Including Mean Arterial Blood Pressure Research Articles

Cardiorespiratory fitness attenuates the association between fatness and cardiometabolic risk in Chinese children.

Childhood obesity tends to persist into adulthood, predisposing individuals to cardiometabolic risk (CMR). This study aims to investigate the mediating role of cardiorespiratory fitness (CRF) in the associations between multiple fatness indicators and individual CMR markers and clustered CMR-score, and explore sex differences. We recruited 1,557 children (age: 8 to 10, male/female: 52.7%/47.3%) in September 2022 in Ningbo, China. Physical examinations, overnight fasting blood test, and CRF was evaluated. The CMR-score was calculated by summing age- and sex-specific z scores of four CMR markers, including mean arterial blood pressure, triglycerides, the total cholesterol to high-density lipoprotein cholesterol ratio, and homeostatic model assessment for insulin resistance. Generalized linear mixed models were used to identify the associations, mediation analyses were performed to dissect the function of CRF. Partial correlation analyses revealed positive associations between high fatness indicators (including body mass index [BMI], BMI z score, body fat mass index [BFMI] and waist-to-height ratio [WHtR]) and increased CMR markers, whereas high CRF was associated with decreased CMR markers (all P < 0.05). In the mediation analyses, CRF emerged as a partial mediator, attenuating the relationship between four fatness indicators and CMR-score. Specifically, CRF mediated 6.5%, 7.7%, 5.3%, and 12.5% of the association between BMI, BMI z score, BFMI, WHtR and CMR-score (all P < 0.001). And the mediating effects of CRF between WHtR and four individual CMR markers was particularly robust, ranging from 10.4% to 21.1% (all P < 0.05). What's more, CRF mediates the associations between WHtR and CMR-score more pronounced in girls than boys with a mediation effect size of 17.3% (P < 0.001). In Chinese children, CRF partially mitigates the adverse effects of fatness on CMR, underscoring the significance of enhancing CRF in children.

Paper 16: The Use of Intravenous Tranexamic Acid Does Not Improve Arthroscopic Visualization in Shoulder Surgery: A Randomized Controlled Trial

Objectives: Adequate visual clarity is paramount to performing arthroscopic shoulder surgery safely, efficiently, and effectively. The addition of epinephrine in irrigation fluid, and the intravenous or local administration of tranexamic acid (TXA) have independently been reported to decrease bleeding thereby improving the surgeon’s visualization during arthroscopic shoulder procedures. No study has compared the effect of systemic administered TXA, epinephrine added in the irrigation fluid or the combination of both TXA and epinephrine on visual clarity during shoulder arthroscopy with a placebo group. The purpose of this study is to determine if intravenous TXA is an effective alternative to epinephrine delivered by a pressure-controlled pump in improving arthroscopic shoulder visualization during arthroscopic procedures and whether using both TXA and epinephrine together has an additive effect in improving visualization. Methods: The design of the study was a double-blinded, randomized controlled trial with four 1:1:1:1 parallel groups conducted at one center. Patients aged ≥18 years undergoing arthroscopic shoulder procedures including rotator cuff repair, arthroscopic biceps tenotomy/tenodesis, distal clavicle excision, subacromial decompression and labral repair by five fellowship-trained upper extremity surgeons were randomized into one of four arms: Pressure pump-controlled regular saline irrigation fluid (control), epinephrine (1ml of 1:1000) mixed in irrigation fluid (EPI), 1g intravenous TXA (TXA), and epinephrine and TXA (EPI/TXA). Visualization was rated on a 4-point Likert scale every 15 minutes with 0 indicating ‘poor’ quality and 3 indicating ‘excellent’ quality. The primary outcome measure was the unweighted mean of these ratings. Secondary outcomes included mean arterial blood pressure (MAP), surgery duration, surgery complexity, and adverse events within the first postoperative week. Unweighted means (SD) were calculated for visualization and mean arterial pressure (MAP) for each patient. Study group allocation was represented with epinephrine and tranexamic acid being coded in dichotomous variables (used or not used) for each patient. A step-wise linear regression was performed using visualization as the dependent variable and a series of independent variables considered for inclusion: epinephrine, tranexamic acid, surgery duration, complexity, mean arterial pressure, increase in pump pressure, and volume of irrigation fluid. All statistical tests were considered significant if p&lt;0.05. Results: One-hundred and twenty-eight participants with a mean age (± SD) of 56 (± 11) years were randomized. Figure 1 presents the patient flow through the study. Mean visualization quality for the control, TXA, EPI, and EPI/TXA groups were 2.1 (±0.40), 2.1 (±0.52), 2.6 (±0.37), 2.6 (±0.35), respectively. In a regression model with visual quality as the dependent variable, the presence/absence of EPI was the most significant predictor of visualization quality (R=0.525; p&lt;0.001). TXA presence/absence had no effect, and there was no interaction between TXA and EPI. The addition of MAP and surgery duration strengthened the model (R=0.529; p&lt;0.001). Increased MAP and surgery duration were both associated with decreased visualization quality. When surgery duration was controlled, surgery complexity was not a significant predictor of visualization quality. No adverse events were recorded in any of the groups. Conclusions: Intravenous administration of TXA is not an effective alternative to epinephrine in the irrigation fluid to improve visualization during routine arthroscopic shoulder surgeries although its application is safe. There is no additional improvement in visualization when TXA is used in combination with epinephrine beyond the effect of epinephrine alone. [Figure: see text]

