Hemodynamic Complications Research Articles

Comparison of Inhalational Vital Capacity Induction with Sevoflurane to Intravenous Induction with Propofol

Introduction: Intravenous propofol is commonly used for induction of general anesthesia because it is smooth and rapid. Inhalational induction method is used in limited situations like absence of venous access and difficult intubation. Sevoflurane also produces rapid induction comparable to propofol. We conducted this study to compare induction time and quality of sevoflurane with that of propofol.
 Methods:Total 102 patient undergoing elective laparoscopic surgery were divided into Group S and Group P with 51 patient in each group. In group S patient were induced with Sevoflurane 8% via vital capacity induction method. In group P, patients were induced with injection propofol 1% with titrating dose. Induction time, hemodynamic changes and complications during induction, patient satisfaction and cost of induction were compared.
 Results: Induction was rapid in Group S (53.33±17.29s) compared to Group P (72.27±25.15s) (p=0.01). The heart rate and mean arterial pressure were stable in both groups upto one minute after induction. Hypotension occurred more in Group P than in Group S (47.05%vs.37.25%).Cough (9.80 %vs.5.88%) and excessive secretions (5.88%vs.0%) were common in Group S while apnea (3.92%vs5.88%) and involuntary movements(17.64% vs. 27.45%) were common in Group P. Patient satisfaction score was high in both the groups. Cost of induction was cheaper in Group S compared with Group P (1.6±0.54 $vs.1.9±0.43$).
 Conclusions: Vital capacity induction with 8% sevoflurane has rapid induction and cheaper as compared to intravenous induction with propofol in a titrating dose. Hemodynamic changes and complications were comparable in both the groups.

Effect of Dexmedetomidine Combined with Inhalation of Isoflurane on Oxygenation Following One-Lung Ventilation in Thoracic Surgery.

BackgroundOne-lung ventilation (OLV) is commonly used during thoracic surgery. At this time, hypoxemia is considered one of the remarkable consequences of the anesthesia management. Hypoxic pulmonary vasoconstriction (HPV) is the defense mechanism against hypoxia.ObjectivesThe aim of the present study was to investigate the effect of infusion of dexmedetomidine on improving the oxygenation during OLV among the adult patients undergoing thoracic surgery.MethodsA total of 42 patients undergoing OLV by general anesthesia with isoflurane inhalation were randomly assigned into two groups: IV infusion of dexmedetomidine at 0.3 microgram/kg/h (DISO) and IV infusion of normal saline (NISO). Three Arterial Blood Gas (ABG) samples were obtained throughout the surgery. Hemodynamic parameters, PaO2, PaCO2, and complications at recovery phase were recorded. The collected information was analyzed using SPSS software version 22.ResultsIn the dexmedetomidine group, the mean hemodynamic parameters had a significant reduction at 30 and 60 minutes following OLV. Administration of dexmedetomidine resulted in a significant increase in the PaCO2 and a reduction in the PaO2 when changing from two-lung ventilation to OLV, where PaO2 reached its maximum value within 10 minutes after OLV in the DISO group, and it began to gradually increase to the end of operation. The duration of the recovery phase, also complications at the recovery phase decreased significantly in DISO group.ConclusionsThe results of the study showed that, dexmedetomidine may improve arterial oxygenation during OLV in adult patients undergoing thoracic surgery, and can be a suitable anesthetic agent for thoracic surgery.

Survival, Neurocognitive, and Functional Outcomes After Completion of Staged Surgical Palliation in a Cohort of Patients With Hypoplastic Left Heart Syndrome.

