Higher Incidence Of Bradycardia Research Articles

Long-Term Incidence of Bradycardia and Pacemaker Implantations Among Cross-Country Skiers: A Cohort Study.

Bradycardia is more common among well-trained athletes than in the general population, but the association with pacemaker implantations is less known. We investigated associations of endurance training with incidence of bradycardia and pacemaker implantations, including sex differences and long-term outcome, in a cohort of endurance trained individuals. All Swedish skiers who completed >1 race in the cross-country skiing event Vasaloppet between 1989 and 2011 (n=209 108) and a sample of 532 290 nonskiers were followed until first event of bradycardia, pacemaker implantation, or death, depending on end point. The Swedish National Patient Register was used to obtain diagnoses. Cox regression was used to investigate associations of number of completed races and finishing time in Vasaloppet with incidence of bradycardia and pacemaker implantations. In addition, Cox regression was used to investigate associations of pacemaker implantations with death in skiers and nonskiers. Male skiers had a higher incidence of bradycardia (adjusted hazard ratio [aHR], 1.19 [95% CI, 1.05-1.34]) and pacemaker implantations (aHR, 1.17 [95% CI, 1.04-1.31]) compared with male nonskiers. Those who completed the most races and had the best performances exhibited the highest incidence. For female skiers in Vasaloppet, the incidence of bradycardia (aHR, 0.98 [95% CI, 0.75-1.30]) and pacemaker implantations (aHR, 0.98 [95% CI, 0.75-1.29]) was not different from that of female nonskiers. The indication for pacemaker differed between skiers and nonskiers, with sick sinus syndrome more common in the former and third-degree atrioventricular block in the latter. Skiers had lower overall mortality rates than nonskiers (aHR, 0.16 [95% CI, 0.15-0.17]). There were no differences in mortality rates by pacemaker status among skiers. In this study, male endurance skiers had a higher incidence of bradycardia and pacemaker implantations compared with nonskiers, a pattern not seen in women. Among male skiers, those who completed the most races and had the fastest finishing times had the highest incidence of bradycardia and pacemaker implantations. Within each group, mortality rates did not differ in relation to pacemaker status. These findings suggest that bradycardia associated with training leads to a higher risk for pacemaker implantation without a detrimental effect on mortality risk.

INCIDENCE OF BRADYCARDIA IN INFANTS UNDERGOING INTUBATION WITH OR WITHOUT ATROPINE

Bradycardia is a life-threatening arrhythmia that endangers life by compromising blood flow to the brain. During intubation, its prevention is life-saving—the benefit of atropine in preventing bradycardia before intubation is controversial in the literature. Objective: The objective of the study was to find and compare the incidence of bradycardia with and without atropine. Methods: This single-centre randomised controlled trial was conducted at a tertiary care pediatric emergency department for six months. After applying inclusion and exclusion criteria, children were divided into two groups. Group 1 was given atropine before intubation, and group 2 was not. The overall incidence of bradycardia in subgroups was noted, along with the number of attempts and intubation time. Data was analysed using SPSS 26.0. Results: 86 patents were included in the study, with 43 in both groups. The mean age of the participants was 69.02+109.10 days. 48 (55.8%) were males and 38 (44.2%) were females. The incidence of bradycardia was 7% (6 Patients), with no statistically significant difference in both the groups (p-value was greater than 0.05). The number of attempts for intubation and intubation duration was also neither associated with bradycardia nor with atropine use. (p-value> 0.05).Conclusion: There is a higher incidence of bradycardia during intubation in children, with no significant difference in its occurrence with the use of atropine.

Application of intranasal dexmedetomidine in magnetic resonance imaging of preterm infants: The ED50, efficacy and safety analysis.

