Hemodynamic Disturbances Research Articles

Chest Tube Insertion Following a Failed Needle Decompression in a Patient with Tension Pneumothorax: a Case ReportChest tube insertion following a failed needle decompression in a patient with tension pneumothorax: A case report

Pneumothorax occurs when the pleural space is filled with air due to trauma, iatrogenic injury, or underlying lung disease. If this air leak forms a one-way valve that causes air to be trapped, an uncontrolled increase in air volume can occur, causing lung collapse and shift of the mediastinum to the contralateral side, which can eventually cause respiratory and hemodynamic disturbances or even death. Here, we report a 46-year-old male patient who came to the hospital complaining of shortness of breath and chest pain radiating to the left shoulder. On physical examination, the patient had severe shortness of breath, tracheal deviation, decreased expansion and air entry of the left hemithorax, hyperresonance of the left hemithorax, and a shift of the punctum maximum of the heart sounds to the left sternal line. The chest x-ray performed on the patient confirmed the suspicion of a tension pneumothorax. A needle decompression in the 2nd intercostal space in the left midclavicular line failed to improve the tension pneumothorax. A chest tube insertion was performed which managed to improve the patient's clinical condition.

Giant myxoma of the right sections of the heart obstructing the inferior vena cava: A case report

Objective: We present a rare case of surgical management of giant myxoma of the right heart with obstruction of the orifice of the inferior vena cava (IVC), obstruction of the right atrioventricular orifice, with the development of high pulmonary hypertension, and severe heart failure. Case presentation: A 39 years old male patients applied to the consultative polyclinic with typical complaints of severe shortness of breath, palpitations, severe weakness, almost bed rest, severe swelling of the lower extremities, with a transition to the anterior abdominal wall (edema). On physical examination signs of severe heart failure NYHA class IV were revealed. Imaging demonstrated giant right atrial myxoma obstructing IVC with base originated in fossa ovalis, obstructing tricuspid valve and protruding in the right ventricle occupying 50% of its cavity. The surgical removal of the giant RA myxoma protruding the right ventricle and obstructing IVC and tricuspid valve was performed under cardiopulmonary bypass and hemodynamic support. The patient was discharged on the 10th day after surgery and only residual minimal tricuspid regurgitation was revealed on follow-up examination. Conclusion: The described case from our practice proves the possibility of a severe course of giant myxomas of the right heart, with the development of deep hemodynamic complications of systemic and pulmonary circulation. The chosen correct tactics of surgical treatment provided a favorable result, despite the severity of the initial condition and the degree of hemodynamic disturbance. Intraoperative tactics and technique for performing the stages of urgent surgery were chosen based on the situation, the features of the anatomical structure of the tumor, and the severe complications that arose. Our case proves the possibility of adequate implementation of such interventions, when choosing the right tactics of surgical treatment. Take home message: If clinical signs of circulatory failure, heart failure are detected, it is necessary to perform echocardiography. If mass formations of the heart chambers are detected, immediately refer the patient to specialized cardiac surgery clinics to resolve the issue of surgical correction of pathology.

3D imaging of left atrial dissection: a case report

BackgroundLeft atrial dissection (LAD) is an uncommon but potentially devastating complication of cardiac surgery. Though surgical and conservative treatment strategies have been reported, the choice depends on each clinical situation. Especially in sensitive cases, the decision could be difficult, where the detailed assessment of the multiple imaging modalities is mandatory.Case presentationOpen surgical total arch replacement (TAR) was performed on a male patient aged 79 years old, who had severe chronic obstructive pulmonary disease (COPD) and a history of aortofemoral bypass for abdominal aortic aneurysm and arteriosclerosis obliterans (ASO). During the weaning off the cardiopulmonary bypass (CPB), LAD was detected on intraoperative transesophageal echocardiography (TEE). It was 18 × 26 mm and full of hematoma with the TEE. Due to the patient’s frailty and not to elongate the CPB duration, we selected a conservative strategy. The patient was extubated on postoperative day (POD) 1 and transferred from ICU to the ward on POD 3. On POD 7, ECG-gated 3D-CT was performed, on which LAD occupied 26% of the left atrial volume. It also revealed the opening of the pulmonary veins and the proximity of the LAD and the coronary sinus (CS). The cause of the LAD was considered to be the CS perforation with a retrograde cardioplegic cannula. A follow-up 3D-TEE was performed on POD 15, where the hematoma inside the LAD was absorbed. He was discharged home at POD 23. With transthoracic echocardiography, LAD itself disappeared after 3 months.Conclusion3D imaging, such as 3D-TEE and 3D-CT, is valuable in the assessment of the volume and quality of LAD. Furthermore, it clarifies the exact position and configuration of LAD, which help in assessing the etiology, predicting the hemodynamic disturbance, and determining the treatment strategy. They are potent tools, especially in complex cases.

