. Conventional Macintosh laryngoscope dominates in anaesthesia practice. Standard, existing and contemporary devices were compared in difficult airways resulting from mucormycosis. Aim: To compare the relative performance of KVVL, McCoy, and Macintosh laryngoscopes based on the ease of intubation and haemodynamic response in patients with mucormycosis. Materials and Methods: The present study was a randomised clinical trial done during June-August 2021 on 90 consenting patients of 18-65 years age, belonging to either sex with microbiologically confirmed mucormycosis undergoing debridement surgery. Group A was intubated with a non channeled KVVL, while group B had McCoy and group C had Macintosh laryngoscope. Primary outcome parameters were Cormack Lehane (CL) grade, time from laryngoscopy to successful intubation, number of attempts, any adjuncts or optimisation maneuvers, and any mucosal injury. Secondary outcome parameters were Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Blood Pressure (MBP) measured on arrival, before induction, after induction, and at 1, 2, 3, 5, and 7 minutes after intubation. Comparison of quantitative variables not normally distributed were analysed using Kruskal Wallis test. Post-hoc analysis by Dunn's multiple pairwise comparison test. Friedman test followed by pairwise comparison was done to compare haemodynamic parameters within each group. Chi-square test was used for qualitative variables. The p-value ≤0.05 was considered to be statistically significant. Results: CL grade was lowest in group B (1.83±0.38) against group A (1.93±0.25), group C (2.13±0.35) with p-value of 0.029. Time from laryngoscopy to successful intubation was the least in group B (19.5±3.98) against group A (26.07±9.8), group C (21.33±3.74) with p-value of 0.002. No significant difference was there in the number of attempts, airway adjuncts/optimisation maneuvers, mucosal injury. Haemodynamic variables were comparable. Conclusion: McCoy laryngoscope was found to perform best in difficult airways resulting from mucormycosis. It was most effective for glottic visualisation, with the shortest time to successful intubation and, haemodynamic parameters were comparable to KVVL and Macintosh laryngoscopes.

Abstract 10384: Continuous Blood Pressure Monitoring During Six-Minute Walk Test and the Hemodynamic Response in Patients with Pulmonary Hypertension

Introduction: The six-minute walk test (6MWT) is frequently performed in patients with pulmonary hypertension (PH) to assess exercise capacity. Systolic blood pressure (SBP) values and variation during 6MWT may hold prognostic significance, but technologic limitations have precluded routine measurement. We used a novel device for continuous SBP monitoring during 6MWT and analyzed the relationship with PH severity. Methods: Caretaker®, an FDA-approved wireless continuous noninvasive BP device that uses pulse decomposition analysis was worn during 6MWT in patients with and without PH. We compared SBP values before, during, and after 6MWT. A repeated-measures ANOVA was used to compare SBP between groups. Results: Of the 80 patients tested, fifty patients (62.5%) demonstrated adequate signal quality for SBP monitoring. SBP varied significantly with the 6MWT in the PH group (N = 26; before vs. during vs. after; 129.1 [18.7] vs. 126.7 [18.6] vs. 140.3 [23.5] mmHg, p = 0.0006), but not in the non-PH group (N = 24; 136.1 [17.6] vs. 137.8 [17.9] vs. 143.1 [20.0] mmHg, p = 0.16). In the PH group, SBP variation while walking was inversely correlated with baseline pulmonary artery systolic pressure (PASP) (R = -0.47, p = 0.039, Figure 1 ). Conclusions: Continuous, clinic based SBP monitoring was feasible in nearly two-thirds of patients undergoing 6MWT. SBP response during walking differed between patients with and without PH and may provide clinically relevant insight into a patients exercise response. In patients with PH, change in SBP during 6MWT was inversely correlated with baseline PASP, suggesting dysregulated exertional hemodynamic response in patients with severe PH.

Types of hemodynamic response to orthostasis according to continuous blood pressure monitoring: a case series of heart failure with reduced ejection fraction

Heart failure (HF) is associated with unfavorable outcomes and high health care costs. Determination of the hemodynamic response to orthostasis can be an additional tool in assessing the stability and compensation of HF patients. Active orthostatic test (AOT) with blood pressure monitoring serves as a simple and available screening method. However, a complete characteristic of the hemodynamic response, especially during the first minute of orthostasis, can be obtained only with continuous blood pressure monitoring. The presented case series demonstrate the types of hemodynamic response in patients with heart failure with reduced ejection fraction in AOT with continuous blood pressure monitoring, available data on the mechanisms of its development, clinical and prognostic role, and also presents the advantages and limitations of AOT.

