Heart Rate Trends Research Articles

Does early heart rate detection and continuous monitoring have an impact on neonatal resuscitation in newborns with intact cord? – An observational study

ABSTRACT Context: Heart rate (HR) is the most vital parameter to assess hemodynamic transition at birth. ECG is considered a gold standard for HR assessment. New devices with dry electrodes are easy to apply on a wet newborn. However, the utilization of newer technology that captures fast and reliable HR, and its impact on neonate resuscitation are yet to be explored, especially in newborns with intact cords. Aims: to detect HR early by dry electrode devices and its impact on neonatal resuscitation. Settings and Design: This is an observational study conducted at a tertiary care hospital in India. Methods and Material: A portable pulse oximeter, conventional ECG with modified 3 electrodes, and dry electrodes ECG (Neo Beat) were applied to capture HR ECG and Sp02. First reliable HR and outcomes of neonates were compared. Statistical Analysis Used: Median (IQR) was calculated for quantitative data. These were conducted using an updated version of IBM SPSS Statistics 22 software. Results: Out of 329 newborns, 24 newborns had their first documented HR of less than 100 bpm, out of which 14 (58%) initiated respiration with initial steps and the rest 10 required resuscitation (42%) in the form of positive pressure ventilation. Among newborns with a first HR of more than 100 bpm, 8 newborns (2.6%) required resuscitation. The median duration to capture the first reliable HR using dry electrodes was 15 sec (IQR 12.7–20 sec), which was much faster than the time required by conventional ECG (37 sec) and pulse oximetry (80 sec). Conclusions: First reliable HR can effectively predict the need for neonatal resuscitation. Dry electrode ECG can effectively capture continuous and reliable HR. HR trends can further assist in predicting the need for neonatal resuscitation and the efficacy of neonatal resuscitation.

Visceral Fat Affects Heart Rate Recovery but Not the Heart Rate Response Post-Single Bout of Vigorous Exercise: A Cross-Sectional Study in Non-Obese and Healthy Participants

Body composition could influence exercise physiology. However, no one has ever studied the effect of visceral fat (VF) on heart rate (HR) trends during and after exercise by using bioimpedance analysis (BIA). This study aims to investigate BIA variables as predictors of HR trends during vigorous exercise. Ninety-six participants (age 22.5 ± 4.8 years) were included in the data analysis. After performing BIA, the HR was recorded at three time points: baseline HR (BHR), peak HR (PHR) at the end of vigorous exercise, and resting HR (RHR) 1 min after the end of the exercise. After BHR, a 30 s squat jump test was performed. Linear regression analysis showed the body fat percentage and VF as a predictor of HR recovery post-exercise (p < 0.01). However, body weight has no association with HR recovery (p > 0.05). On the other hand, BIA variables were not associated with the variation of HR from the baseline to the end of the exercise. The results show that higher VF is associated with a slower HR recovery. To schedule a training program, it would be safer to monitor visceral fat before prescribing recovery time.

Optimum oxygen concentration for initiation of delivery room stabilization in preterm neonates: A Randomized Controlled Trial

RationaleThe ideal choice of initial fraction of inspired oxygen (FiO2) to stabilize preterm neonates in the delivery room (DR) is not well-established. ObjectiveTo compare the effects of different initial FiO2 in neonates < 34 weeks’ gestation requiring respiratory support for DR stabilization. MethodsIn this open-labeled, assessor-blinded, parallel-group randomized controlled trial, 150 neonates were allocated to initiate DR-stabilization with 60 % (n = 75) versus 30 % (n = 75) FiO2, followed by titration to peripheral oxygen saturation (SpO2) targets. The primary outcome was the proportion of neonates achieving a target SpO2 of ≥ 80 % at 5 min of life. Secondary outcomes were minute-specific SpO2, heart rate (HR) and FiO2 trends till 10 min, regional cerebral oxygenation (CrSO2) at one hour, need for surfactant and caffeine, respiratory support duration, in-hospital adverse events, mortality, and duration of hospitalization. Stata 15 was used for an intention-to-treat analysis. ResultsThe proportion of neonates achieving SpO2 ≥ 80 % at 5 min was 58 (73.3 %) with 60 % compared to 38 (50.7 %) with 30 % FiO2 [relative risk (95 % confidence interval), 1.53 (1.18, 1.97); p < 0.001]. Though minute-specific SpO2 and FiO2 were significantly higher in the 60 % group, HR trends were comparable. No difference was observed in CrSO2, need and duration of respiratory support, surfactant, and caffeine, incidences of adverse events including mortality, and the duration of hospital stay. ConclusionA significantly higher number of preterm neonates < 34 weeks’ gestation requiring DR stabilization achieved a 5-minute SpO2 of ≥ 80 % with higher minute-specific SpO2 trends when stabilized with an initial FiO2 of 60 % compared to 30 %.