NEUROPLASTICITY IN CEREBRAL VISUAL IMPAIRMENT

Introduction. The field of pediatric stroke has developed rapidly and has reached the stage where focused funding prioritization is required to make further advances including understanding mechanisms and optimal treatments. The existence of highly motivated and collaborative researchers in this field provides tremendous potential for leveraging research productivity. In recent years, research has been expanding in the direction of studying central hemodynamics, general and local intracerebral circulation, as well as orbital and intraocular hemodynamics when studying the dynamics of cerebral visual impairment (CVI) in children with pre- and perinatal encephalopathy. The aim of the study was studying the mechanisms of the relationship between neuroplasticity and cerebral visual impairment at the recovery stages of intracranial hemodynamic and liquor dynamic disturbances in children with NE. Materials and methods. Over the past 10 years, out of 3,500 children aged from 3 months to 6 years examined by us, with the help and cooperation of the children's neurological hospital, the Republican Perinatal Center and the Research Institute of Pediatrics, 1,500 children were diagnosed with acute cerebrovascular accident in the neonatal period of life. Homeostasis indicators-catecholamines in the blood, excretion in the urine, the sugar and cortisol in the blood, electrolytes in plasma and erythrocytes. NSG, MRI, CDU. The reactivity of BP, of the pulse and respiration to vegetotropic drugs and PA.EEG (sleep rhythm, emotional and motor activity) Results. It has been proven that the decisive mechanisms of recovery options depend on the orientation of the hypothalamic-pituitary relationship and the nature of homeostatic aberrations. The overwhelming majority of these children have experienced catecholamine excite dumping syndrome over these long years and had a clinical picture of both cerebral pathology and CVI. By compiling histograms, it was possible to establish that the effect of cholinergic mechanisms on general hemodynamics was less pronounced than on intraorbital blood circulation. In other words, the assessment of hemodynamic responsiveness to the stimulus revealed a more significant fluctuation in the index of intracranial rather than general hemodynamics. Conclusion. Analysis of variance proves that the stability of the mean dynamic blood pressure is one of the leading mechanisms for stabilization of adaptive homeostatic neuroplasticity of the CNS and visual analyzer.

Microvasculature‐on‐a‐Post Chip That Recapitulates Prothrombotic Vascular Geometries and 3D Flow Disturbance

AbstractStenosis, characterized by partial vessel narrowing, alters blood hemodynamics and can lead to unpredictable thrombosis. Existing models struggle to accurately represent the complex vascular geometries and hemodynamics involved in such conditions. To address this challenge, a microvasculature‐on‐a‐post chip is developed to mimic partially stenotic vascular geometries and thrombogenicity, featuring isolated 3D micropost structures with variable sizes that recreate disturbed flow profiles. To emulate the diseased vessel wall, the post microfluidics are vascularized with a confluent layer of endothelial cells. Subsequently, human blood is perfused through the endothelialized post microfluidics, observing the temporal and spatial thrombotic response governed by Virchow's triad, including vessel wall injury, hemodynamic disturbance, and hypercoagulability. The innovative model offers valuable insights into stenosis‐induced thrombosis and endothelial behavior, paving the way for improved assessment of thrombotic risks associated with stenotic vessels. This advanced microfluidic platform also offers new approaches for evaluation of prothrombotic phenotypes and cardiovascular risk assessment in the future.