Effect of intrathecal buprenorphine on the haemodynamic response in patients undergoing laparoscopic appendicectomy under general anaesthesia

: Combined regional and general anaesthesia for laparoscopic appendicectomy offers better intraoperative haemodynamic stability. Buprenorphine is a long acting opioid which can be administered intrathecally and provides excellent analgesia intraoperatively and post operatively while allowing early ambulation without prolonged motor block. The study aimed to compare the haemodynamic response during laparoscopic appendicectomy using combined general anaesthesia with intrathecal buprenorphine and general anaesthesia alone. In this observational study 80 patients who underwent laparoscopic appendicectomy were divided into two groups of 40 each by random sampling. The patients in the GA group received general anaesthesia whereas patients in the GA+SAB group received intrathecal buprenorphine along with general anaesthesia. The heart rate, systolic and diastolic blood pressures and SpOwere noted after induction of general anaesthesia, immediately after endotracheal intubation, after creating pneumoperitonium and post extubation. Student’s t test was used for comparing the haemodynamic variables There were no statistically significant differences between GA and GA+SAB group in the heart rate, systolic and diastolic blood pressure after pneumoperitonium was created. When compared to general anaesthesia alone, addition of intrathecal burenorphine provides little advantage in preventing stress response during laparoscopic appendicectomy.

Effect of Intramuscular Dexmedetomidine Administration Before Extubation on Post-Extubation Haemodynamics, Postoperative Sedation, and Analgesic Requirements: A Double Blind Placebo Controlled Study.

Dexmedetomidine, an α2-adrenoreceptor agonist has been successfully used for attenuating stress response to laryngoscopy. The present study was designed to evaluate the effects of intramuscular dexmedetomidine 30 minutes before extubation on hemodynamic response in patients undergoing laminectomy for prolapsed intervertebral disc (PIVD) under endotracheal intubation and general anesthesia. Present double-blinded randomized placebo-controlled study, included 100 patients from either sex with American Society of Anesthesiologists grades I and II and age from 18 to 60 years undergoing laminectomy for PIVD under general anesthesia. Patients were randomly divided into two groups of 50 each based on computer generated random numbers. The study group received dexmedetomidine (2.0 μg/ kg, i.m.) in 2.5 mL saline, and the control group received normal saline (placebo, i.m.) 2.5 mL. Drugs had been administered 30 minutes before anticipated time of extubation intramuscularly at the deltoid region. Comparison of continuous variables between two groups was done by using student's unpaired t-test. Categorical data were analyzed by using chi-square test and Fischer Exact test as applicable. Heart rate was found to be significantly lower in the study group, 15 minutes before extubation (P = 0.003), during and after extubation (P ＜ 0.0001). The systolic and diastolic blood pressure was significantly lower in the study group during and after extubation (P ＜ 0.05). Cough was significantly lower in the study group during extubation. No significant difference was observed in other complications (respiratory stridor, incidence of laryngospasm or bronchospasm and reintubation) between the two groups. Pain score at 5 minutes, 2 hours, and 4 hours post-extubation was significantly lower in the study group (P ＜ 0.01). P-value ＜ 0.05 was considered statistically significant. Dexmedetomidine provides haemodynamic stability during extubation and post-extubation. It also provides post-operative calmness and reduces analgesic requirement and post-extubation complications.

Hemodynamic Responses in Carotid Bifurcation Induced by Enhanced External Counterpulsation Stimulation in Healthy Controls and Patients With Neurological Disorders.

Enhanced external counterpulsation is a Food and Drug Administration–approved, non-invasive, assisted circulation therapy for ischemic cardiovascular and cerebrovascular diseases. Previous studies have confirmed that EECP stimulation induces largely different cerebral hemodynamic responses in patients with ischemic stroke and healthy controls. However, the underlying mechanisms remain uncertain. We hypothesize that different blood redistributions at the carotid bifurcation may play a key role. Ten subjects were enrolled in this study, namely, five patients with neurological disorders and five young healthy volunteers as controls. Magnetic resonance angiography (MRA) was performed on the carotid artery. All the subjects received a single session of EECP treatment, with external cuff pressures ranging from 20 to 40 kPa. Vascular ultrasound measurements were taken in the common carotid artery (CCA), external carotid artery (ECA) and internal carotid artery (ICA). Three-dimensional patient-specific numerical models were developed to calculate the WSS-derived hemodynamic factors. The results indicated that EECP increased CCA and ECA blood flow in both groups. The ICA blood flow in the patient group exhibited a mean increase of 6.67% during EECP treatment compared with the pre-EECP condition; a mean decrease of 9.2% was observed in the healthy control group. EECP increased the averaged wall shear stress (AWSS) throughout the carotid bifurcation in the patient group; the ICA AWSS of the healthy group decreased during EECP. In both groups, the oscillatory shear index (OSI) in the ICA increased proportionally with external cuff pressure. In addition, the relative resident time (RRT) was constant or slightly decreased in the CCA and ECA in both groups but increased in the ICA. We suggest that the benefits of EECP to patients with neurological disorders may partly result from blood flow promotion in the ICA and increase in WSS at the carotid bifurcation. In the healthy subjects, the ICA blood flow remained constant during EECP, although the CCA blood flow increased significantly. A relatively low external cuff pressure (20 kPa) is recommended as the optimal treatment pressure for better hemodynamic effects. This study may play an important role in the translation of physiological benefits of EECP treatment in populations with or without neurological disorders.