BackgroundManagement of patients with hypoplastic left heart syndrome has benefited from advancements in medical and surgical care. Outcomes have improved, although survival and long‐term functional and cognitive deficits remain a concern.Methods and ResultsThis is a cohort study of all consecutive patients with hypoplastic left heart syndrome undergoing surgical palliation at a single center. We aimed to examine demographic and perioperative factors from each surgical stage for their association with survival and neurocognitive outcomes. A total of 117 consecutive patients from 1996 to 2010 underwent surgical palliation. Seventy patients (60%) survived to the Fontan stage and 68 patients (58%) survived to undergo neurocognitive assessment at a mean (SD) age of 56.6 months (6.4 months). Full‐scale, performance, and verbal intelligence quotient, as well as visual‐motor integration mean (SD) scores were 86.7 (16.1), 86.3 (15.8), 88.8 (17.2), and 83.2 (14.8), respectively. On multivariable analysis, older age at Fontan, sepsis peri‐Norwood, lowest arterial partial pressure of oxygen postbidirectional cavopulmonary anastomosis, and presence of neuromotor disability pre‐Fontan were strongly associated with lower scores for all intelligence quotient domains. Older age at Fontan and sepsis peri‐Norwood remained associated with lower scores for all intelligence quotient domains in a subgroup analysis excluding patients with disability pre‐Fontan or with chromosomal abnormalities.ConclusionsOlder age at Fontan and sepsis are among independent predictors of poor neurocognitive outcomes for patients with hypoplastic left heart syndrome. Further studies are required to identify the appropriate age range for Fontan completion, balancing a lower risk of acute and long‐term hemodynamic complications while optimizing long‐term neurocognitive outcomes.

Tunneled central venous catheterization, a viable option for long-term venous access in pediatric burn patients

Introduction: Pediatric patients with severe burns often require long-term venous access over the course of their recovery. The need for long-term venous access in these critically ill patients often necessitates the placement of a central venous catheter (CVC). Many techniques exist for the establishment of a CVC in pediatric burn patients, and each technique poses its own set of inherent risks. No studies to date have clearly delineated the risk associated with tunneled central venous catheterization in the pediatric burn patient population. The primary aim of this study was to evaluate the use of tunneled CVCs in pediatric burn patients at the University Medical Center Hospital in Lubbock, Texas.
 Methods: To evaluate this method of central venous catheterization, we retrospectively reviewed the charts of pediatric burn patients who received a tunneled CVC to determine the incidence of specific complications associated with this catheterization technique. We present our findings here in a case series format.
 Results: Our initial search of patient charts yielded 86 potential candidates for inclusion in the study. After reviewing each chart, 26 pediatric patients were found to have received a CVC. Of these 26 patients, five met all of the inclusion criteria of our study. In these five patients, eight tunneled CVCs were placed. The average age of the patients in this series at the time of their respective burn injuries was 3.9 years old. Mean percent TBSA involvement was 38% with an average length of stay totaling 64.6 days. The average dwell time of the tunneled CVCs in this series was 28 days, and our analysis of the data revealed one tunneled catheterrelated infection and one hemodynamic complication.
 Conclusions: Overall, our data show that placement of long-term tunneled CVCs in pediatric burn patients appears to be a relatively safe practice. However, our small sample size warrants more investigation into this topic.Keywords: pediatrics, burns, central vein catheters

Myocardite aiguë auto-immune secondaire à une maladie de Basedow : à propos d’un cas

IntroductionInteractions between heart and thyroid are strong. Main cardiac complications of Graves’ disease are supra-ventricular tachycardia or high output cardiac failure, without real myocardial involvement. ObservationA 40-year-old man with history of refractory Graves’ disease was hospitalized for an acute chest pain with elevated cardiac biomarkers and normal coronarography. Acute myocarditis was confirmed by cardiac MRI. We found no evidence for an infectious etiology. We retained the hypothesis of acute autoimmune myocarditis in the context of active Graves’ disease. ConclusionAcute myocarditis is an exceptional complication of Graves’ disease, with most likely an autoimmune mechanism. Possible occurrence of fulminant rhythmic or hemodynamic complications justify minimal cardiological check-up before introducing beta blockers.