Dosiahnennia kardiolohii u vyvchenni kryteriiv diahnostyky ta predyktoriv prohnozuvannia uskladnen systemy krovoobihu pid chas ishemichnoi khvoroby sertsia u poiednanni z arterialnoiu hipertenziieiu (ohliad literatury; rezultaty vlasnykh doslidzhen)

Introduction. It is generally accepted, that activation of renin-angiotensin-aldosterone system is the first step in the development of hypertension, subsequently leading to the formation of atherosclerotic lesions in blood vessels of heart, brain, kidneys, aorta, and further alteration of peripheral vessels. Some time after the onset of hypertension, left ventricle hypertension develops, inducing various forms of coronary heart disease, strokes, etc. Currently the above circumstances turned to be a global problem of cardiology and medicine. However, data on diagnostic criteria and the evaluation of these combined diseases prognostic predictors are far from complete. The aim of the study. To reflect achievements of modern cardiology in the investigation of criteria predicting complications in the blood circulatory system. Materials and methods. A review of 51 articles is supplemented with author`s own results. Results. It is estimated that arterial hypertension induce hypertrophy of the left ventricle with further cardiac remodeling, which contributes to myocardial infarction, strokes, and cardiac arrhythmias. In patients with coronary heart disease combined with hypertension, structural reorganization of myocardium is supplemented with remodeling of cardiac conducting system resulting with ventricular extrasystoles, atrial fibrillation, etc. Predictors of acute left ventricular failure and chronic heart failure have been published in the literature. Due to our observations, coronary heart disease in patients with hypertension correlates with disturbances in central hemodynamics, decreased contractile function of the left ventricle, changes in blood supply of different pulmonary zones, significant disturbances in tissue metabolism, these pathological signs leading to the development of chronic heart failure, arrhythmias and heart blockage, disorders of cerebral blood circulation. Conclusion. The obtained results make it possible the identification of diagnostic criteria and predictors of various circulatory complications in patients with the diagnosed coronary heart disease combined with hypertension. However, more observations are needed to get new insight into the pathogenic mechanisms of complications development, further specification of their predictors and creating more effective methods of their prevention. Keywords: prediction of malignant arrhythmias, atrial fibrillation, left ventricular hypertrophy.

A Comparative Study of Sevoflurane Versus Isoflurane as an Anaesthetic Agents

Background: Inhalational anesthesia has come a long way since the day of open ether and chloroform, newer better inhalational agents continue to be introduced at regular intervals leading the earlier ones to obsolence. Objective: To study recovery characteristics and compare the clinical cardiovascularparameters during maintenance of anesthesia and post-operative events resulting from Sevoflurane and Isoflurane anesthesia. Materials and Method: Fifty adult patients of ASA grade - I and ASA grade - II between the ages of 18-55 years were selected for the study at municipality hospital during anesthesia residency program of author in India. Patients maintained on Sevoflurane were designated as Group - I and those on Isoflurane as Group - II. Inhalational agent was started and maintained with 50% Oxygen and 50% Nitrous Oxdie. Patients were maintained with controlled ventilation with Vecuronium bromide and Inhalational agent. Vital signs were recorded every 15 minutes. After completion of surgery inhalational agent was stopped. Post operatively, the patient’s vital signs, muscle tone and power were checked and recorded. Result: In group II, Heart rate increased in 96% as compared to Group I where heart rate increased in 88%. In group II, 92% of patients showed a decrease in MAP as compared to 76% in Group I. In Group I mean (average) time interval between loading dose and 1st maintenance dose of muscle relaxant was 38.48 + 2.40 min and in Group II it was 30.08 + 1.44 min. Recovery was fast in Group - I as compared to Group – II. Conclusion: It was concluded that though hemodynamic disturbances are present with both the agents, Sevoflurane ensures more cardiovascular stability than Isoflurane. The recovery was faster with Sevoflurane than Isoflurane. The incidence of post-operative complications is slightly less with Sevoflurane than Isoflurane. In nutshell, Sevoflurane is a better volatile agent of choice as compared to Isoflurane.

The use of lidocaine during anesthesiological support, in the surgical treatment of inversion of the large colon in horses