Effects of acupuncture on the relationship between cerebral hemodynamics and arterial blood pressure in patients with hypertension

The present study aimed to investigate the effect of an auricular acupuncture intervention on the relationship between changes in oxyhemoglobin concentration (Δ [O2Hb]) and arterial blood pressure (ABP). The cerebral oxygenation signals in the bilateral prefrontal cortex (PFC), sensorimotor cortex (SMC), and temporal lobe cortex (TLC) of 15 patients with hypertension were measured by a 24-channel functional near-infrared spectroscopy (fNIRS) device before (State_R) and after (State_AT) the auricular acupuncture intervention. Coupling strength was used to quantitatively evaluate the strength of the couplings between ABP and Δ [O2Hb] in low-frequency oscillations (LF, 0.07–0.2 ​Hz) and very-low-frequency oscillations (VLF, 0.02–0.07 ​Hz). Results showed that the changes in wavelet amplitudes in the LF and VLF intervals did not exhibit significant differences after auricular acupuncture. The coupling strength from ABP to Δ [O2Hb] was significantly lower in the LF range after auricular acupuncture in the bilateral PFC, SMC, and TLC (p ​< ​0.0083). Additionally, the coupling strength from ABP to Δ [O2Hb] in the VLF range was significantly lower in the bilateral PFC in State_AT than in State_R (p ​< ​0.0083). These results indicated that fNIRS together with ABP can effectively evaluate cerebral hemodynamic responses to interventions and is therefore capable of guiding more individualized acupuncture strategies. The auricular acupuncture intervention improved hemodynamic responses in patients suffering from hypertension.

COMPARISON OF SEVOFLURANE VERSUS PROPOFOL FOR TRACHEAL INTUBATION IN CHILDREN

Objective: To compare the quality of intubation and hemodynamic response in children undergoing endotracheal intubation facilitated with propofol versus sevoflurane.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Department of Anesthesia, Combined Military Hospital Multan, from Aug 2018 to Apr 2019.&#x0D; Methodology: A total number of 112 children planned for tracheal intubation were included in this randomized controlled trial. Patients were randomly allocated into two equal groups. In group P (propofol) patient’s 2.5-3.0 mg/kg propofol was given before insertion of endotracheal tube and in group S (sevoflurane) patients 8.0% sevoflurane with 100% O2. Quality of intubation was assessed in all children at the time of intubation. Hemodynamic response of patients was also noted before induction of anesthesia, immediately after intubation and after 5 minutes of intubation.&#x0D; Results: Mean age of children included in this study was 2.11 ± 0.80 years. Quality of intubation was excellent in 51 (91.1%) patients in propofol group and in 38 (67.9%) patients in sevoflurane group (p-value 0.009). Mean HR after 5 minutes of intubation in group S and group P 111.98 ± 5.43 beats/min versus 109.05 ± 5.99 beats/min with p-value 0.008. Mean arterial pressure after 3 minutes of intubation mean arterial pressure in group S and P was 74.58 ± 4.45 mmHg versus 71.0 ± 3.90 mmHg with p-value &lt;0.001. After 5 minutes of intubation mean arterial pressure in group S and P was 73.16 ± 4.13 mmHg versus 68.61 ± 4.07 mmHg with p-value &lt;0.001.&#x0D; Conclusion: Sevoflurane was found to be associated.........

Effects of Buddhist walking meditation on exercise capacity and quality of life of patients with chronic heart failure: A randomized controlled trial

BackgroundBuddhist walking meditation (BWM) is widely practiced in many countries. However, there is a lack of evidence relating to its effectiveness for patients with heart failure (HF). PurposeTo determine the effects of a six-week BWM program on exercise capacity, quality of life, and hemodynamic response in patients with chronic HF. MethodsPatients with HF were randomly assigned to a BWM program or an aerobic exercise program. Each group trained at least three times a week during the six-week study period. The outcome measures included exercise capacity (six-minute walk test), disease-specific quality of life (Minnesota Living with Heart Failure Questionnaire), and hemodynamic response (blood pressure and heart rate) immediately after the six weeks of training. ResultsThe study enrolled 48 patients with a mean age of 65 years and a New York Heart Association functional class of II and III. At baseline, there were no significant differences in their clinical and demographic characteristics or the outcome measures. Although six patients withdrew, all participants were included in the intention-to-treat analysis. There was no statistically significant increase in the functional capacity of the BWM group; however, there was a significant improvement for the aerobic group. With both groups, there was no significant improvement in quality of life or most hemodynamic responses. ConclusionsThe six-week BWM program did not improve the functional capacity, quality of life, or hemodynamic characteristics of the HF patients, compared with the values of the patients in the aerobic exercise program.

