Intravenous Atropine Research Articles

Peribulbar anesthesia for strabismus surgery in adult patients.

To evaluate the efficacy and safety of peribulbar anesthesia during strabismus surgery. Medical records of patients undergoing strabismus surgery and peribulbar anesthesia were reviewed. The overall efficacy of peribulbar anesthesia was evaluated as requirement of supplemental peribulbar anesthesia, impossibility to perform eye muscles surgery due to inadequate efficacy of the block and peribulbar block complications that occurred up to 6 weeks postoperatively. Presence of oculocardiac reflex (OCR) and presence of decreased visual acuity and afferent pupillary defect postoperatively were reported. A total of 510 patients comprised our study group. The total amount of peribulbar injections was 717. Four patients (0.7%) required supplemental injection in the superonasal quadrant. Five of 510 (0.9%) required an anesthesiologic intervention with intravenous atropine. Eighty patients of 510 (15.6%) complained about transitory complete ptosis and/or amaurosis postoperatively. No complications were observed up to 6 weeks postoperatively. Peribulbar anesthesia was an effective and safe option during strabismus surgery in adult patients.

Activation of the carotid body increases directly recorded cardiac sympathetic nerve activity and coronary blood flow in conscious sheep.

Activation of the carotid body (CB) using intracarotid potassium cyanide (KCN) injection increases coronary blood flow (CoBF). This increase in CoBF is considered to be mediated by co-activation of both the sympathetic and parasympathetic nerves to the heart. However, whether cardiac sympathetic nerve activity (cardiac SNA) actually increases during CB activation has not been determined previously. We hypothesized that activation of the CB would increase directly recorded cardiac SNA, which would cause coronary vasodilatation. Experiments were conducted in conscious sheep implanted with electrodes to record cardiac SNA and diaphragmatic electromyography (dEMG), flow probes to record CoBF and cardiac output, and a catheter to record arterial pressure. Intracarotid KCN injection was used to activate the CB. To eliminate the contribution of metabolic demand on coronary flow, the heart was paced at a constant rate during CB chemoreflex stimulation. Intracarotid KCN injection resulted in a significant increase in directly recorded cardiac SNA frequency (from 24 ± 2 to 40 ± 4 bursts/min; P < 0.05) as well as a dose-dependent increase in mean arterial pressure (79 ± 15 to 88 ± 14 mmHg; P < 0.01) and CoBF (75 ± 37 vs. 86 ± 42 mL/min; P < 0.05). The increase in CoBF and coronary vascular conductance to intracarotid KCN injection was abolished after propranolol infusion, suggesting that the increased cardiac SNA mediates coronary vasodilatation. The pressor response to activation of the CB was abolished by pretreatment with intravenous atropine, but there was no change in the coronary flow response. Our results indicate that CB activation increases directly recorded cardiac SNA, which mediates vasodilatation of the coronary vasculature.

Safety of withholding intubation in gamma-hydroxybutyrate- and gamma-butyrolactone-intoxicated coma patients in the emergency department.

The objective of this study was to determine if supportive care without endotracheal intubation in the emergency department (ED) was safe in the absence of complications in gamma-hydroxybutyrate (GHB)/gamma-butyrolactone (GBL) intoxicated patients with a decreased Glasgow Coma Scale (GCS) score. This was a retrospective chart review of patients presenting to a Dutch tertiary urban ED with a reduced level of consciousness related to alleged GHB/GBL intoxication between April 2011-December 2014. Primary endpoint was major adverse events, defined by: upper airway obstruction not resolved with mayo tube or nasopharyngeal airway, hypoxia not resolved with 15 l of oxygen delivered via non-rebreathing mask, bradypnea not resolved after stimulation, intubation, bradycardia not resolved after intravenous atropine bolus, hypotension for which inotropes were started. Data of 209 patients were retrieved. Major adverse events were reported in five patients (2.4%; 95% CI: 0.8-5.5). Intubation with subsequent ICU admission was required for 1.4% of patients (95% CI: 0.3-4.1). The most frequently seen minor adverse events (N = 209) were: airway obstruction (22%), hypothermia (14.8%), hypoxia (12.9%), bradycardia (8.1%), hypotension (6.7%), bradypnea (5.7%), vomiting (5.3%). There were no deaths. None of the patients had signs of aspiration pneumonia or returned to our ED due to complications. Our study suggests that conservative airway management for patients with a decreased GCS due to suspected GHB intoxication may be safe. Major adverse events were present in 2.4% of patients, only 1.4% of patients required intubation. All minor adverse events were managed effectively with conservative treatment.

