Hemodynamic Changes Research Articles

Blood flow assessment technology in aortic surgery: a narrative review.

Blood flow assessment is an emerging technique that allows for assessment of hemodynamics in the heart and blood vessels. Recent advances in cardiovascular imaging technologies have made it possible for this technique to be more accessible to clinicians and researchers. Blood flow assessment typically refers to two techniques: measurement-based flow visualization using echocardiography or four-dimensional flow magnetic resonance imaging (4D flow MRI), and computer-based flow simulation based on computational fluid dynamics modeling. Using these methods, blood flow patterns can be visualized and quantitative measurements of mechanical stress on the walls of the ventricles and blood vessels, most notably the aorta, can be made. Thus, blood flow assessment has been enhancing the understanding of cardiac and aortic diseases; however, its introduction to clinical practice has been negligible yet. In this article, we aim to discuss the clinical applications and future directions of blood flow assessment in aortic surgery. We then provide our unique perspective on the technique's translational impact on the surgical management of aortic disease. Articles from the PubMed database and Google Scholar regarding blood flow assessment in aortic surgery were reviewed. For the initial search, articles published between 2013 and 2023 were prioritized, including original articles, clinical trials, case reports, and reviews. Following the initial search, additional articles were considered based on manual searches of the references from the retrieved literature. In aortic root pathology and ascending aortic aneurysms, blood flow assessment can elucidate postoperative hemodynamic changes after surgical reconfiguration of the aortic valve complex or ascending aorta. In cases of aortic dissection, analysis of blood flow can predict future aortic dilatation. For complicated congenital aortic anomalies, surgeons may use preoperative imaging to perform "virtual surgery", in which blood flow assessment can predict postoperative hemodynamics for different surgical reconstructions and assist in procedural planning even before entering the operating room. Blood flow assessment and computational modeling can evaluate hemodynamics and flow patterns by visualizing blood flow and calculating biomechanical forces in patients with aortic disease. We anticipate that blood flow assessment will become an essential tool in the treatment planning and understanding of the progression of aortic disease.

Perioperative analgesic management in patients with bladder exstrophy: A clinical study

Background: Bladder exstrophy is a complex, rare congenital malformation with an incidence of 3.3 cases in every 100000 live births and is slightly more common in males. Primary surgical repair requires many hours of surgery with fluid and blood loss. Because of wide fluctuations in hemodynamics, a longer duration of surgery, smaller age, risk of hypothermia and post-operative intensive care may be required. We evaluated the use of continuous caudal epidural infusion of bupivacaine and fentanyl under general anesthesia for urinary bladder exstrophy-epispadias surgery in children. Aims and Objectives: Aim of the study was to evaluate the postoperative analgesia in patients undergoing surgery for bladder exstrophy. The primary objective was to assess the postoperative pain using FLACC scale and sedation score after successful caudal administration. Secondary objective was to assess the hemodynamic changes after caudal administration. Materials and Methods: A total of 13 patients aged between 9months and 13 years of either sex, weighing between 5kg to 30kg, belonging to ASA grade II to IV, underwent surgery for epispadias–exstrophy complex. Initial bolus 0.75ml/kg of 0.25% bupivacaine with fentanyl 1ug/kg was given through epidural. Postoperative analgesia was maintained by continuous infusion of 0.0625% bupivacaine @0.1ml/kg/hr in young children and 0.125% bupivacaine with fentanyl 1ug/ml in older children for 4-5 days with the help of ON-Q pump or infusion pump. Baseline hemodynamic parameters including MAP, heart rate and SpO2 was recorded at various time intervals. Postoperative pain was assessed using face, legs, activity, cry and consolability (FLACC) pain scale and sedation score was assessed by using ramsay sedation score. Results: There was a statistically significant decrease in mean pulse rate in the study group from baseline to thirty minutes after reversal (p<0.001). Similar observation was made for mean arterial pressure which also showed statistically significant decrease from baseline to thirty minutes after reversal (p<0.001). No change was observed in SpO2 from baseline to any other follow-up interval. Conclusion: Perioperative anesthetic and analgesic management of the bladder exstrophy patient can improve the success rate. Epidural bupivacaine with or without fentanyl infusions for short duration can provide safe analgesia.

Cardiac hemodynamics phenotypes and individual responses to training in coronary heart disease patients.