Effects of Ultrasound-Guided Supraclavicular Block Using Bupivacaine-Dexmedetomidine or Bupivacaine Alone in Hemodynamics of Patients Undergoing Upper Limb Orthopedic Surgery

The aim of this study was to evaluate the effect of bupivacaine with dexmedetomidine in comparison with bupivacaine during supraclavicular block with ultrasound guide on the hemodynamics of patients undergoing upper limb orthopedic surgery. Eighty patients (40 patients in each group) who were candidates for upper limb orthopedic surgery randomly received 30 ml of bupivacaine alone (group 1) or 30 ml of bupivacaine with 20 μg of dexmedetomidine (group 2). The supraclavicular nerve block was performed using an ultrasound guide. Patients' hemodynamic data (including mean arterial blood pressure, heart rate per minute, respiration rate per minute, and peripheral blood oxygen saturation), the onset of action, and duration of sensory-motor block were compared between the two groups. The mean arterial blood pressure during surgery in group 2 was lower than in group 1, but the differences were not statistically significant. The onset of sensory and motor block in group 2 was significantly shorter than in group 1 (P=0.0001). The duration of sensory and motor block in group 2 was significantly longer than in group 1 (P=0.0001). During this study, none of the patients had hemodynamic disturbance or surgical complications. The addition of dexmedetomidine to bupivacaine during the supraclavicular block, in addition to hemodynamic stability of the patient during surgery, increases the duration of sensory and motor block.

Hypertensive disorders in twin pregnancy

Hypertensive disorders such as gestational hypertension, preeclampsia, eclampsia and HELLP syndrome are one of the most common pregnancy-associated entities that imply substantial maternal-fetal mortality and morbidity. When hypertensive disorders are associated with a multiple pregnancy, the outset is established sooner, with a rapid evolution and a more severe development. Although, the pathophysiology of hypertensive disorders is not fully understood, there are several risk factors that could be identified. A multiple pregnancy implies additional risks due to specific features: larger or multiple placentas, failure of the uteroplacental unit to uphold the natural development of multiple fetuses or elevated risk of abnormal placental site. Hypertensive disorders include complications that are common for both single and multiple pregnancies, complications such as kidney failure, liver dysfunction, neurological or hematological malfunction, among others. Maternal features, including mean arterial blood pressure, uterine artery pulsatility index and blood levels of PAPP-A and/or PlGF could be determined at an early age and used as screening methods.

Subfoveal Choroidal Thickness in Pre-eclampsia.

To our knowledge, this is the first time a study looking at the association between subfoveal choroidal thickness (SFCT) and the parameters affecting the severity of pre-eclampsia has been reported. We provide evidence that SFCT is thicker in pre-eclamptic (PE) patients and speculate on the possible causes. The purposes of this study were to compare SFCT in PE, normal pregnant, and nonpregnant women using spectral domain optical coherence tomography and to correlate SFCT with severity of pre-eclampsia. A cross-sectional, observational study was performed. A total of 150 participants were divided into three groups: group 1 (50 PE women), group 2 (50 normal pregnant women), and group 3 (50 nonpregnant healthy women). Subfoveal choroidal thickness was measured using spectral domain optical coherence tomography. Other parameters including mean arterial blood pressure (MABP), central corneal thickness, macular thickness, IOP, ocular perfusion pressure (OPP), and urine protein-to-creatinine ratio were also measured. ANOVA and Pearson correlation analysis were used to look at differences between the groups. P < .05 was considered as statistically significant. The MABP was higher in group 1 than in groups 2 and 3 (103.0 ± 12.9 vs. 83.2 ± 9.8 vs. 89.5 ± 7.2 mmHg, respectively; all P < .001). The SFCT of the PE group was higher than in groups 2 and 3 (370.7 ± 23.8 vs. 344.5 ± 30.8 vs. 315.8 ± 49.9 μm, respectively; all P < .001). There were no statistically significant differences in central corneal thickness, macular thickness, or IOP between the PE and healthy pregnant groups (all P > .05). The OPP was greater in PE patients (52.8 ± 8.5 vs. 41.9 ± 6.9 vs. 43.4 ± 5.2 mmHg, respectively; both P < .001). The SFCT was positively correlated with MABP (r = 0.464, P < .001), OPP (r = 0.495, P < .001), and urine protein-to-creatinine ratio (r = 0.635, P < .001) in the PE group. Subfoveal choroidal thickness is higher in pre-eclampsia and is proportional to established markers of severity of the condition. This parameter might serve as a novel predictive marker for the severity of pre-eclampsia.