Performance Evaluation of QT-RR Adaptation Time Lag Estimation in Exercise Stress Testing.

Slower adaptation of the QT interval to sudden changes in heart rate has been identified as a risk marker of ventricular arrhythmia. The gradual changes observed in exercise stress testing facilitates the estimation of the QT-RR adaptation time lag. The time lag estimation is based on the delay between the observed QT intervals and the QT intervals derived from the observed RR intervals using a memoryless transformation. Assuming that the two types of QT interval are corrupted with either Gaussian or Laplacian noise, the respective maximum likelihood time lag estimators are derived. Estimation performance is evaluated using an ECG simulator which models change in RR and QT intervals with a known time lag, muscle noise level, respiratory rate, and more. The accuracy of T-wave end delineation and the influence of the learning window positioning for model parameter estimation are also investigated. Using simulated datasets, the results show that the proposed approach to estimation can be applied to any changes in heart rate trend as long as the frequency content of the trend is below a certain frequency. Moreover, using a proper position of the learning window for exercise so that data compensation reduces the effect of nonstationarity, a lower mean estimation error results for a wide range of time lags. Using a clinical dataset, the Laplacian-based estimator shows a better discrimination between patients grouped according to the risk of suffering from coronary artery disease. Using simulated ECGs, the performance evaluation of the proposed method shows that the estimated time lag agrees well with the true time lag.

A feasibility study on predicting cow calving time over 40 h in advance using heart rate and financial technical indicators

In dairy farming, the uncertainty of cow calving date often imposes waiting costs for days on farmers. Improving the accuracy of calving date prediction would mitigate these costs, specifically before a few days of the event. We monitored and analyzed the heart rate patterns of eight pregnant cows in the days leading up to calving using a dedicated monitoring device. We decomposed the heart rate data into three distinct components: trend, daily cycle, and the remainder, and discovered that the heart rate trend exhibited a sharp decline more than 40 h before the calving event via the trend turning point. To detect the turning point, we applied common financial technical indicators traditionally used to identify turning points of asset prices in trading markets for the extracted heart rate trend. This study remains a feasibility study because of the limited observations, but it indicates that these indicators can effectively capture the trend’s turning point in real time, offering a promising approach for enhanced calving prediction. In addition to discussing the practical implications for cow management, we also contemplate the broader utility of these technical indicators in the context of various dynamic scientific data analyses.

Quantification of physiological effect of respiration on automated measurement of blood pressure among normotensive adult individuals.

Accurate blood pressure measurement necessitates meticulous methodology, as even minor variations like speaking or sitting can impact the readings. Additionally, respiration plays a role in blood pressure, exhibiting a dip during inhalation and a subsequent increase during exhalation. However, the influence of breathing patterns, duration, and rate on blood pressure remains largely unexplored. In this study, we have attempted to quantify the changes in blood pressure and heart rate (HR) of normotensive individuals while performing predefined respiratory patterns - slow, medium, and fast (respiratory rates of 5, 10, and 20/m, respectively). For each respiratory pattern, age-matched and gender-matched (18-40 years) volunteered normotensive individuals were selected as volunteers. Baseline readings were recorded and each volunteer was randomly allotted a respiratory pattern. The volunteers performed the assigned respiratory pattern while the BP and HR were recorded. A fall in both SBP and DBP was observed in all three patterns of respiration. There was no inter-pattern difference in the blood pressure change. A novel finding in our study was a trend of respiratory rate and HR - the change in HR linearly increased with a rise in respiratory rate difference. We also proposed a linear regression equation for this increase in HR with the increase in respiratory rate which was statistically significant. The findings suggest the decline in blood pressure is independent of the respiratory pattern employed. The study also demonstrates that the HR is a linear function of respiratory rate.

Efficacy of Ultrasound-Guided Intercostal Nerve Block on Pain Management and Physiological Outcomes in Breast Cancer Mastectomy: A retrospective study.