Diferencias sexuales en el síndrome coronario agudo. Hospital Comandante Manuel Fajardo, 2016-2017

IntroductionThere are both biological and sociocultural differences in patients with cardiovascular diseases. Inequalities in the prognosis between women and men are due to several variables, including specific risk factors for females, discrepancies in treatment strategies, and pathophysiological differences. ObjectiveTo identify gender differences in patients with acute coronary syndrome. MethodsAn observational, analytical, cross-sectional study was carried out on the gender differences in 170 patients with a diagnosis of acute coronary syndrome who were discharged from the Intensive Coronary Care Unit of the Comandante Manuel Fajardo Clinical-Surgical Hospital in 2016 and 2017. ResultsFemales had a statistically very significant association, with a higher mean age (68 vs. 62, P<.01) and with a history of arterial hypertension (91.2 vs. 72.3% P<.01). The smoking habit showed a statistically significant association with male individuals (50.5 vs. 30.4% P=.017). Males had a significantly higher median creatinine (90μmol/L vs. 80μmol/L, P<.01). Women showed an increased risk of haemodynamic complications (OR=3.11, 95% CI=1.20-8.04). ConclusionsIn women with acute coronary syndrome, being female is associated with older age, a history of arterial hypertension, and the appearance of haemodynamic complications during admission. Males are associated with smoking habits and higher concentrations of serum creatinine.

Prophylactic Effects of Intravenous Dexamethasone and Lidocaine on Attenuating Hemodynamic-Respiratory and Pain Complications in Children Undergoing Cleft Palate Repair Surgery With General Anesthesia

This study aimed to compare the prophylactic effects of intravenous (IV) dexamethasone and lidocaine on hemodynamic condition, respiratory complications, pain control, and vomit incidence following cleft palate repair surgery. This double-blind randomized controlled trial was carried out on 87 children assigned to three groups. Prior to anesthesia, subjects in groups D and L received 0.2 and 1 mg/kg IV dexamethasone and lidocaine, respectively. Moreover, group C received placebo in a similar condition. The outcome variables were recorded prior to the surgery and then every 15 minutes during the surgical and recovery time. Mean heart rate (HR), mean arterial blood pressure (MABP), and mean end-tidal carbon dioxide (ETCO2) during the surgical time were not significantly different between dexamethasone and lidocaine groups. Dexamethasone significantly improved the level of blood oxygen saturation (SPO2) during the recovery time. Nevertheless, MABP in recovery time did not significantly decrease in the dexamethasone group. There were no significant differences in respiratory complications, pain score, and vomiting incidence between lidocaine and dexamethasone groups. Premedication with both IV dexamethasone and lidocaine provided similar stable hemodynamic and respiratory conditions during the surgical time. However, the use of dexamethasone developed more desirable effects on HR and SPO2 than administration of lidocaine during the recovery time. Both drugs significantly lessened postoperative pain compared to the placebo group at this time.

Association of the European Society of Cardiology echocardiographic probability grading for pulmonary hypertension with short and mid-term clinical outcomes after heart valve surgery

Background and aimsPulmonary hypertension (PH) is associated with higher mortality and morbidity after valvular heart surgery, mainly through its adverse effect on right ventricular hemodynamic. Recently, the European Society of Cardiology (ESC) PH guidelines introduced a PH probability grading that lists additional parameters related to right ventricular dimensions. We evaluated the impact of such score on short- and mid-term outcomes in patients undergoing left heart valvular surgery. Methods and resultsWe included 60 consecutive patients (mean age 70 ± 9 years) undergoing left heart valvular surgery with or without coronary artery bypass. Patients were divided into 3 groups according to the PH probability: “low” (n = 18), “intermediate” (n = 18), or “high” (n = 24). The high PH probability group had higher rate of World Health Organization-Functional Class (WHO-FC) III and IV, hemodynamic complications, deaths, major bleeding events and infections after heart surgery than the other groups. A “high” PH probability was associated with reduced right ventricular systolic function, as measured by the fractional area change (FAC), but not with the tricuspid annular plane systolic excursion (TAPSE). ConclusionThe high PH probability as evaluated by the ESC PH echocardiographic probability model, is associated with increased short- and mid-term mortality and morbidity and reduced right ventricular systolic function after cardiac surgery, Thus, additional echocardiographic parameters assessing PH probability are valuable tools to stratify risk in patients undergoing cardiac surgery.