Infants undergoing magnetic resonance imaging (MRI) often require pharmacological sedation. Dexmedetomidine serves as a novel sedative agent that induces a unique unconsciousness similar to natural sleep, and therefore has currently been used as the first choice for sedation in infants and young children. To determine the 50% effective dose (ED50) and 95% confidence interval (95%CI) of intranasal dexmedetomidine for MRI in preterm and term infants, and to observe the incidence of adverse events. To explore whether there were differences in ED50 and 95%CI, heart rate (HR) and blood oxygen saturation (SpO2), the induction time and wake-up time and the incidence of adverse events between the 2 groups, so as to provide guidance for clinical safe medication for the meanwhile. A total of 68 infants were prospectively recruited for MRI examination under drug sedation (1 week ≤ age ≤ 23 weeks or weight ≤ 5kg). The children were divided into 2 groups according to whether they had preterm birth experience (Preterm group, Atterm group). The Dixon up-and-down method was used to explore ED50. The basic vital signs of the 2 groups were recorded, and the heart rate and SpO2 were recorded every 5 minutes until the infants were discharged from the hospital. The induction time, wake-up time and adverse events were recorded. The ED50 (95%CI) of intranasal dexmedetomidine in the Preterm group and the Atterm group were 2.23 (2.03-2.66) μg/kg and 2.64 (2.49-2.83) μg/kg, respectively (P < .05). the wake-up time was longer in Preterm group (98.00min) than in Atterm group (81.00 min) (P < .05), the incidence of bradycardia in Preterm group was 3/33, which was higher than that in Atterm group (1/35). There was no difference in the induction time between the 2 groups (P > .05), and there was no significant difference in other adverse events. Intranasal dexmedetomidine can be safely used for sedation in preterm infants undergoing MRI. Compared with term infants, preterm infants have a lower dose of dexmedetomidine, a higher incidence of bradycardia, and a longer weak-up time.

Abstract 11662: Efficacy And Safety Outcome Of Intravenous Vernakalant For Recent-onset Atrial Fibrillation: A Systematic Review And Meta-analysis

Introduction: Vernakalant hydrochloride is a relatively new atrial-selective antiarrhythmic approved in &gt;40 countries to pharmacologically cardiovert patients with recent-onset atrial fibrillation (ROAF). Due to safety concerns, it is yet to be approved in the USA. Objectives: To determine the effectiveness and safety of vernakalant in patients with ROAF. Methods: We systematically searched PubMed, EMBASE, Ovid MEDLINE, and CENTRAL from inception to December 2022 for studies that compared intravenous vernakalant to another drug(s) or placebo in patients with ROAF (onset ≤7 days). The pre-specified efficacy endpoint was conversion to sinus rhythm within 90minutes of administering interventions. Safety outcome of interest was mortality rate. Random-effects model meta-analysis was performed on extracted quantitative data. Results: 886 patients got vernakalant, 353 received placebo, and 401 got an antiarrhythmic agent. Vernakalant was significantly superior to placebo (conversion rate: 49.5% vs 6.2%, OR: 14.94, 95% CI: 7.18-31.07, P&lt;0.001, I 2 : 49%), Flecainide (72.3% vs 53.8%, OR: 2.44, 95% CI: 1.46-4.06, p&lt;0.001, I 2 : 0%), Amiodarone (55.7% vs 8.5%, OR: 17.42, 95% CI: 7.75-39.13, p&lt;0.001, I 2 : 0%), but not Ibutilide (62.4% vs 47.3%, OR: 1.77, 95% CI: 0.61-5.08, p=0.29, I 2 : 67%) in efficacy endpoint. In the vernakalant group, there was significantly lower incidence of ventricular arrhythmia (OR:0.65, 95% CI: 0.45-0.95, p=0.027) but higher incidence of bradycardia (OR:8.58, 95% CI: 4.69-15.67, p&lt;0.0001) and dysgeusia (OR:14.51, 95% CI: 7.03-29.95, p&lt;0.0001). No significant difference in mortality rate between vernakalant and other groups combined (OR: 2.51, 95% CI: 0.26-24.21, p=0.427). Conclusions: This hypothesis-generating study showed that intravenous vernakalant, though associated with a higher incidence of bradycardia and dysgeusia, is superior to placebo, Flecainide, and Amiodarone not Ibutilide in converting ROAF to sinus rhythm.

A Prospective Single-Center Brazilian Study Investigating the Efficacy and Safety of Prophylactic Phenylephrine Infusion for the Management of Hypotension During Cesarean Section Under Spinal Anesthesia.