In patients with coronary heart disease (CHD), individualized exercise training (ET) programs are strongly recommended to optimize peak oxygen uptake ( O2peak) improvement and prognosis. However, the cardiac hemodynamic factors responsible for a positive response to training remain unclear. The aim of this study was to compare cardiac hemodynamic changes after an ET program in responder (R) versus non-responder (NR) CHD patients. A total of 72 CHD patients completed a 3-month ET program and were assessed by cycle ergometer cardiopulmonary exercise test (CPET: O2peak assessment) with impedance cardiography (ICG) for hemodynamic measurements before and after training. Cardiac hemodynamics (e.g., CO, CI, SV, ESV, EDV, and SVR) were measured by ICG during CPET. The R and NR groups were classified using the median change in O2peak (>the median for R and ≤the median for NR). In the R group, O2peak (+17%, p < 0.001), CO, CI, SV, and HR increased by 17%, 17%, 13%, and 5%, respectively (p < 0.05) after the training program. In the NR group, O2peak, CO, CI, and SV increased by 0.5%, 5%, 8%, and 6%, respectively (p < 0.01). The SVR decreased in both groups (-19% in R and -11% in NR, p < 0.001). Among CHD patients, the R group showed a better improvement in peak cardiac output via an increase in peak stroke volume and heart rate and a reduced systemic vascular resistance than the NR group. Different cardiac phenotype adaptations and clinical individual responses were identified in CHD patients according to the aerobic fitness responder's status.

Sildenafil improves hemodynamic changes caused by acute pulmonary embolism by inhibiting Rho kinase activity.

This study examined the effects of sildenafil on acute pulmonary embolism (APE) using a rat model. Sprague-Dawley rats were randomly divided into the sham, pulmonary thromboembolism (PTE), and sildenafil groups. The sham and PTE groups received normal saline once daily via gavage for 14 consecutive days, whereas the sildenafil group received sildenafil (0.5 mg/kg/day) once daily via gavage for 14 consecutive days. Autologous emboli were prepared from blood samples collected from the left femoral artery of rats in each group on day 13, and autologous emboli were injected into the jugular vein cannula of rats in the PTE and sildenafil groups on day 14. Sham-treated rats received the same volume of saline. Right systolic ventricular pressure (RVSP) and mean pulmonary arterial pressure (MPAP) were used to assess pulmonary embolism, and western blotting and enzyme-linked immunosorbent assay were used to detect relevant markers. The Rho kinase signaling pathway was significantly activated in rats with APE, and sildenafil significantly inhibited this activation. Sildenafil protected against APE through inhibiting Rho kinase activity, thereby reducing pulmonary vasoconstriction and decreasing elevated pulmonary arterial pressure. These findings might provide new ideas for the clinical treatment of acute pulmonary thromboembolism.

Impact of catheterized ductal closure on renal and cerebral oximetry in premature neonates.

Percutaneous catheter-based closure is increasingly utilized in premature newborns. While near-infrared spectroscopy (NIRS) has been examined for assessment of interventional closure in surgical ligation, its application in percutaneous transcatheter closure remains unexplored. This study aims to assess cerebral and renal hemodynamic changes using NIRS during percutaneous closure compared to surgical closure in preterm infants. A prospective observational study enrolled preterm infants born at 32 weeks of gestation or less and diagnosed with hsPDA between January 2020 and December 2022. These infants received either surgical or catheter-based closure of the PDA. Cerebral and renal oxygen saturation was monitored using the INVOS 5100 device from 12 h before the intervention until 24 h after. Linear mixed-effects models were used to analyze time-dependent variables. Twenty-two patients were enrolled, with catheter-based closure performed in 16 cases and conventional surgery in 6 cases. Following ductal closure, a significant increase in renal and cerebral oximetry was observed alongside a decrease in renal and cerebral tissue oxygen extraction. These changes were particularly pronounced in the renal territory. No differences were detected between catheterization and surgical closure. Conclusion: An improvement in cerebral and renal oximetry following hsPDA closure was observed. However, we did not identify differences in this pattern based on the type of interventional procedure for PDA, whether surgery or catheterization. What is Known: •The presence of a significant ductus is common in premature patients. Studies have shown that it affects cerebral and renal hemodynamics negatively, leading to decreased oximetry values in these areas. It has been reported that closure of the ductus, either pharmacologically or surgically, results in improved oximetry values. What is New: •This study assess the impact of percutaneous closure of ductus, revealing increased oximetry values in cerebral and renal territories without significant differences compared to surgical ligation. Notably, renal oximetry values showed a greater increase, underscoring the importance of multi-location monitoring.