Expiratory Resistances Prevent Expiratory Diaphragm Contraction, Flow Limitation, and Lung Collapse.

Rationale: Tidal expiratory flow limitation (tidal-EFL) is not completely avoidable by applying positive end-expiratory pressure and may cause respiratory and hemodynamic complications in ventilated patients with lungs prone to collapse. During spontaneous breathing, expiratory diaphragmatic contraction counteracts tidal-EFL. We hypothesized that during both spontaneous breathing and controlled mechanical ventilation, external expiratory resistances reduce tidal-EFL.Objectives: To assess whether external expiratory resistances 1) affect expiratory diaphragmatic contraction during spontaneous breathing, 2) reduce expiratory flow and make lung compartments more homogeneous with more similar expiratory time constants, and 3) reduce tidal atelectasis, preventing hyperinflation.Methods: Three positive end-expiratory pressure levels and four external expiratory resistances were tested in 10 pigs after lung lavage. We analyzed expiratory diaphragmatic electric activity and respiratory mechanics. On the basis of computed tomography scans, four lung compartments-not inflated (atelectasis), poorly inflated, normally inflated, and hyperinflated-were defined.Measurements and Main Results: Consequently to additional external expiratory resistances, and mainly in lungs prone to collapse (at low positive end-expiratory pressure), 1) the expiratory transdiaphragmatic pressure decreased during spontaneous breathing by >10%, 2) expiratory flow was reduced and the expiratory time constants became more homogeneous, and 3) the amount of atelectasis at end-expiration decreased from 24% to 16% during spontaneous breathing and from 32% to 18% during controlled mechanical ventilation, without increasing hyperinflation.Conclusions: The expiratory modulation induced by external expiratory resistances preserves the positive effects of the expiratory brake while minimizing expiratory diaphragmatic contraction. External expiratory resistances optimize lung mechanics and limit tidal-EFL and tidal atelectasis, without increasing hyperinflation.

Postoperative hemodynamic changes for predicting anastomotic leakage after esophagectomy in patients with esophageal cancer using the FloTrac system.

Background : Anastomotic leakage after esophagectomy is significantly associated with more severe complications, such as sepsis and mortality. Early prediction for anastomotic leakage is usually difficult and needs to be treated rapidly. In the current study, we investigated the correlation between hemodynamic and several complications after esophagectomy in patients with esophageal cancer, using the FloTrac system. Materials and Methods : Between April 2013 and December 2014, 39 patients with a mean age of 66.6 ± 8.9 years underwent postoperative supervision using the FloTrac sensor / Vigileo monitoring system after curative surgery for esophageal cancer. We retrospectively evaluated the association between the number of aberrant cardiac index (CI) along with stroke volume variability (SVV) values and clinicopathological parameters of postoperative complications in this report. Results : There were significant positive correlations between the number of aberrant values of CI along with SVV and depth of invasion during pathological stage. Concerning major postoperative complications, there was a significant positive correlation between the number of aberrant values of CI and anastomotic leakage. Discussion: The hemodynamic change by employing the FloTrac system could predicts the complication of anastomotic leakage after esophagectomy. Adequate management of hemodynamic stability by utilizing it will reduce the complications of anastomotic leakage. J. Med. Invest. 67 : 240-245, August, 2020.

Comparison between I-gel and endotracheal tube for hemodynamic stability and perioperative complications in hypertensive patients undergoing elective surgery under general anaesthesia

Comparison between I-gel and endotracheal tube for hemodynamic stability and perioperative complications in hypertensive patients undergoing elective surgery under general anaesthesia

P264 Comparison of in-hospital mortality between acute inferior wall STEMI patients with right ventricular infarction and without right ventricular infarction undergoing a primary PCI in KCMH

