Hemodynamics In Adults Research Articles

A controlled, double blind, study of adding Nalbuphine to Propofol for laryngeal mask insertion conditions and hemodynamics in adults

PurposeThe purpose of this study was to evaluate laryngeal mask airway placement conditions achieved with Nalbuphine/Propofol combination when given intravenously as well as hemodynamic changes if any.Methods60 ASA grade 1 and 11 patients of age group 20–60 years, scheduled for general anesthesia with spontaneous breathing were randomly allocated to receive intravenously either Fentanyl 2 μg/kg, controlled group (Group F, n = 30) or Nalbuphine 0.2 mg/kg (Group N, n = 30), before induction of anesthesia with Propofol 2–2.5 mg/kg. Heart rate and arterial blood pressure were measured before induction of anesthesia and at 1, 3, and 5 min after LMA insertion. Assessment of LMA insertion was done using 6 variables: mouth opening, gagging, swallowing, head and limb movements, laryngospasm and resistance to insertion. Incidence and duration of apnea were recorded.ResultsThe incidence of coughing/gagging was higher in the F group (50%) compared to the N group (30%), (P = 0.019). Swallowing was also statistically significant (P = 0.017), being higher in F group (50%), compared to N group (16.6%). Limb moving followed the same pattern being higher in the F group (40%) compared to (13.3%) in the N group, (P = 0.008). Laryngospasm was seen in neither group. There was also statistically significant difference (P = 0.007) in the incidence of apnea between the control group (F) 86.6% and (N) group. Heart rate variation and MAP changes were not statistically significant in either F or N groups.ConclusionThe addition of Nalbuphine to Propofol for LMA insertion provides excellent insertion conditions with stable hemodynamics in adults.

Arterial haemodynamics and coronary artery calcification in adult patients with juvenile idiopathic arthritis

ObjectiveTo compare arterial haemodynamics in adults with long-term juvenile idiopathic arthritis (JIA) to that of healthy controls, and explore the influence of traditional cardiovascular risk factors and disease characteristics on...

Abstract P064: Effects Of Pistachios On Blood Pressure And Systemic Hemodynamics In Type 2 Diabetes

Controlling blood pressure in diabetes is important for reducing cardiovascular morbidity and mortality. This study compared the effects of two healthy diets that differed in fat content on blood pressure and hemodynamics. We enrolled 30 adults with type 2 diabetes in a randomized, crossover, controlled-feeding study with isocaloric diet periods. After a 2wk run-in on a typical Western diet (36% total fat, 12% saturated fat), participants consumed a low-fat control diet (27% total fat, 7% saturated fat) and a moderate fat pistachio diet (33% total fat, 7% saturated fat) for 4wk each. While on the pistachio diet, participants consumed pistachios equivalent to 20% of daily calories (ranging from 2-5 ounces/day). At the end of each diet period, blood pressure and systemic hemodynamics were assessed at rest and during acute psychological stress (mental arithmetic and hand cold pressor). A subset of participants (n=20) also underwent 24hr ambulatory blood pressure monitoring. Treatment effects were assessed with the mixed models procedure in SAS v9.3. There was no difference between treatments in resting blood pressure or systemic hemodynamics. During acute stress, stroke volume and cardiac output were significantly lower following the control diet (66.4 ml/beat and 4.43 l/min) than the pistachio diet (68.4 ml/beat and 4.57 l/min). Total peripheral resistance was significantly lower following the pistachio diet than the control diet (1682 vs 1746 dyne-sec/cm5). Systolic blood pressure during the 24hr ambulatory monitoring was significantly lower following the pistachio diet than the control diet (113.8 vs 117.3 mmHg). Taken together with other recent studies, these results provide evidence that daily pistachio consumption can benefit blood pressure and systemic hemodynamics in adults with type 2 diabetes.

Оценка конструктивного стеноза механических клапанов сердца у взрослых в аортальной позиции: преимущество полнопроточного протеза клапана сердца

The analysis of transprosthetic hemodynamics in adults after aortic valve replacement in the Bakoulev Center for Cardiovascular Surgery in 2007-2010 demonstrated the hemodynamic advantage of the concept of new full-flow mechanical aortic valve prosthesis "CorBeat". Having the same size of internal orifice and tissue annulus diameters, the values of transprosthetic parameters (peak and mean gradients, blood flow velocities) through "CorBeat" were close to physiological values of transvalvular native aortic parameters and had a tendency to be not dependent on the size of prosthesis (p = 0.63). In the article for the first time a morphometric database of geometric values of internal orifice area of normal native aortic valves in adults was used taking into account both the gender and the body surface area's of a patient. There was also used the standardized prosthesis size Z-score which represents the number of SDs by which the internal prosthesis area differs from the mean normal native aortic valve area for the patient's body surface area. The article emphasizes the need of the personal selection of the size and the type of prosthesis for any patient as well as the need for new design development of prosthetic heart valves.