Comparative study between the effect of opioid-free anesthesia versus opioid-based anesthesia in morbid obese patients

Introduction Multimodal techniques for pain management involve using two or more analgesic drugs with different mechanisms of action working in synergy. These drugs may be given by either the same or different routes of administration preoperatively, intraoperatively, and/or postoperatively [1]. By targeting different pain pathways within the central and peripheral nervous systems, the use of multiple agents with different mechanisms of action allows for lower doses of individual agents, which in turn results in a lower risk of adverse effects. Aim We have conducted this study to compare the effect of opioid-free anesthesia (OFA) with opioid-based anesthesia (OA) on postoperative pain relief as a primary outcome and hemodynamic variables, including mean arterial blood pressure (MAP), heart rate (HR) and oxygen saturation%, total pethidin consumption 24 h postoperatively, and postoperative complications developed in postanesthetic care unit (PACU), such as hypoxia, shivering, nausea, and vomiting as secondary outcomes in morbid obese patients. Patients and methods A total of 40 patients (morbidly obese) aged 25–50 years with BMI of at least 35, having ASA status II scheduled for laparoscopic cholecystectomy were divided into two groups in a randomized controlled fashion: group 1 was the OA group (n=20), which received general anesthesia with propofol, muscle relaxant (rocuronium), and fentanyl as the main anesthetic adjuvant and analgesic, and group 2 was the OFA group (n=20), which received general anesthesia with propofol, muscle relaxant (rocuronium), dexmedetomidine, magnesium sulfate, and lidocaine as anesthetic adjuvant and analgesic. Hemodynamic variables such as MAP, HR, and oxygen saturation% were recorded preoperatively, postintubation, and every 15 min till the end of surgery. Postoperative visual analog scale done immediately postoperatively, and at 2, 6, 12, and 24 h postoperatively; total pethidine consumption in 24 h postoperatively; and postoperative complications developed in PACU such as hypoxia, shivering, nausea, and vomiting were also recorded for each patient. Results There were no differences between the two groups regarding demographic data. There was a statistically significant decrease in HR in OFA group compared with OA group from 15 min after induction to 15 min postoperatively and a statistically significant decrease in MAP in group II (OFA) compared with group I (OA) from 30 min after induction to 90 min postoperatively in PACU. Visual analog scale for pain postoperatively was lower in nonopioid group than opioid group. The postoperative pethidine consumption was significantly lower in OFA versus OA. Postoperative complications like nausea, vomiting, shivering, and hypoxia were significantly higher in the OA group. Conclusion OFA provides postoperative pain relief and intraoperative hemodynamic stability without significant associated adverse effects compared with OA.

Determination of the Relationship between Healthy Lifestyle Behaviors, Physical Fitness, and Risk Factors of Coronary Heart Diseases in University Students

The purpose of the present study was to determine the relationship between healthy lifestyle behaviors, physical fitness, and coronary risk factors in university students. 320 male and female (nm: 171; nf: 149, respectively) students from a university participated in this study voluntarily. For the determination of body composition and Body Mass Indexes (BMI), subjects’ height, body weight, and skinfold thickness were taken and body fat percentage (% fat) was determined. Healthy lifestyle behaviors were determined using the healthy lifestyle behaviors questionnaire. Indicators of physical fitness included flexibility (sit-up) (F), muscle strength and endurance (isometric knee (KS), back strength (BS) and a total of shuttle (TS), sprint performance, BMI, and body fat percentage (% fat). Coronary heart disease risk factors included mean arterial blood pressure (systolic (SBP) and diastolic (DBP)), fasting blood levels of triglycerides (TG), total cholesterol (TC), hematocrit (HCT), and hemoglobin (HGB). Results indicated subjects have normal body mass index, body fat percentage, SBP, DBP, TG, TCF, BS, and KS. The results of the Pearson Product Moment Correlation Analysis, indicated that SBP, DBP, TG, TCF, BS, and KS for male and female was significantly correlated with flexibility (sit-up) (F), muscle strength and endurance (isometric knee (KS), back strength (BS) and total of shuttle (TS)), sprint performance. (p &lt; 0.01; p &lt; 0.05), In conclusion, the findings of the present study indicated that physical fitness and healthy lifestyle behaviors play a determinant role in coronary heart disease risk factors for male and female students from a university.

A comparative study between combined spinal anesthesia with bilateral thoracic paravertebral block and general anesthesia in laparoscopic cholecystectomy