To evaluate the efficacy of ultrasound-guided intercostal nerve block in managing pain and physiological responses in patients undergoing radical mastectomy for breast cancer. A retrospective study analyzed 120 patients scheduled to undergo radical mastectomy in our hospital between January 2022 and December 2023. Depending on the type of anesthesia received, participants were assigned to the experimental group (60 patients) to receive ultrasound-guided intercostal nerve block and intravenous general anesthesia, or the control group (60 patients) to receive intravenous general anesthesia only. Both groups will utilize patient-controlled intravenous analgesia (PCIA) postoperatively. We will monitor and compare hemodynamic parameters, SpO2, and bispectral index (BIS) at multiple time points, and assess postoperative pain, inflammatory markers, PCIA utilization, and adverse reaction incidence. Comparative analysis showed distinct trends in heart rate, mean arterial pressure (MAP), BIS, and SpO2 across various surgical stages between groups. Notably, MAP values were consistently higher and less variable in the experimental group during surgery (P < .05). Pain assessments at 4, 12, and 24 hours postoperatively in both quiet and coughing states revealed significantly milder pain in the experimental group (P < .05). Preoperative inflammatory markers (PGE2, TNF-α, IL-6, MCP-1) were similar between groups; however, 24 hours post-surgery, the experimental group showed significantly lower levels of PGE2, IL-6, and MCP-1 (P < .05). Sufentanil consumption during surgery and PCIA use were notably lower in the experimental group (P < .05). The experimental group also experienced fewer anesthesia-related adverse reactions (8.33%) compared to the control group (25.00%) (P < .05). Ultrasound-guided intercostal nerve block significantly improves hemodynamic stability, reduces postoperative inflammatory markers, lowers the need for sufentanil, and minimizes adverse reactions in patients undergoing radical mastectomy for breast cancer.

Evaluating psychological anxiety in patients receiving radiation therapy using smartwatch.

Patients undergoing radiation therapy (RT) often experience psychological anxiety that manifests as muscle contraction. Our study explored psychological anxiety in these patients by using biological signals recorded using a smartwatch. Informed consent was obtained from participating patients prior to the initiation of RT. The patients wore a smartwatch from the waiting room until the conclusion of the treatment. The smartwatch acquired data related to heart rate features (average, minimum, and maximum) and stress score features (average, minimum, and maximum). On the first day of treatment, we analyzed the participants' heart rates and stress scores before and during the treatment. The acquired data were categorized according to sex and age. For patients with more than three days of data, we observed trends in heart rate during treatment relative to heart rate before treatment (HRtb) over the course of treatment. Statistical analyses were performed using the Wilcoxon signed-rank test and paired t-test. Twenty-nine individuals participated in the study, of which 17 had more than 3 days of data. During treatment, all patients exhibited elevated heart rates and stress scores, particularly those in the younger groups. The HRtb levels decreased as treatment progresses. Patients undergoing RT experience notable psychological anxiety, which tends to diminish as the treatment progresses. Early stage interventions are crucial to alleviate patient anxiety during RT.

Hemodynamic comparison between minimally invasive and conventional approaches in off-pump coronary artery bypass grafting: A randomized controlled trial

This study aimed to investigate the hypothesis that minimally invasive coronary artery bypass grafting (CABG) induces fewer hemodynamic alterations compared to conventional approaches, attributing this to reduced heart rotation during grafting. Given the critical role of hemodynamic stability in patient outcomes and the growing popularity of minimally invasive CABG, we sought to assess and compare the hemodynamic responses during left anterior descending artery grafting. This randomized controlled trial was conducted at a tertiary center, enrolling a total of 60 patients, with 30 in each group. Parameters such as heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), and perfusion index (PI) were measured at baseline, after octopus stabilization prior to grafting, at 3 minutes during grafting, and at the end of grafting. Additionally, serum lactate levels were assessed at baseline and upon completion of grafting. The baseline HR was comparable between the groups. However, the trends in HR revealed a significant increase in the conventional group after octopus stabilization (P value = 0.0038), at 3 minutes post-initiation of grafting (p &amp;#60; 0.001), and at the completion of grafting (P value = 0.001). MAP and CVP remained comparable at all time points. Notably, PI showed a significant increase in the conventional group during positioning (after octopus stabilization), at 3 minutes post-initiation of grafting, and at the completion of grafting. There were no significant differences in lactate levels between the groups. Despite no significant differences in MAP, CVP, and lactate levels, our findings highlight significant disparities in HR and PI between the two groups. We conclude that the observed variations in heart rate may be attributed to minimal positional changes in the minimally invasive approach compared to the conventional approach.