Adverse Cardiovascular Effects of Phenylephrine Eye Drops Combined with Intravenous Atropine

Background: Phenylephrine and atropine can cause serious adverse effects, when applied in combination. We investigated the effect of phenylephrine eye drops combined with intravenous atropine on the cardiovascular system in patients under general anaesthesia undergoing intraocular surgery. Methods: Thirteen patients undergoing intraocular surgery under general anaesthesia were observed in this study; all were injected intravenously with atropine due to the oculocardiac reflex during surgery. Fifty-four SD rats that received phenylephrine eye drops and intravenous atropine treatment under general anaesthesia were assessed, of which 24 treated with these drugs simultaneously were administered normal saline or antagonists. Blood pressure and heart rate were recorded and analysed. Findings: In patients, topical ocular application of 5% phenylephrine and intravenous atropine treatment led to a significant heart rate increase ten minutes after intravenous atropine treatment; the increase lasted 20 minutes. The significant increase in diastolic blood pressure (DBP) and systolic blood pressure (SBP) lasted 20 and 25 minutes, respectively. From five to 25 minutes after intravenous atropine treatment, SBP and DBP were both more than 20% higher than the at baseline. In rats, the blood pressure and heart rate changes were independent of the phenylephrine and atropine administration sequence but were related to the administration time interval. The variations in blood pressure and heart rate reached their peak when phenylephrine and atropine were administered simultaneously. The urapidil and neostigmine groups showed a significant decrease in blood pressure after the increase from the administration of phenylephrine and atropine. After neostigmine treatment, the heart rate was significantly lower than that associated with normal saline treatment. Interpretation: Phenylephrine eye drops combined with intravenous atropine treatment have obvious cardiovascular effects, which can be reversed by neostigmine. These drugs combination should be used carefully for ophthalmic surgery, especially in patients with cardiocerebrovascular diseases. Funding Statement: This work was supported by the Science and Technology Program of Guangzhou of Wei Chi (No. 201804010415). Declaration of Interests: The authors have declared that no conflict of interest exists. Ethics Approval Statement: The use of experimental animals in this study complied with the animal ethics principles, and the protocol was approved by the laboratory animal ethics committee (No. 00201878).

Urethral dysfunction and therapeutic effects of a PDE 5 inhibitor (tadalafil) in a rat model of detrusor underactivity induced by pelvic nerve crush injury.

The urethral dysfunction produced by a rat model of peripheral neurogenic detrusor underactivity (DU) using pelvic nerve crush (PNC) injury was characterized and then tested with the administration of tadalafil, a phosphodiesterase type 5 (PDE 5) inhibitor. Ten days after producing PNC rats, awake cystometrograms (CMGs) and isovolumetric cystometrograms with urethral perfusion pressure (IC-UPP) measurements were performed. Also, in control rats, IC-UPP was recorded before and after intravenous atropine administration to determine if the reduction of bladder contraction pressure affects urethral relaxation during voiding. Then, CMG and IC-UPP measurements in PNC rats were recorded after intravenous administration of tadalafil. Lastly, real-time polymerase chain reaction was used to measure transcript levels of neuronal nitric oxide synthases (nNOS), endothelial nitric oxide synthases, and PDE 5 in urethral specimens from PNC and control rats. PNC rats demonstrated the characteristics of DU in CMG. Also, PNC rats exhibited significant decreases in isovolumetric bladder contraction amplitudes and urethral relaxation. Atropine attenuated the amplitude of isovolumetric bladder contractions; however, atropine did not affect urethral relaxation in control rats. Tadalafil decreased postvoid residual and increased voiding efficiency without changing bladder contraction amplitude in PNC rats. Also, tadalafil improved the amplitude of urethral relaxation during bladder contraction in PNC rats. Urethral nNOS transcript levels were upregulated in PNC rats compared to control rats. PNC rats revealed both DU and impaired urethral relaxation. PDE 5 inhibition in PNC rats enhanced urethral relaxation during voiding, resulting in improved voiding efficiency. Thus, urethral dysfunction could be a potential target for the treatment of inefficient voiding associated with neurogenic DU.

