Hemodynamic Profile Research Articles

Impact of nitroglycerin-induced vasodilation on stroke volume and diuretic response in acute heart failure: A protocol for a mechanistic trial.

Acute heart failure is a clinical syndrome characterized by cardiac dysfunction and neurohumoral activation, encompassing complex underlying pathophysiology which may vary across phenotypes. Nitroglycerine is a nitrate donor with vasodilatory effects on both venous capacitance vessels and arterial resistance vessels in higher doses, typically used with the aim of reducing congestion, preload, and afterload. A limited number of studies have proposed that nitroglycerin could promote diuresis and natriuresis. However, the exact hemodynamic effects of nitroglycerin remain uncertain in the clinical setting of acute decompensated heart failure. We hypothesize that intravenous nitroglycerin induces a significant increase in stroke volume and urinary output while lowering cardiac filling pressures. This will be a prospective single-center interventional clinical study of 21 patients hospitalized with a diagnosis of AHF. Patients are examined before and after administration of intravenous nitroglycerin. To characterize hemodynamic phenotypes of AHF, continuous estimates of stroke volume will be obtained, and total blood volume estimated. Vital signs and estimates of peripheral perfusion will be recorded continuously. Measures of cardiac function, renal function, volume status, and autonomic function will be assessed sequentially. This study will assess the acute effects of vasodilation on stroke volume and urinary output in hospitalized patients with AHF. Furthermore, characterizing the hemodynamic profile of the patient prior to vasodilation may help explore which patients will benefit from vasodilation.

Evaluating the efficacy of carbetocin versus oxytocin for preventing intraoperative blood loss, early postpartum hemorrhage, and maintaining a favorable hemodynamic profile in lower segment cesarean section: A prospective observational study

Background: Postpartum hemorrhage (PPH) remains a significant concern in obstetric practice, contributing substantially to maternal morbidity and mortality worldwide. Uterine atony, characterized by inadequate uterine muscle tone, constitutes approximately 70% of PPH cases. The initial step in medical management involves the use of uterotonic agents such as oxytocin, ergot alkaloids, and prostaglandins. However, their use is compounded by the accompanying side effects, hence the need for uterotonic agents with relatively better pharmacokinetic and pharmacodynamic profile continues. Carbetocin may require less additional uterotonic administration to manage blood loss compared to oxytocin alone. Carbetocin has a significantly longer half-life than oxytocin, potentially leading to more sustained uterine contractions and reduced blood loss. Aims and Objectives: The aim of this study was to compare the efficacy of carbetocin versus oxytocin in preventing intraoperative blood loss and their individual impact on hemodynamics. Materials and Methods: A total of 360 patients were enrolled for the study, sample size was calculated using Cochran’s formula considering 95% confidence level, and 0.5 variability of proportions and a precision of 5%, with 180 patients in each group, using simple randomization technique, the patients in either group received their assigned drugs during lower segment cesarean section (LSCS). Both the groups were assessed in terms of hemodynamic profile, intraoperative blood loss, need for additional uterotonic agents, and blood transfusion. Results: On comparing the data between carbetocin group and oxytocin group, the carbetocin group had less incidence of hypotension and tachycardia (P<0.001), less intraoperative blood loss (Group C: Group O, mean±SD mL; 328.7±72.59:435.9±99.08 [P<0.001]), and minimal use of additional uterotonic agents (P<0.001); however, the requirement of blood transfusion was comparable between the two groups (P=0.157). Conclusions: Carbetocin is an effective alternative to conventionally used oxytocin in LSCS.

FLUID OVERLOAD MODIFIES HEMODYNAMIC IMPACT OF CONTINUOUS RENAL REPLACEMENT THERAPY: EVIDENCE OF A COVERT CARDIORENAL SYNDROME?