Background Maternal hypotension occurs in up to 80% of parturients during cesarean section (CS) under spinal anesthesia. Phenylephrine, a direct-acting α-1 agonist, has been widely recommended for the prevention of hypotension. We evaluated the efficacy and safety of phenylephrine infusion to prevent hypotension in obese and non-obese patients during cesarean section. Methods One hundred forty-one patients were included in this single-arm study. Patients received prophylactic phenylephrine infusion at a rate of 50 μg/min-1 immediately after spinal local anesthetic injection until delivery.Hypotension was defined as a systolic blood pressure <100 mmHg or <20% of baseline. The primary outcome was the incidence of hypotension. Results The incidence of hypotension was 17%. The median and interquartile range (IQR) of the number of hypotensive episodes was 0 (0-0). It was observed that 79.1% of the patients had hypotension in the first six minutes. Reactive hypertension and bradycardia occurred in 20.5 and 12.7% of the patients, respectively. In addition, there was a higher incidence of bradycardia in pregnant women with a body index mass of < 30 kg/m-2.Patients with baseline systolic blood pressure <120 mmHg had a threefold increased risk of hypotension. The incidence of nausea and vomiting was 13.4 and 2.8%, respectively. The incidence of an Apgar score <7 at the first minute was 2.8%, and no neonates presented an Apgar score <7 at the fifth minute. A pH of <7.2 occurred in 6.3% of the neonates.All neonates had no sequelae and were discharged together with their mothers. Conclusion The prophylactic infusion of phenylephrine 50 μg/min-1 is safe and demonstrates efficacy in reducing maternal hypotension providing adequate maternal hemodynamic stability during CS under spinal anesthesia.

Effect of Dexmedetomidine versus Propofol on Intraoperative Seizure Onset During Awake Craniotomy: A Retrospective Study.

The effect of dexmedetomidine (DEX) compared with propofol on intraoperative seizures (IOSs) detected using electrocorticography during awake craniotomy for resection of brain tumors is unknown. This investigation aimed to compare IOS rate in patients receiving DEX versus propofol as sedative agent. In this retrospective single-center study, awake craniotomies performed from January 2014 to December 2019 were analyzed. All IOSs detected by electrocorticography along with vital signs were recorded. Of 168 adults enrolled in the study, 58 were administered DEX and 110 were administered propofol. IOSs occurred more frequently in the DEX group (22%) versus the propofol group (11%) (P= 0.046). A higher incidence of bradycardia was also observed in the DEX group (P < 0.001). Higher incidence of hypertension and a higher mean heart rate were recorded in the propofol group (P= 0.006 and P < 0.001, respectively). No serious adverse events requiring active drug administration were noted in either group. At univariate regression analysis, DEX demonstrated a tendency to favor IOS onset but without statistical significance (odds ratio= 2.36, P= 0.051). Patients in both groups had a similar epilepsy outcome at the 1-year postoperative follow-up. IOSs detected with electrocorticography during awake craniotomy occurred more frequently in patients receiving DEX than propofol. However, patients receiving DEX were not shown to be at a statistically significant greater risk for IOS onset. DEX is a valid alternative to propofol during awake craniotomy in patients affected by tumor-related epilepsy.

Long-term incidence of pacemaker implantations and bradycardia among cross-country skiers

Abstract Background Bradycardia is more common among well-trained athletes. The associations of training with pacemaker implantations are less known. We aim to investigate the association of endurance training with incidence of bradycardia and pacemaker implantations in a cohort of endurance athletes. Furthermore, we aim to establish potential sex differences of such associations. Methods Swedish skiers (209,072) that completed 1 or more races in the 30 to 90 km cross-country skiing event Vasaloppet (1989–2011) and a matched sample (n=531,949) of nonskiers were followed until first event of bradycardia or pacemaker implantation. The Swedish National Patient Register of in-patient and specialized outpatient care was used to obtain the date of diagnoses. Cox regression was used to investigate associations of number of completed races and finishing time with incidence of bradycardia and pacemaker implantations. Results Male skiers had higher incidence of bradycardia (hazard ratio [HR], 1.14; 95% CI, 0.99–1.30) and pacemaker implantations (HR, 1.14; 95% CI, 1.02–1.28) than male nonskiers. Male skiers completing most races or with the fastest finishing times had the highest incidence. The incidence of bradycardia (HR, 0.96; 95% CI, 0.70–1.30) and pacemaker implantations (HR, 0.97; 95% CI, 0.75–1.25) among female skiers in Vasaloppet was not different to that of female nonskiers. There was a trend that female skiers completing most races or with fastest finishing times had lower incidence. Conclusions Male skiers had higher incidence of bradycardia and pacemaker implantations. Female skiers in Vasaloppet had non-different incidence of bradycardia and pacemaker implantations. Men with the highest number of races and fastest finishing times had the highest incidence of pacemaker implantations. This indicates that bradycardia associated with training is not always as benign as previously suggested. The response appears to be different between sexes. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Uppsala UniversityCKF Dalarna

Comparison of norepinephrine and phenylephrine boluses during spinal anesthesia for cesarean delivery