Effect of Serotonin Reuptake Inhibitors on Pulmonary Hemodynamics in Humans

BackgroundSerotonin promotes pulmonary arterial vasoconstriction and pulmonary arterial smooth muscle cell proliferation, thereby having the potential to increase pulmonary arterial blood pressure. Although serotonin reuptake inhibitors (SRIs) might inhibit further deterioration in patients with manifest pulmonary arterial hypertension, they may induce pulmonary hypertension in healthy newborns after fetal exposure. As it is unclear whether treatment with SRIs affects pulmonary hemodynamics in adults without pulmonary hypertension, the aim of the present study was to investigate the effect of SRIs on pulmonary hemodynamics in such subjects.MethodsSixteen patients with stable angina pectoris scheduled for first time coronary artery bypass grafting were included in the study. Of these 8 were currently treated with an SRI (the SRI group) and 8 were not (the control group). Pulmonary arterial pressures were measured before induction of anesthesia by means of a pulmonary artery catheter. Serotonin transporter and 5-HT2A receptor gene polymorphisms and platelet 5-HT2A receptor expression were studied to elucidate their possible role as modifying factors.ResultsNo patients in any of the groups had pulmonary arterial hypertension. Mean pulmonary artery pressure was 15.0 mmHg in the SRI group and 14.5 mmHg in the control group (P = 0.50; 95% confidence interval for the difference, -2.9 to +3.9 mmHg). Neither were there any significant differences between the groups for any of the other hemodynamic variables studied. The various gene polymorphisms and the extent of platelet 5-HT2A receptor expression did not influence the hemodynamic variables.ConclusionsSRI treatment did not significantly influence pulmonary hemodynamics in patients without pulmonary hypertension.KeywordsSerotonin; Selective serotonin reuptake inhibitors; Pulmonary hemodynamics; Pulmonary hypertension

P97 Do intravenous antibiotics influence arterial stiffness in adults with cystic fibrosis?

Introduction and objectivesAdults with cystic fibrosis (CF) have evidence of increased arterial stiffness which is associated with a chronic systemic inflammatory status (1). We hypothesised that an intervention which decreased...

Safety and efficacy of autologous endothelial progenitor cells transplantation in children with idiopathic pulmonary arterial hypertension: Open‐label pilot study

Experimental data suggest that transplantation of EPCs attenuates monocrotaline-induced pulmonary hypertension in rats and dogs. In addition, our previous studies suggested that autologous EPC transplantation was feasible, safe, and might have beneficial effects on exercise capacity and pulmonary hemodynamics in adults with IPAH. Thus, we hypothesized that transplantation of EPCs would improve exercise capacity and pulmonary hemodynamics in children with IPAH. Thirteen children with IPAH received intravenous infusion of autologous EPCs. The right-sided heart catheterization and 6-MWD test were performed at baseline and at the time of 12 wk after cell infusion. At the time of 12 wk, mPAP decreased by 6.4 mmHg from 70.3 +/- 19.0 to 63.9 +/- 19.3 mmHg (p = 0.015). PVR decreased by approximately 19% from 1118 +/- 537 to 906 +/- 377 dyn s/cm(5) (p = 0.047). CO increased from 3.39 +/- 0.79 to 3.85 +/- 0.42 L/min (p = 0.048). The 6-MWD increased by 39 m from 359 +/- 82 to 399 +/- 74 m (p = 0.012). NYHA functional class also improved. There were no severe adverse events with cell infusion. The small pilot study suggested that intravenous infusion of autologous EPCs was feasible, safe, and associated with significant improvements in exercise capacity, NYHA functional class, and pulmonary hemodynamics in children with IPAH. Confirmation of these results in a randomized controlled trial are essential.