Background: Fluid overload (FO) in critically ill children correlates with higher morbidity and mortality rates. Continuous renal replacement therapy (CRRT) is commonly employed to manage FO. In adults, both FO and CRRT adversely affect myocardial function. It remains unclear if children experience similar cardiovascular effects. Methods: Observational single-center study on children (<18 years) receiving CRRT at Texas Children's Hospital from 11/2019 to 3/2021. Excluded were those with end-stage renal disease, pacemakers, extracorporeal membrane oxygenation, ventricular assist devices, apheresis, or without an arterial line. Electrocardiometry (ICON Osypka Medical GmbH, Berlin, Germany) which is noninvasive and utilizes bioimpedance, was applied to obtain hemodynamic data over the first 48 h of CRRT. Our aim was to identify how FO >15% affects hemodynamics in children receiving CRRT. Results: Seventeen children, median age 43 months (interquartile range [IQR] 12-124), were included. The median FO at CRRT initiation was 14.4% (2.4%-25.6%), with 9 (53%) patients having FO >15%. Differences were noted in systemic vascular resistance index (1,277 [IQR 1088-1,666] vs. 1,030 [IQR 868-1,181] dynes/s/cm 5 /m 2 , P < 0.01), and cardiac index (3.90 [IQR 3.23-4.75] vs. 5.68 [IQR 4.65-6.32] L/min/m 2 , P < 0.01), with no differences in heart rate or mean arterial pressure between children with and without FO. Conclusion: FO affects the hemodynamic profile of children on CRRT, with those having FO >15% showing higher systemic vascular resistance index and lower cardiac index, despite heart rate and mean arterial pressure remaining unchanged. Our study illustrates the feasibility and utility of electrocardiometry in these patients, suggesting future research employ this technology to further explore the hemodynamic effects of dialysis in children.

Unfavorable systemic and coronary hemodynamic profile of left ventricular hypercontractile phenotype in hypertrophic cardiomyopathy

Abstract Background The left ventricular (LV) hypercontractile phenotype (HP) plays a critical role in hypertrophic cardiomyopathy (HCM) and is usually identified with the left ventricular outflow tract gradient (LVOTG). Purpose To assess the systemic and coronary hemodynamic profile associated with HP identified with increased LV elastance (also known as force) at rest in patients with HCM. Methods We enrolled 1248 HCM patients (age 50 ± 15 years, 798 males, 64%) with ejection fraction (EF) ≥50%, referred for rest transthoracic echocardiography (TTE) in 14 quality-controlled sites from 7 countries TTE assessment included LVOTG, EF, and LV force (systolic blood pressure + LVOTG/LV end-systolic volume, mmHg/mL). Volumetric echocardiography with Simpson’s method was used to measure EF from end-diastolic volume (EDV) and end-systolic volume (ESV), stroke volume (SV), arterial elastance (AE) and ventricular-arterial coupling (VAC). We also assessed resting peak diastolic coronary flow velocity (D-CFV) in the mid-distal left anterior descending artery in a subset of 275 patients. Results EF equaled 68 ± 7%, force = 6.8 ± 5.3 mmHg/ml and LVOTG = 22 ± 28 mmHg. HP was identified as the highest quartile of force (&amp;gt; 7.85 mmHg/ml, mean value= 13.3 ± 7.0). HP showed the lowest SV (46 ± 18 ml) and EDV (61 ± 20 ml), with the highest AE (3.19 ± 1.35 mmHg/ml) and VAC (3.46 ± 1.59) compared to other quartiles (p&amp;lt;0.001) ( see Picture) . D-CFV was not higher in patients with HP (n = 65) compared to those (n = 210) without HP (41± 11 vs 38 ± 14 cm/s, p=ns, but higher in comparison to joint first and second Force quartile (n=122) vs 37 ±14 p =0.0472). Table displays the demografic, clinical and TTE parameters related to HP (Table). In multivariate logistic analysis 4 independent predictors of HP were identified: SBP &amp;gt;130 mmHg with OR 2.5, female sex with OR 5.4, LV EF &amp;gt;70% with OR 6.1 and LVOTG &amp;gt;30 mmHg with the highest OR = 6.3. Conclusion: HCM patients with HP exhibit a distinctive systemic hemodynamic and coronary physiology profile, characterized by low SV, high VAC, and supranormal baseline D-CFV compared to non-HP patients. These findings suggest reduced cardiovascular efficiency and increased myocardial oxygen demand, possibly detrimental over time.