Background: Cesarean sections are frequently carried out under spinal anesthesia (SA) to reduce the risk of neonatal drug transfer and airway difficulties associated with general anesthesia. Maternal hypotension is a typical consequence following SA, despite sufficient fluid loading. Aims and Objectives: The aim of this study was to evaluate the efficacy of norepinephrine and phenylephrine in treating spinal hypotension caused by cesarean delivery. Materials and Methods: This hospital-based interventional study was carried out at Sri Venkateswaraa Medical College Hospital and Research Centre, Ariyur, Puducherry from February 2020 to March 2022. Eighty patients were included in our trial and were split equally into two groups at random following approval by an ethical committee and written informed consent. Age, weight, height, and American Society of Anesthesiologists physical state of the patients was equivalent across the two groups. Results: In our study, mean age found in N group (25.96±2.046) and P group (24.84±1.748) which were insignificant. Vasopressor bolus dose needed for the treatment of hypotension was considerably less inGroup N patients (1.71±0.77 vs. 2.43±1.01, P=0.024). Group P had a higher incidence of bradycardia, although the difference was statistically insignificant (four patients vs. eight patients P=0.242). The fetal parameters such as birth weight, umbilical PH, PCO, PO2, and Apgar 1 and 5 min were comparable across the two groups, and no statistically significant differences were found. Conclusion: Intermittent norepinephrine boluses are a successful treatment for spinal hypotension during cesarean delivery. We found no evidence that norepinephrine had a detrimental effect on the newborn outcome as compared to phenylephrine, when used to maintain blood pressure during spinal and combined spinalepidural anesthesia for cesarean birth.

Dexmedetomidine in combination with ketamine for pediatric procedural sedation or premedication: A meta-analysis.

To evaluate effectiveness of combinational use of dexmedetomidine and ketamine (DEX-KET) for pediatric procedural sedation or premedication. Relevant studies were identified after a literature search in electronic databases and study selection was based on precise eligibility criteria. Meta-analyses of mean differences were performed to examine differences in sedation onset and recovery times between DEX-KET and comparators. Changes from baseline in heart rate (HR), respiratory rate, oxygen saturation, and mean arterial pressure (MAP), were pooled. Meta-analyses of proportions were performed to estimate incidence of adverse events. 15 studies (1087 patients) were included. Onset of sedation was significantly shorter in DEX-KET than in DEX group. HR declined in DEX-KET group from start (-3.5 beats per minute (BPM) [95% CI: -5.1, -1.9]) through midpoint (-7.2 BPM [95% CI: -12.1, -2.3]) and at end of sedation (-8.7 BPM [95% CI: -13.1, -4.4]). Decrease in HR after DEX administration at start was -11.6 BPM [95% CI: -16.0, -7.1] and remained consistent afterward. There was no change in MAP during DEX-KET sedation. However, after DEX administration, MAP decreased by -6.9 [95% CI: -10.4, -3.3] at start, -7.8 [95% CI: -11.4, -4.2] at middle, and by -6.6 [95% CI: -14.4, 1.1] at end of sedation. Incidence of hypotension was 3% [95% CI: 0, 9] in DEX-KET, 7% [95% CI: 2, 14] in DEX, and 0% [95% CI: 0, 2] in KET groups. Incidence of bradycardia was 2% [95% CI: 0, 6] with DEX-KET and 12% [95% CI: 5, 20] with DEX. Incidence of oxygen desaturation was 3% [95% CI: 0, 8] in DEX-KET, 2% [95% CI: 0, 6] in DEX, 12% [95% CI: 5, 20] in KET, and 13% [95% CI: 6, 21] in PROP-KET groups. MIDA-KET sedation had 13% [95% CI: 4, 25] incidence of tachycardia. DEX-KET for pediatric sedation results in better sedation outcomes than DEX or KET by shortening onset of sedation and recovery while maintaining hemodynamic and respiratory stability with low incidence of adverse events. DEX sedation was associated with higher incidence of bradycardia. Higher incidence of oxygen desaturation was observed with KET and PROP-KET whereas MIDA-KET was associated with higher incidence of tachycardia.

Combination of Dexmedetomidine and Butorphanol Optimized Sedation in Drug-Induced Sleep Endoscopy: A Randomized, Double-Blind Trial.