Identifying Cardiovascular System Involvement through Heart Rate Trends in Food-Induced Systemic Reactions in Infants and Toddlers

Identifying Cardiovascular System Involvement through Heart Rate Trends in Food-Induced Systemic Reactions in Infants and Toddlers

P540 Non-serious adverse events in patients with ulcerative colitis receiving etrasimod: An analysis of the phase 2 OASIS and phase 3 ELEVATE UC 52 and ELEVATE UC 12 clinical trials

Abstract Background Etrasimod is an oral, once-daily, selective sphingosine 1-phosphate (S1P)1,4,5 receptor modulator for the treatment of moderately to severely active ulcerative colitis (UC). Adverse events (AEs) pertaining to tolerability, laboratory and serious AEs are described elsewhere1,2; we present a post hoc analysis of the incidence, onset and duration of the most commonly occurring non-serious AEs in the etrasimod UC clinical programme. Methods Data from the pooled Placebo-controlled UC cohort, derived from the phase 2 OASIS (NCT02447302) and phase 3 ELEVATE UC 52 (NCT03945188) and ELEVATE UC 12 (NCT03996369) double-blind clinical trials, were included. Cohorts comprised OASIS and ELEVATE UC 12 12-week induction periods alongside the ELEVATE UC 52 12-week induction and 40-week maintenance periods utilising a "treat-through" design. Patients (pts) with moderately to severely active UC were eligible for the etrasimod UC clinical programme. Pts were randomised to etrasimod 1 mg once daily (QD; OASIS only), etrasimod 2 mg QD or placebo. Proportions and incidence rates (IRs) of non-serious AEs (MedDRA v24.1 Preferred Terms of headache, pyrexia, nausea, fatigue and dizziness) were analysed in the Placebo-controlled UC cohort. Results Among 943 pts (any dose of etrasimod, N=629 [288.1 pt years (PY)]; placebo, N=314 [115.1 PY]), there were 77, 36, 30, 15 and 23 headache, pyrexia, nausea, fatigue and dizziness AEs, respectively. All were non-serious and did not lead to treatment discontinuation, apart from one case of pyrexia in which early termination visits were incomplete. Proportions and IRs (per 100 PY) for headache and dizziness AEs were higher with etrasimod (any dose) vs placebo (IRs: 13.45 vs 8.63 and 6.52 vs 1.69, respectively); IRs for other non-serious AEs were similar in etrasimod (any dose) and placebo groups (Table). Onset of AEs varied over time and most AEs were short in duration (Figure shows onset and duration for headache and dizziness AEs). Most AEs were deemed not related to study treatment by the site investigator. Pts with dizziness on Days 1–3 had similar changes in heart rate vs those with dizziness after Day 3. No consistent trend in heart rate was observed in pts receiving etrasimod with early dizziness. Conclusion Among pts in the etrasimod UC clinical programme, all headache, pyrexia, nausea, fatigue and dizziness events were non-serious. IRs were similar for most non-serious AEs across treatment groups, excluding headache and dizziness. Most non-serious AEs were short in duration and judged as not related to study treatment, suggesting they may not impact on the overall tolerability of etrasimod.

Pre-operative screening of diabetic patients for heart rate variability and their hemodynamic responses during induction of general anaesthesia

: Cardiovascular autonomic neuropathy (CAN) is one of the least frequently diagnosed and the most clinically significant complications of Diabetes mellitus (DM). Impaired heart rate variability (HRV) is the earliest indicator of CAN. Peri-operative hemodynamic instability is a major concern during general anaesthesia (GA) in patients with autonomic dysfunction. Purpose of this study was to assess and compare the autonomic function using HRV in diabetic and non-diabetic patients pre-operatively and to study the haemodynamic responses of these patients during induction.: The primary objective was to assess and compare the autonomic function using HRV in diabetic and non-diabetic patients preoperatively. Secondary objective was to study hemodynamic responses of these patients during induction of GA.: We included 68 patients (34 diabetics- group D and 34 non-diabetics- group N) aged between 30 to 65 years, with American society of anaesthesiologists (ASA) physical status 1 and 2 undergoing elective surgeries under GA. All the eligible patients underwent HRV evaluation for 10 minutes on the previous day of surgery and the time &amp; frequency domain variables were evaluated. The hemodynamic parameters were recorded at pre-induction, post-induction, post-intubation and for every 3 minutes thereafter for 15 minutes and analysed.: The diabetics had a significantly lower total power (TP) with p-value 0.003. The post- induction mean arterial pressures (MAP) were comparatively lower in diabetics and the difference was significant at 12 minutes post intubation (p= 0.04). The lower trends in heart rate (HR) were comparatively more in diabetics rather than non-diabetics (p= 0.06) and the ephedrine usage was also higher in diabetics (p= 0.07). The measurement of HRV is a simple tool to evaluate the peri-operative risks in patients with suspected cardiovascular autonomic neuropathy.