Abstract Background Patients with acute inferior wall ST elevation myocardial infarction, if there is a right ventricular myocardial infarction involvement, they have pretended a worse prognosis with hemodynamic and electrophysiologic complications causing higher in-hospital morbidity and mortality. However most patients in previous studies were mainly treated with intravenous fibrinolysis and also studied in the Caucasian populations. Objectives To compare the in-hospital mortality rate of patients with acute inferior wall ST elevation myocardial infarction with and without right ventricular infarction involvement, whom were treated with primary percutaneous coronary intervention (PPCI). Methods The study was a retrospective descriptive study which enrolled patients with acute inferior wall ST elevation myocardial infarction who were treated with PPCI in our hospital from 1 January 2007 - 31 December 2016. Results Among 452 acute inferior wall ST elevation myocardial infarction patients who were treated with PPCI, there were 99 patients who had right ventricular infarction involvement, the in-hospital mortality rate was 23.2%, mainly due to cardiogenic shock, compared with 5.1 % in patients who had no right ventricular infarction (p &amp;lt; 0.001). Patients with right ventricular infarction had a significantly higher incidence of cardiogenic shock (48.5% versus 15.6%, P &amp;lt; 0.001), the lower number of left ventricle ejection fraction (51.15 ± 17.27% versus 55.79 ± 12.46%, p = 0.037), the higher incidence of complete heart block (33.3% versus 11.9%, p &amp;lt; 0.001) and ventricular tachycardia (15.2% versus 5.9%, p = 0.003). After adjustment for age, female sex, diabetes, hypertension, previous myocardial infarction, cardiogenic shock on admission, left ventricular ejection fraction, ventricular tachycardia and complete heart block, the right ventricular infarction remained the independent predictor of in-hospital death (adjusted hazard ratio, 1.69; 95% confidence interval, 0.38 to 7.48; P = 0.489) and significant independent predictor for 1-year mortality (adjusted hazard ratio, 2.76; 95% confidence interval, 1.08 to 7.03; P = 0.034). Conclusion Patients with acute inferior wall STEMI whom were treated with PPCI, if there was right ventricular infarction involvement, the in-hospital death and 1-year mortality were significantly higher than who were without right ventricular infarction.

A prospective randomized double-blinded study of dexmedetomidine versus propofol infusion for orbital surgeries.

PURPOSE:Orbital surgeries are traditionally taken up under general anesthesia. Local anesthesia combined with moderate sedation can also be considered as an alternative option. This study was performed to compare the safety and efficacy of dexmedetomidine and propofol infusion for orbital surgeries under local anesthesia.METHODS:Twenty patients undergoing orbital surgery by a single surgeon were enrolled in this prospective randomized study. Selected patients were randomly administered dexmedetomidine (Group D) or propofol (Group P). Hemodynamic and respiratory effects, sedation levels, recovery profile, analgesic properties, and satisfaction levels of the patients and the surgeon were assessed.RESULTS:There was a significant decrease in mean arterial pressures following drug administration compared to initial measurements in both the groups. However, a statistically significant decrease in heart rate was observed only in Group P. The sedation score at the end of loading dose was 3.3 ± 0.82 in Group D and 2.5 ± 0.52 in Group P and this difference was also statistically significant (P value-0.027). The surgeon's satisfaction score was 6.5 ± 0.71 in Group D and 5.6 ± 1.07 in Group P (P value – 0.045). There were no statistically significant differences observed in patients' satisfaction, pain, and anxiety scores in either group. No major hemodynamic changes or complications were noted in either of the groups.CONCLUSION:Dexmedetomidine, in comparison to propofol, provides better sedation levels with good hemodynamic stability. It also offers better surgeon satisfaction, thus providing a useful alternative for general anesthesia in selective patients undergoing orbital surgery.