Use of levosimendan, a new inodilator, for postoperative myocardial stunning in a premature neonate

To first report the successful use of the new inodilator levosimendan in a premature infant with congestive heart failure (CHF) following cardiac surgery. Although the calcium sensitizer levosimendan improves hemodynamics in adults with CHF, no data are available on the use of levosimendan in premature infants with CHF. Single case report. Twenty-bed postoperative adult and pediatric cardiac intensive care unit. A 32 wks gestational age, 1525-g premature male twin with transposition of the great arteries. The patient underwent arterial switch operation. Immediately after operation, the patient developed signs of low cardiac output syndrome. Mixed venous saturation was 56%, serum lactate increased to 14.8 mmol/L, systolic arterial pressure was 40 mm Hg, left atrial pressure was 24 mm Hg, and echocardiography showed reduced left ventricular function with a fractional shortening of 10%. There were no signs of reduced coronary perfusion. Milrinone, dobutamine, and epinephrine did not improve hemodynamics. Levosimendan was initiated at a dose of 0.05 mug.kg.min, increased to 0.1 mug.kg.min, and continuously infused for 24 hrs. Within 6 hrs after starting the levosimendan infusion, left atrial pressure decreased to 7 mm Hg and systolic arterial pressure increased to 60 mm Hg; within 24 hrs after initiation serum lactate level normalized to 1.7 mmol/L and mixed venous saturation increased to 81%. Echocardiography revealed improvement of left ventricular function with a fractional shortening of 25%. No side effects were recognized during administration of levosimendan. In this premature neonate with postoperative low cardiac output syndrome due to failing myocardial function, levosimendan was a potent inotropic agent.

Comparison of the Effects of Tai Chi Chuan and Wai Tan Kung Exercises on Autonomic Nervous System Modulation and on Hemodynamics in Elder Adults

The health of the middle-aged and elderly people is a major concern given the rapid aging population and rising costs of medical care. Low-impact exercise on a regular basis is ideal for maintaining the well-being of an aging population. Tai Chi Chuan (TCC) is the most well-known and most widely practiced form of low-impact martial arts therapy and has been shown to have positive health effects. A lesser-known form of martial arts therapy is Wai Tan Kung (WTK), which our previous study found to have positive health effects as well. The present study compares the effects of TCC and WTK on autonomic nervous system modulation and on hemodynamics in adults among non-exercising control (30), TCC practitioners (30) and WTK practitioners (30). Our study found that in a short-term, WTK and TCC exercises enhanced the vagal modulation, lowered the sympathetic modulation and lowered arterial blood pressures in the practitioners. It was also observed that the forced vital capacity of TCC practitioners was significantly higher than that of WTK practitioners before exercise. There were no significant differences in the percentage changes in HRV measures and hemodynamics between WTK and TCC practitioners 30 and 60 min after exercise, indicating that the effects of WTK and TCC were similar in magnitude. In conclusion, TCC and WTK are comparable to each other in terms of their effects on autonomic nervous system modulation and hemodynamics, thus suggesting that WTK can be just as beneficial as TCC as a form of low-impact exercise for elderly adults.

Atrial septal defect in adults: echocardiography and cardiopulmonary exercise capacity associated with hemodynamics before and after surgical closure

The study aimed to evaluate pre and postoperative echocardiographic data and exercise capacity in relation to age and hemodynamics in adults with atrial septal defect (ASD). Fifty-two subjects with ASD (mean age: 38.6+/-15 years) were enrolled. Echocardiography and cardiopulmonary exercise test were performed before and a year after surgery. Pre and postoperative data were analyzed for the entire group and then compared in terms of age: <40 and >or=40 years, right ventricular systolic pressure (RVSP): <or=30 and >30 mmHg and pulmonary to systemic flow ratio (Qp/Qs): <2.5 and >or=2.5. After surgery right ventricle dimension decreased in all patients, although it remained significantly larger in patients over 40 years. There was a negative correlation between peak oxygen uptake and preoperative RVSP (r=-0.69, P<0.001). Exercise capacity improved irrespective of the age at surgery, preoperative RVSP and Qp/Qs, although it failed to normalize in patients with RVSP >30 mmHg. Adults with ASD benefit from surgical closure irrespective of the actual age at surgery. Patient's age at surgery and pulmonary hypertension crucially impact the results of surgical intervention. Early defect correction is therefore highly recommendable, specifically with a view to preventing the hemodynamic consequences of ASD.

Haemodynamic responses to salbutamol and isometric exercise are altered in young adults with mild asthma

Tolerance to the haemodynamic effects of regularly inhaled beta(2) agonists has been reported in a research setting. It is unclear whether cardiovascular responses in adults with asthma are influenced by their use in routine clinical practice. This study aimed to characterise the effects of acute salbutamol administration on systemic haemodynamics in adults with mild asthma who were receiving intermittent beta(2) agonist treatment. Ten patients with mild asthma and ten healthy age and sex-matched controls were recruited to a randomised placebo-controlled double-blind two-way crossover study. Each received salbutamol 200 mug or placebo, then performed sustained isometric handgrip exercise as an adrenergic cardiovascular stimulus. Heart rate and blood pressure responses were observed during rest and exercise, and cardiac index and systemic vascular resistance index were measured using non-invasive impedance cardiography. Isometric exercise caused a greater increase in heart rate (12+/-3 vs. 8+/-3 bpm, P<0.01) and diastolic blood pressure (19+/-3 vs. 12+/-3 mmHg, P<0.01) in patients with asthma compared with healthy controls. Salbutamol administration significantly increased heart rate, blood pressure and cardiac index in healthy controls, but these responses were attenuated in patients with asthma. These findings indicate that adults with asthma, who are receiving intermittent beta(2) agonist treatment, have a greater cardiovascular responses to sympathetic stimulation, and haemodynamic tolerance to acute salbutamol administration.