Volvulus of the large colon is one of the most severe diseases of the gastrointestinal tract in horses. Without surgical treatment of this pathology, the mortality of horses reaches 100%. The success of surgical treatment depends on the complexity of the pathology, the time since the onset of the disease, the patient's condition before surgery. Operations in this pathology are impossible without general multimodal anesthesia. However, the anesthetic support of such patients is often accompanied by a large number of complications due to hemodynamic and metabolic disorders in the body, as a result of strangulation and stretching of the intestinal wall, abdominal compartment syndrome, as well as the impossibility of full stabilization of the patient's condition due to the need to perform the operation as soon as possible. This article discusses our experience of anesthetic management in the surgical treatment of horses diagnosed with volvulus of the large colon with and without lidocaine, the effect of lidocaine on the patient's condition during general anesthesia, recovery from anesthesia, and the occurrence of postoperative complications. The material for the article was data from twelve patients who underwent surgery for the elimination of volvulus of the large colon at the Forside Veterinary Clinic in the period 2021-2023. During the analysis of the data obtained, it was revealed that with the inclusion of infusion at a constant rate of lidocaine at a dosage of 2 mg/kg per hour in the protocol of multimodal anesthesia, the concentration of isoflurane decreased by an average of 1%, and the use of tiletamine-zolazepam became irrelevant. This made it possible to reduce the time of recovery from anesthesia and recovery of patients in the soft box, as well as the number of postoperative complications associated with general anesthesia, such as paralytic ileus and myopathy, even in patients with severe hemodynamic disturbances in the preoperative period. A lethal outcome was recorded in two out of six operated horses, in the anesthetic protocol of which lidocaine was not used. In patients with the use of lidocaine in the anesthesia protocol, a lethal outcome was recorded in one case out of six. Thus, after the inclusion of constant-rate infusion of lidocaine into the anesthesia protocol, the mortality rate was halved, from 30 to 15%.

Operative experience on descending aorta with Takayasu Arteritis: a review.

Patients with Takayasu arteritis (TA) and descending aorta involvement often experience insidious onset and slow progression, leading to irreversible vascular lesions despite medication therapy. Surgical management plays a crucial role in resolving hemodynamic disturbances and has shown promise in improving the outcomes of this patient population, owing to significant advancements in surgical expertise. However, studies focusing on this rare disease are lacking. This review summarizes the characteristics of patients with stenosis in descending aorta, emphasizing surgical approaches, perioperative management, and disease outcomes. The operative approach depends on lesion location and extent. Existing studies have confirmed that the choice of surgical modality significantly influences postoperative complications and long-term prognosis in patients, highlighting the effectiveness of bypass surgery as a favorable option in clinical practice with a satisfactory long-term patency rate. To mitigate postoperative complications, it is advisable to conduct regular imaging follow-ups to prevent the deterioration of the condition. Notably, the occurrence of restenosis and pseudoaneurysm formation deserves particular attention due to their impact on patient survival. The use of perioperative medication remains a topic of debate, as previous studies have presented divergent perspectives. The primary objective of this review is to provide a comprehensive perspective on surgical treatment and offer customized surgical approaches for patients in this population.

Risk factors associated with trigeminocardiac reflex in patients with trigeminal neuralgia during percutaneous balloon compression: A retrospective cohort study

BackgroundThe trigeminocardiac reflex (TCR) is a brainstem reflex commonly elicited during percutaneous balloon compression (PBC) for the treatment of trigeminal neuralgia (TN), which is characterized by drastic hemodynamic disturbances, such as bradycardia, arrhythmias and even cardiac arrest. In order to prevent catastrophic consequences, it is vital to screen the risk factors of TCR during perioperative period. The primary purpose of this study was to identify potential risk factors associated with TCR in patients with TN undergoing PBC, and to summarize the enlightenment of clinical anesthesia management. MethodsThe clinical data of 165 patients diagnosed with TN undergoing PBC from January 2021 to December 2021 were retrospectively analyzed. TCR was defined as a sudden decrease in heart rate of 20% or more compared with baseline, and / or cardiac arrest, coinciding with the stimulus of any branch of the trigeminal nerve. And a clear cause-effect relationship between heart rate reduction and PBC-related intervention was required. All demographic characteristics as well as surgical and anesthetic data were compared between TCR group and TCR-free group. Univariate and multivariate logistic regression analysis were used to further analyze TCR-related risk factors. ResultsOf the 165 patients enrolled in this study, 73 (44.2%) were male and 92 (55.8%) were female, and the average age was 64.22 ± 9.72 years. The incidence of TCR in the patients with TN during PBC was 54.5%. The results of multivariate regression analysis indicated that the risk factor for TCR was heart rate < 60 beats/min immediately before foramen ovale puncture (OR: 4.622; 95%CI: 1.470–14.531; P < 0.05). ConclusionHeart rate < 60 beats/min immediately before foramen ovale puncture was independently associated with TCR. Therefore, it is necessary for anesthesiologists to raise heart rate appropriately to prevent TCR during PBC.

