Changes In Hemodynamic Parameters Research Articles

Changes in hemodynamic parameters with different anaesthesia induction agents in elderly patients with coronary heart disease

Background. Coronary heart disease (CHD) is one of the most common diseases in Ukraine and worldwide. Open myocardial revascularisation procedures require general anaesthesia with endotracheal intubation. Prevention of peri-intubation hypotension in elderly patients with CHD is relevant today. The purpose was to improve the safety of surgery in elderly CHD patients by determining the induction schedule for anaesthesia with minimal cardiodepressant and vasodilator effects. Materials and methods. A cohort prospective randomized study of 40 patients with ASA III–IV who underwent off-pump coronary artery bypass grafting. Their mean age was 67.00 ± 5.78 years. The participants were divided into 2 groups based on the type of induction agent: group 1 — propofol 1.5 mg/kg, fentanyl 2.0 μg/kg; group 2 — propofol 1.5 mg/kg, fentanyl 2.0 μg/kg, ketamine 0.5 mg/kg. Relaxation: pipecuronium bromide 0.1 mg/kg. Hemodynamic parameters were recorded at the following stages: 1) upon arrival to the operating room; 2) before it; 3) after intubation; 4) 25 minutes after intubation. Results. After the administration of induction drugs, a significant difference was observed only in mean arterial pressure (MAP): group 1 — 72.71 ± 4.76 %, group 2 — 81.29 ± 5.4 % of the baseline, p = 0.0001. At the third stage, a statistically significant difference between the groups was determined in three indicators: MAP (86.74 ± 8.82 %, 92.34 ± 7.26 %; p < 0.05), stroke volume index (SVI) (99.91 ± 2.94 %, 109.63 ± 8.16 %, p < 0.05), cardiac index (CI) (96.63 ± 11.77 %, 110.38 ± 12.37 %, p < 0.05). At the fourth stage, a statistical difference between the groups was observed in MAP (74.87 ± 7.90 % in group 1 vs. 86.47 ± 6.07 % in group 2, p < 0.05), SVI (87.09 ± 5.30 % in group 1 vs. 108.21 ± 8.32 % in group 2, p < 0.05), ejection fraction (88.26 ± 3.58 % in group 1 vs. 106.89 ± 6.22 % in group 2, p < 0.05), CI (79.59 ± 10.11 % in group 1 vs. 108.29 ± 9.95 % in group 2, p < 0.05), systemic vascular resistance index (91.13 ± 9.34 % in group 1 vs. 77.86 ± 9.83 % in group 2, p < 0.05). Conclusions. The addition of ketamine to the classic combination of propofol and fentanyl increases the effectiveness and reduces the percentage of possible potential complications by stabilizing hemodynamics during anaesthetic support for coronary artery bypass grafting in older patients with CHD.

The association between changes in cerebral hemodynamics and cerebrovascular complications during ECMO treatment in neonates.

To investigate whether changes in cerebrovascular hemodynamic parameters during extracorporeal membrane oxygenation (ECMO) treatment in neonates are associated with the occurrence of cerebrovascular complications. This study selected neonatal patients who received ECMO treatment at a pediatric hospital in China from June 2021 to June 2024. Relevant clinical data were collected from the electronic medical record system. Data from cranial ultrasound examinations before and during ECMO treatment, as well as the occurrence of cerebrovascular complications, were collected for further analysis. A total of 37 neonates were enrolled in this study. Among them, 15 neonates who developed cerebrovascular complications during ECMO were included in the complication group, while the remaining 22 neonates were included in the non-complication group. The age difference between the two groups was statistically significant. The systolic blood pressure coefficient of variation (SBP-CV) and diastolic blood pressure CV (DBP-CV) were significantly higher in the complication group compared to the non-complication group. Additionally, the anterior cerebral artery peak systolic velocity CV (ACA-PSV-CV) and ACA resistance index CV (ACA-RI-CV) were significantly higher in the complication group than in the non-complication group. However, there was no significant difference in the ACA end-diastolic velocity CV (ACA-EDV-CV) between the two groups. The receiver operating characteristic (ROC) curve analysis of risk factors for cerebrovascular complications indicated that the area under the curve (AUC) for ACA-RI-CV was 0.765 (95% CI: 0.608-0.923, p = 0.007). The AUC for ACA-SBP-CV was 0.815 (95% CI: 0.666-0.964, p = 0.001). Moreover, when ACA-RI-CV and ACA-SBP-CV were combined, the AUC was 0.873 (95% CI: 0.758-0.988, p<0.001). High ACA-RI-CV and ACA-SBP-CV were associated with the occurrence of cerebrovascular complications during ECMO treatment in neonates. The combined detection of ACA-RI-CV and ACA-SBP-CV had a predictive role in the early identification of cerebrovascular complications in neonatal ECMO patients.