Extremely late recurrences (≥3 years) of atrioventricular nodal reentrant tachycardia: Electrophysiological characteristics of the index and repeat ablation procedures

BackgroundCatheter ablation is an effective treatment for atrioventricular nodal reentrant tachycardia (AVNRT). However, the characteristics of extremely late (>3 years) recurrences of AVNRT after a successful initial ablation are not fully elucidated. We aimed to explore the electrophysiological characteristics of extremely late recurrences of AVNRT after a successful ablation. MethodsFrom 1991 to 2018, 3311 patients (mean age: 48.7 ± 17.4 years; men: 1328 [40.1%]) who underwent catheter ablation for AVNRT were investigated. Baseline characteristics of the patients, recurrence status, and detailed electrophysiological parameters of the index and repeat ablation procedures were obtained for analysis. ResultsAfter a mean follow-up period of 129.5 ± 58.0 months, 65 (2.0%) patients underwent repeat ablation for recurrences of AVNRT, of whom 17 (0.5%) presented with extremely late recurrences. The incidence of transient AV block was significantly higher in patients with extremely late recurrences (5.9%) than in those without recurrences (1.9%) but lower than that in patients with recurrences within <3 years (12.5%, P < .001). In addition, among patients with extremely late recurrences of AVNRT, the atrial–His bundle interval was significantly longer (99.1 ± 23.4 vs. 76.5 ± 13.1 ms, P < .01) and the need for intravenous isoproterenol and/or atropine for the induction of AVNRT (88.2% vs. 47.1%, P = .03) was higher in the repeat ablation procedure than in the index ablation procedure. ConclusionRecurrences of AVNRT can occur 3 years after a successful initial ablation. The electrophysiological features of the index and repeat ablation procedures differed between patients with extremely late recurrences of AVNRT and those with recurrences within <3 years.

Conservative Management with Atropine Therapy for Infantile Hypertrophic Pyloric Stenosis

Aim To study success rate efficacy and complications of atropine therapy in the management of Infantile Hypertrophic Pyloric Stenosis.Material and Method This prospective study was conducted over a period of 4 years from March 2016 to February 2020. 25 infants presented with diagnosis of Infantile Hypertrophic pyloric stenosis and subsequently managed conservatively with atropine were included in the study.The diagnosis of IHPS was made clinically by the typical clinical presentation of non-bilious vomiting gastric peristalsis or palpable pyloric mass and was confirmed with ultrasound.Atropine was initially administered intravenously in a dose of 0.06 mgkgday in eight divided doses in a day increased by 0.15 mgkgday till vomiting ceased and remained so for a period of 48 hours at a stretch and Ultrasonography showed a transit time of less than 1 minute.Oral feeding was started at a volume of 10 ml3 hourly 8 times a day. The volume was increased day by day until patients tolerated 150 mlkgday. Intravenous atropine was then substituted by oral atropine which was given at an initial dose of 0.05 mgkgd and increased to a maximum dose of 0.1 mgkgd for 3 weeks.Results A total 25 IHPS infants were admitted and managed with atropine therapy during the period of study. Out of 25 infants 22 88 were males and 0312 were females with a male to female ratio of 7.31. Mean birth weight of infants was 3.1plusmn1.4 kg. 20 80 infants were first-born children.Progressive non-bilious vomiting was the most frequent symptom and it was described in all 100 patients Visible peristalsis seen in 20 80 infants and A palpable mass was found in 1456 of infants. Metabolic alkalosis was seen in 1872 infants. Electrolyte abnormality seen in 20 80 infants in which Hyponatremia seen in 1872 Hypokalaemia seen in 16 64 Hypo chloremia seen in 16 64 infants.Of the 25 patients 20 became free from projectile vomiting during atropine treatment and treated successfully with atropine therapy. Five cases continued to vomit at least twice daily even after 12 days of IV treatment and ultimately opted out for pyloromyotomy after 12 days of intravenous atropine. Full feeding was achieved at 5- 4.3 days.Complications included transiently elevated heart rates 180-200 beatsmin in 0312 patients and facial flushing after the first dose of IV atropine in 01 4 patient. Mean duration of hospital stay was 10.36 plusmn 3.59 days range of 8 ndash16 days. There was no mortality in the study population.Conclusion Conservative Management with atropine therapy for Infantile Hypertrophic Pyloric Stenosis proved to be an effective and safe alternative to pyloromyotomy.