Drug-induced sleep endoscopy (DISE) allows for the evaluation of dynamic airway collapse in patients with obstructive sleep apnea. However, a standardized sedation regimen for DISE is not yet available. This study aimed to investigate the safety profiles and efficacies of dexmedetomidine combined with butorphanol for DISE. Sixty patients with obstructive sleep apnea scheduled to undergo DISE were randomly divided into Group D and Group DB. All recipients were initially given intravenous butorphanol (1 mg) (Group DB) or saline (Group D). Subsequently, both groups were sedated using a loading dose of 1.0 µg/kg/h of dexmedetomidine. Hemodynamic and respiratory parameters, the time to attain sufficient sedation, wakeup time, and adverse events during DISE were recorded. Compared with Group D, the time until sufficient sedation and wakeup time in Group DB were significantly reduced. A higher performer satisfaction level was achieved in Group DB. Patients in Group DB showed a higher incidence of bradycardia compared with Group D. However, the bradycardia resolved spontaneously in both groups without any treatment. There was no instance of cough, hypotension, arrhythmia, nausea or vomiting in either group. Compared to dexmedetomidine alone, a small dose of butorphanol infusion (1 mg) as an adjunct treatment to dexmedetomidine during DISE can reduce the dosage of dexmedetomidine, shorten the time until sufficient sedation and enhance the performer satisfaction level. This synergistic combination could be a promising sedation regimen for DISE in terms of procedural convenience and patient safety.

Abstract 12351: Perioperative Interventions for Prevention of Postoperative Atrial Fibrillation After Cardiac Surgery: A Systematic Review and Network Meta-Analysis

Background: Postoperative atrial fibrillation (POAF) is the most common complication of cardiac surgery, which increases the risk of stroke and death, the length of hospital stays, and costs. Guidelines recommendations on the use of β-blockers (BBs) have only a modest influence on overall rates of POAF. The key clinical outcomes such as stroke and death have not been improved. The best approach to prophylaxis remains obscure. Method: We used Bayesian network meta-analysis to synthesize evidences from randomized controlled trials (RCTs) that compared interventions for POAF prophylaxis. The primary outcomes were incidence of POAF hypotension and bradycardia. Results: We included 262 RCTs with 52636 participants (age &gt; 18, undergoing CABG, valvular or combined surgery), in which 14 different interventions were investigated. For the incidence of POAF, sotalol, amiodarone, BBs, posterior pericardiotomy, atrial pacing, magnesium, polyunsaturated fatty acids, colchicine, glucocorticoid and statin had positive results compared to placebo with statistical significance. The best three therapeutics were sotalol (OR 0.29, 95% CI 0.21-0.41; probability of being best 84.6%), amiodarone (OR 0.39, 95% CI 0.31-0.48) and BBs (OR 0.39, 95% CI 0.31-0.49). For safety, BBs (OR 4.09, 95% CI 2.10-7.96), magnesium (OR 2.51, 95% CI 1.09-5.76) and sotalol (OR 2.07, 95% CI 1.06-4.05) were associated with higher incidence of hypotension. Sotalol (OR 2.80, 95% CI 1.66-4.74) and amiodarone (OR 2.27, 95% CI 1.66-3.10) were associated with higher incidence of bradycardia. For secondary outcomes, no significant effect on all-cause or cardiovascular mortality was observed. Amiodarone was the only intervention that reduced stroke rate (OR 0.57, 95% CI 0.34-0.96). Conclusions: Sotalol appeared to be superior in efficiency compared with others. BBs do not work as well as we expected with the highest incidence of hypotension.Further studies are required to define the better interventions

Perioperative effect of dexmedetomidine on quality of analgesia and hemodynamic parameters in vaginal hysterectomy: A tertiary centre experience

Vaginal hysterectomy Surgery with long acting local anaesthetic like bupivacaine still requires higher doses of analgesics in the post-operative period. Dexmedetomidine is highly selective αadrenoreceptor agonist and sympatholytic drug is a useful adjunct drug in patients undergoing vaginal hysterectomy under continuous spinal epidural block (CSE). We sought to study duration of perioperative analgesia, observe the intra-operative and post-operative hemodynamic changes and post-operative sedation effect of dexmedetomidine.: The study groups were divided as Group D (study group) administered 1 µg/kg Dexmedetomidine and Group C (control group) administered 0.9% saline drip at the rate of 1ml/kg. Dexmedetomidine group had prolonged duration of sensory blockade, duration for 2 dermatomal regression of sensory blockade and the duration for motor block regression to Modified Bromage scale 0. This group had prolonged duration of Time to first request for rescue analgesic.14% patients required mephentermine for management of hypotension.Intraoperative diastolic blood pressure (DBP) was lower in study group while Intraoperative Systolic blood pressure (SBP) was comparable in both the groups. Intravenous dexmedetomidine significantly decreases the heart rate and is associated with higher incidence of bradycardia. It is effective in providing postoperative analgesia and in preventing postoperative shivering with reduced incidence of postoperative nausea and vomiting.