Study of physiological reactions in healthy individuals in different microclimate: a pilot study

Introduction. Studying the influence of meteorological and heliophysical factors on the human body is an urgent problem in restorative medicine. Aim. To study the characteristics of the microclimatic zones of the territory of the village of Arkhipo-Osipovka, the Black Sea coast of the Krasnodar Territory and the physiological parameters of healthy volunteers before and after the terrainkur in order to assess the effectiveness of its individual routes. Materials and methods. Bioclimatic zoning of the territory of the SKK “Vulan” was carried out, the village of Arkhipo-Osipovka, the Black Sea coast of the Krasnodar Territory, according to standard methods in October 2023. In October 2023, a clinical study was conducted with the participation of 12 healthy volunteers, using a cross-sectional study design. All study participants went through a standard health path route every day in different microclimatic zones, before and after which a psychophysiological study was carried out, heart rate variability (HRV) was assessed, microcirculation and composition body weight using the bioimpedance method. Results and discussion. It was revealed that the psychophysiological state of the volunteers was characterized by overstrain of regulatory systems (the median indicator of activity of regulatory systems in all zones was 7.0); after the health path, statistically significant changes in HRV, hemodynamic parameters, microcirculation and body composition were noted (p 0.05). However, the rate of increase or decrease in indicators was heterogeneous in different microclimates (p 0.05). According to the results of the cluster analysis, the circulation regime was associated with indicators of HRV and microcirculation, and ambient temperature with HRV and body composition. When analyzing the body’s adaptive response to the influence of climatic factors and identified microclimatic zones, the same type of nonspecific response of the body of healthy volunteers to physical activity was recorded, but the degree of severity of this response was different. Conclusion. The introduction of bioclimatic zoning in sanatorium-resort organizations will allow optimizing health path techniques, due to the possibility of dosing the climatic load, by determining the optimal location, time of year and microclimate for conducting sanatorium-resort treatment.

The Effect of Isometric Handgrip Training With and Without Blood Flow Restriction on Changes in Resting Blood Pressure

ABSTRACT To investigate the effects of high-intensity contractions and low-intensity contractions with and without blood flow restriction on changes in blood pressure and hemodynamic parameters. A total of 179 participants (18–35 years) were randomly assigned to one of three training groups that exercised 3 times per week for six weeks or a non-exercise control group. The groups are as follows: 1) Control [CON, n = 44]; 2) completed 4 sets of two-minute isometric contractions at 30% maximal voluntary contraction [LI, n = 47]; 3) completed 4 sets of two-minute isometric contractions at 30% maximal voluntary contraction with a 12 cm cuff inflated to 50% of arterial occlusion pressure [LI+BFR, n = 41]; or 4) completed 4 maximal isometric contractions lasting 5 seconds [MAX, n = 47]. Blood pressure, vascular resistance, and reactive hyperemia were measured at pre and post. Data are presented as means (SD). There was no evidence that SBP (BF10: 0.066), DBP (BF10: 0.057), vascular resistance (BF10: 0.085), or peak reactive hyperemia changed (BF10: 0.044) or A.U.C. (BF10: 0.074). Change scores for SBP were 1.1 (6.7), 0.7 (5.8), −0.4 (6.5), and −0.9 (6.3) mmHg for CON, LI, LI+BFR, and MAX, respectively. DBP change scores were 1.5 (6.6), 1.5 (7), −0.7 (5.9), and 0.3 (6.3) mmHg for CON, LI, LI+BFR, and MAX, respectively. Although recommended as a non-pharmacological method of blood pressure control, isometric exercise with or without BFR did not lower blood pressure. Future work could examine the inclusion of a daily strength test prior to the low intensity protocol.

Comparison of Macintosh laryngoscope and King Vision video laryngoscope for endotracheal intubation in adult patients

Background: Development of video laryngoscope has made management of airway easier. 0ur study was aimed to compare the efficacy of Macintosh laryngoscope and King Vision video laryngoscope for endotracheal intubation in adult patients under general anesthesia. Objectives: The primary objective of the study was to compare the glottic view obtained , the need for external manipulation, endotracheal tube insertion time and attempts taken for successful intubation with Macintosh laryngoscope and King Vision video laryngoscope. The secondary objective was to estimate the changes in hemodynamic parameters and to evaluate the occurrence of complications during intubation. Materials and Methods: The study included 136 patients posted for surgery under general anesthesia. Patients were randomly allocated in group C (N=68) and group V (N=68 ).Endotracheal intubation was done in group C by Macintosh and in group V by King Vision video laryngoscope. Laryngoscopy was assessed by Cormack Lehane grading and the need for any manipulation. The intubation time was calculated with each blade. Hemodynamic parameters were recorded and any complication during laryngoscopy and intubation were noted. The observations were analysed statistically by SPSS Program for windows version 28. Results: In group C, 61.8% of patients had Cormack and Lehane score I while in group V 76.5 % of patients had score I . Mean time of successful intubation was 34.90±8.35 sec in group C while in group V it was 32.82± 5.20 second . There was no statistical difference in distribution of patients according to number of attempts of intubation. In group C, 64.7% of patients needed external laryngeal pressure while in group V 97.1 % patients were intubated without external laryngeal pressure. Both the groups were comparable in relation to changes in hemodynamic parameters and any complications associated with laryngoscopy and intubation. Conclusion: We conclude that glottic view is better obtained with King Vision Video laryngoscope whereas optimisation of position and external laryngeal manipulation is often required with Macintosh laryngoscope to get similar glottic view. Introduction of King Vision video laryngoscope into the oral cavity takes time but intubation is easier with it. Hemodynamic variables and complications during the procedure are equally distributed between the two devices.