Sedative reduction method for children with intussusception.

Intussusception is common emergency condition in children. Pneumatic or hydrostatic reduction (HR) is considered the first-choice management strategy in cases lacking indications for surgical intervention. Generally, sedatives are not used in children undergoing interventional radiology procedures. Surgical management is associated with long hospitalization durations and high costs, unlike nonsurgical reduction. To avoid surgery, reduction procedures are repeated despite initial treatment failure. However, in cases involving repeated failures, children should be referred for surgery.To ensure good response to reduction, we planned HR under sedation during the third reduction attempt. Sedative reduction (SR) was performed with the administration of ketamine, midazolam, and atropine. All patients with contraindications against HR underwent laparoscopic reduction (LR) without HR.During 3 years, SR was performed in 43 patients, and in 28 (65.1%), the treatment was successful. Among the 15 patients in whom the procedure failed, 14 underwent LR without intestinal resection. There was no significant risk factor contributing to failed reduction under sedation.During the second or third HR attempt, successful reduction may be ensured with the SR procedure with intravenous ketamine, midazolam, and atropine; this procedure may further reduce surgery rates in pediatric intussusception.

P4423Extreme bradycardia in athletes is due to intrinsic changes within the heart

Abstract Background It is well known that athletes and in particular endurance athletes have lower resting heart rates than non-athletes. This has generally been considered a healthy adaptation. Traditionally this was thought be due to increased vagal tone. Several studies have shown that endurance athletes continue to have lower heart rates in the absence of autonomic influence suggesting bradycardia is due to intrinsic changes within the heart. A subset of endurance athletes have very low heart rates with Tour de France cyclists having described heart rates in the 30s. It is unclear whether in these elite athletes with very low heart rates the profound bradycardia is due to autonomic influence or intrinsic changes within the heart. Aim The aim of this study was to determine if extreme bradycardia in athletes is due to excess vagal tone or more profound intrinsic changes within the heart. Methods We recruited three cohorts for this study: non-athlete controls (NA), endurance athletes with a documented resting heart rate &gt;40 (EA) and endurance athletes with a resting heart rate &lt;40 (BA). All participants underwent baseline testing including ECG, echocardiography and VO2 max testing. All participants came back on a second occasion for treatment with dual autonomic blockade (DAB) to determine intrinsic heart rate in the following manner. After resting supine for five minutes resting heart rate was measured. Participants were then administered 0.04mg/kg of intravenous atropine. After five minutes participants were then administered 0.05mg/kg of intravenous metoprolol. This was repeated every five minutes until there was no further drop in heart rate or 0.2mg/kg had been administered. The resting heart rate at this stage was recorded as the intrinsic heart rate. Parasympathetic blockade was confirmed by lack of response to Valsalva manoeuvre and sympathetic blockade was confirmed by lack of response to metoprolol. VO2 max testing was then performed to determine maximum heart rate. Results 9 NA (7 male), 10 EA (8 male) and 5 BA (4 male) participated in this study. The average age was similar in all groups (NA 32.9y, EA 32.4y, BA 31.4y). The average resting heart rate was 71.7 in the NA group, 48.3 in the EA group and 41.6 in the BA group (p&lt;0.05 for comparisons between all three groups). Following dual autonomic blockade resting heart rate was 86.0 in the NA group, 76.9 in the EA group and 64.4 in the BA group (p&lt;0.05 for comparisons between all three groups). Maximum heart rate under DAB was 140.1 in the NA group, 138.0 in the EA group and 140.4 in the BA group. These differences were not significant. Conclusion In athletes with very low heart rates, bradycardia is due to more profound intrinsic changes within the heart. Acknowledgement/Funding NHMRC Project Grant