Background Paravertebral block is a common regional anesthetic technique such as intraoperative anesthesia and perioperative analgesia used in multiple surgical procedures. Many studies have demonstrated that laparoscopic cholecystectomy (LC) with the patient under spinal anesthesia (SA) was feasible and safe and was associated with stable hemodynamics and better postoperative pain control. Aim The aim is to compare the anesthetic effect of combined SA with bilateral thoracic paravertebral block and general anesthesia in LC. Patients and methods Sixty patients undergoing LC were randomized into two groups: group I receiving general anesthesia and group II receiving SA with bilateral thoracic paravertebral block at the level of T7 with a catheter on the right side, and then injecting 10 ml plain bupivacaine 0.5% on the left side through the epidural needle without catheter as a single shot. Patients were still in the sitting position, and then SA was performed using a 25 G spinal needle at L2–L3 intervertebral space. 2 ml=10 mg of hyperbaric bupivacaine hydrochloride (0.5%) was injected intrathecally. Results Intraoperatively, there was significant increase in stress response including mean arterial blood pressure and heart rate in group I than in group II at 30 min and at the end of operation. Significant decrease in intraoperative opioid requirement as fentanyl in group II than in group I was observed. The time of first analgesic requirement within 8 h in the postoperative period if the Visual Analogue Scale more than 3 was significantly increased in group II than in group I. As regards intraoperative end tidal CO2, oxygen saturation, operative time, nausea, vomiting, headache and patient satisfaction, there was insignificant difference between the two groups. Conclusion LC can be performed under SA and bilateral thoracic paravertebral block at low pressure pneumoperitoneum, providing hemodynamic stability and with no respiratory complications.

Efficacy and safety of remifentanil for analgesia in cesarean delivery.

Background:This study aimed to assess the efficacy and safety of remifentanil as a general anesthetic during cesarean delivery.Material and Methods:Fifty women with singleton pregnancies undergoing cesarean delivery were randomly divided into intervention and control groups, each group containing 25 subjects. Participants in the intervention group received remifentanil (infused at 2 μg/kg/h), whereas subjects in the control group were given dexmedetomidine (infused at 0.4 μg/kg/h). Outcome measurements included mean arterial blood pressure (MAP), heart rate (HR), bispectral index (BIS), Apgar scores at 1 and 5 minutes, and the pH, PCO2, PO2, and base excess (BE) of umbilical venous and arterial blood.Results:Forty-four participants completed the study. Patients in the intervention group did not experience greater effect and safety than those in the control group (P > .05), although MAP and BIS values decreased significantly immediately before laryngoscopy (P < .05). In addition, BIS values were reduced significantly at the time of skin incision, at uterine incision, and immediately after fetal delivery when compared with baseline values in both groups (P < .01).Conclusion:This study concluded that remifentanil and dexmedetomidine exhibited similar efficacy and safety during general anesthesia for cesarean delivery.

Plethysmography variability index for prediction of fluid responsiveness during graded haemorrhage and transfusion in sevoflurane-anaesthetized mechanically ventilated dogs

ObjectiveTo examine the accuracy of plethysmography variability index (PVI) as a noninvasive indicator of fluid responsiveness in hypovolaemic dogs. Study designProspective experimental study. AnimalsSix adult healthy sevoflurane-anaesthetized Beagle dogs. MethodsDogs were anaesthetized with 1.3-fold their individual minimum alveolar concentration of sevoflurane. The lungs were mechanically ventilated after neuromuscular blockade with vecuronium bromide. Cardiopulmonary variables including mean arterial blood pressure (MAP), central venous pressure (CVP), transpulmonary thermodilution cardiac output (TPTDCO), stroke volume (SV), perfusion index (PI), pulse pressure variation (PPV), stroke volume variation (SVV) and PVI were determined during six stages of graded venous blood withdrawal (5 mL kg−1 increments) and six stages of graded blood infusion (5 mL kg−1 increments). The cardiopulmonary variables were analysed using paired t test or Wilcoxon signed rank test. Correlations between PPV and SVV or PVI were analysed by linear regression. The accuracy of PPV, SVV and PVI for predicting fluid responsiveness was examined by using receiver operating characteristic curve analysis. A value of p < 0.05 was considered statistically significant. ResultsBlood withdrawal resulted in significant increases in PPV and PVI and decreases in MAP, CVP, TPTDCO, SV and PI. Blood infusion resulted in significant increases in MAP, CVP, TPTDCO, SV and PI and decreases in PPV and PVI. PPV and PVI showed a relevant correlation (p < 0.001, r2 = 0.62) and threshold values of PPV ≥ 16% (sensitivity 71%, specificity 82%) and PVI ≥ 12% (sensitivity 78%, specificity 72%) for identifying fluid responsiveness. SVV did not change. Conclusions and clinical relevanceNoninvasive measurement of PVI predicted fluid responsiveness with moderate accuracy equal to PPV in sevoflurane-anaesthetized mechanically ventilated dogs. Provisional threshold values for identification of fluid responsiveness were PPV ≥ 16% and PVI ≥ 12%. Clinical trials are needed to confirm these threshold values in dogs.

Impact of Acute Intestinal Ischemia and Reperfusion Injury on Hemodynamics and Remote Organs in a Rat Model.