Effects of integrated blood purification on haemodynamics and oxygen metabolism in children with severe sepsis.

To investigate the effects of integrated blood purification on haemodynamics and oxygen metabolism in children with severe sepsis. Clinical data of 12 children with severe sepsis admitted to the pediatric intensive care unit of our hospital between October 2021 and June 2022 were retrospectively analyzed. All patients were treated with integrated blood purification, and changes in haemodynamic parameters, including heart rate, blood pressure, mean arterial pressure and cardiac output, and oxygen metabolism parameters (blood lactic acid, oxygen delivery, oxygen consumption and oxygen extraction rate) were observed before and after treatment. The heart rate (134[106,160] vs 111[101,128], p = 0.037), central venous pressure (9[7,10] vs 8[7,9], p = 0.04), stroke output (28[18,43] vs 21[15,31], p = 0.01), blood lactate (3.3[2,4] vs 2.5[1.3,3.6], p = 0.015), oxygen consumption (165.99[121.44,230.31] vs 124.18[82.51,162.86], p = 0.041) and oxygen extraction rate (38.83[31.87,44.62] vs 28.67[21.05,32.72], p = 0.019) were decreased, whereas systolic blood pressure (97[83,104] vs 107[94,116], p = 0.033) and central venous oxygen pressure (32[29, 37] vs 39[34,46], p = 0.005) were increased in the children after treatment compared with before treatment. There were no statistically significant differences in diastolic blood pressure, mean arterial pressure, cardiac output, arterial oxygen pressure and oxygen delivery before and after treatment (all p > 0.05). Integrated blood purification can improve haemodynamic and oxygen metabolism parameters in children with severe sepsis, with a high value in clinical application.

Comparison Of Bolus Ephedrine, Mephentermine And Phenylephrine For The Management Of Hypotension During Spinal Anaesthesia For Caesarean Section – A Clinical Study

Background: Anaesthesia to a parturient is not only unique but also requires highest degree of care because the anaesthesiologist has to look after two individuals, the mother and fœtus. Hypotension during spinal anaesthesia for caesarean delivery can have detrimental effects on both mother and neonate. These effects include decreased utero-placental blood flow, impaired foetal oxygenation with asphyxial stress and foetal acidosis and maternal symptoms of low cardiacoutput such as nausea, vomiting, dizziness and decreased consciousness. Vasopressor like Ephedrine, Mephentermine, Phenylephrine, are used for treating the hypotension. In this study we compared the efficacy of Ephedrine, Mephentermine and Phenylephrine in treating the hypotension for caesarean section and their desirable side effects. Materials and Methods: In this prospective randomised controlled study, 90 patients of ASA physical status I and II belonging to age group of 18-35 years undergoing elective or emergency LSCS under sub-arachnoid block were randomly allocated into 3 groups of 30patients each, Group E (Ephedrine) and Group M (Mephentermine) and Group P (Phenyephrine). Group E received Inj Ephedrine 6 mg IV bolus, Group M received Inj Mephentermine 6 mg IV bolus and Group P received Inj Phenylephrine 100 microgram IV bolus for spinal anaesthesia. The changes in hemodynamic parameters, neonatal outcome, side-effects and usage of rescue vasopressor were compared between the groups. Results: The mean age in group P was 24.2 years, in group E 25.7 years and in group M was 25.7 years, which was similar across the groups. The time between induction and delivery was 87.8 sec in group P, 89.4 sec in group E and 89.6 sec in group M. The time at which 1st vasopressor dose given was 5.2 min in group P, 4.8 min in group E and 4.87 min in group M. The mean heart rate was lower in group P at all the points of study after episode of hypotension. The bolus drug requirement was highest in group P with mean of 3.52 followed by group M with mean of 2.86 and group E with mean of 2.55. The group E required rescue analgesia 73% of time, group M 70% of time and group P also 70% of time in study. The mean APGAR score at 1 minute was 8.2 in group P, 8.4 in group E and 8.6 in group M. Conclusion: During subarachnoid block for cesarean delivery, all three of the study's vasopressors— phenylephrine, ephedrine, and mephentermine—effectively maintained arterial blood pressure and were safe to use in the treatment of hypotension. Compared to ephedrine and mephentermine, phenylephrine significantly lowered heart rate, which may be helpful for cardiac patients or those in whom tachycardia is not desired

Real-world evidence on pulmonary arterial hypertension: interim analysis from the Italian observational study INSPECTIO