Cardiac Arrhythmia Related to Remdesivir in COVID-19

<strong>Background:</strong> Remdesivir has shown a positive impact on patient’s clinical improvement with COVID-19 and could represent and future viral infections. <strong>Results:</strong> 16 out of 37 patients presented bradycardia, 4 of these patients had QTc &gt; 450 ms. Infusion for 3 days or more of infusion had a higher incidence of bradycardia (12 vs 4 patients). Overall, patients without bradycardia had a longer hospitalization (20.5 vs 15.5 days); 7 patients died, 2 of them had bradycardia. <strong>Conclusion:</strong> Our results have shown clear evidence of bradycardia after remdesivir infusion. Prospective, double-blinded, and randomized studies with an evident representative sample size with various ethnicities and races are highly needed earlier than later to establish these important findings.

Comparative study between Bupivacaine with Magnesium sulphate v.s. Bupivacaine with Dexmedetomidine in ultrasound guided Transversus Abdominus Plane (TAP) block as postoperative analgesia for pain in Cesarean section

Background: Magnesium sulfate and dexmedetomidine were used as adjuvants to local anesthesia to improve the quality of regional anesthesia. Objectives: To evaluate and compare the effects of magnesium sulfate and dexmedetomidine when added to bupivacaine on the quality of trasversus abdominus plane block (TAPB). Patients and Methods: The study was done at the department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt from November 2019 to October 2020. A total of 50 female patients undergoing elective Cesarean section using post operative transversus abdominus plane (TAP) block were randomly assigned into two groups; Ultrasound-guided transversus abdominus plane (TAP) block was performed using 20 ml 0.25% Bupivacaine. Magnesium sulfate 150 mg (1.5 ml) and dexmedetomidine 0.5 mcg/kg were added in the magnesium sulfate group and dexmedetomidine group, respectively. Time to first analgesia, pain scores at 2/6/12/24/48 hours, hemodynamic data and side effects were recorded. Results: Dexmedetomidine group provided the longest duration of analgesia and the least consumption of postoperative rescue analgesia versus magnesium sulfate group (P = 0.001). Dexmedetomidine group had higher incidences of bradycardia and hypotension. Conclusion: Magnesium sulfate or dexmedetomidine was a useful adjuvant to bupivacaine for transversus abdominus plane block in lengthening the duration of analgesia. Dexmedetomidine provided quicker onset and longer duration of analgesia with lesser consumption of postoperative rescue analgesia; However, it showed a higher incidence of intraoperative hypotension and bradycardia than magnesium sulfate.

Comparison of different concentration of dexmedetomidine added to ropivacaine in ultrasound guided supraclavicular block for orthopedic forearm surgery-a prospective, randomized, comparative clinical study

There is no fix and ideal dose is known for dexmedetomidine as an adjuvant in brachial plexus block. So this study was performed to evaluate different doses of dexmedetomidine added to 0.5% ropivacaine, with the primary outcome of the duration of analgesia. Secondary outcomes included the effect on block characteristics, sedation, hemodynamics and adverse effects.Totally 60 adult patients were randomly allocated to two equal groups (n = 30) using computer generated randomization. Patients in Group RD50 received 24 ml 0.5% ropivacaine + 50 µg of dexmedetomidine and Group RD100 received 24 ml 0.5% ropivacaine + 100 µg of dexmedetomidine in ultrasonography guided supraclavicular block.The primary aim was the duration of analgesia and secondary aim were onset and duration of the sensorimotor blockade, hemodynamic variables, sedation score, and adverse effects The data were interpreted with the help of t-test and Chi-square test.In group RD50, the onset of both sensory and motor block was 8.18 ± 1.49 min and 14.11 ± 2.09 min, respectively, while in group RD100 it was 8.23 ± 1.41 min and 14.06 ± 2.44 min, respectively. The duration of analgesia was similar in both groups (862.32 ± 45.51 vs. 864.43 ± 44.02 min; P &amp;#62;.05). The occurrence of bradycardia was observed significantly greater in RD100 group patients.The addition of 100 µg dexmedetomidine to ropivacaine has similar effects on block characteristics and duration analgesia with a higher incidence of bradycardia as compare to 50 µg.