Organophosphate poisoning at Chris Hani Baragwanath Academic Hospital 2012 - 2015

Background. Patients with acute organophosphate poisoning are frequently admitted to the Chris Hani Baragwanath Academic Hospital (CHBAH), and yet there is little literature assessing aspects of these admissions. Objectives . To determine the demographic profile, common clinical and biochemical findings, use of prognostic tools (APACHE II), management and outcome of adult patients admitted to the high care area (HCA) and intensive care unit (ICU) at CHBAH. Methods . A retrospective data analysis of hospital records for 129 patients admitted to the HCA and ICU at CHBAH for the period 2012 - 2015 was undertaken. The demographic profiles and clinical and biochemical presentations of the patients were determined, together with their subsequent management and outcomes. Use of the APACHE II score as a prognostic tool was evaluated, and the average enzyme inhibition levels demonstrated by the patients was assessed. Results. The median age of the group was 30 years, with 68.2% being male. The most common clinical finding was pinpoint pupils (96.1%) followed by a Glasgow Coma Score &lt;13 (85.3%), fasciculations (60.5%), diarrhoea (37.2%) and seizures (10.1%). Admissions to the HCA (52.7%) predominated, with the majority of patients requiring ventilator support (99.2%). The mean (SD) duration of stay was 6.8 days for ICU (6.4) and 3.7 days for HCA (5.2). The overall mortality rate was 5.4%. Standard treatment was intravenous atropine. Blood results reflected low levels of acetylcholinesterase enzyme activity. The APACHE II score was underutilised. Conclusion. The findings of the study underscore the frequent use of organophosphate compounds in our area. Further studies across the country will help to highlight the magnitude of the consequences of organophosphate poisoning, as well as the burden imposed on limited healthcare resources.

Organophosphate poisoning at Chris Hani Baragwanath Academic Hospital 2012 - 2015.

Background Patients with acute organophosphate poisoning are frequently admitted to the Chris Hani Baragwanath Academic Hospital (CHBAH), and yet there is little literature assessing aspects of these admissions. Objectives To determine the demographic profile, common clinical and biochemical findings, use of prognostic tools (APACHE II), management and outcome of adult patients admitted to the high care area (HCA) and intensive care unit (ICU) at CHBAH. Methods A retrospective data analysis of hospital records for 129 patients admitted to the HCA and ICU at CHBAH for the period 2012 - 2015 was undertaken. The demographic profiles and clinical and biochemical presentations of the patients were determined, together with their subsequent management and outcomes. Use of the APACHE II score as a prognostic tool was evaluated, and the average enzyme inhibition levels demonstrated by the patients was assessed. Results The median age of the group was 30 years, with 68.2% being male. The most common clinical finding was pinpoint pupils (96.1%) followed by a Glasgow Coma Score <13 (85.3%), fasciculations (60.5%), diarrhoea (37.2%) and seizures (10.1%). Admissions to the HCA (52.7%) predominated, with the majority of patients requiring ventilator support (99.2%). The mean (SD) duration of stay was 6.8 days for ICU (6.4) and 3.7 days for HCA (5.2). The overall mortality rate was 5.4%. Standard treatment was intravenous atropine. Blood results reflected low levels of acetylcholinesterase enzyme activity. The APACHE II score was underutilised. Conclusion The findings of the study underscore the frequent use of organophosphate compounds in our area. Further studies across the country will help to highlight the magnitude of the consequences of organophosphate poisoning, as well as the burden imposed on limited healthcare resources.

Intravenous dexamethasone combined with intrathecal atropine to prevent morphine-related nausea and vomiting after cesarean delivery: A randomized double-blinded study