Abstract Background Pulmonary arterial hypertension (PAH) is a rare, progressive disease leading to right-sided heart failure. The interest in risk assessment based on non-invasive parameters is growing, and insights from clinical practice are needed in this regard. INSPECTIO is an Italian observational study aimed at filling this knowledge gap. The results of an interim analysis at month 12 are presented below. Purpose The primary objective was to assess the change from baseline to month 12 in the number of the non-invasive low-risk parameters among World Health Organization functional class, 6-minutes walking distance, Brain Natriuretic Peptide (BNP) or N-terminal proBNP. Secondary objectives are the evaluation of echocardiographic and haemodynamic parameters, and the proportion of patients in which the therapy was optimized according to the guidelines. Methods Prospective, multicentre study on PAH patients at low/intermediate mortality risk treated with macitentan and/or selexipag as part of the oral combination therapy. Results Among 177 patients who were enrolled in 29 centres, 148 patients [median age 63.0 years (Q1/Q3: 53.5/73.0), 76.4% females] completed the 12-month follow up and were considered for this analysis. The median time from PAH diagnosis was 22.6 months (4.9/60.1). Sixty-four (43.2%) patients had idiopathic PAH; 4 (2.7%) heritable; 80 (54.1%) associated with other diseases [58 (72.5%) connective tissue disease, 11 (13.8%) congenital heart disease corrected for at least one year, 5 (6.3%) portal hypertension, 5 (6.3%) human immunodeficiency virus infection, 1 (1.3%) drug and toxins]. At baseline, 45.9% patients and 28.4% were in double and triple oral combination therapy, respectively. Primary objective: at month 12, the number of noninvasive low-risk parameters increased in 43 (29.1%) patients and remained stable in 80 (54.1%) patients [mean change 0.16 (p=0.017)]. The values at baseline, at month 12 and the change from baseline for each noninvasive parameter are shown in Table 1. Mean right atrial (RA) area (end-systole) and tricuspid annular plane systolic excursion (TAPSE) remained unchanged while a reduction of systolic pulmonary artery pressure (sPAP) was observed. Regarding the haemodynamic parameters, the mean pulmonary arterial pressure decreased [median change -4.5, (p=0.0346)], while cardiac index, pulmonary vascular resistance, and RA pressure remained stable (Table 2). The number of patients on triple therapy increased from 42 to 51 (+21.4%). Conclusions This study confirms that a noninvasive low-risk profile can be achieved with current combination PAH therapy. The modest or absent changes in echocardiographic and hemodynamic parameters suggest that treatment of PAH in real world is yet to be improved; on the other hand, the optimization of therapy in a significant portion of patients can possibly account for the improvement or stabilization observed.Noninvasive parametersEcho and hemodynamic parameters

The association of early passive mobilization with intracranial pressure in the adult intensive care unit: A prospective, cohort study.

Early mobilization are key components of the ABCDEF Care Bundle and critical treatments to reduce acquired muscle weakness, delirium and prolonged intensive care unit (ICU) stay. This study aimed to determine whether routine early mobilization related to intracranial pressure in intensive care patients on mechanical ventilation, using optic nerve sheath diameter measurement (ONSD). This study was planned as a prospective, cohort study in the third-step adult ICU of a faculty hospital. The study included only patients who were intubated and followed up on a mechanical ventilator and were clinically stable. Passive range of motion (PROM) exercises were performed daily by the physiotherapists as part of routine care from the day of hospitalization. ONSD was assessed before, during and 10 min after PROM exercises. The study included 20 eligible patients out of the 142 who were evaluated upon admission to the ICU. The median age of the patients was 65 years, and nine (45%) of them were female. The analyses showed that there was no statistically significant change in ONSD during and at the end of the PROM (ONSD right eye p:.621, Partial η2: 0.025, ONSD left eye p:.935, Partial η2: 0.004). Similarly, there was no statistically significant change in haemodynamic parameters in during and at the end of the PROM (Heart beat p:.849, Partial η2: 0.009, Systolic Pressure p:.435, Partial η2: 0.043, Diastolic Pressure p:.128, Partial η2:0.103, Saturation p:.103, Partial η2: 0.113 and Respiratory rate p:.071, Partial η2:0.130). This study suggests that daily extremity physiotherapy exercises can be safely applied without causing increased intracranial pressure or haemodynamic instability in intensive care patients followed up on mechanical ventilation, including patients with vasopressor therapy. Early mobilization, including PROM, is considered safe in terms of intracranial pressure for intubated patients in the ICU.

8483 Changes in kidney hemodynamics during gender-affirming hormone therapy in transgender individuals - findings from the KNIGHT pilot study