The role of nonspecific proteolysis in the development of alterative changes in lung tissue when using electronic cigarettes

In recent years, the number of electronic cigarettes (ES) users has been growing steadily around the world. ES heat and vaporize components of a mixture of propylene glycol, vegetable glycerin, nicotine, and flavors. Reports of severe forms of lung injury caused by the use of ES, some of which have resulted in death, urge studying the pathogenetic mechanisms of such complications. One of the mechanisms is the activation of nonspecific proteolysis accompanied by the destruction of connective tissue components of the blood-air barrier.Aim of the study. To study the dynamics of the proteinase-inhibitor system indicators and its role in the morphological changes of lung tissue in experimental modeling of the effects of ES.Methods. Experimental studies were performed in 24 white male Wistar rats weighing 160 – 180 g. ES use of was simulated by intermittent exposure to smoke mixture vapors using a POD system connected to a two-channel compressor.Results. Analysis of the state of the nonspecific proteinase inhibitory system in rat broncho-alveolar lavage and blood serum and the results of morphological studies indicate activation of trypsin-like proteinases and depletion of the local antitryptic potential, leading to biochemical changes with subsequent structural changes in lung tissue. The latter are characterized by congestion, leukocyte infiltration, and stromal proliferation. In addition, exposure to nicotine-containing mixtures has been shown to affect the proteinase inhibitory system and blood serum composition, which is associated with a compensatory increase in antitrypsin activity.Conclusion. The results of the study indicate the activation of trypsin-like proteinases in broncho-alveolar lavage, which have a damaging effect on lung tissue, leading to disturbances in tissue hemodynamics, extravasation of leukocytes, remodeling and thickening of the blood-air barrier.

Incidence, severity and detection of blood pressure and heart rate perturbations in postoperative ward patients after noncardiac surgery

Study objectiveWe sought to determine changes in continuous mean and systolic blood pressure and heart rate in a cohort of non-cardiac surgical patients recovering on the postoperative ward. Furthermore, we estimated the proportion of vital signs changes that would remain undetected with intermittent vital signs checks. DesignRetrospective cohort. SettingPost-operative general ward. Patients14,623 adults recovering from non-cardiac surgical procedures. Interventions & measurementsUsing a wireless, noninvasive monitor, we recorded postoperative blood pressure and heart rate at 15-s intervals and encouraged nursing intervention as clinically indicated. Main results7% of our cohort of 14,623 patients spent >15 sustained minutes with a MAP <65 mmHg, and 23% had MAP <75 mmHg for 15 sustained minutes. Hypertension was more common, with 67% of patients spending at least 60 sustained minutes with MAP >110 mmHg. Systolic pressures <90 mmHg were present for 15 sustained minutes in about a fifth of all patients, and 40% of patients had pressures >160 mmHg sustained for 30 min. 40% of patients were tachycardic with heart rates >100 beats/min for at least continuous 15 min and 15% of patients were bradycardic at a threshold of <50 beats/min for 5 sustained minutes. Conventional vital sign assessments at 4-h intervals would have missed 54% of mean pressure episodes <65 mmHg sustained >15 min, 20% of episodes of mean pressures >130 mmHg sustained >30 min, 36% of episodes of heart rate > 120 beats/min sustained <10 min, and 68% of episodes of heart rate sustained <40 beats per minute for >3 min. ConclusionsSubstantial hemodynamic disturbances persisted despite implementing continuous portable ward monitoring coupled with nursing alarms and interventions. A significant proportion of these changes would have gone undetected using traditional intermittent monitoring. Better understanding of effective responses to alarms and appropriate interventions on hospital wards remains necessary.

Dapagliflozin Mitigates Hypotension in Lipopolysaccharide-Induced Acute Inflammation Independent of Glycemia Level.