(832) - The Utility of Conventional and Novel Hm3 Pump Parameters in the Assessment of Haemodynamic Changes: A Mock Loop Study

(832) - The Utility of Conventional and Novel Hm3 Pump Parameters in the Assessment of Haemodynamic Changes: A Mock Loop Study

Pheochromocytoma – A challenge to anesthetist

Abstract Phaeochromocytoma is a catecholamine-secreting tumor of the sympathoadrenal system. It poses a significant challenge to the anesthesiologist, as sudden and intense hemodynamic changes are common in the preoperative and intraoperative periods. Preoperative optimization with sympatholytic drugs along with fluid resuscitation and intraoperative hemodynamic stability is essential for improved patient outcome. The anatomy of the tumor and proximity to major vasculature prove a challenge to anesthetists and surgeons alike. We are presenting a case of a 53-year-old male with a phaeochromocytoma of the right adrenal gland posted for laparoscopic right adrenalectomy, with the tumor mass compressing the inferior vena cava.

(420) - Trajectories of Early Hemodynamic Changes After Heart Transplantation: The Evil is in the Details

(420) - Trajectories of Early Hemodynamic Changes After Heart Transplantation: The Evil is in the Details

Hyperosmolar Therapy in Elderly Neurosurgical Patients: Comparison of the Effect of Mannitol (20%) and Hypertonic Saline (3%) on Advanced Cardiovascular Parameters Using Transesophageal Echocardiography: A Preliminary Randomized Controlled Trial

Osmotherapeutic agents increase the intravascular volume by withdrawing water from the brain followed by relative hypovolemia due to diuresis leading to significant changes in systemic hemodynamics which might have adverse consequences in the elderly. We studied the effect of mannitol (20%) and hypertonic saline (3%) on left ventricle outflow tract velocity-time integral (LVOT-VTI) and cardiac output in elderly patients undergoing supratentorial neurosurgical procedures using transesophageal echocardiography. We recruited twenty-eight patients aged above 65 years undergoing supratentorial craniotomy who received equiosmolar solutions of 5.35 ml/kg of 3% hypertonic saline (Group HS, n=14) or 5 ml/kg of 20% mannitol (Group M, n=14). LVOT-VTI was recorded at baseline, 15, 30, 45, 60 and 90 minutes post-infusion and cardiac output (CO) was derived. We also recorded heart rate, blood pressure, fluid balance, brain relaxation, vasopressor use, complications and neurological outcome. We found a significant decrease in LVOT-VTI at 45, and 60 mins in Group M as compared to Group HS [mean(SD), 16.76(1.81) v/s 20.78(1.87), P <0.001, 17.4(2.38) v/s 19.16(2), P = 0.044, respectively]. We also found a corresponding significant fall in CO [3863.16(845.87) v/s 4745.59 (1209.33) ml/min, P = 0.034] and systolic blood pressure (P = 0.039), at 45 mins in Group M. Urine output was higher in Group M (P <0.001). All other parameters were comparable. Hypertonic saline appears to be associated with better systemic hemodynamics (LVOT-VTI, CO) while providing equivalent brain relaxation as mannitol in elderly patients. A future larger study is required to confirm our preliminary findings.

(336) - Changes in Right Ventricular Function and Pulmonary Hemodynamics During LVAD Support and Impact on Outcomes After LVAD Discontinuation: VAD Wean Registry Analysis

(336) - Changes in Right Ventricular Function and Pulmonary Hemodynamics During LVAD Support and Impact on Outcomes After LVAD Discontinuation: VAD Wean Registry Analysis