Abstract Disclosure: S.A. van Eeghen: None. C. Wiepjes: None. L.L. Pyle: None. M. den Heijer: Research Investigator; Self; Kyowa Kirin. Other; Self; Novartis Pharmaceuticals. P. Bjornstad: Advisory Board Member; Self; AstraZeneca, Bayer, Inc., Boehringer Ingelheim, Novo Nordisk, XORTX. Consulting Fee; Self; AstraZeneca, Bayer, Inc., Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly &amp; Company, LG Chemistry, Horizon Pharma, Novo Nordisk, Sanofi. Research Investigator; Self; AstraZeneca, Merck, Horizon Pharma. Other; Self; Bayer, Inc. D. van Raalte: Consulting Fee; Self; AstraZeneca, Bayer, Inc., Boehringer Ingelheim, Eli Lilly &amp; Company, Merck, Sanofi, MSD. Research Investigator; Self; AstraZeneca, Boehringer Ingelheim, Eli Lilly &amp; Company, Merck, Sanofi, MSD. N.J. Nokoff: Consulting Fee; Self; Neurocrine Biosciences, Inc, Ionis Pharmaceuticals Inc.. Research Investigator; Self; Neurocrine Biosciences, Inc. Other; Self; World Athletics. Background: Studies in transgender individuals have shown that gender-affirming hormone therapy (GAHT) impacts estimated glomerular filtration rate (eGFR). Masculinizing hormone therapy decreases, while feminizing hormone therapy increases eGFR, based on changes in serum creatinine and cystatin C. These substantial changes suggest an effect of sex hormones on kidney hemodynamics. To investigate this, we studied kidney hemodynamic changes before and after 3 months of gender-affirming hormone therapy (GAHT) in transgender individuals. Methods: This prospective observational pilot study assessed kidney hemodynamics in 23 transgender individuals assigned male at birth receiving feminizing hormone therapy and 21 transgender individuals assigned female at birth receiving masculinizing hormone therapy. Feminizing therapy included transdermal (n=16), sublingual (n=5), or oral estradiol (n=2), in combination with an anti-androgen (n=22); intramuscular triptorelin (n=16), spironolactone (n=5) or finasteride (n=1). Masculinizing therapy involved transdermal (n=17) or injected testosterone (n=4). Measures included glomerular filtration rate (GFR; Iohexol clearance), effective renal plasma flow (ERPF; p-aminohippurate clearance), and renal vascular resistance (RVR; mean arterial pressure/renal blood flow). Glomerular hydraulic pressure (PGLO), and afferent/efferent vascular resistance (RA/RE) were estimated by Gomez equations. Linear mixed models compared baseline and three-month measurements. Results: Individuals undergoing feminizing hormone therapy [median age 21 (IQR 19-29) years, BMI median 22.9 (IQR 18.9-30.7) kg/m²] had increased GFR by 2.8 mL/min per 1.73m² (95% CI, 0.01 to 5.6) and a nonsignificant increase in ERPF (+42 mL/min per 1.73m²; 95% CI, -5 to 90). RVR and RA significantly decreased [RVR: -0.007 mmHg/L/min (95% CI, -0.015 to -0.0003), RA: -294 dyn/s per cm5 (5% CI, -568 to -21)], indicating afferent vasodilation. In contrast, individuals receiving masculinizing therapy (median age median 20 (IQR 18-23) years, BMI median 24.2 (IQR 21.1-27.3) kg/m²) showed a slight, nonsignificant decrease in GFR (-2.1 mL/min per 1.73m²; 95% CI, -4.9 to 0.8), with no changes in other kidney hemodynamic parameters. Conclusions: In this cohort of transgender individuals, GFR increased during feminizing hormone therapy, likely due to afferent vasodilatation, while during masculinizing hormone therapy GFR tended to decrease. These findings suggest an influence of sex hormones on kidney hemodynamics, especially during feminizing hormone therapy. Presentation: 6/3/2024

Pharmacokinetic and pharmacodynamic evaluation of various vasopressin doses and routes of administration in a neonatal piglet model

Epinephrine is the only recommended vasopressor during neonatal cardiopulmonary resuscitation. However, there are concerns about the potential adverse effects of epinephrine, which might hamper efficacy during cardiopulmonary resuscitation. An alternative might be vasopressin, which has a preferable adverse effect profile, however, its optimal dose and route of administration is unknown. We aimed to compare the pharmacodynamics and pharmacokinetics of various vasopressin doses administered via intravenous (IV), intraosseous (IO), endotracheal (ETT), and intranasal (IN) routes in healthy neonatal piglets. Forty-four post-transitional piglets (1–3 days of age) were anesthetized, intubated via a tracheostomy, and randomized to receive vasopressin via intravenous (control), IO, ETT, or IN route. Heart rate (HR), arterial blood pressure, carotid blood flow, and cardiac function (e.g., stroke volume, ejection fraction) were continuously recorded throughout the experiment. Blood was collected prior to drug administration and throughout the observation period for pharmacodynamics and pharmacokinetic analysis. Significant changes in hemodynamic parameters were observed following IO administration of vasopressin while pharmacokinetic parameters were not different between IV and IO vasopressin. Administration of vasopressin via ETT or IN did not change hemodynamic parameters and had significantly lower maximum plasma concentrations and systemic absorption compared to piglets administered IV vasopressin (p < 0.05). The IV and IO routes appear the most effective for vasopressin administration in neonatal piglets, while the ETT and IN routes appear unsuitable for vasopressin administration.