Comparison of laryngeal mask airway &amp; endotracheal intubation in pediatric age group: A cross sectional study

The laryngeal mask airway, it is a supraglottic airway instrument developed by British Anesthesiologist Dr. Archie Brain. Initially it was designed only for the use in the operating room for the purpose of elective ventilation; it is a proved alternative to bag-valve-mask ventilation, freeing the hands of the provider with the benefit of less gastric distention. Initially used primarily in the operating room setting, the laryngeal mask airway has more recently come into use in the emergency situation as a very important device for the treatment of the difficult airway. The objective of the study was To compare the various parameters that occur during laryngeal mask airway insertion and endotracheal intubation for surgical procedures under general anesthesia. In the present study, 18 children’s belongs to age group of 2 to 6 years and 32 children’s belongs to age group of 7 to 10 years. Totally 29 children’s were male and 21 children’s were female. In LMA group, LMA insertion was graded easy in 97% of patient and difficult in 3% cases. In none of the case was LMA insertion impossible (0%). In the ETT group, endotracheal intubation was easy in 85% of patients and difficult in 15% of patients. In none of the patients was endotracheal intubation impossible. In the LMA group, LMA was placed correctly in the first attempt in 94% patients and was placed correctly in the 2nd attempt in 6%. The ETT was placed in the first attempt in 80% patients and was placed correctly in the 2nd attempt in 20%. According to the results of our study, laryngeal mask airway it is device of choice for elective outpatient surgeries in pediatric patients due to its lesser hemodynamic changes and complications, ease of insertion in cases where endotracheal tube insertion gets difficult and also faster insertion.

Natural history of secundum atrial septal defect in adults over 60 years

Atrial septal defect (ASD) is one of the most common causes of congenital heart disease manifested in adulthood and a subgroup of patients may not develop symptoms until late adulthood. The aim of our study was to describe clinical and likelihood picture of adults over 60 years born with an ASD type II. We performed a retrospective analysis of adult's ASD referred to our institution from 2010 through 2018. Clinical, electrocardiographic, echocardiographic and hemodynamic data were reviewed. For follow up study, patients were investigated by echocardiography, ECG and assessed for quality of life by a questionnaire. Among forty ASD type II manifested in adulthood, which were referred to our department of cardiology, five cases of ASD manifested in octogerian. Two men and three woman. Complaints were dyspnea and palpitations in 4 cases and chest pain in only one patient. Complete right bundle branch block and right ventricular hypertrophy were found in all cases. Three patients presented atrial fibrillation. Echocardiographic data revealed large secundum ASD (mean 20 mm,), severe systolic pulmonary pressure in two cases and moderate in one case. All patients were studied by venous cardiac catheterisation. The arterial saturation was markedly reduced in patients who had small right to left shunt. Three patients underwent percutaneous atrial septal defect closure. There were no deaths. At mean follow up of 50 months, most survival patients remain in good clinical condition. Two patients were in chronic atrial fibrillation developed during follow up. There is a lack of evidence regarding treatment options for adults with an ASD aged more than 60 years. Percutaneous correction of ASD is associated with low morbidity and mortality, and should be as early as possible to prevent hemodynamic complications, such as the development of pulmonary hypertension and cardiac arrhythmias.

Effect of Hydroxyethyl Starch on Blood Sugar Levels in Surgeries under Subarachnoid Block: A Cross-sectional Study

Introduction: Ringer’s Lactate (RL), a crystalloid is the most common co-loading fluid used to limit haemodynamic complications following the Subarachnoid Block (SAB). Colloids like Hydroxyethyl Starches (HES) are occasionally used as the co-loading fluid despite controversies due to its better haemodynamic effect and are not written-off to date. So knowledge of the effect of co-loading fluid is of paramount importance if it contributes to hyperglycaemia, a detrimental factor for the outcome. Aim: To compare the Blood Sugar Levels (BSL) in different preparations of HES and to that of RL when administered as co-loading fluid following SAB. Materials and Methods: Eighty-nine patients were randomly allocated into three groups, namely HES 200, HES 130, and RL, and were co-loaded with either 20 mL/kg body weight of HES 200/0.5, 20 mL/kg body weight of HES 130/0.4 or 20 mL/kg body weight of RL respectively. BSL for each subject was recorded at 0, 15, 30, 45, 60, 120, 180, 240 min (post-hoc analysis was done with Tukey’s test). Results: In all the three groups, there was a statistically significant rise in BSL from baseline. The BSL in the RL group reached its peak at 45 minutes and gradually dropped down to baseline. BSL increased more gradually with HES 130/0.4 reaching a peak value at 60 minutes, and at around 240 minutes for HES 200/0.5. Conclusion: HES causes an increase in BSL, though within physiological limits.