ABSTRACTBackground: Intrathecal morphine can be considered as a gold standard for analgesia following cesarean section (CS), which is not devoid of complications namely postoperative nausea and vomiting. We evaluated the antiemetic effect of intravenous dexamethasone combined with intrathecal atropine after CS.Methods: 120 parturient undergoing elective CS under spinal anesthesia were randomized into three groups. Dexamethasone group (D): Received intrathecal hyperbaric bupivacaine (0.5% in 2 ml) mixed with morphine (200 µg in 0.5 ml) and normal saline (0.5 ml as placebo) and intravenous (iv) dexamethasone (8 mg in 2 ml). Atropine group (A): Received hyperbaric bupivacaine (0.5% in 2 ml) mixed with morphine (200 µg in 0.5 ml) and atropine (100 µg in 0.5 ml), in addition to iv normal saline (2 ml as placebo). Dexamethasone and Atropine group (DA): Received intrathecally as group A, and iv dexamethasone (8 mg in 2 ml). Follow-up of both nausea and vomiting was done during the first 24 hours postoperatively.Results: Nausea was noticed in 7 patients (17.5%) in group D, 8 patients (20%) in group A, and one patient (2.5%) group DA, with significant differences between DA and D (p = 0.025) and DA and A (p = 0.013). Regarding vomiting, there were 5 patients (12.5%) in group D, 4 patients (10%) in group A only, with significant differences between DA and D (p = 0.021) and DA and A (p = 0.041).Conclusions: Combination of intravenous dexamethasone and intrathecal atropine has additive antiemetic effect after spinal anesthesia for cesarean delivery using bupivacaine and morphine.

The Effect of Retrobulbar Block and Intravenous Atropine on Oculocardiac Reflex in Vitreoretinal Surgery

Background: Cardiac parasympathetic stimulation due to manipulation or stimulation of ocular structures that leads to sinus bradycardia, atrioventricular block or even asystole is called oculocardiac reflex. Objectives: This study aimed at comparing two anesthetic techniques (i.e., retrobulbar block and intravenous atropine for oculocardiac reflex prevention in vitreoretinal surgery). Methods: Patients undergoing vitreousandretinal surgery wererandomlyselected as a source of sampling during six months, from September 2017 to February 2018. All the patients enrolled in the study after the inclusion and exclusion criteria were assigned and after getting informed consent. A total of 124 patients were evaluated and compared in two groups, each consisting of 62 patients (retrobulbar block and intravenous atropine). Results: Essentially, there were no demonstrated differences between groups in regards to patient demographics or basic heart rate (HR). Among the patients, there was not any oculocardiac reflex (OCR) in the retrobulbar block group; however, in the atropine group, two patients (3.2%) hadOCR, and in contrast, 60 patients (96.8%) had no reflex. There was no statistically significant difference between two groups in OCR occurrence (P = 0.496). Conclusions: In a general conclusion, there was no difference between the two methods (i.e., retrobulbar block anesthesia and intravenous atropine) in the prevention of OCR. However, based on the results, it is believed that the retrobulbar block is associated with more stable HR and lower frequency of OCR in vitreoretinal surgery.

Successful Treatment of Neonatal Pylorospasm with Intravenous Atropine

Successful Treatment of Neonatal Pylorospasm with Intravenous Atropine

Ketamine versus in total intravenous anesthetic management of children undergoing strabismus surgery: a prospective randomized controlled study

Background Strabismus is a malalignment of the visual axes. Manipulation of the globe and traction on the extraocular muscle can elicit oculocardiac reflex (OCR). Propofol anesthesia is associated with rapid induction and recovery with minimal postoperative confusion, while ketamine anesthesia is associated with less hemodynamic changes. Thus both are preferred for anesthesia of strabismus surgery in pediatric patients. Aim The aim of this work was to compare total intravenous anesthesia (TIVA) with ketamine versus propofol in the anesthetic management of children undergoing strabismus surgery. Patients and methods This study had been carried out on 50 children with ASA I scheduled for strabismus surgery. Patients were randomized into two equal groups (25 patients in each group). Group K: received TIVA with ketamine; group P: TIVA with propofol. Heart rate and mean arterial pressure, incidence of OCR, number of patients who needed intravenous atropine, recovery time, postoperative nausea and vomiting (PONV), evaluation of postoperative pain and finally the satisfaction score of the surgeon were recorded. Results Heart rate and the incidence of PONV showed a significant decrease in group P in comparison with group K. Incidence of OCR, the need for usage of atropine and the severity of postoperative pain in group P was higher in comparison with group K. There were no significant differences between the two groups regarding satisfaction score of the surgeon Conclusion TIVA with ketamine showed significant decrease in postoperative pain and incidence of OCR owing to its hemodynamic stability in comparison with propofol, which showed more rapid onset of action with rapid recovery and decreased incidence of PONV.