Respiratory complications of propofol, sevoflurane, and dexmedetomidine anesthesia for fiberoptic bronchoscopy in children aged 1 month to 3 years: a randomized trial

To evaluate the effect of propofol, sevoflurane, and dexmedetomidine on respiratory complications in children undergoing fiberoptic bronchoscopy (FOB). This double-blind randomized clinical trial was conducted among 120 children aged 1 month to 3 years undergoing FOB. The patients were randomized into 3 groups (n=40) for anesthesia induction with sevoflurane inhalation, 1 mg/kg propofol, or 1 μg/kg dexmedetomidine before bronchoscopy, and the changes in hemodynamic parameters, sedation level, and respiratory complications during and after the procedure were assessed. The patients' heart rate during bronchoscopy was significantly lower and the mean arterial blood pressure significantly higher in dexmedetomidine group than in sevoflurane and propofol groups (P < 0.05). Cough during bronchoscopy did not occur in any of the cases in propofol group, while the highest frequency of cough was recorded in dexmedetomidine group. The incidence of laryngospasm in the propofol group (12.5%) was significantly lower than those in sevoflurane and dexmedetomidine groups (30% and 32.5%, respectively) (P < 0.05). Sevoflurane and propofol are safe and suitable for anesthesia induction in children below 3 years of age undergoing diagnostic FOB and can achieve better sedative effect and lower the incidences of cough and respiratory complications as compared with dexmedetomidine.

Using an in-office passive leg raise to identify older adults with suboptimal blood pressure control.

Passive leg raise (PLR) is a simple, dynamic maneuver that has been used to increase preload to the heart. We hypothesize that PLR may offer a new and efficient office-based tool for assessing blood pressure (BP) control in older adults. One hundred and three veterans (≥60 years old) without known cardiovascular disease and varying degrees of blood pressure control were included in this cross-sectional cohort study. Twenty-four hour ambulatory BP monitoring identified Veterans with optimal and suboptimal BP control (≥125/75 mmHg). Bioimpedance electrodes (Baxter Medical, Deerfield, Illinois, USA) and brachial BP were used to calculate hemodynamic parameter changes across PLR states [pre-PLR, active PLR (3 min), and post-PLR]. Multiple linear regression was used to assess associations between BP control status with changes in hemodynamic parameters between PLR states. The 24-h ambulatory BP monitoring identified 43 (42%) older Veterans with optimal BP control (mean age of 70.5 ± 7.0 years) and 55 (54%) with suboptimal BP (mean age of 71.3 ± 8.7 years). Veterans with suboptimal BP control had significantly reduced change in total peripheral resistance (ΔTPR) (7.0 ± 156.0 vs. 127.3 ± 145.6 dynes s/cm 5 ; P = 0.002) following PLR compared with Veterans with optimal BP control. Suboptimal BP control ( β = -0.35, P = 0.004) had a significant association with reduced ΔTPR, even after adjusting for demographic variables. Measuring PLR-induced hemodynamic changes in the office setting may represent an alternative way to identify older adults with suboptimal BP control when 24-h ambulatory BP monitoring is not available.

Clinical Effect of Norepinephrine Combined with Esmolol Treatment in Patients with Septic Shock and Its Impact on Prognosis.

To unveil the influence of norepinephrine (NE) combined with esmolol treatment on cardiac function, hemodynamics, inflammatory factor levels, and prognosis in patients with septic shock. Ninety-six patients with septic shock admitted to our hospital from January 2021 to June 2023 were retrospectively analyzed and divided into the control and observation groups according to the different treatment methods. The control group was treated with standard anti-infection and fluid resuscitation, followed by NE administration [with an infusion rate of 0.1-0.5 μg/(kg-min)]. The observation group was treated with esmolol [starting pumping rate of 50 μg/(kg-min) and adjusting the pumping rate according to the target heart rate] in combination with the control group. Changes in hemodynamic parameters, including heart rate, mean arterial pressure, central venous pressure, cardiac index, stroke volume index, and systemic vascular resistance index, were monitored by pulse-indicating continuous cardiac output monitors before treatment (T0), 24h after treatment (T1), and 72h after treatment (T2); changes in cardiac function before and after 72h of treatment, indicators of inflammatory factors before and after treatment, and indicators of oxygenation metabolism were assessed; and adverse drug reactions during treatment were recorded in both groups. NE combined with esmolol treatment improved the efficacy of patients with septic shock; was beneficial for the enhancement of blood perfusion in patients; improved the patient's cardiac function, reduced myocardial injury, and suppressed the inflammatory response in patients; improved the oxygenation metabolism and the prognosis of patients; did not significantly increase the adverse drug reactions of patients and had a better safety profile. NE combined with esmolol treatment can improve the efficacy of patients with septic shock, improve their cardiac function and hemodynamic indices, reduce myocardial injury and inflammatory response, and have a better safety profile, which is conducive to improving patient prognosis and reducing mortality.

Changes in perfusion and permeability in glioblastoma model induced by the anti-angiogenic agents cediranib and thalidomide.