Hemodynamic changes between different anatomically designed stents after carotid stenting: a prospective multicenter study

The aim of this study was to investigate differences in the dynamic changes and risk factors of hemodynamic depression (HD) between straight and tapered carotid stenting (SCS and TCS, respectively). A total of 148 and 167 patients were included in TCS and SCS groups in this study, respectively. All clinical data were collected and analyzed for differences in HD and primary endpoint events at 12months. The SCS procedure had a lower predilation rate and a higher incidence of intra- and postprocedure HD; furthermore, the decline in heart rate in the SCS procedure was higher in patients with intra- and postprocedure HD (P < 0.05). Right stenosis [odds ratio (OR) 1.67] and stent type (ev3) (OR 2.31) were confirmed as risk factors, and older age (> 70years) was accompanied by a lower risk (OR 0.58; P < 0.05). The SCS procedure had a higher incidence of bradycardia and hypotension after 24h and a longer duration of hypotension (P < 0.05). Stenosis (> 80%) (OR 1.68), the SCS procedure (OR 1.72), and alcohol intake (OR 2.38) were defined as risk factors. There was no difference in the complications or clinical endpoint events in either procedure, and the restenosis rate was lower in the TCS procedure (1.35% vs 5.42%). Our results reveal that TCS has a lower incidence of HD and that intra- and postprocedure HD have different manifestations and risk factors.

Effectiveness of intravenous boluses of phenylephrine, ephedrine and mephentermine as vasopressors for management of perioperative hypotension in elective lower segment caesarean section under spinal anaesthesia – A prospective comparative study

Hypotension after subarachnoid block for caesarean section is the commonest but serious complication encountered by anaesthesiologists. Various vasopressors are used to prevent/treat this complication. This study was done to compare the efficacy of three commonly used vasopressors – phenylephrine, ephedrine, mephentermine for treatment of perioperative hypotension. Sixty American Society of Anaesthesiologists (ASA) physical status class II parturients undergoing elective caesarean section under subarachnoid block were randomly allotted three groups (P, E, M) (n = 20) to receive intravenous boluses of phenylephrine 100 mcg, ephedrine 6mg &amp; mephentermine 6mg respectively, following hypotension. Maternal Haemodynamic parameters, complications &amp; neonatal APGAR scores were recorded. P-value &amp;#60; 0.05 was considered significant and P-value &amp;#60; 0.001 considered highly significant. Demographic values, baseline vital parameters and mean number of vasopressor boluses required were similar in the three groups (P &amp;#62; 0.05). The mean trends of systolic blood pressure (P = 0.06), diastolic blood pressure (P = 0.7) and mean arterial pressure (P = 0.6) were similar in the three groups. Heart rate was raised during periods of hypotension; the mean heart rate was lower in the phenylephrine group after vasopressor administration. The overall trend was similar (P = 0.1) among the three groups. There was (P = 0.003) higher incidence of bradycardia in the phenylephrine group. The neonatal APGAR scores were &amp;#62; 7 in the three groups at the 1st and 5th minute (P = 0.5). All three vasopressors effectively maintained arterial blood pressure during the subarachnoid block for caesarean section. Phenylephrine caused a significant reduction in heart rate compared to ephedrine or mephentermine.

Heart rate changes following the administration of sugammadex in children: a prospective, observational study.

Sugammadex is a novel agent to reverse steroidal neuromuscular blocking agents (NMBA) with potential clinical advantages over acetylcholinesterase inhibitors such as neostigmine. However, rare instances of bradycardia were reported during its initial clinical trials. To better define this issue, its incidence and mitigating factors, we prospectively evaluated heart rate changes after sugammadex administration in pediatric-aged patients. Patients less than 18years of age who were to receive sugammadex were included. After sugammadex administration, heart rate (HR) was recorded every minute for 15min and then every 5min for the next 15min or until the patient was transferred from the operating room. Bradycardia was defined as HR below the 5th percentile for age. The study cohort included 221 children. Bradycardia was noted in 18 cases (8%; 95% confidence interval 5%, 13%), occurring at a median of 2min (IQR: 1, 6) after sugammadex administration. Among patients developing bradycardia, 7 of 18 (38%) had comorbid cardiac conditions (congenital heart disease). No patient required treatment for bradycardia and no clinically significant blood pressure (BP) changes were noted. On bivariate analysis, initial sugammadex dose was not associated with bradycardia onset. In multivariable analysis, cardiac comorbid conditions and male gender were associated with an increased incidence of bradycardia. The incidence of bradycardia following the administration of sugammadex is low, is not associated with BP changes or other clinically significant effects, and did not require treatment. A higher incidence of bradycardia was noted in patients with cardiac comorbid conditions.