Comparative Evaluation of Dexmedetomidine and Fentanyl Infusion on Haemodynamic Response in Patients Undergoing Elective Surgery Under General Anaesthesia

Context: The procedures like laryngoscopy and intubation evoke stress response in patients undergoing elective surgeries under general anaesthesia Aims: To compare and evaluate dexmedetomidine and fentanyl on hemodynamic response like Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP) in patients during intubation and extubation. Settingsand Design: Doubleblinded Randomised Control prospective Study Materials and Methods: AAfterobtainingethical clearance, 90 patients belonging to American Society of Anaesthesiologists class I/II, Scheduled for surgeries with duration of approx. 90mins were randomly divided into two groups. Group A received dexmedetomidine 1µg/ kg as loading dose over 10mns prior to induction followed by infusion at 0.5µg/kg/hr until 10mins prior to extubation. Group B received IV Fentanyl 1µg/kg as loading dose over 10mins prior to induction followed by infusion at 0.5 µg/kg/hr until 10mins prior to extubation. Exclusion criteria included cardiovascular disease, Obesity &gt;30kg/m2, patients with anticipated difficult airway, on sedatives, hypnotics and who have allergy to the study drug. Statistical analysis used: Data analyzed- SPSS22.0 software. Test of significance: Chi-squaretest. Continuousdata: Mean standard deviation. Testof significance:Independentttest p value: &lt;0.05- statistically significant.&gt; Results: With respect to hemodynamic response during intubation and extubation, Group A has shown significantly lower HR, SBP, DBP and MAP in comparison to Group B. Postoperative Visual Analogue Score for first 24hrs was significantly less in Group A compared to Group B. Conclusion: Dexmedetomidine is better and safe alternative to fentanyl in attenuating hemodynamic response during both intubation and extubation.

Effects of Intravenous Dexmedetomidine and Clonidine on Haemodynamic Response in Laparoscopic Lower Abdominal Oncosurgeries under General Anaesthesia: A Randomised Controlled Trial

Introduction: From the early 1970’s, laparoscopic procedures became well established because of their advantages like excellent visualisation, improved cosmesis, reduced postoperative pain and reduced hospital stay. Despite its advantages, laparoscopic surgeries have its demerits such as pneumoperitoneum and positional changes. Alpha-2 agonists have shown promising results in attenuating the stress response in laparoscopic surgeries. Aim: To compare clonidine and dexmedetomidine in attenuating haemodynamic stress response during laparoscopic lower abdominal oncosurgeries. Materials and Methods: A randomised controlled trial was conducted at Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India, during the period of December 2018 to May 2019. Institutional Ethical Committee clearance was obtained for the trial. Total 48 patients were recruited into two groups with 24 participants in each group: A (clonidine) and B (dexmedetomidine). Both drugs were infused at a dose of 1 μg/kg for 15 minutes along with premedication before induction. Haemodynamic stress response was estimated using parameters like Heart Rate (HR), systolic and diastolic blood pressure and mean arterial pressure at induction, pneumoperitoneum and at extubation. All the data were analysed using the statistical software R (V3.6.2). Continuous data were presented in the form of Mean±Standard Deviation (SD). The difference in mean value of the various parameters between the two groups was analysed using Student’s t-test. A p-value of &lt;0.05 was considered to be significant. Results: Patients in both the groups were comparable with regards to demographic features. The mean age was 46.76±8.17 years, 46.24±9.70 years and weight was 55.76±7.28 and 56.08±6.06 for group A and group B, respectively. There were statistically significant differences in attenuating stress response in dexmedetomidine compared to clonidine group. Statistically significant reduction in the HR was noticed in group B as compared to group A at 12 minutes of infusion (p=0.008), at the end of infusion (p=0.008), before intubation (p=0.005), 10 minutes after intubation (p=0.008) and after pneumoperitoneum (p=0.045). Group B which was given dexmedetomidine drug compared to group A with clonidine drug showed better attenuation of the systolic blood pressure during extubation (p=0.006). Conclusion: To conclude, both clonidine and dexmedetomidine effectively attenuate the haemodynamic response in patients undergoing laparoscopic lower abdominal oncosurgeries when administered as intravenous bolus dose. In addition, the dexmedetomidine attenuates haemodynamic responses better than clonidine.