The poor delivery of drugs to infiltrating tumor cells contributes to therapeutic failure in glioblastoma. During the early phase of an anti-angiogenic treatment, a remodeling of the tumor vasculature could occur, leading to a more functional vessel network that could enhance drug delivery. However, the restructuration of blood vessels could increase the proportion of normal endothelial cells that could be a barrier for the free diffusion of drugs. The net balance, in favor or not, of a better delivery of compounds during the course of an antiangiogenic treatment remains to be established. This study explored whether cediranib and thalidomide could modulate perfusion and vessel permeability in the brain U87 tumor mouse model. The dynamic evolution of the diffusion of agents outside the tumor core using the fluorescent dye Evans Blue in histology and Gd-DOTA using dynamic contrast-enhanced (DCE)-MRI. CD31 labelling of endothelial cells was used to measure the vascular density. Cediranib and thalidomide effectively reduced tumor size over time. The accessibility of Evans Blue outside the tumor core continuously decreased over time. The vascular density was significantly decreased after treatment while the proportion of normal vessels remained unchanged over time. In contrast to histological studies, DCE-MRI did not tackle any significant change in hemodynamic parameters, in the core or margins of the tumor, whatever the parameter used or the pharmacokinetic model used. While cediranib and thalidomide were effective in decreasing the tumor size, they were ineffective in transiently increasing the delivery of agents in the core and the margins of the tumor.

A comparative study of head-elevated positions at 25° versus 45° for intubation in obese patients posted for elective surgery under general anesthesia

Background: Obese patients generally present with an increased risk of difficult intubation. The head-elevated position has been shown to improve laryngeal view, reduce airway complications, and prolong safe apnea time during intubation as compared to the sniffing position. Aims and Objectives: The aim of this study is to compare the head-elevated positions at 25° versus 45° for intubation in obese patients, in terms of ease of intubation assessed by first-attempt intubation success rate and laryngeal exposure using Cormack–Lehane grading and to assess intubation time, use of intubation aides, changes in hemodynamic parameters, and hypoxia. Materials and Methods: In this randomized controlled trial, 100 consenting patients undergoing elective surgery requiring general anesthesia were selected who fulfilled the eligibility criteria and assigned to either of the two groups by block randomization: Group A – 25° or Group B – 45° head-elevated positions for intubation in a tertiary care hospital (February 2021–July 2022). Results: The 45° head-elevated position was found to provide a better laryngeal exposure, the mean time to intubate was lesser and the first attempt success rate was also higher. Further, 45° head-elevated position is better chosen as per anesthesiologist comfort, using Likert scale grading. Conclusion: This study concluded that 45° head-elevated position provides better ease of intubation in obese patients as compared to 25° head-elevation.

Comparison of intraoperative hemodynamics in classical and single-port adrenalectomy

BACKGROUND: Pheochromocytoma (PCC) is a tumor from the chromaffin tissue of the adrenal medulla, capable of hyperproduction of catecholamines. An important feature of pheochromocytoma, due to its hormonal activity, is the threat of sudden changes in hemodynamic parameters during surgical treatment. Retroperitoneoscopic access is currently becoming increasingly popular in the surgical treatment of chromaffin tumors of the adrenal glands. In clinical practice, two variants of the mentioned access are used: classic (three-port) and single-port. In this study, the influence of these options of retroperitoneoscopic access on intraoperative hemodynamic control was evaluated.AIM: Comparison of treatment results and intraoperative hemodynamic parameters of patients with adrenal pheochromocytomas operated with single-port and three-port retroperitonescopic access options.MATERIALS AND METHODS: A retrospective single-center cohort study was conducted on a sample of patients initially operated for pheochromocytoma at the Pirogov St. Petersburg State University High Medical Technology Clinic from October 2015 to February 2020 with intraoperative invasive hemodynamic control using PiCCO+ systems.RESULTS: 47 patients were examined, 24 of whom underwent single–port adrenalectomy (included in the first group), 23 — three-port (second group). The average tumor size in the second group was larger (40.12±9.3 and 56.7±21.5, p&lt;0.05), presumably, in this regard, the average duration of surgery was statistically significantly higher (73±21.5 and 111.7±36.1, p&lt;0.05). The body mass index (BMI) of patients in the two groups did not differ statistically significantly. Intraoperatively measured values of maximum and minimum mean systolic and diastolic blood pressure, the number of episodes of increased diastolic blood pressure above 120 mmHg and their duration did not differ statistically in both groups (p&gt;0.05). Episodes of increased systolic blood pressure above 180 mm Hg were more frequent in the second group (p=0.03), but their total duration in the two groups was without significant differences (p&gt;0.05). Intraoperative consumption of antihypertensive drugs during the release of the adrenal gland and vasopressor drugs after compression of the central vein of the adrenal gland were similar. Blood pressure after compression of the central vein in the first and second groups did not differ significantly (p&gt;0.05). No deaths and postoperative complications were registered in both groups.CONCLUSION: Single-port modification of retroperitoneoscopic access with sufficient experience of the anesthesiological team and the operating surgeon does not lead to deterioration of hemodynamic control and operation results, being safe and effective in the surgical treatment of pheochromocytoma.

Type 2 diabetes increase the risk of arteriovenous fistula non-maturation, mediated by postoperative vascular hemodynamics.