Vasopressor Use in Acute Spinal Cord Injury: Current Evidence and Clinical Implications

Acute spinal cord injury (SCI) often results in severe neurologic deficits, with hemodynamic instability contributing to secondary ischemic damage. Beyond surgical decompression, maintaining adequate mean arterial pressure (MAP) is key to enhancing spinal cord perfusion and oxygenation. Vasopressor therapy is frequently used to achieve hemodynamic stability, but optimal MAP targets and vasopressor selection remain controversial. This review explores updated guidelines and current evidence regarding MAP management and the use of vasopressors in SCI, focusing on their impact on spinal cord perfusion and neurologic outcomes. Recent studies highlight the role of durotomy in directly improving spinal cord perfusion pressure (SCPP) by reducing intraspinal pressure (ISP), offering a complementary mechanical intervention as part of pharmacologic therapies. Recent guidelines suggest an MAP range of 75–80 mmHg as a lower limit and 90–95 mmHg as an upper limit for 3–7 days post-injury, highlighting the need for personalized hemodynamic management. Norepinephrine is commonly preferred due to its balanced effects on peripheral vascular resistance and spinal cord perfusion pressure (SCPP), though dopamine, phenylephrine, and dobutamine each offer unique hemodynamic profiles suited to specific clinical scenarios. Despite their benefits, vasopressors carry significant risks, including arrhythmias and potential myocardial strain, necessitating careful selection based on individual patient factors. Further research is needed to refine vasopressor use and establish evidence-based protocols that optimize neurologic recovery, alongside continued exploration of SCPP as a potential therapeutic target.

Discovery of an Ultralong-acting Nondepolarizing Neuromuscular Blocker That Displays Short Onset Time and On-Demand Rapid Reversal by a Biocompatible Antagonist.

The combination of ultralong-acting neuromuscular block and subsequent on-demand rapid reversal may provide prolonged surgeries with improved conditions by omitting continuous or repetitive blocker administration, enabling a more stable and predictable hemodynamic profile and eliminating residual block. For this target, we prepared 19 imidazolium-incorporated tetracationic macrocycles. In vivo studies with rats revealed that one macrocycle (IMC-14) displays extremely high blocking activity. At the dose of 12.5-fold ED90, IMC-14 exhibits an onset time shorter than that of cisatracurium of 2-fold dose and a duration time corresponding to more than 13 h for human adults. Moreover, within the dose range of 12.5-187.5-fold ED90, the profound block induced by IMC-14 can be rapidly reversed at any stage by a highly biocompatible acyclic cucurbit[n]uril antagonist, with a reversal time significantly shorter than that achieved by sugammadex for reversing the block of rocuronium, a clinically widely used intermediate-acting neuromuscular blocking agent.

Prediction of pre-eclampsia using maternal hemodynamic parameters at 12 + 0 to 15 + 6 weeks.

To compare the maternal hemodynamic profile at 12 + 0 to 15 + 6 weeks' gestation in women who subsequently developed pre-eclampsia (PE) and those who did not, and to assess the screening performance of maternal hemodynamic parameters for PE in combination with the Fetal Medicine Foundation (FMF) triple test, including maternal factors (MF), mean arterial pressure (MAP), uterine artery pulsatility index and placental growth factor. This was a prospective case-control study involving Chinese women with a singleton pregnancy who underwent preterm PE screening at 11 + 0 to 13 + 6 weeks' gestation using the FMF triple test, between February 2020 and February 2023. Women identified as being at high risk (≥ 1:100) for preterm PE by the FMF triple test were matched 1:1 with women identified as low risk (< 1:100) for maternal age ± 3 years, maternal weight ± 5 kg and date of screening ± 14 days. Two-dimensional transthoracic echocardiography was performed at 12 + 0 to 15 + 6 weeks to evaluate maternal hemodynamic parameters (heart rate (HR), stroke volume (SV), cardiac output (CO) and systemic vascular resistance (SVR)). Maternal hemodynamic parameters were expressed as multiples of the median (MoM) values, determined by linear regression models to adjust for gestational age (GA) and MF. The distribution of log10 MoM values of maternal hemodynamic parameters in cases of PE and unaffected pregnancies, and the association between these hemodynamic parameters and GA at delivery, were assessed. The risks of preterm PE (delivery before 37 weeks) and any-onset PE (delivery at any time) were reassessed using Bayes' theorem after maternal hemodynamic parameters were added to the FMF triple test. The screening performance for preterm PE and any-onset PE was determined by the area under the receiver-operating-characteristics curve (AUC) and detection rate at a 10% fixed false-positive rate (FPR). Differences in AUC (ΔAUC) were assessed using DeLong's test. A total of 743 cases were analyzed, of whom 39 (5.2%) subsequently developed PE, including 29 (3.9%) cases of preterm PE and 10 (1.3%) cases of term PE. Mean log10 SVR MoM was significantly higher in cases of preterm PE and any-onset PE compared with unaffected pregnancies. Mean log10 SV MoM and log10 CO MoM were significantly lower in cases of preterm PE and any-onset PE compared with unaffected pregnancies. Mean log10 HR MoM was not significantly different between the study groups. Mean log10 CO MoM and log10 SVR MoM were not significantly correlated with GA at delivery in preterm PE and any-onset PE. For the prediction of preterm PE and any-onset PE, adding CO or SVR or replacing MAP with CO and SVR in the FMF triple test achieved an identical or greater AUC compared with the FMF triple test, but ΔAUC was not significantly different. In addition, adding CO or SVR or replacing MAP by CO and SVR in the FMF triple test did not improve the detection rate for preterm PE and any-onset PE at a fixed FPR of 10%. Women with preterm PE or any-onset PE exhibited increased SVR and decreased CO before the clinical manifestations of PE became apparent. These changes may serve as early indicators of cardiovascular maladaptation. However, assessment of maternal hemodynamics at 12 + 0 to 15 + 6 weeks does not enhance the screening performance for preterm PE and any-onset PE of these parameters. The FMF triple test remains superior to other biomarker combinations for predicting PE. © 2025 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Cerebral perfusion alterations in healthy young adults due to two genetic risk factors of Alzheimer's disease: APOE and MAPT.