Sodium-glucose cotransporter-2 (SGLT2) inhibitors have been suggested to have anti-inflammatory properties in diabetes. The goal of this study was to evaluate the role of the SGLT2 inhibitor dapagliflozin (DAPA) in the attenuation of lipopolysaccharide (LPS)-induced hypotension. Male Wistar albino rats were divided into normal and diabetic groups and received DAPA (1 mg/kg/day) for two weeks followed by a single dose of 10 mg/kg LPS. Blood pressure was recorded throughout the study and the circulatory levels of cytokines were assessed using a multiplex array, while the aortas were harvested for analysis. DAPA attenuated the vasodilation and hypotension caused by LPS. Mean arterial pressure (MAP) was preserved in the normal and diabetic DAPA-treated septic groups (MAP = 83.17 ± 5.27, 98.43 ± 5.57 mmHg) compared to the vehicle-treated septic groups (MAP = 65.60 ± 3.31, 68.21 ± 5.88 mmHg). Most of the cytokines induced by LPS were decreased in the DAPA-treated septic groups. In the aorta, the inducible nitric oxide synthase-derived nitric oxide had lower expression in the DAPA-treated rats. In contrast, the expression of α-smooth muscle actin, a marker of the vessel's contractile state, was higher in the DAPA-treated rats in comparison with non-treated septic rats. These findings revealed that the protective role of DAPA against LPS-induced hypotension is likely to be glucose-lowering independent, as was observed in the non-diabetic septic group. Taken together, the results show that DAPA has a potential effect in the prevention of the hemodynamic disturbances of sepsis regardless of glycemia levels.

Is the transradial approach associated with decreased acute kidney injury following percutaneous coronary intervention in patients not complicated by major bleeding and haemodynamic disturbance?

The impact of the transradial approach (TRA) on the development of acute kidney injury (AKI) after percutaneous coronary interventions (PCI) has been controversial. We retrospectively analysed 463 patients undergoing PCI for either acute or chronic coronary syndrome. Excluded patients were those with missing laboratory or procedural data, acute/decompensated heart failure, major bleeding, haemodynamic instability, long-term dialysis and mortality. The primary endpoint of the study was the incidence of AKI after PCI, which was defined as an increase in serum creatinine (SCr) level of 0.5 mg/dl or 25% from the baseline. Secondary endpoints were change in SCr level, increase in SCr of ≥ 0.3 and ≥ 0.5 mg/dl, and increase in SCr of ≥ 25 and ≥ 50%. We compared the incidence of AKI between the TRA and the transfemoral approach (TFA) in the overall and a propensity score (PS)-matched study population. The study population included 339 patients. After PS matching, we obtained a well-balanced population of 182 patients. The differences between the incidence of AKI in the TRA and TFA were not significant in both the overall (9.0 vs 11.2%, p = 0.503) and PS-matched (9.9 vs 7.7%, p = 0.601) study population. TRA resulted in a significantly lower incidence of SCr increase of ≥ 50% in unmatched patients. However, after PS matching, there was no difference between the TRA and TFA in any variable of secondary post-PCI renal outcomes. Age, female gender, baseline SCr level, baseline estimated glomerular filtration rate and contrast volume were independent predictors of AKI. Compared to the conventional TFA, TRA was not associated with a reduced incidence of AKI after PCI in patients not complicated by major bleeding, acute heart failure and haemodynamic disturbances.

A Prospective, Randomized, Double-blinded Study on the Comparison of Propofol and Ketofol (Combination of Ketamine and Propofol) for Modified Electroconvulsive Therapy

ABSTRACT Background and Aims: Modified electroconvulsive therapy is routinely used to treat complicated psychiatric disorders. Its therapeutic effect is directly proportional to induced seizure duration but it is associated with hemodynamic disturbances. The aim of this study was to evaluate the effect of a ketamine + propofol combination (“ketofol”) for electroconvulsive therapy and to compare these with the effects of propofol alone. Methods: In this prospective study, 60 patients aged 18–60 years with American Society of Anesthesiologists (ASA) Ι and ΙΙ for psychiatric disorders were included. Patients were divided into two groups (30 each). Group P received propofol at 10 mg/ml and group K received ketofo at 10 mg/ml (ketamine 5 mg/ml and propofol 5 mg/ml in a 1:1 ratio). Motor/electroencephalography (EEG) seizure duration, induction time, hemodynamic variables, recovery time, agitation score, and complications were recorded. Standard qualitative and quantitative tests were used to compare the data (e.g., unpaired student t-test, Chi-squared test, etc). A P value of &lt; 0.05 was considered to be significant. Results: The mean duration of (motor/EEG) seizure was statistically significantly high in the ketofol group compared to the propofol group (P = 0.0001/0.0001). The mean induction time was significantly less in the ketofol group compared to propofol group (P = 0.0001). The recovery time was significantly early in group K patients compared to group P (P = 0.004). The ketofol group was more hemodynamically stable with comparable agitation score and side effects than patients in the propofol group. Conclusion: In modified ECT, ketofol was associated with longer seizure duration, lesser induction time, better hemodynamic stability, early recovery with comparable post ECT agitation and adverse effects compared to propofol alone.