T-Piece resuscitator versus self-inflating bag for delivery room resuscitation in preterm neonates: a randomized controlled trial.

TPR and SIB resulted in comparable SpO2 at 5min along with similar minute-specific SpO2, HR, and FiO2 trends. Clinical trial registry of India, Registration no: CTRI/2021/10/037384, Registered prospectively on: 20/10/2021, https://ctri.icmr.org.in/ . • Compared to self-inflating bags (SIB), T-piece resuscitators (TPR) provide more consistent inflation pressure and tidal volume as shown in animal and bench studies. • There is no strong recommendation for one device over the other in view of low certainty evidence. • TPR and SIB resulted in comparable peripheral oxygen saturation (SpO2) at 5min along with similar minute-specific SpO2, heart rate, and fractional-inspired oxygen requirement trends. • Short-term complications and mortality rates were comparable with both devices.

Time-series clustering for pattern recognition of speed and heart rate while driving: A magnifying lens on the seconds around harsh events

Driving pattern recognition has been applied for the purposes of driving styles identification and harsh driving events detection. However, the evolution of driving behavior around and especially before such events has not been investigated at a microscopic level. The objective of this research is to reveal existing driving patterns around harsh events at the driving ‘pulse’ level i.e. a few seconds before and after the event. For that purpose, a time-series clustering approach is applied on speed and heart rate metrics of individual drivers using data collected from a large naturalistic driving study. Results show that there are distinct speed patterns before harsh braking, harsh acceleration, and harsh cornering events. A deceleration is identified shortly before most harsh acceleration and cornering events, which possibly indicates reckless behavior, i.e. drivers not dedicating enough time to smoothly brake before cornering, or of a brief ‘decision-making’ moment before the harsh manoeuvre. On the contrary, speed seems to be steady before harsh braking events. Regarding heart rate, the analysis revealed certain patterns only after raw data were cleansed and filtered. These patterns may show increasing, decreasing or variable heart rate trends, which may correspond to different stress patterns of drivers around harsh events. Finally, we introduce the concept of driving pattern consistency, which can reveal the share of individual drivers that follow the same harsh event pattern. It is indicated that more than half of the drivers are not consistent, suggesting that driving patterns around harsh events may be more context-related than driver personality-related.

Developmental toxicity in early chicken embryos on exposure to an organophosphorus flame retardant, tris(2-chloroisopropyl) phosphate

Tris(2-chloroisopropyl) phosphate (TCIPP) is an organophosphate flame retardant detected in the environment and eggs, feathers, and livers. Early-developmental-stage avian embryos are vulnerable to the toxic effects of chemicals. However, studies on the specific effects of TCIPP on avian embryonic development are limited. We aimed to investigate the toxicity of TCIPP in early chicken embryos using a previously developed shell-less incubation system. Fertilized chicken (Gallus gallus domesticus) eggs (n = 220) were exposed to 50 or 500 nmol TCIPP/(g egg) or dimethyl sulfoxide (DMSO) as a vehicle control on Day 0 of incubation. Development of 198 embryos was monitored from Days 3–9 of incubation, and 22 embryos on Day 4 and 74 embryos on Day 9 were dissected. Messenger RNA expression levels for several genes were measured in embryos on Day 4. Both TCIPP-exposed groups showed a significant reduction in survival rate. Imaging analyses revealed significant decreases in body length, head and bill length, eye diameter, and forelimb and hindlimb length in both TCIPP-treated groups. TCIPP exposure significantly impaired the development of extraembryonic blood vessels and the production of red blood cells. A TCIPP-dose-dependent decreasing trend in heart rate was observed on Days 4–7. The somitic angle increased significantly on Days 4–6, and embryos with curved somites showed cleavage in the back and gaps between somites, resulting in asymmetrical somite formation. A significant correlation was found between the somitic angle and FGF8 expression levels, suggesting that TCIPP exposure affects somite formation through an altered FGF-signaling pathway. Embryos with somitic deformities in TCIPP-exposed groups had significantly reduced survival rates, indicating that abnormal segment formation directly increased mortality. Finally, eye weight and ocular luminosity values were significantly reduced, suggesting that TCIPP may also affect eye development. Overall, these findings highlight severe toxic effects of TCIPP on avian embryonic development, including in vascularization, cardiac function, and somite and ocular development.