Functional brain changes such as altered cerebral blood flow occur long before the onset of clinical symptoms in Alzheimer's disease (AD) and other neurodegenerative disorders. While cerebral hypoperfusion occurs in established AD, middle-aged carriers of genetic risk factors for AD, including APOE ε4, display regional hyperperfusion due to hypothesised pleiotropic or compensatory effects, representing a possible early biomarker of AD and facilitating earlier AD diagnosis. However, it is not clear whether hyperperfusion already exists even earlier in life. Here, 160 young and cognitively healthy participants from the Chinese PREVENT cohort underwent 3 T arterial spin labelling and T1 MRI and genetic testing for APOE and MAPT rs242557 status. Using FSL, we performed a whole brain voxel-wise analysis and a global mean grey matter analysis comparing for the effects of both risk genes on cerebral perfusion. No significant alterations were seen for APOE genotype, but in MAPT rs242557 A carriers, we observed a significantly hyperperfusion in the left anterior cingulate cortex and left insular cortex. There were no effects of APOE or MAPT status on the global perfusion. These results are novel and may suggest that MAPT genotypes demonstrated a distinct hemodynamic profile in a very young age.

A Double-Blind Randomized Controlled Trial Comparing Intrathecal 0.5% Isobaric Levobupivacaine With Fentanyl to 0.5% Isobaric Ropivacaine With Fentanyl for Elective Cesarean Section.

Background This study was planned to compare the onset and duration of action and the levels of sensory and motor blocksof 0.5% isobaric levobupivacaine with fentanyl to 0.5% isobaric ropivacaine with fentanyl addition in subarachnoid block in elective cesarean cases. Materials and methods This hospital-based randomized interventional controlled study was conducted in a tertiary care facilityin Jaipur. Sixty women who planned for elective lower-segment cesarean section, with more than 37 weeks of gestational period during the study period, were included in our study. These women were randomly divided into two study groups, using sealed opaque envelopes, and double blinding was ensured. In group L, women received 0.5% isobaric levobupivacaine with fentanyl, and in group R,0.5% isobaric ropivacaine with fentanylwas given. Results The mean time for sensory and motor block onset was significantly lower in group L than in group R (p<0.05). The mean time for two-segment regression for sensory block was significantly higher in group L than in group R (p<0.05). The mean duration of total motor blockade (B0) was significantly higher in group L compared to group R. The differences in the mean duration of total motor blockade were statistically significant (p<0.05).The mean change in mean arterial pressure (MAP) in group L was significantly higher than in group R (p<0.05). Conclusion This study provides valuable insights into the comparative effects of 0.5% isobaric levobupivacaine with fentanyl and 0.5% isobaric ropivacaine with fentanyl for spinal anesthesia in cesarean sections. Both anesthetic agents were well-tolerated, with no severe complications or side effects observed in either group. While levobupivacaine offers an early onset of action, ropivacaine demonstrates a more favorable hemodynamic profile with an early regression of motor block. Ropivacaine may be a suitable alternative to levobupivacaine for spinal anesthesia in cesarean sections, particularly in patients with unstable hemodynamics. Further research is necessary to investigate the long-term effects of these agents and to optimize their use in different patient populations.