Dexmedetomidine Effects on Surgical Stress Hormones

Background: Increased levels of cortisol and catecholamines are the reaction to tissue damage due to surgical trauma. Dexmedetomidine inhibits the synthesis of these two hormones.Objective: This study aimed to prove that dexmedetomidine reduces the endocrine response to surgical stress.Method: 40 patients who underwent Total Knee or Hip Replacement surgery with regional anesthesia were involved in the Double-Blind Randomized Controlled Trial Pre-Test – Post-Test Design, which was divided into two research groups: the therapy group and the control group. Changes in the body's response to stress during surgery were compared by assessing blood cortisol levels, heart rates (HRs), and mean arterial pressures (MAPs). The Beck Depression Inventory (BDI) was used to evaluate the level of depression. The numeric rating scale is used to evaluate perioperative pain, while the Ramsay scale is used to measure the level of sedation. Data analysis was carried out using the Statistical Program for Social Sciences (SPSS).Results: The cortisol levels of the therapy group compared to the control group (p = 0.016) decreased significantly immediately after surgery. Hemodynamic changes in the study, the heart rate (p=0.001), and mean arterial pressure (p=0.000) were significantly lower than the control group.Conclusion: Administration of dexmedetomidine during the surgical period reduces stress hormone responses. These results indicate that dexmedetomidine administration is good to apply, especially in TKR/THR.

Comparison of grooved and conventional Macintosh laryngoscope blades for throat pack insertion: A randomized control trial

Abstract Background and Aims: Throat pack insertion is required for many otolaryngological surgeries under general anesthesia. To facilitate surgery, an oral Ring, Adair, and Elwyn (RAE) endotracheal tube is used. When the Macintosh blade is used to insert the pack, the tube often moves to the left as per its design. We designed a groove in the Macintosh laryngoscope blade to hold the endotracheal tube in place during pack placement. This study was done to compare the grooved and conventional Macintosh laryngoscope blades for throat pack insertion with respect to the intraoral movement of the tube, ease of packing, time taken, and associated hemodynamic changes in patients who have been intubated with a preformed oral endotracheal tube. Material and Methods: This randomized control trial included 80 patients after approval from the institutional ethics committee and CTRI. Informed written consent was taken from all patients. Packing of cases was done with either grooved (group G) or conventional Macintosh laryngoscope blade (group C). Student’s t-test, Chi-square test, and Mann–Whitney U test were used to analyze data. Results: The tube remained in the center in 35/40 patients in group G as compared to 10/40 patients in group C (P &lt; 0.0001). Packing the throat was significantly easier (P = 0.005), and time taken to pack the throat was shorter in group G as compared to group C (P = 0.0008). Conclusions: The endotracheal tube remains in the center more often during throat pack insertion using a grooved laryngoscope blade as compared to the conventional Macintosh laryngoscope blade. The grooved blade is easier to use and takes less time to insert the throat pack.

Alpha-180 spin-echo-based line-scanning method for high-resolution laminar-specific fMRI in animals

Abstract Laminar-specific functional magnetic resonance imaging (fMRI) has been widely used to study circuit-specific neuronal activity by mapping spatiotemporal fMRI response patterns across cortical layers. Hemodynamic responses reflect indirect neuronal activity given the limitation of spatial and temporal resolution. Previously, a gradient-echo-based line-scanning fMRI (GELINE) method was proposed with high temporal (50 ms) and spatial (50 µm) resolution to better characterize the fMRI onset time across cortical layers by employing two saturation RF pulses. However, the imperfect RF saturation performance led to poor boundary definition of the reduced region of interest (ROI) and aliasing problems outside of the ROI. Here, we propose an α (alpha)-180 spin-echo-based line-scanning fMRI (SELINE) method in animals to resolve this issue by employing a refocusing 180˚ RF pulse perpendicular to the excitation slice (without any saturation RF pulse) and also achieve high spatiotemporal resolution. In contrast to GELINE signals which peaked at the superficial layer, we detected varied peaks of laminar-specific BOLD signals across deeper cortical layers using the SELINE method, indicating the well-defined exclusion of the large draining-vein effect using the spin-echo sequence. Furthermore, we applied the SELINE method with a 200 ms repetition time (TR) to sample the fast hemodynamic changes across cortical layers with a less draining vein effect. In summary, this SELINE method provides a novel acquisition scheme to identify microvascular-sensitive laminar-specific BOLD responses across cortical depth.