Propofol and thiopental for intravenous induction in neonates: study protocol for a dose-finding trial.

Propofol and thiopental are commonly used induction agents in neonatal anesthesia. Even though both hypnotics have been used off-label for many years, pharmacological knowledge regarding these agents is scarce in neonates. The significant variability in neonates' body composition, organ function, and maturation makes pharmacological studies highly relevant albeit challenging. As a result, there is currently limited data about the anesthetic induction dose of thiopental and propofol in neonates. In addition, a knowledge gap exists concerning the pharmacodynamics of induction doses. To determine the median effective anesthetic induction dose of propofol and thiopental in neonatal patients of different gestational and postnatal ages and evaluate the pharmacodynamics of the anesthesia induction doses on the neonatal systemic and cerebral hemodynamics. This is a single-center, prospective, open-label, interventional, dose-finding study, including neonatal patients from birth up to 28 postnatal days undergoing general anesthesia for surgical or diagnostic procedures. The patients will be stratified according to their gestational and postnatal age and allocated to one of the two trial arms: anesthesia induction with propofol or anesthesia induction with thiopental. We will use Dixon's up-and-down method to estimate the median effective anesthesia induction dose of both agents in neonates of different gestational and postnatal ages. In addition, we will study the relationship between anesthesia induction doses and changes in systemic and cerebral hemodynamics. Alterations in the systemic and cerebral regional hemodynamics secondary to anesthesia induction may be harmful in neonates, especially premature and critically ill newborns, due to their immature organ systems, reduced physiological reserves, and impaired cerebral autoregulation. Perfusion homeostasis is considered one of the significant and modifiable determinants of anesthesia-related neurocognitive outcomes. Therefore, dose-finding and safety pharmacological studies of the anesthetic induction agents in neonates are urgently needed and acknowledged as a high priority by the European Medicine Agency. Estimating adequate induction doses to ensure optimal depth of anesthesia while avoiding systemic and cerebral hemodynamic disturbances will help ensure safe anesthesia and potentially improve anesthesia-related outcomes in this group of patients. This article is protected by copyright. All rights reserved.

Evaluation of single-delay arterial spin labeling-based spatial coefficient of variation and histogram-based parameters in relation to cerebrovascular reserve in patients with Moyamoya disease.

Single-delay Arterial Spin Labeling (ASL)-based spatial coefficient of variation (CoVCBF) has been suggested as a measure of hemodynamic disturbance in patients with cerebrovascular diseases. However, spatial CoVCBF and other histogram-based parameters such as skewness and kurtosis and the volume of the arterial transit time artefact (ATAvol), has not been evaluated in patients with MMD nor against cerebrovascular reserve (CVR). The aim of this study was to assess whether any associations between spatial CoVCBF, skewness, kurtosis, and ATAvol are present and to analyze any potential associations with CVR, derived from single-delay ASL in patients with MMD. Fifteen MMD patients were included before or after revascularization surgery. Cerebral blood flow (CBF) maps were acquired using pseudo-continuous ASL before, and 5, 15, and 25 min after an intravenous acetazolamide injection. CVRmax was defined as the highest percentual increase in CBF at any of the three post-injection time points. A vascular territory template was spatially normalized to each patient, including the bilateral anterior, middle, and posterior cerebral arteries. All affected anterior and middle cerebral artery regions and all unaffected posterior cerebral artery regions were included, based on Suzuki grading by digital subtraction angiography. Significant differences between affected and unaffected regions were found for CBF, CVRmax, and ATAvol. No association was found between CVRmax and any other parameter. High correlations were found between spatial CoVCBF, skewness and ATAvol. Spatial CoVCBF derived from single-delay ASL does not correlate with CVR in patients with MMD. Moreover, skewness and kurtosis did not provide additional information of clinical value.