The progression of atherosclerosis in small and medium-sized vessels has been associated with Type 2 diabetes (T2D). However, the influence of T2D on postoperative vascular remodeling and arteriovenous fistula (AVF) maturation is inconclusive. Besides, hemodynamic changes of postoperative vessel are also associated with AVF maturation. This study is intended to investigate the link between T2D and the occurrence of AVF non-maturation, as well as to delve into the impact of postoperative vascular hemodynamic parameters in this process. A total of 477 hemodialysis patients, with or without type 2 diabetes, underwent AVF creation at Beijing Haidian Hospital (Haidian Section of Pecking University Third Hospital) from August 2018 to March 2022 were collected, and were followed for 1-5years. Logistic regression was applied to analyze the association of T2D, postoperative vascular hemodynamic parameters with the risk of AVF non-maturation. To verify the stability of the results, the sensitivity analyses were performed using propensity scores to match patients. We further investigated the regulatory role of the postoperative vascular hemodynamics. There were 173 patients with T2D and 304 patients without T2D in this study. The maturation rate in T2D and non-T2D group was 47.977% and 63.816%, respectively. The findings of logistic regression analysis suggested that T2D significantly increased the risk of AVF immaturity [OR 1.716 (1.019-2.890), P = 0.042]. Besides, T2D was associated with the restriction of postoperative vascular hemodynamic parameters changes, including with decreased diameter of forearm cephalic radial artery and dilation rate of radial artery. The result of logistic regression analysis indicated that cephalic vein diameter at 1-month [0.402 (0.237-0.681), P = 0.001] and cephalic vein diameter at 2-month [0.501 (0.355-0.708), P < 0.001] were independently correlated with AVF maturation. Besides, the results of sensitivity analysis were consistent with that of logistic regression analysis. Moreover, the mediating effects of cephalic vein diameter were significant. Our findings discovered that T2D significantly increased the risk of arteriovenous fistula non-maturation, which was mainly mediated by the changes of cephalic vein diameter.

A recommendation for the use of electrical biosensing technology in neonatology.

Non-invasive cardiac output monitoring, via electrical biosensing technology (EBT), provides continuous, multi-parameter hemodynamic variable monitoring which may allow for timely identification of hemodynamic instability in some neonates, providing an opportunity for early intervention that may improve neonatal outcomes. EBT encompasses thoracic (TEBT) and whole body (WBEBT) methods. Despite the lack of relative accuracy of these technologies, as compared to transthoracic echocardiography, the use of these technologies in neonatology, both in the research and clinical arena, have increased dramatically over the last 30 years. The European Society of Pediatric Research Special Interest Group in Non-Invasive Cardiac Output Monitoring, a group of experienced neonatologists in the field of EBT, deemed it appropriate to provide recommendations for the use of TEBT and WBEBT in the field of neonatology. Although TEBT is not an accurate determinant of cardiac output or stroke volume, it may be useful for monitoring longitudinal changes of hemodynamic parameters. Few recommendations can be made for the use of TEBT in common neonatal clinical conditions. It is recommended not to use WBEBT to monitor cardiac output. The differences in technologies, study methodologies and data reporting should be addressed in ongoing research prior to introducing EBT into routine practice. IMPACT STATEMENT: TEBT is not recommended as an accurate determinant of cardiac output (CO) (or stroke volume (SV)). TEBT may be useful for monitoring longitudinal changes from baseline of hemodynamic parameters on an individual patient basis. TEBT-derived thoracic fluid content (TFC) longitudinal changes from baseline may be useful in monitoring progress in respiratory disorders and circulatory conditions affecting intrathoracic fluid volume. Currently there is insufficient evidence to make any recommendations regarding the use of WBEBT for CO monitoring in neonates. Further research is required in all areas prior to the implementation of these monitors into routine clinical practice.

ВЛИЯНИЕ ПРОЦЕССА ЖЕВАНИЯ НА ГЕМОДИНАМИЧЕСКИЕ ПОКАЗАТЕЛИ

Chewing has been shown to have a significant effect on systemic circulation, with circulatory responses appearing to be largely regulated by autonomic nervous activity through a more complex regulatory system than responses to other activities. However, the results of studies on the relationship between masticatory movements and changes in autonomic nervous activity and systemic circulation are still rare and contradictory. We examined changes in systemic circulation during gum chewing. Blood pressure, heart rate, and chewing electromyograms were recorded during continuous gum chewing as indicators of systemic circulation in 27 healthy subjects with normal occlusion. Nonparametric matched-sample analyzes were performed to determine the chronological changes in each variable during gum chewing, and nonparametric Spearman correlations were calculated to assess the relationship between changes in hemodynamic parameters and masticatory muscle activity. Chewing gum increased heart rate and blood pressure, indicating significant changes in sympathetic activity and vagal tone. We have identified a pronounced, statistically significant strong correlation between changes in heart rate and the magnitude of contractions of the masticatory muscles. These results suggest that changes in the activity of parts of the autonomic nervous system may be due to the trigeminal nerve reflex, which explains some of the features of the autonomic nervous regulation of chewing movements.