Exercise Doppler echocardiography identifies abnormal hemodynamics in adults with congenital heart disease

The hemodynamic factors contributing to reduced exercise capacity in adults with congenital heart disease are not fully defined. We hypothesized that they would demonstrate reduced exercise capacity compared with age-matched control subjects because of abnormal exercise hemodynamics and ventricular performance demonstrable by echocardiography. We retrospectively analyzed the results of all studies in all patients with congenital heart disease (from 1988 to 1993) and found that the peak work load and double product achieved were decreased in comparison with normal values (79 ± 47 W vs 149 ± 52 W [ p < 0.0001] and 19,210 ± 6805 vs 25,701 ± 6440 [ p = 0.005], respectively). Seven patients achieved work loads <40 W associated with an exaggerated exercise pulmonary artery pressure response, decreases in right and/or left ventricular function with exercise, or both. Normal or near-normal exercise tolerance was observed in the following patient groups: (1) repaired tetralogy of Fallot, (2) uncomplicated l-transposition of the great arteries, and (3) Ebstein's anomaly with atrial septal defect. We conclude that exercise echocardiography provides new hemodynamic information for evaluating functional limitations in congenital heart disease.

Relationship between clinical evaluation of peripheral perfusion and global hemodynamics in adults after cardiac surgery

The relationship between clinical indicators of peripheral perfusion and global hemodynamics after cardiac surgery was examined in 40 adults. We found no significant relationship between capillary refill, pedal pulses, or extremity (toe or finger) core temperature gradients and cardiac index (CI) or systemic vascular resistance index immediately after surgery on the day of operation. However, on the first postoperative day we did observe a crude (r = -.60) correlation between CI and toe-core temperature gradient.

Acute hemodynamic effects of converting enzyme inhibition in infants with congestive heart failure

ville Medical therapy for congestive heart failure has traditionally included the use of digitalis glycosides and diuretics. Most investigators believe that left ventricular contractility is not impaired in infants with large left-to-right shunts, and therefore treatment with inotropic agents alone may not significantly improve symptoms, l, 4 Vasodilator therapy is often used in the treatment of congestive heart failure in adults but may adversely affect hemodynamics in infants with large left-to-right shunts. 5 Blockade of the reninangiotensin-aldosterone axis has been shown to improve hemodynamics in adults with congestive heart failure. 6-9 Recent studies of children have suggested a beneficial effect of angiotensin II blockade in children with heart failure caused by left:to-right shunts. 1~ I I In this study, we sought to investigate the acute hemodynamic effects of blockade of therenin-angiotensin system, using a single intravenous dose of the converting enzyme inhibitor enalaprilat in infants with congestive heart failure caused by large left-to-right shunts. METHODS The study group consisted of 11 patients, 1 to 13 months of age, with congestive heart failure secondary to leftto-right shunt lesions. Congestive heart failure was manifested clinically by tachypnea, tachycardia, hepatomegaly, and growth failure on physical examination, and by cardiomegaly and increased vascularity on a chest radiograph. Four patients with Down syndrome were included in the study. All patients had been treated with digoxin or diuretics or both, although medications were withheld for 12 hours before cardiac catheterization. This study was approved by the human investigation committee, and informed consent for participation in this study was obtained from the subjects' parents.

Congenital intracardiac shunting in the adult: outline for nursing care

Adults with an untreated intracardiac shunt present a unique challenge to the critical care nurse. The disease process necessitates an understanding of cardiac anatomy and physiology in order to determine the etiology of the cardiac defect and resulting shunt. An understanding of fluid and pressure dynamics is also of importance since anatomic shunting alters usual adult hemodynamics. Arterial and mixed venous oximetry monitoring is most helpful in determining the response to therapies. One must rethink some of the hemodynamic goals that are traditionally used in caring for adults with primary left ventricular dysfunction. Therapeutic response is usually limited to a narrow hemodynamic range. Many of these patients have superimposed health problems such as atherosclerosis, hypertension, and cigarette smoking. Therefore, the critical care nurse is confronted with caring for a patient with unique problems that test creativity and assessment skills.