Indicators of intracardiac haemodynamics in patients with chronic coronary syndrome with concomitant coronavirus disease (COVID-19)

the nature of cardiovascular damage caused by SARS-CoV-2 coronavirus infection due to acute severe respiratory distress syndrome is associated with high mortality. However, the pathophysiological impact of COVID-19 (C19) on intracardiac haemodynamics remains unknown. The aim of our study was to evaluate intracardiac haemodynamics in patients with chronic coronary syndrome (CCS) in combination with coronavirus disease (COVID-19). The prospective study included: 30 patients with CAD with a negative PCR test for COVID-19 (1Agroup), 38 patients with CAD with a positive PCR test for COVID-19 (1Bgroup), of whom 12 were diagnosed with an increase in the level of troponin I (1B/T+), 26 patients had a normal level of troponin I (1B/T-). As a comparison, 30 patients with COVID-19 with PCR(+), without signs of CAD - group 2, as well as 30 healthy volunteers without signs of CAD and with negative PCR were studied. Clinical and laboratory data, treatment, and intracardiac haemodynamics were assessed by echocardiography in all groups. The left ventricular myocardial mass index, left ventricular end-diastolic volume, right ventricular size, and pulmonary artery systolic pressure were highest in the group of CAD with COVID-19 with a positive troponin test (1B/T+), compared with the (1B/T-) group, also in the (1B/T+) group, the ejection fraction and total longitudinal strain by speckle tracking were lower than in the (1B/T-) group. When compared with group 1A, LVEF was lower in the (1B/T+) group, and STla was higher in the (1B/T+) group. When comparing the indicators of group 1A and (1B/T-), a similar pattern of changes in intracardiac haemodynamics was noted: LV myocardial mass index, right ventricular diameter, systolic pressure in the pulmonary artery were higher, while longitudinal strain was slightly lower in (1B/T-) than in group 1A. When comparing the echocardiography parameters of patients in the (1B/T+) subgroup with group 2, larger left ventricular end-diastolic volume, left atrium, left ventricular myocardial mass index were found in (1B/T+), but the ejection fraction was lower in (1B/T+), while the right ventricular size and pulmonary artery systolic pressure were slightly higher than in group 2. In the subgroup (1B/T-), the nature of the changes was similar, but the size of the RV and PASP did not differ from those in group 2. The echocardiographic parameters of group 1A differed from those of group 2 by higher values of LVEF, LVEDV, LVMMS and lower EF, but the size of the RV and PASP were larger in patients with COVID-19. Cardiac damage associated with SARS-CoV-2 in patients with concomitant CAD has an effect on the myocardium, which is manifested in an increase in left ventricular EF due to increased preload, at the expense of a decrease in global strain and systolic function of the LV myocardium, due to the direct cytotoxic effect of SARS-CoV-2 on the one hand, and destabilisation of existing atherosclerotic plaques, as well as hypoxia and worsening of endothelial dysfunction on the other. An increase in the size of the right ventricle is associated with an increase in peripheral vascular resistance in the small circle as a consequence of increased systolic pressure in the pulmonary artery in covidassociated pneumonia. The impact of SARS-CoV-2 infection on the heart is associated with cardiovascular risk factors and the severity of the inflammatory process.

Salt-Sensitive Hypertension and the Kidney.

Salt-sensitive hypertension (SS-HT) is characterized by blood pressure elevation in response to high dietary salt intake and is considered to increase the risk of cardiovascular and renal morbidity. Although the mechanisms responsible for SS-HT are complex, the kidneys are known to play a central role in the development of SS-HT and the salt sensitivity of blood pressure (SSBP). Moreover, several factors influence renal function and SSBP, including the renin-angiotensin-aldosterone system, sympathetic nervous system, obesity, and aging. A phenotypic characteristic of SSBP is aberrant activation of the renin-angiotensin system and sympathetic nervous system in response to excessive salt intake. SSBP is also accompanied by a blunted increase in renal blood flow after salt loading, resulting in sodium retention and SS-HT. Obesity is associated with inappropriate activation of the aldosterone mineralocorticoid receptor pathway and renal sympathetic nervous system in response to excessive salt, and mineralocorticoid receptor antagonists and renal denervation attenuate sodium retention and inhibit salt-induced blood pressure elevation in obese dogs and humans. SSBP increases with age, which has been attributed to impaired renal sodium handling and a decline in renal function, even in the absence of kidney disease. Aging-associated changes in renal hemodynamics are accompanied by significant alterations in renal hormone levels and renal sodium handling, resulting in SS-HT. In this review, we focus mainly on the contribution of renal function to the development of SS-HT.