A REVIEW ON RECENT ADVANCEMENTS IN THE HEMODYNAMICS OF NANO-DRUG DELIVERY SYSTEMS

Cardiovascular disease (CVD) is a leading cause of mortality and morbidity in developed countries. CVD is produced by atherosclerotic lesions that reduce arterial lumen size through plaque formation and arterial thickening. This decreases blood flow to the heart and frequently manifests in severe hemodynamic complications like myocardial infarction or angina pectoris. A drug delivery system (DDS) is a clinical methodology (formulation or device) which enables the introduction of a therapeutic substance into the body and improves its efficacy and safety by controlling the rate, time, and place of release of drugs in the body. Drug delivery technologies modify drug release profile, absorption, distribution and elimination for the benefit of improving product effectiveness and patient convenience and compliance. The review explores extensively hemodynamic aspects of the cardiovascular system and diseases which can be treated via nanodrug delivery with a comprehensive overview of research efforts in these areas. Nanomedicine is an expeditiously growing science in which biomaterials (drugs) engineered at the nanoscale are implemented to enhance therapeutic performance and improve patient treatments. Among the many other diverse applications of nanomaterials in medicine (e.g. bio-UIRtribology, tissue repair, orthopaedic implants etc), nano-drug delivery systems have emerged as among the most promising. This technology has evolved into a significant platform for delivering successfully remedial agents to diseased sites with substantially greater target control, precision and sophistication. By greatly increasing site specificity, lowering toxicity and target-oriented 2 delivery, nanotechnological drug delivery (“nano-pharmacodynamics”) has consistently achieved very impressive consistency, benefits and has aided massively in the fight against potentially lethal haemotological diseases. Recently, nanomedicine has embraced an even wider range of applications including the administration of chemotherapeutic agents, biological agents, diabetes regulation, sterilization, cancer and tumour inhibition, rheumatic fever mitigation etc. The current review presents a comprehensive appraisal of nano-drug delivery systems, simulation with engineering methods, types of nanodrugs and their effectiveness. The excellent targeting properties attainable with magnetic nanoparticles as engineering pharmacodynamic agents, in particular, offers huge potential in the treatment of many complex hemodynamic disorders. Furthermore, the present review summarizes the efficiency of drug carrier nanoparticles in mitigating the adverse effects of stenosed blood vessels and outlines other future potential uses for nano-drugs in biomedical applications.

Comparison of standard and low-pressure pneumoperitoneum; reduction in frequency and intensity of post-operative shoulder pain

Laparoscopic cholecystectomy is now gold standard and depends on good exposure of the peritoneal cavity. It is achieved by insufflation of the abdominal cavity with CO2. Operating at lower intraabdominal pressure (&lt;12 -15mmHg) has been associated with fewer pulmonary and hemodynamic complications and lesser postoperative pain.&#x0D; Objective: To ascertain the advantages of low pressure pneumoperitoneum over standard pressure pneumoperitoneum&#x0D; Methods: Our study was quasi experimental study conducted at KRL Hospital, Islamabad over period of 3years from 2013 to 2016. SPSS version 20 was used to calculate p value. &#x0D; Results: A total of 456 patients of gallstones were equally divided in two groups assigned to undergo low pressure (7-8mm of Hg) pneumoperitoneum or standard pressure (12-14mm of Hg) pneumoperitoneum laparoscopic cholecystectomy The average age of patients was 46.2+/-13.6yrs in group A compared to 43.5 +/- 12.9 in group B. There were 60 (26.3%) male and 168 (73.7%) female patients in group A compared to 53 (23.2% and 175 (76.85) in group B respectively. It was found that group A 14 (6.1%) had no pain, 26 (11.4%) had VAS between 1 – 7 and 188 (82.5%) had VAS of 8 – 10 where as in group B 164 (72.6%) patients reported no shoulder tip pain postoperatively, 42 (18.6%) had VAS of 1 – 7 and 20 (8.8%) had VAS OF 8 – 10. The difference was statistically significant (p-value = &lt;0.001).&#x0D; Conclusions: reduced pressure of pneumoperitoneum to 7 – 8 mm of Hg produce lower incidence of postoperative shoulder tip pain.