Karakteristik Pendertia Snakebite Disertai Gangguan Hemodinamik dan Asidosis Respiratorik pada Pasien Anak dan Dewasa

Snakebite or snakebite is a defense mechanism for snakes and can become a medical emergency. Snakebites are a significant cause of morbidity and mortality worldwide, especially in South and Southeast Asia, sub-Saharan Africa and Latin America. The snakebite can be life-threatening if it has a neurotoxic, cytotoxic and hemotoxic effect. Complications from snakebite include hemodynamic disturbances and respiratory acidosis. International online databases (PubMed and Google Scholar) were used to search for articles in this systematic review. A total of 24 related research articles indexed by Scopus have been published in the last ten years. This research is a literature systematic review. Research sources were taken in the last 10 years from 2012 to 2022, taken from PubMed and Google Scholar. After exclusion, 24 articles and studies that met the exclusion and inclusion criteria were considered for systematic review. Of all the journals reviewed, there are many that explain snake bite associated with hemodynamic disturbances and respiratory acidosis. Snakebite is proven to provide long-term complications in the form of hemodynamic disturbances around the bite site. Another complication that has been proven to occur in snakeibite victims is cardiac shock, especially impaired cardiac return. Pathophysiology, symptoms, and diagnosis of snakebite in pediatric and adult patients are the same. The majority of journals discuss heart disorders and infections, necrosis of muscles and bones related to venomous snake bites. Hemodynamic disturbances and respiratory acidosis are complications that can occur in snakebite victims. There are similarities in symptoms and management of venomous snake bites in children and adults.

Prevention of metabolic syndrome implies prevention of severe and multivessel coronary artery disease

Abstract Funding Acknowledgements Type of funding sources: None. Background and Purpose Metabolic Syndrome (MS) is the result of metabolic, clinical, and hemodynamic disturbances caused by a group of cardiometabolic risk factors. The particular components of the syndrome are each individually also a predisposing factor for Coronary Artery Disease (CAD). The purpose of our study is to demonstrate the direct correlation of MS with the angiographic severity of CAD so that by affecting by prevention of one axis of this equation, a favorable effect is automatically achieved on its outcome as well. Methods We have studied 151 patients, 124 males - 27 females of mean age 63.56 ± 11.28 years, who were hospitalized for Acute Coronary Syndrome (ACS) and underwent coronary angiography. MS definition is according to the criteria set by the respective scientific companies. Thus, patients were classified into Group A with MS (46 patients - 35 males, 11 females - mean age 62.07 ± 11.35 years) and Group B without MS (105 patients - 89 males, 16 females – a mean age 65.06 ± 12.54 years). The correlation between MS, and the severity of CAD, has been estimated using the SYNTAX Score. Results Group A patients had a higher incidence of ST-elevation myocardial infarction (STEMI) than Group B patients, namely 32 patients (69.56%) versus 28 patients (26.67%), (p = 0.002), a higher incidence of multivessel disease, 20 patients (43.48%) versus 16 patients (16.8%), (p = 0.02), reduced Ejection Fraction (42.4% ± 9.6% vs. 53.5% ± 6.54% - p = 0.01) and higher SYNTAX Score (19.52 ± 7, 68 vs. 9.64 ± 5.32 - p = 0.01). In Group A with MS, lipid levels disorders were also observed (Total cholesterol, triglycerides, LDL, HDL - p = 0.01), higher values of fasting plasma glucose and HbA1c but also of mean platelet volume (MPV), which is considered a significant prognostic factor in patients with CAD (11.91 ± 1.93 femtolitres vs. 9.84 ± 1.06 femtolitres). Conclusions MS is associated with more severe clinically and angiographically CAD. Prevention and regulation of MS factors are significant for the avoidance of the occurrence of severe coronary syndrome.

Organ dysfunction and failure in liver disease.

Acute-on-chronic liver failure (ACLF) is a complex syndrome defined by the existence of different organ failures (OFs) in patients with chronic liver disease, mainly cirrhosis. Several definitions have been proposed to define the syndrome, varying in the grade of the subjacent liver disease, the type of precipitants and the organs considered in the definition. Liver, coagulation, brain, kidney, circulatory and pulmonary are the six types of OFs proposed in the different classifications, with different prevalence worldwide. Irrespective of the definition used, patients who develop ACLF present a hyperactive immune system, profound haemodynamic disturbances and several metabolic alterations that finally lead to organ dysfunction. These disturbances are triggered by different factors such as bacterial infections, alcoholic hepatitis, gastrointestinal bleeding or hepatitis B virus flare, among others. Because patients with ACLF present high short-term mortality, a prompt recognition is needed to start treatment of the trigger event and specific organ support. Liver transplantation is also feasible in carefully selected patients and should be evaluated.