Optimizing Mechanical Ventilation: A Clinical and Practical Bedside Method for the Identification and Management of Patient-Ventilator Asynchronies in Critical Care.

The prompt identification and correction of patient-ventilator asynchronies (PVA) remain a cornerstone for ensuring the quality of respiratory failure treatment and the prevention of further injury to critically ill patients. These disruptions, whether due to over- or under-assistance, have a profound clinical impact not only on the respiratory mechanics and the mortality associated with mechanical ventilation but also on the patient's cardiac output and hemodynamic profile. Strong evidence has demonstrated that these frequently occurring and often underdiagnosed events have significant prognostic value for mechanical ventilation outcomes and are strongly associated with prolonged ICU stays and hospital mortality. Halting the consequences of PVA relies on the correct identification and approach of its underlying causes. However, this often requires advanced knowledge of respiratory physiology and the evaluation of complex ventilator waveforms in patient-ventilator interactions, posing a challenge to intensive care practitioners, in particular, those less experienced. This review aims to outline the most frequent types of PVA and propose a clinical algorithm to provide physicians with a structured approach to assess, accurately diagnose, and correct PVA.

Hemodynamic profile of terlipressin and octreotide in patients with cirrhosis and portal hypertension: A randomized, single-blind clinical trial

Hemodynamic profile of terlipressin and octreotide in patients with cirrhosis and portal hypertension: A randomized, single-blind clinical trial

Cardiovascular and Metabolic Effects of Modulating Circulating Ketone Bodies With 1,3-Butanediol in Patients With Heart Failure With Reduced Ejection Fraction.

Oral treatment with the exogenous ketone body 3-hydroxybutyrate improves cardiac function in patients with heart failure with reduced ejection fraction, but ketosis is limited to 3 to 4 hours. Treatment with (R)-1,3-butanediol (BD) provides prolonged ketosis in healthy controls, but the hemodynamic and metabolic profile is unexplored in patients with heart failure with reduced ejection fraction. This was a randomized, single-blind, placebo-controlled, crossover study. Transthoracic echocardiography and venous blood samples were performed at baseline and hourly for 6 hours after an oral dose of BD (0.5 g/kg) or taste-matched placebo. The primary end point was the average between-treatment difference in cardiac output during the 6-hour period after intake. Secondary end points were stroke volume, heart rate, left ventricular ejection fraction, circulating 3-hydroxybutyrate, and free fatty acids. Twelve patients with heart failure with reduced ejection fraction were included. BD treatment provided significant increase in circulating 3-hydroxybutyrate by 1400 μmol/L (95% CI, 1262-1538 μmol/L, P<0.001) and increased cardiac output by 0.9 L/min (95% CI, 0.7-1.1 L/min, P<0.001) compared with placebo. Stroke volume increased by 15 mL (95% CI, 11-19 mL, P<0.001), and heart rate remained similar between treatments (P=0.150). Left ventricular ejection fraction increased by 3 percentage points (95% CI, 1-4 percentage points, P<0.001). Global longitudinal strain improved (P<0.001). Left ventricular contractility estimates increased after BD intake, and parameters of afterload were reduced. Finally, free fatty acids and glucose levels decreased. Oral dosing of BD led to prolonged ketosis and cardiovascular and metabolic benefits in patients with heart failure with reduced ejection fraction. Treatment with BD is an attractive option to achieve beneficial effects from sustained therapeutic ketosis. URL: https://www.clinicaltrials.gov; Unique identifier: NCT05768100.

Two Different Hemodynamic Responses in ME/CFS Patients with Postural Orthostatic Tachycardia Syndrome During Head-Up Tilt Testing.