Acute mesenteric ischemia following cardiovascular surgery is a rare but fatal complication. We established a new rat model for hemodynamic monitoring during mesenteric ischemia/reperfusion (I/R) and evaluated the impact of mesenteric I/R on hemodynamics and remote organ injury. Mesenteric I/R was induced in male Wistar rats by superior mesenteric artery occlusion for 90 minutes, followed by 120 minutes of reperfusion. Before I/R, ventilation and hemodynamic monitoring including mean arterial blood pressure (MAP) and cardiac output (CO) were established. During reperfusion Geloplasma (I/R + Geloplasma, N = 6) and Ringer's solution (I/R + Ringer, N = 6) were titrated according to CO and compared with I/R without volume resuscitation (I/R only, N = 6) and a sham group (sham, N = 6). Blood samples were regularly taken for serum marker measurements. After reperfusion organs were harvested for histology studies. After acute mesenteric I/R, MAP and CO decreased (p < 0.01) while systemic and pulmonary vascular resistance increased (p < 0.01) continuously in the I/R group. Volume substitution according to CO initially stabilized hemodynamic parameters, but CO declined independently in the late stage. Compared with the I/R + Ringer group, the I/R + Geloplasma group required less volume for resuscitation (p < 0.01), experienced less metabolic acidosis. I/R groups had more organ injuries, more neutrophils sequestration, and higher creatine phosphokinase-MB levels than sham group. A new model for CO monitoring after mesenteric I/R injury demonstrated severe hypovolemic shock during reperfusion followed by remote myocardial and lung injury. Far less colloid volume is needed for hemodynamic stabilization after I/R compared with crystalloid volume.

32 Gestational hypertensive disorders and retinal microcirculation: The Generation R Study

Introduction Gestational hypertensive disorders (GHD), such as gestational hypertension (GH) and pre-eclampsia (PE), are risk factors for cardiovascular disease (CVD) in later life. Although the exact underlying mechanisms are not clear, changes in the microcirculation have also been proposed as a potential pathway in the development of CVD. Objective We examined whether a history of GHD is related to the maternal status of the microcirculation after pregnancy, as visualized by retinal imaging. Methods This study was embedded in the Generation R Study, a population-based prospective cohort study. Data on pregnancy, including GHD, and retinal vessel calibers six years after pregnancy were available for 3391 women. Retinal arteriolar and venular calibers were measured unilaterally from digitalized retinal photographs. Results Women with a history of PE had smaller retinal arteriolar calibers than women with a normotensive pregnancy (age-adjusted difference: −0.49SDS; 95% confidence interval (CI) −0.74, −0.25)). Additional adjustment for retinal venular caliber, ethnicity, educational level, smoking and pre-pregnancy BMI did not alter these results. After including mean arterial blood pressure at the time of retinal imaging, the association attenuated (−0.22SDS; 95% CI −0.43, −0.01), but remained significant. For women with a history of GH similar trends were observed, which disappeared after including mean arterial blood pressure at the time of retinal imaging in the model (−0.001SDS; 95% CI −0.14, 0.14). With respect to retinal venular calibers, we did not observe consistent trends for women with a history of PE. However, in women with a history of GH we observed larger venular calibers (multi-variable adjusted 0.16SDS; 95% CI 0.01, 0.31) than in women with a previous normotensive pregnancy. Conclusions Women with a history of GHD show an altered state of the microcirculation as reflected by smaller retinal arteriolar vessel calibers and larger retinal venular calibers six years after index pregnancy. These microvascular changes may contribute to the development of CVD in later life.

Cardiovascular function during maintenance of anaesthesia with isoflurane or alfaxalone infusion in greyhounds experiencing blood loss

ObjectiveTo compare adequacy of oxygen delivery and severity of shock during maintenance of anaesthesia with isoflurane or alfaxalone infusion in greyhounds experiencing blood loss. Study designProspective, randomised study. AnimalsTwenty-four greyhounds (ASA I). MethodsAll greyhounds were premedicated with methadone (0.2 mg kg−1) intramuscularly. Anaesthesia was induced with alfaxalone 2.5 mg kg−1intravenously. Following endotracheal intubation, the dogs were connected to an anaesthetic circle circuit delivering oxygen. Dogs were allocated to receive inhaled isoflurane or an intravenous infusion of alfaxalone for maintenance of anaesthesia. Isoflurane was initially administered to achieve an end-tidal concentration of 1.4% and alfaxalone was initially administered at 0.13 mg kg−1 minute−1. The dose of isoflurane or alfaxalone was adjusted during instrumentation to produce a clinically equivalent depth of anaesthesia. All dogs were mechanically ventilated to normocapnia (PaCO2 35–40 mmHg; 4.67–5.33 kPa). Passive warming maintained core body temperature between 37 and 38 °C. Measured and calculated indices of cardiovascular function, including mean arterial blood pressure (MAP), cardiac index (CI), systemic vascular resistance index (SVRI), oxygen delivery index ( D˙O2I), oxygen consumption index ( V˙O2I) and oxygen extraction ratio (OER), were determined at baseline (60 minutes after start of anaesthesia) and after removal of 32 mL kg−1and 48 mL kg−1of blood. ResultsIn all dogs, blood loss resulted in a significant decrease in MAP, CI, D˙O2, and a significant increase in SVRI, V˙O2I, and OER. The changes in each of the indices did not differ significantly between dogs receiving isoflurane and dogs receiving alfaxalone. Conclusion and clinical relevanceNo difference in oxygen delivery or severity of shock was observed when either inhaled isoflurane or intravenous alfaxalone infusion was used for maintenance of anaesthesia in greyhounds experiencing blood loss. There appears to be no clinical advantage to choosing one anaesthetic agent for maintenance of anaesthesia over the other in a dog experiencing blood loss.