Application of Dexmedetomidine versus Propofol in elderly patient undergoing transurethral resection of the prostate

Objective To investigate the efficiency and safety of Dexmedetomidine as adjuvant to local anesthetics in elderly patient undergoing transurethral resection of the prostate. Methods Sixty elderly patients undergoing selective transurethral resection of the prostate were randomly divided into the Dexmedetomidine group and the Propofol group(n=30, each). After block level of spinal anesthesia was determined, Dexmedetomidine(a bolus dose of 0.5 μg/kg for 10 minutes, then continuous injection of 0.2-0.4 μg·kg-1·h-1)or Propofol(initial plasma concentration of 0.5 mg/L, after getting equal to an effect compartment drug concentration, plasma concentration was gradually increased by 0.1 mg/L)was injected with an infusion pump.Observation items were recorded, including the onset time[observer's assessment of alertness/sedation(OAA/S)≤3 points], blood pressure, heart rate, respiratory rate, pulse oxygen saturation, end-tidal carbon dioxide partial pressure, bispectral index value(BIS), and OAA/S score as well as adverse events and patients' satisfaction to sedation. Results The OAA/S score after 20 minutes of drug injection was lower in the Propofol group than in the Dexmedetomidine group(3.0±0.5 scores vs.3.5±0.6 scores, t=2.300, P=0.030). The systolic pressure levels were lower in the Propofol group than in the Dexmedetomidine group after 30 minutes and 40 minutes of drug injection(107.6±11.2 mmHg vs.119.2±16.4 mmHg, 106.7±9.6 mmHg vs.121.2±18.3 mmHg, 1 mmHg=0.133 kPa, t=2.151 and 2.555, P=0.041 and 0.017). The diastolic pressure was lower in the Propofol group than in the Dexmedetomidine group after 10 minutes of drug injection(69.8±6.7 mmHg vs.78.0±10.1 mmHg, t=2.462, P=0.021). The incidence of bradycardia was higher in the Dexmedetomidine group than in the Propofol group(20.0% or 6/30 vs.0.0% or 0/30, χ2=6.667, P=0.010). The incidences of respiratory depression and involuntary movement were lower in the Dexmedetomidine group than in the Propofol group(0.0% or 0/30 vs.13.3% or 4/30, 0.0% or 0/30 vs.30.0% or 9/30, χ2=4.286 and 10.588, P=0.038 and 0.001). Conclusions Compared with the conventional Propofol, Dexmedetomidine has a definite sedative effect in elderly patients undergoing transurethral resection of the prostate under spinal anesthesia, with peace and cooperation, greater stability of blood pressure, without breath depression, but with higher incidence of bradycardia. Key words: Dexmedetomidine; Propofol; Transurethral resection of prostate

Predictors of Complications in Anorexia Nervosa and Atypical Anorexia Nervosa: Degree of Underweight or Extent and Recency of Weight Loss?

PurposeAdolescents with atypical anorexia nervosa (AAN) can experience severe physical complications despite not being underweight, posing questions about the contribution of weight loss to complications experienced in restrictive eating disorders (EDs). This study compared total weight loss and recent weight loss with admission weight as predictors of physical and psychological complications. MethodsRetrospective (2005–2010) and prospective (2011–2013) studies were undertaken of 12- to 19-year-old hospitalized adolescents with anorexia nervosa (AN) or AAN, defined as meeting criteria for AN except underweight (≥85% median body mass index). Predictors were total weight loss (from lifetime maximum), recent weight loss (past 3 months), and admission weight. Outcomes were hypophosphatemia, clinical, anthropometric, and psychometric markers during admission. ResultsIn 171 participants (AN, 118 [69%]; AAN, 53 [31%]), there was little evidence of an association between weight measures and hypophosphatemia. Greater total weight loss (regression coefficient [Coeff]: −1.70, 95% confidence interval [CI]: −2.77, −.63, p = .002) and greater recent weight loss (Coeff: −3.37, 95% CI: −5.77, −.97, p = .006), but not admission weight, were associated with a lower pulse rate nadir. Greater total weight loss (odds ratio [OR]: 1.70, 95% CI: 1.19, 2.24, p = .003) and greater recent weight loss (OR: 2.12, 95% CI: 1.11, 4.02, p = .02) were also associated with a higher incidence of bradycardia. ConclusionsIn adolescents with restrictive EDs, total weight loss and recent weight loss were better predictors than admission weight of many physical complications. This suggests that future diagnostic criteria for AN place greater emphasis on weight loss.