Introduction: While the diagnosis of postural orthostatic tachycardia syndrome (POTS) is based on heart rate (HR) and blood pressure (BP) criteria, the pathophysiology of POTS is not fully understood as multiple pathophysiological mechanisms have been recognized. Also, cardiac function, being dependent on preload, afterload, contractility, and HR, has not been properly studied. Preload and contractility changes can be inferred from stroke volume index (SVI) changes during a tilt test. Afterload plays a minor role in POTS as a normal BP response is a prerequisite for POTS. Therefore, we analyzed the HR-SVI relation during a tilt test in myalgic encephalomyelitis (ME/CFS) patients with POTS and compared the data with ME/CFS patients with a normal HR-BP response and with that of healthy controls (HC). Material and Methods: In ME/CFS patients with either POTS (n = 233) or a normal HR-BP response (n = 507) and healthy controls (n = 48), we measured SVI (by suprasternal echo), HR, and BP during the tilt. Results: In all ME/CFS patients, the decrease in SVI was larger compared to HC. In patients with a normal HR-BP response and in POTS patients with a HR increase between 30-39 bpm, there was an inverse relationship between the HR increase and SVI decrease during the tilt, compatible with increased venous pooling. In POTS patients with a HR increase ≥40 bpm, this inverse relation was lost, and SVI changes were significantly less compared to POTS patients with a HR increase between 30-39 bpm, suggestive of a hyperadrenergic response. Conclusions: In ME/CFS patients with POTS, two different hemodynamic profiles can be observed: in patients with a limited HR increase, mainly increased venous pooling is observed, while in patients with a large (≥ 40 bpm) HR increase the data are suggestive of a hyperadrenergic response. These two different profiles may have different therapeutic implications.

A Clinical Comparative Study of Dexmedetomidine, Dexamethasone, and Clonidine as Adjuvants to Local Anesthetics in Supraclavicular Brachial Plexus Blocks.

The brachial plexus block is one of the peripheral blocks, beneath which the majority of upper limb surgical procedures are carried out. During upper limb surgery, a supraclavicular nerve block is an excellent substitute for general anesthesia. This is a clinical comparative study of dexmedetomidine, dexamethasone, and clonidine as adjuvants to local anesthetics in supraclavicular brachial plexus block. Ninety patients with American Society of Anesthesiologists (ASA) grades I and II scheduled for upper limb surgeries were randomly divided into three groups. Group RDEX (ropivacaine + dexmedetomidine; n = 30) received 20 ml of 0.5% inj. ropivacaine with 10 ml of 2% lignocaine and adrenaline with inj. dexmedetomidine 1 µg /kg (32 ml solution). Group RC (ropivacaine + clonidine; n = 30) received 20 ml of 0.5% inj. ropivacaine with 10 ml of 2% lignocaine and adrenaline with inj. clonidine 1 µg /kg (32 ml solution). Group RD (ropivacaine + dexamethasone; n = 30) received 20 ml of 0.5% inj. ropivacaine with 10 ml of 2% lignocaine and adrenaline with inj. dexamethasone 2 ml (8 mg) (32 ml solution). The onset of sensory and motor block was a statistically significant difference among the three groups (p < 0.001), showing that Group RDEX has the faster onset, followed by Group RC and Group RD as the slowest. There was a statistically significant difference in the mean duration of sensory and motor block among the three groups (p < 0.001), showing that Group RDEX has the longest average duration, followed by Group RC, while Group RD has the shortest.The comparison of the mean duration of analgesia shows a statistically highly significant difference among the three groups(p < 0.001). Dexmedetomidine (RDEX) has the longest duration of analgesia, followed by Group RC and then Group RD. The hemodynamic profile was comparable among the three groups. Sedation was observed in Groups RDEX and RC. Overall, no complications were found in Group RD. Dexmedetomidine, when added to 0.5% ropivacaine for supraclavicular brachial plexus blocks, decreases the time of onset of sensory and motor blockade and prolongs the duration of the block and the duration of analgesia as compared to clonidine and dexamethasone with 0.5% ropivacaine, making it a better adjuvant to ropivacaine for upper limb surgeries.

A Retrospective Study to Investigate the Relationship Between Body Mass Index and Hemodynamic Characteristics in Hypertensive Patients.