Hemodynamic changes in child acute respiratory distress syndrome with airway pressure release ventilation: a case series.

Airway pressure release ventilation (APRV) is widely used in adult critical care settings. However, information on the use of APRV in the pediatric population is limited. All patients admitted to the medical-surgical pediatric intensive care unit with a diagnosis of acute respiratory distress syndrome (ARDS) who received APRV for at least 12 h between 2007 and 2009 were reviewed. Thirteen patients with a variety of etiologies of ARDS were included, with a mean weight of 18.2 ± 15.0 kg, a mean age of 68 ± 57 months and a predicted mortality (based on Pediatric Index of Mortality version 2) of 23.9 ± 13.8%. Patients were placed on APRV for a median of 4 days (range 1-10 days). There was no change in blood gas parameters after 1 h or 12 h of APRV when compared with pre-APRV. There was no statistical difference in hemodynamic parameters, including mean arterial blood pressure, central venous blood pressure and heart rate, while the patients were on APRV. APRV could be safely used in pediatric ARDS patients, without significant hemodynamic compromise or side effects.

Cationic derivative of polyprenol, a potential component of liposomal drug carriers, does not alter renal function in rats

Potential toxicity of a cationic derivative of polyprenol (APren‐7) with lipofecting activity was examined, especially its influence on renal haemodynamics and function, in order to conduct further investigation of its suitability as a component of liposomal drug carriers. Sprague–Dawley rats received daily injections (0.5 mL, s.c.) of liposomes comprised of 1,2‐dioleoyl‐sn‐glycero‐3‐phosphoethanolamine (DOPE) and APren‐7 (LP); classic liposomes composed of DOPE only (L); water solvent (W). After 4 weeks rats were anaesthetised and a wide spectrum of functional parameters were measured. These included mean arterial blood pressure (MBP), total renal blood flow (RBF), renal cortical, outer and inner medullary blood flow (CBF, OMBF, IMBF, respectively), diuresis, and sodium and solute excretion. Most parameters did not significantly differ between treated and control groups. A lower OMBF/IMBF ratio in liposome‐treated groups (L: 1.0 ± 0.1; LP: 1.1 ± 0.1 vs. W: 1.9 ± 0.3, p &lt; 0.05) might be an early sign of renal function impairment, however, since the lowering occurred in both L and LP groups, there was no reason to suspect that APren‐7 had any untoward influence on renal haemodynamics or excretion. The present results did not reveal toxic effects of APren‐7 in experimental rats, indicating that it could be suitable as a component of liposomal drug carriers.Practical applications: Many currently used drugs have severe side effects, which present a serious problem in the treatment of numerous diseases. Searching for compounds augmenting efficacy of drugs to reduce their dosage seems to be a promising strategy. This can be accomplished by facilitating the bioavailability of the drug, e.g. by improving penetration of biological membranes or delivery to the areas distant from the lumen of blood vessels and in particular instances by improving drug stability. The cationic derivative of polyprenol APren‐7 has lipofecting properties. In this study we found APren‐7 to be harmless to the experimental animals. Newly designed liposomal carriers could find application not only in the pharmaceutical and cosmetics industry but also in biological laboratories and in molecular medicine.

Melatonin augments hypothermic neuroprotection in a perinatal asphyxia model

Despite treatment with therapeutic hypothermia, almost 50% of infants with neonatal encephalopathy still have adverse outcomes. Additional treatments are required to maximize neuroprotection. Melatonin is a naturally occurring hormone involved in physiological processes that also has neuroprotective actions against hypoxic-ischaemic brain injury in animal models. The objective of this study was to assess neuroprotective effects of combining melatonin with therapeutic hypothermia after transient hypoxia-ischaemia in a piglet model of perinatal asphyxia using clinically relevant magnetic resonance spectroscopy biomarkers supported by immunohistochemistry. After a quantified global hypoxic-ischaemic insult, 17 newborn piglets were randomized to the following: (i) therapeutic hypothermia (33.5°C from 2 to 26 h after resuscitation, n = 8) and (ii) therapeutic hypothermia plus intravenous melatonin (5 mg/kg/h over 6 h started at 10 min after resuscitation and repeated at 24 h, n = 9). Cortical white matter and deep grey matter voxel proton and whole brain (31)P magnetic resonance spectroscopy were acquired before and during hypoxia-ischaemia, at 24 and 48 h after resuscitation. There was no difference in baseline variables, insult severity or any physiological or biochemical measure, including mean arterial blood pressure and inotrope use during the 48 h after hypoxia-ischaemia. Plasma levels of melatonin were 10 000 times higher in the hypothermia plus melatonin than hypothermia alone group. Melatonin-augmented hypothermia significantly reduced the hypoxic-ischaemic-induced increase in the area under the curve for proton magnetic resonance spectroscopy lactate/N-acetyl aspartate and lactate/total creatine ratios in the deep grey matter. Melatonin-augmented hypothermia increased levels of whole brain (31)P magnetic resonance spectroscopy nucleotide triphosphate/exchangeable phosphate pool. Correlating with improved cerebral energy metabolism, TUNEL-positive nuclei were reduced in the hypothermia plus melatonin group compared with hypothermia alone in the thalamus, internal capsule, putamen and caudate, and there was reduced cleaved caspase 3 in the thalamus. Although total numbers of microglia were not decreased in grey or white matter, expression of the prototypical cytotoxic microglial activation marker CD86 was decreased in the cortex at 48 h after hypoxia-ischaemia. The safety and improved neuroprotection with a combination of melatonin with cooling support phase II clinical trials in infants with moderate and severe neonatal encephalopathy.