Management of anesthesia in elderly patients, special considerations and challenges

Introduction: Anesthesia management in elderly patients presents distinct challenges due to physiological changes related to aging. Comorbidities, physical frailty and increased risk of postoperative complications are important aspects to be considered. Methods: Systematic reviews of the literature and analyzes of clinical and experimental studies that addressed the management of anesthesia in elderly patients were carried out. Articles published in English, Spanish and Portuguese were selected. The keywords used were "anesthesia in the elderly", "preoperative assessment", "anesthetic techniques", "intraoperative monitoring", "postoperative pain control" and "prevention of complications". Results: Comprehensive and individualized preoperative assessment was identified as crucial for identifying and treating comorbidities and physical frailty in elderly patients. The choice of the appropriate anesthetic technique depends on the type of surgery and the patient's clinical conditions. Careful monitoring during anesthesia, including blood pressure, heart rate, oxygenation and capnography, is essential to detect and intervene early on hemodynamic and respiratory changes. Postoperative pain control in the elderly requires an individualized approach, with appropriate use of analgesics and regional blocks. Complication prevention strategies, such as optimizing hydration, glycemic control, early mobilization and appropriate use of medications, are essential to reduce the risk of delirium, infection and cognitive dysfunction. Conclusion: Anesthesia management in elderly patients requires an individualized and comprehensive approach, taking into account physiological changes related to aging and associated comorbidities. Careful preoperative assessment, appropriate choice of anesthetic technique, strict intraoperative monitoring, postoperative pain control and prevention of complications are essential to ensure a safe perioperative period and successful recovery in the elderly. Keywords: anesthesia in the elderly, preoperative assessment, anesthetic techniques, intraoperative monitoring, postoperative pain control, prevention of complications.

Experience of Morphologic Left Ventricle Training in Congenitally Corrected Transposition of the Great Arteries in Children: Evaluation of the Operation Results

The aim. To evaluate the efficacy of morphologic left ventricle (mLV) training through pulmonary artery banding (PAB) in pediatric patients with congenitally corrected transposition of the great arteries.&#x0D; Materials and methods. From 2003 to 2023, 12 patients underwent PAB for mLV training at the Ukrainian Children`s Cardiac Center. The mean age of the patients was 30.3 ± 25.1 months, the mean weight was 11.6 ± 5.2 kg. Hemodynamic parameters were assessed to determine the size of the band applied to the pulmonary artery (PA) trunk during the operation. Intraoperative transesophageal echocardiography was performed in 6 patients. Transthoracic echocardiography (TTE) was performed in the early postoperative period. In the remote period, all the patients underwent TTE and X-ray angiography.&#x0D; Results. During PAB, the mLV pressure averaged 58 ± 12.6% (from 40% to 80%) of the systemic arterial pressure. PAB dilatation was required for one patient in the early postoperative period (postoperative day 2) because of significant hemodynamic changes. In the early postoperative period, the maximum gradient across PA measured by TTE averaged 39.3 ± 10.0 mm Hg (from 25 to 60 mm Hg). There was no hospital mortality.&#x0D; The follow-up period averaged 47.2 ± 26.0 months (8 to 113 months). In the long-term observation period, 2 patients (16.6%) died, one 8 months and the other 5 years after the operation. The double switch operation was performed in 6 patients, on average, 48.2 ± 6.9 months after PAB. According to angiography, the mLV pressure before the double switch operation was 90.2 ± 11.6% of that in the systemic right ventricle. The end-diastolic pressure in the mLV averaged 14 ± 4.1 mm Hg. The peak pressure gradient across the PA measured by echo was 81.3 ± 28.8 mm Hg. The mLV mass index averaged 62.9 ± 8.8 g/m2, the mLV ejection fraction averaged 61.2 ± 2.9%. Overall radiographic and echocardiographic data in these patients indicated that mLV is trained and capable of performing the role of a systemic ventricle after anatomical correction.&#x0D; Conclusions. PA banding as a method of mLV training can be used in patients with congenitally corrected transposition of the great arteries with intact ventricular septum, restrictive ventricular septal defects and severe tricuspid regurgitation.&#x0D; To evaluate the effectiveness of PAB for mLV training, a multimodal diagnostic approach is used, including non-invasive and invasive methods such as TTE, transesophageal echocardiography, and cardiac catheterization. The optimal age for PAB in patients of this group for the purpose of training the LV was on average 2-2.5 years.