The relationship between hemodynamic parameters and body mass index (BMI) in the context of blood pressure regulation in hypertension is unclear. Here, we analyzed data from 1368 uncontrolled hypertensive patients, including key hemodynamic indicators such as heart rate (HR), cardiac index (CI), arterial stiffness (AS), systemic vascular resistance index (SVRI), and thoracic blood ratio (TBR). In this cohort, the average BMI across all hypertension patients was 26.859±3.897 (kg/m2), with obese patients (BMI≥28kg/m2) averaging 31.01±2.87kg/m2 and non-obese (BMI<28kg/m2) averaging 24.70±2.28kg/m2. Younger obese patients exhibited higher diastolic pressures than non-obese peers (p<0.01). Hemodynamic analysis showed obese patients had increased HR and SVRI but lower CI and AS (p<0.01). Hypertensive males aged under 60 with obesity displayed a more prominent peripheral vascular phenotype (p<0.05) and volemic phenotype (p<0.01) than non-obese males. Obese females aged under 60 showed a higher incidence of cardiac phenotype (p<0.01). Across genders, obese hypertensive patients aged over 60 had a greater prevalence of volemic phenotype than non-obese patients (p<0.05, p<0.01, respectively). BMI inversely correlated with CI and positively with SVRI across age and gender categories (p<0.01). Taken together, we find that patients with hypertension exhibit diverse hemodynamic profiles, and BMI significantly correlates with hemodynamic parameters such as SVRI and CI. Our research identifies BMI as a valuable target for personalized hypertension treatment.

To compare the efficacy of hyperbaric levobupivacaine (0.5%) versus hyperbaric bupivacaine (0.5%) in the subarachnoid block for infraumbilical surgeries

Background: Spinal anesthesia is the neuraxial regional anesthesia technique used in infraumbilical surgeries such as inguinal hernia, hydrocele, hysterectomy, and lower limb surgeries. Levobupivacaine and bupivacaine are local anesthetic agents used for spinal anesthesia. Aims and Objectives: The aim of the study was to compare the efficacy of hyperbaric levobupivacaine (0.5%) versus hyperbaric bupivacaine (0.5%) in subarachnoid blocks for infraumbilical surgeries. Materials and Methods: A total of 112 patients with American Society of Anesthesiologists grades 1 and 2 scheduled for infraumbilical surgeries were randomly divided into two groups. Group L received 3 mL of hyperbaric levobupivacaine, and group B received 3 mL of hyperbaric bupivacaine intrathecally. The onset of sensory block, onset, and duration of motor block, duration of analgesia and time of first rescue analgesia, hemodynamic parameters, and post-operative side effects, if any, were recorded. Results: The time of onset of sensory block at T10 for group L was 03.16±00.29 min and for group B was 02.16±00.27 min and the time of onset of motor block was higher in group L (03.29±00.32 min) compared to group B (02.45±00.32 min). Duration of motor block was significantly shorter in group L (209.80±6.44 min) compared to group B (252.41±11.49 min). All these findings were statistically significant. Conclusion: Levobupivacaine had a delayed onset of sensory and motor block as compared to bupivacaine, but due to its short duration of motor block and better hemodynamic profile, it seems to be a better alternative to bupivacaine.

Comparative evaluation of Bailey manoeuvre of deep extubation with conventional awake extubation technique - A randomized clinical study

Background: Extubation is a critical procedure in anesthesia and critical care, often accompanied by complications, such as bucking, coughing, and hemodynamic instability, particularly after major surgeries. The Bailey manoeuvre, involving deep extubation with the i-gel laryngeal mask airway (LMA), may mitigate these issues. The study was planned to compare the hemodynamic effects and side effect profiles of conventional awake endotracheal extubation and exchange extubation with the i-gel LMA. Aims and Objectives: The study was designed to compare hemodynamic stress response and respiratory complication between the conventional extubation group and the following exchange extubation group. Materials and Methods: In a prospective, randomized, single-blinded controlled study, 60 patients undergoing surgery under general anesthesia were divided into two groups: Group T (awake extubation) and Group L (exchange extubation with the i-gel LMA). Hemodynamic parameters and side effects were recorded and analyzed. Results: Group L exhibited significantly lower heart rates, systolic and diastolic blood pressures, and mean arterial pressures at various time points post-extubation compared to Group T. The incidence of hypertension was significantly higher in Group T (90%) versus Group L (50%). Bucking and coughing less in the i-gel LMA exchange group compared to the standard endotracheal tube extubation group. Conclusion: Exchange extubation with the i-gel LMA offers better hemodynamic stability and a lower incidence of hypertension compared to conventional awake extubation. This technique may be particularly beneficial for high-risk patients and those undergoing complex surgeries.