Hypertonic Fluid Administration in Patients With Septic Shock

We assessed the short-term effects of hypertonic fluid versus isotonic fluid administration in patients with septic shock. This was a double-blind, prospective randomized controlled trial in a 15-bed intensive care unit. Twenty-four patients with septic shock were randomized to receive 250 mL 7.2% NaCl/6% hydroxyethyl starch (HT group) or 500 mL 6% hydroxyethyl starch (IT group). Hemodynamic measurements included mean arterial blood pressure (MAP), central venous pressure, stroke volume index, stroke volume variation, intrathoracic blood volume index, gastric tonometry, and sublingual microcirculatory flow as assessed by sidestream dark field imaging. Systolic tissue Doppler imaging velocities of the medial mitral annulus were measured using echocardiography to assess left ventricular contractility. Log transformation of the ratio MAP divided by the norepinephrine infusion rate (log MAP/NE) quantified the combined effect on both parameters. Compared with the IT group, hypertonic solution treatment resulted in an improvement in log MAP/NE (P = 0.008), as well as an increase in systolic tissue Doppler imaging velocities (P = 0.03) and stroke volume index (P = 0.017). No differences between the groups were found for preload parameters (central venous pressure, stroke volume variation, intrathoracic blood volume index) or for afterload parameters (systemic vascular resistance index, MAP). Hypertonic solution treatment decreased the need for ongoing fluid resuscitation (P = 0.046). No differences between groups were observed regarding tonometry or the sublingual microvascular variables. In patients with septic shock, hypertonic fluid administration did not promote gastrointestinal mucosal perfusion or sublingual microcirculatory blood flow in comparison to isotonic fluid. Independent of changes in preload or afterload, hypertonic fluid administration improved the cardiac contractility and vascular tone compared with isotonic fluid. The need for ongoing fluid resuscitation was also reduced.

Hydration Status After Overnight Fasting as Measured by Urine Osmolality Does Not Alter the Magnitude of Hypotension During General Anesthesia in Low Risk Patients

The increased distribution of crystalloid solution into the interstitial space may decrease the effectiveness of intravascular volume loading in patients. We investigated whether preoperative hydration status after overnight fasting affects interstitial fluid redistribution and thus the magnitude of hypotension during general anesthesia. Sixty ASA physical status I/II patients undergoing tympanoplasty fasted from midnight. Anesthesia was induced by fentanyl and propofol and maintained with sevoflurane and remifentanil. Coinciding with the induction of anesthesia, 15 mL/kg acetated Ringer solution was infused IV over 60 minutes followed by 1 mL/kg acetated Ringer solution over the next 30 minutes. Urine osmolalities after induction of anesthesia and during the study period (pre-U(osm), post-U(osm)) and percent decreases of whole-body bioelectrical resistance for extracellular fluid relative to baseline at the end of the study period (ΔR(e)) were measured. Patients with a pre-U(osm) < the 25th percentile or with a pre-U(osm) > the 75th percentile of pre-U(osm) were categorized in the hydrated or the dehydrated group, respectively. A range of variables, including mean arterial blood pressure during the 30- to 90-minute period relative to baseline, and ΔR(e), were compared between the groups. The dehydrated group (pre-U(osm) >759.5 mOsm/kg, n = 15) had a lower age (44 vs 52 years, P = 0.049) and had a higher post-U(osm) (181 vs 55 mOsm/kg, P = 0.001) compared with the hydrated group (pre-U(osm) <378.5 mOsm/kg, n = 15). Mean arterial blood pressure during the 30- to 90-minute period relative to baseline (0.67 vs 0.67, P = 0.85) with 95% confidence interval for the difference of means (-0.070 to 0.084) and ΔR(e) (5.6% vs 6.0%, P = 0.58) with 95% confidence interval for the difference of means (-1.85% to 1.06%) were similar for the hydrated and dehydrated groups. Preoperative dehydration after overnight fasting as measured by urine osmolality did not alter the magnitude of hypotension during general anesthesia. This finding suggests that intravascular volume loading with crystalloid solution to prevent hypotension during general anesthesia is an unfounded practice for low risk patients after overnight fasting.