Assessment of short-term effects of thoracic radiotherapy on the cardiovascular parasympathetic and sympathetic nervous systems.

Prior research suggests that cardiovascular autonomic dysfunction might be an early marker of cardiotoxicity induced by antitumor treatment and act as an early predictor of cardiovascular disease-related morbidity and mortality. The impact of thoracic radiotherapy on the parasympathetic and sympathetic nervous systems, however, remains unclear. Therefore, this study aimed to evaluate the short-term effects of thoracic radiotherapy on the autonomic nervous system, using deceleration capacity (DC), acceleration capacity (AC) of heart rate, and heart rate variability (HRV) as assessment tools. A 5 min electrocardiogram was collected from 58 thoracic cancer patients before and after thoracic radiotherapy for DC, AC, and HRV analysis. HRV parameters employed included the standard deviation of the normal-normal interval (SDNN), root mean square of successive interval differences (RMSSD), low frequency power (LF), high frequency power (HF), total power (TP), and the LF to HF ratio. Some patients also received systemic therapies alongside radiotherapy; thus, patients were subdivided into a radiotherapy-only group (28 cases) and a combined radiotherapy and systemic therapies group (30 cases) for additional subgroup analysis. Thoracic radiotherapy resulted in a significant reduction in DC (8.5 [5.0, 14.2] vs. 5.3 [3.5, 9.4], p = 0.002) and HRV parameters SDNN (9.9 [7.03, 16.0] vs. 8.2 [6.0, 12.4], p = 0.003), RMSSD (9.9 [6.9, 17.5] vs. 7.7 [4.8, 14.3], p = 0.009), LF (29 [10, 135] vs. 24 [15, 50], p = 0.005), HF (35 [12, 101] vs. 16 [9, 46], p = 0.002), TP (74 [41, 273] vs. 50 [33, 118], p < 0.001), and a significant increase in AC (-8.2 [-14.8, -4.9] vs. -5.8 [-10.1, -3.3], p = 0.003) and mean heart rate (79.8 ± 12.6 vs. 83.9 ± 13.6, p = 0.010). Subgroup analysis indicated similar trends in mean heart rate, DC, AC, and HRV parameters (SDNN, RMSSD, LF, HF, TP) in both the radiotherapy group and the combined treatment group post-radiotherapy. No statistically significant difference was noted in the changes observed in DC, AC, and HRV between the two groups pre- and post-radiotherapy. Thoracic radiotherapy may induce cardiovascular autonomic dysfunction by reducing parasympathetic activity and enhancing sympathetic activity. Importantly, the study found that the concurrent use of systemic therapies did not significantly amplify or contribute to the alterations in autonomic function in the short-term following thoracic radiotherapy. DC, AC and HRV are promising and feasible biomarkers for evaluating autonomic dysfunction caused by thoracic radiotherapy.

The effect on vital signs of concomitant administration of nicardipine and dexmedetomidine sedation after spinal anesthesia: A double-blind, randomized controlled trial.