A prospective comparative study of levobupivacaine hydrochloride 0.5% with ropivacaine hydrochloride 0.75% for peri-operative epidural anesthesia in infra- umbilical surgeries

Background: Epidural anesthesia is a neuraxial regional anesthesia used to provide surgical anesthesia, to supplement general anesthesia, and to provide intra and post-operative analgesia. Levobupivacaine and ropivacaine are local anesthetic agents used in an epidural. Aims and Objectives: The aim of this study is to evaluate the onset and duration of sensory and motor block, duration of analgesia, hemodynamics, and adverse effects of levobupivacaine and ropivacaine given epidurally for infra-umbilical surgeries. Materials and Methods: This prospective randomized study was conducted in a total of 142 patients undergoing an infra-umbilical surgery, divided into two groups of 71 patients each. Group L received 15 mL of 0.5% levobupivacaine and Group R received 15 mL of 0.75% of ropivacaine. The onset and duration of sensory and motor blockade, duration of analgesia, hemodynamics, and side effects were assessed. Results: The mean time of onset of sensory and motor block is faster with ropivacaine (P&lt;0.05). The duration of sensory and motor block and analgesia was longer with ropivacaine (P&lt;0.05), whereas the incidence of side effects such as hypotension was more with ropivacaine. Conclusion: Our study concluded that ropivacaine produced a superior quality of epidural block but levobupivacaine had a more stable hemodynamic profile.

In Vitro Analysis of Left Ventricular Assist Device Outflow Graft Orientations and Their Effect on Aortic Hemodynamics.

Continuous-flow left ventricular assist devices have become an important treatment option for patients with advanced heart failure. However, adverse hemodynamic effects as consequence of an altered blood flow within the aorta and the aortic root remain a topic of concern. In this work, we investigated the influence of the outflow graft orientation on the hemodynamic profile and flow parameters within the thoracic aorta. Aortic models with different outflow graft orientations were designed and three-dimensional (3D) printed to mimic common implantation configurations and were integrated into a pulsatile mock circulatory flow loop. Assist device function was achieved using a rotary pump, replicating nonpulsatile, continuous support flows of 1-5 L/min. Flow velocity, wall shear stress, and pressure gradients were investigated for each configuration using sonography and four-dimensional (4D) flow magnetic resonance imaging. Mean wall shear stresses measured in 4D flow software were lowest for a graft inclination angle of 45°. Streamline visualization revealed areas of nonuniform, retrograde, and vortex flow in all models but most prominent for the aortic model with an outflow graft inclination of 60°. The insights gained from this research may aid in understanding clinical outcomes following assist device implantation and long-term mechanical circulatory support.

The Safety and Late Hemodynamics of Donor Cardiac Undersizing in Heart Transplantation.

Predicted heart mass ratio (PHMr) has become the standard donor-recipient size matching method in heart transplantation. While utilization of small PHMr hearts is associated with increased one-year mortality, the underlying mechanisms and time horizon of mortality remain uncertain. A single institution analysis of isolated heart transplant recipients (01/2019-7/2022) was performed (N=334). Patients were stratified by PHMr: undersized (<0.86) (n=106), matched (0.86-1.15) (n=175), and oversized (>1.15) (n=53). Survival within PHMr groups was further stratified: complex transplant group (preoperative LVAD, adult congenital, or preoperative ECMO) and non-complex transplant group (all others). Donor and recipient variables were similar. However, undersized patients were more likely to have a durable LVAD (P=0.022). While postoperative PGD and inotrope score were similar between groups, there was a trend toward increased postoperative dialysis need with undersized hearts (P=0.056). Overall, thirty-day (P=0.012) and one-year survival (P=0.002) was significantly worse in the undersized group compared to matched or oversized groups. However, on subset analysis, these differences only remained among the complex transplant recipients (P=0.013), but not the non-complex transplant recipients (P=0.428). Median mixed venous oxygen saturations at serial time-points were maintained between 65-70% in all heart size groups, with cardiac indices between 2.4-2.8 LPM/m2. Small PHMr hearts are associated with increased one-year mortality, driven by complex transplant operations. Recipients who received undersized PHMr hearts from non-complex transplant operations had a similar hemodynamic profile and survival as those who received matched and oversized hearts. Small PHMr hearts may be selectively safe for transplantation.