Hepatic arterial hemodynamics and model for end-stage liver disease (MELD) scores in chronic liver disease: insights from Doppler ultrasonography

BackgroundDoppler ultrasonography is essential to provide insights into hemodynamic alterations and liver function changes in pre-cirrhotic and cirrhotic patients. Utilizing Doppler examinations, this study aims to explore the correlation between hepatic arterial hemodynamics and Model for end-stage liver disease (MELD) scores in chronic liver disease patients.MethodsA study of 50 chronic liver disease patients included sonographic assessments, measuring liver, portal vein size, and flow. Hepatic artery velocity, resistive index (RI), pulsatility index (PI), and acceleration time (AT) were evaluated. Biochemical parameters (serum bilirubin, creatinine, INR) were used to calculate MELD scores, compared with different Doppler sonographic parameters.ResultsThe study found a mean peak systolic velocity (PSV) of 107.42 ± 48.10, with end-diastolic velocity (EDV) of 26.40 ± 14.68, RI of 0.74 ± 0.06, and PI of 1.47 ± 0.24. The mean MELD score was 19.28 ± 6.09. Correlations between MELD scores and PSV, EDV, RI, PI, and AT did not yield statistically significant correlations. 80% of subjects displayed high RI (> 0.7) values in the hepatic artery, and a significant correlation was found between portal vein thrombosis and hepatic artery PSV and RI (p < 0.05).ConclusionsHepatic artery RI and PSV show a significant correlation with portal vein thrombosis. Doppler ultrasonography, while not directly tied to MELD scores, is valuable for non-invasive liver disease monitoring when invasive methods are impractical. Further research is needed to unravel the relationships between hemodynamic changes, MELD scores, and clinical outcomes in a broader patient population.

Effect of pretreatment with a small dose of esketamine on sufentanil-induced cough during anesthesia induction: a randomized controlled trial

BackgroundSufentanil-induced cough is common during the induction of anesthesia. The objective of this study was to determine whether pretreatment with a small dose of esketamine is effective in treating sufentanil-induced cough.Methods220 patients were screened, and 200 patients who had scheduled elective surgery and were between 18 and 70 years old were randomly divided into two groups. Before sufentanil was administered, esketamine group (group K) was injected with 0.15 mg/kg esketamine at 5 s, and control group (group C) was administered with the same volume. Within 1 min after sufentanil(0.4ug/kg) injection during induction, cough incidence and severity were evaluated. After sufentanil was injected, we recorded its hemodynamic changes and side effects.ResultsIn the esketamine group (group K) and control group (group C), there was an incidence of cough of 5 and 34%, respectively. The esketamine group (group K) had a significantly lower incidence and severity of cough compared to the control group (group C) immediately after sufentanil injection (P < 0.05). MAP and HR did not differ significantly between the two groups during three different times of general anesthesia induction (P > 0.05).ConclusionIn our study, we found that sufentanil-induced cough was significantly reduced by pretreatment with 0.15 mg/kg esketamine, but with no significant changes in the hemodynamic status.Trial registrationChinese Clinical Trial Registry (ChiCTR2200063821, registered date: 17/09/2022), http://www.chictr.org.cn

Review article: Recent advances in ascites and acute kidney injury management in cirrhosis.

Better understanding of disease pathophysiology has led to advances in managing ascites and its associated complications including hepatorenal syndrome-acute kidney Injury (HRS-AKI), especially medicinal and interventional advances. To review the latest changes in the management of ascites and HRS-AKI. A literature search was conducted in Pubmed, using the keywords cirrhosis, ascites, renal dysfunction, acute kidney injury, hepatorenal syndrome, beta-blockers, albumin, TIPS and vasoconstrictors, including only publications in English. The medicinal advances include earlier treatment of clinically significant portal hypertension to delay the onset of ascites and the use of human albumin solution to attenuate systemic inflammation thus improving the haemodynamic changes associated with cirrhosis. Furthermore, new classes of drugs such as sodium glucose co-transporter 2 are being investigated for use in patients with cirrhosis and ascites. For HRS-AKI management, newer pharmacological agents such as vasopressin partial agonists and relaxin are being studied. Interventional advances include the refinement of TIPS technique and patient selection to improve outcomes in patients with refractory ascites. The development of the alfa pump system and the study of outcomes associated with the use of long-term palliative abdominal drain will also serve to improve the quality of life in patients with refractory ascites. New treatment strategies emerged from better understanding of the pathophysiology of ascites and HRS-AKI have shown improved prognosis in these patients. The future will see many of these approaches confirmed in large multi-centre clinical trials with the aim to benefit the patients with ascites and HRS-AKI.