We evaluated heart rate (HR) and blood pressure (BP) trends when nicardipine (NCD) was co-administered during dexmedetomidine (DEX) sedation after spinal anesthesia. Sixty patients aged 19 to 65 were randomly assigned to the DEX or DEX-NCD groups. Five minutes after infusion of the loading dose of DEX, the NCD was administered intravenously at a rate of 5 μg/kg for 5 minutes in the DEX-NCD group. The study starting point was set at 0 minute when the DEX loading dose was initiated. The primary outcomes were the differences in HR and BP between the 2 groups during the study drug administration. Secondary outcomes included the number of patients whose HR was < 50 beats per minute (bpm) after the DEX loading dose infusion, and associated factors were evaluated. The incidence of hypotension in the postanesthesia care unit, postanesthesia care unit length of stay, postoperative nausea and vomiting, postoperative urinary retention, time to first urination after spinal anesthesia, acute kidney injury, and postoperative hospital length of stay were evaluated. The HR was significantly higher at 14 minutes, and the mean BP was significantly lower at 10 minutes in the DEX-NCD group than in the DEX group. The number of patients with an HR < 50 bpm during surgery was significantly higher in the DEX group than in the DEX-NCD group at 12, 16, 24, 26, and 30 minutes. The DEX group and a low initial HR were independently associated with the occurrence of an HR < 50 bpm after DEX loading dose infusion. Postoperative outcomes were not significantly different between the 2 groups. Simultaneous administration of NCD during the administration of a loading dose of DEX prevented severe bradycardia. Co-administration of NCD may be considered in patients with a low initial HR when severe bradycardia is expected during the DEX loading dose infusion. NCD and DEX may be safely infused simultaneously without affecting postoperative complications (see Figure S1, Supplemental Digital Content, http://links.lww.com/MD/J241 , Graphical abstract).

Comparative study between ultrasound-guided erector spinae plane block and thoracic paravertebral block for postoperative analgesia after video-assisted thoracic surgery: an equivalence study

BackgroundIt is advised to use a regional block to lower postoperative opioid usage. Therefore, we aimed to compare the analgesic effect of erector spinae plane block (ESPB) and thoracic paravertebral block (TPVB) on the need for morphine following video-assisted thoracic surgery (VATS).ResultsThe findings revealed that TPVB and ESPB groups were equivalent in analgesic efficacy with postoperative morphine consumption in mg 15.2 ± 2.7 and 14.9 ± 2.4 respectively. statistically significant shorter block time in ESPB was 8.1 ± 1.7 min in contrast to 11.35 ± 1.7 min in TPVB and better patient satisfaction in the ESPB than in TPVB groups (p value < 0.05). No statistically significant differences existed between the two groups in terms of postoperative pain score (VAS) at rest, cough at any time point, or incidence of complications (p value > 0.05). There were significantly lower heart rate (HR) and blood pressure (BP) trends in 15 and 30 min intraoperatively (p value < 0.001) in the TPVB group.ConclusionsESPB has analgesic efficacy equivalent to TPVB from aspects of equivalent postoperative morphine consumption and VAS at rest and during cough with shorter block time and better patient satisfaction.Trial registrationPan African Clinical Trial Registry PACTR202109527452994. Registered on 8 September 2021.

Assessment of fatigue and recovery in elite cheerleaders prior to and during the ICU World Championships.

Little is known about the demands of competitive cheerleading. Therefore, the objective of this study was to assess fatigue and recovery during preparation for world championships. Fifteen participants from the German senior "All-Girl" and "Coed" national teams (nine males and six women) were recruited. Data were collected during the final preparation (T1 -T7) and competition days (C1 -C2). Heart rate variability (HRV) and resting heart rate (HR) were measured every morning. Data on training load, recovery, and stress (Short Scale for Recovery and Stress) were surveyed after training. Countermovement jump height (CMJ), sit-and-reach, and exercise-induced muscle damage (EMID) scores were taken in the afternoon. There was a practically relevant decrease in CMJ (T2, T6). A trend for HR to increase (T5-C2) and HRV to decrease (T4, T6-C2) was evident. Through training, recovery decreased and recovered as C1 approached (mental performance: T2-T4 p = 0.004; T2-C1 p = 0.029; T3-T4 p = 0.029; emotional balance: T3-T4 p = 0.023; T3-C1 p = 0.014; general recovery status T1-T3 p = 0.008; T3-T4 p = 0.024; T3-C1 p = 0.041), whereas stress increased during the first days and returned to normal before C1 (emotional dysbalance: T2-T4 p = 0.014; T2-C1 p = 0.009; T3-T4 p = 0.023; T3-C1 p = 0.014). EMID scores increased for the upper and lower body between T3, T5-T7 (p ≤ 0.036) and T3, T6-T7 (p ≤ 0.047), respectively. Pre-competition training led to substantial fatigue, and most markers indicate that athletes do not compete fully recovered. This could possibly be avoided by optimizing the training load or implementing recovery strategies.

Association Between Periprocedural Heart Rate Trend and Postprocedural Worsening Heart Failure in Patients Receiving Catheter Ablation for Atrial Fibrillation.

Association Between Periprocedural Heart Rate Trend and Postprocedural Worsening Heart Failure in Patients Receiving Catheter Ablation for Atrial Fibrillation.