Beneficial Effects of Activation of PKC on Hemorrhagic Shock in Rats

The reduced vascular reactivity after severe trauma or shock played an important role in the development and outcome of shock. Our previous study showed that protein kinase C (PKC) took part in the regulation of vascular reactivity after hemorrhagic shock. The objective of this study was to investigate the protective effects of activation of PKC on hemorrhagic shock and its related mechanism. Sprague dawley rats were subjected to hemorrhagic shock (40 mm Hg for 2 hours). Effects of the PKC agonist, phorbol-12-myristate-13-acetate (PMA), and its inhibitor, staurosporine, on hemodynamic parameters were observed in vivo or in vitro. The hemodynamic parameters included mean arterial blood pressure, left intraventricular systolic pressure, the maximal change rate of left intraventricular pressure (+/-dp/dtmax), blood gases including pH, Po2, Sao2, and base excess, animal survival time, the vascular reactivity and calcium sensitivity of superior mesenteric artery, and mitochondrial function and blood flow of liver and kidney. Intravenous administration of PKC agonist, PMA, at the concentration of 1 microg/kg significantly increased the mean arterial blood pressure, left intraventricular systolic pressure, +/-dp/dtmax, the pressor effect, and the contractile response of norepinephrine, it also improved the blood gases, and prolonged the survival time of shocked rats. In addition, the intravenous administration of PMA improved mitochondrial function and liver and kidney blood flow. A total of 10(-7) mol/L of PMA administrated in vitro significantly improved the vascular reactivity and calcium sensitivity of superior mesenteric artery to norepinephrine and Ca2+. These effects of PMA were abolished by the PKC specific inhibitor staurosporine (1 microg/kg in vivo or 10(-7) mol/L in vitro). Activation of PKC has protective effects on hemorrhagic shock. The mechanism is related not only to its hemodynamic stabilization effect via improving vascular reactivity and calcium sensitivity but also to its effect on improving the perfusion and mitochondrial function of vital organs.

Effects of music on anxiety and pain in children with cerebral palsy receiving acupuncture: A randomized controlled trial

Objectives To study the effects of music on anxiety and pain in children with cerebral palsy receiving acupuncture daily in a clinical setting. Design A randomized controlled trial. Setting Acupuncture Unit at Shenzhen Hospital of Traditional Chinese Medicine in Shenzhen City of China. Participants Sixty children with cerebral palsy undergoing acupuncture. Methods Intervention: Children listened to their favorite music or a blank disc for 30 min. Measurements: (1) the modified Yale preoperative anxiety scale for children's anxiety (mYPAS); (2) children's hospital of eastern Ontario pain scale (CHEOPS) and Wong-Baker faces pain rating scale (FACES) for pain intensity; (3) vital signs including mean arterial blood pressure (MAP), heart rate (HR) and respiratory rate (RR). Results An independent sample t-test showed significantly lower mYPAS scores in the music group 30 min after the intervention compared with the control group ( t = 4.72, P = 0.00). Significant differences between groups were found in mYPAS scores ( F = 4.270, d.f. = 1, P = 0.043, Partial η 2 = 0.069) and over treatment duration ( F = 143.421, d.f. = 1.521, P = 0.000, Partial η 2 = 0.712). A significant interaction was also found ( F = 4.298, d.f. = 1.521, P = 0.025, Partial η 2 = 0.069). LSD's post hoc testing confirmed that the mYPAS scores significantly increased from the baseline to 1 min ( P = 0.000, 95% CI 14.913, 20.257) and then gradually decreased from 1 to 30 min ( P = 0.000, 95% CI −18.952, −13.714). For pain intensity scores, a highly significant time effect was found in both the CHEOPS ( F = 87.347, d.f. = 2, P = 0.000, Partial η 2 = 0.601) and FACES ( F = 225.871, d.f. = 1.822, P = 0.000, Partial η 2 = 0.796), and a significant interaction effect was found as well ( F = 4.369, d.f. = 2, P = 0.015, Partial η 2 = 0.070; F = 5.859, d.f. = 1.822, P = 0.005, Partial η 2 = 0.092). However, no significant difference between groups was present ( F = 2.343, d.f. = 1, P = 0.131, Partial η 2 = 0.039; F = 3.738, d.f. = 1, P = 0.058, Partial η 2 = 0.061). Significant differences between groups were found in MAP and HR ( P < 0.05) and over time ( P < 0.05), but no significant effects in RR were apparent ( P > 0.05). A significant interaction effect was found in HR ( P < 0.05), but not in MAP or RR ( P > 0.05). Conclusions This study demonstrates that listening to music while receiving acupuncture can relieve anxiety among children with cerebral palsy; however, no effect was observed in terms of pain reduction. Further research is needed to explore the types of music which best impact an individual's treatment. Whether music results in fewer accidents and side effects of acupuncture should be investigated. Music can be considered as adjunctive therapy in clinical situations that may be anxiety-provoking for children.