The Use of Ketamine for Air Medical Rapid Sequence Intubation Was Not Associated With a Decrease in Hypotension or Cardiopulmonary Arrest

ObjectiveRapid sequence intubation (RSI) is associated with a number of complications that can increase morbidity and mortality. Among RSI agents used to blunt awareness of the procedure and produce amnesia, ketamine is unique in its classification as a dissociative agent rather than a central nervous system depressant. Thus, ketamine should have a lower risk of peri-RSI hypotension because of the minimal sympatholysis compared with other agents. Recent recommendations include the use of ketamine for RSI in hemodynamically unstable patients. The main goal of this analysis was to explore the incidence of hypotension and/or cardiopulmonary arrest in patients receiving ketamine, etomidate, midazolam, and fentanyl during air medical RSI. We hypothesized that ketamine would be associated with a lower risk of hemodynamic complications, particularly after adjusting for covariables reflecting patient acuity. In addition, we anticipated that an increased prevalence of ketamine use would be associated with a decreased incidence of peri-RSI hypotension and/or arrest. MethodsThis was a retrospective, observational study using a large air medical airway database. A waiver of informed consent was granted by our institutional review board. Descriptive statistics were used to present demographic and clinical data. The incidence rates of hypotension and cardiopulmonary arrest were calculated for each sedative/dissociative agent. Multivariable logistic regression was used to calculate the odds ratios of both hypotension and arrest for each of the sedative/dissociative agents. The prevalence of use for each agent and the incidence of hemodynamic complications (hypotension and arrest) were determined over time. ResultsA total of 7,466 RSI patients were included in this analysis. The use of ketamine increased over the duration of the study. Ketamine was associated with a higher incidence of both hypotension and arrest compared with other agents, even after adjustment for multiple covariables. The overall incidence of hypotension, desaturation, and cardiopulmonary arrest did not change over the study period. ConclusionsAlthough the incidence of hemodynamic complications was higher in patients receiving ketamine, this may reflect a selection bias toward more hemodynamically unstable patients in the ketamine cohort. The incidence of hypotension and arrest did not change over time despite an increase in the prevalence of ketamine use for air medical RSI. These data do not support a safer hemodynamic profile for ketamine.

Intoxications par les agonistes des récepteurs GABA : aspects pharmacologiques, toxicologiques et épidémiologiques

γ-Aminobutyric acid (GABA), the main inhibitory neurotransmitter of the central nervous system (CNS), binds to two types of receptors: the GABAA and GABAB receptors.GABAA agonists poisonings (ethanol, benzodiazepines) are very common and may induce central nervous system depression. The treatment of ethanol poisoning is symptomatic while there is an antidote for benzodiazepines poisoning, the flumazenil. GABAB receptor agonists (GHB, baclofen) poisonings remain rare but are increasing. GHB poisonings can cause coma frequently associated with bradycardia, respiratory depression, myoclonus and hypothermia. Baclofene poisonings are mainly responsible for neurological complications that may be associated with respiratory and hemodynamic complications. Treatment of GABAB receptor agonists poisonings is symptomatic. After acute GABA agonists poisoning, withdrawal syndrome may occur in chronic users shortly after the resolution of poisoning symptoms.GABAergic agonists are frequently responsibles for acute poisoning. Although GABAA receptor agonists poisonings are well described (ethanol, benzodiazepines), the last twenty years have seen the increase in GABAB receptor agonists poisonings (GHB, baclofen).