GABAPENTIN

Introduction: There have been several methods used to prevent or attenuate the adverse hemodynamic changes following endotracheal intubation, but not many studies have been done for the same purpose in patients undergoing nasotracheal intubation. Deepening of anaesthesia, omitting cholinergic premedication, pre-treatment with vasodilators such as nitroglycerine, beta blockers, calcium channel blockers and opioids are few of the different techniques used when trachea is intubated orally or nasally, to blunt significant swings in hemodynamic parameters. We assessed the effectiveness of oral gabapentin to determine changes in hemodynamic response in normotensive patients following nasotracheal intubationwith or without laryngoscopy for elective maxillofacial surgeries. Study Design: Randomized double blind, placebo-controlled clinical trial. Setting: Department of Anesthesia &amp; Intensive Care, Fauji Foundation Hospital Rawalpindi. Period: 18 months after approval from the ethical committee. Material &amp; Methods: Total 130 patients were included in the study. These patients were randomly divided into 2 groups. In Group-A patients were given 800 mg gabapentin and in Group-B patients were given placebo. Heart rate and mean arterial pressures were recorded just before intubation as base line values, and then average readings were taken at 1 minute, 3 minutes, 5 minutes and 10 minutes after intubation. Bradycardia and hypotension were adequately treated with intravenous atropine and vasopressors. Data entry and analysis was done by using SPSS 17. Results: Total 130 patients who underwent elective surgeries were included in the study and divided into 2 groups each group containing 65 patients each. At 1st minute MAP in Group-A (oral gabapentin) and in Group-B (Placebo) was 86.89±4.36 and 98.70±4.39. At 3rd minute MAP in Group-A, in Group-B was 83.40±4.05 and 92.93±4.79. At 5th minute MAP was 82.50±5.00 and 88.03±4.22 and lastly at 10th minute MAP was 79.81±5.37 in Group-A and 83.18±4.77 in Group-B respectively. P-value at 1st, 3rd, 5th and at 10th minutes showed that statistically MAP was different in both treatment groups at the above mentioned time intervals. 1st minute: p-value=0.042, 3rd minute: p-value=0.000, 5th minute: p-value=0.000 and at 10th minute: p-value=0.000. At 1st minute heart rate in Group-A and Group-B was 87.89±1.39 and 93.47±6.88 respectively. At 3rd minute heart rate in Group-A and Group-B was 83.47±5.47 and 89.70±6.76. At 5th minute heart rate was 82.10±5.01 and 84.60±5.91 and lastly at 10th minute heart rate was 78.09±6.79 in Group-A and 77.27±5.34 in Group-B respectively. P -value at 1st, 3rd and 5th minutes showed that statistically heart rate was different in both treatment groups at the above mentioned time intervals. But at 10th minute heart rate was statistically same in both treatment groups. 1st minute: p-value=0.144, 3rd minute: p-value=0.000, 5th minute: p-value=0.011 and at 10th minute: p-value=0.448. Conclusion: According to the results of this study it was observed that oral gabapentin is effective in modifying hemodynamic response to nasotracheal intubation in normotensive patients undergoing elective maxillofacial surgeries. MAP (10th Minute: Group-A vs. Group-B: 0.000) &amp; Heart Rate (10th Minute: Group-A vs. Group-B:0.448)

Dexmedetomidine attenuates the positive chronotropic effects of intravenous atropine in patients with bradycardia during spinal anaesthesia: a retrospective study

IntroductionDexmedetomidine is a sedative used during spinal anaesthesia. However, it frequently induces bradycardia. Although intravenous atropine is often used for treating bradycardia during regional anaesthesia, the response to atropine might be attenuated by concomitantly administering sedatives. MethodsWe examined the effects of atropine used for treating bradycardia during spinal anaesthesia among patients receiving dexmedetomidine (D group), propofol (P group), or neither (nonDnonP group) for sedation, retrospectively.ResultsA total of 108 patients were included. Heart rate was significantly slower at all time points in the D group (n = 69) than in the nonDnonP group (n = 14) (p < 0.025 for all). On the other hand, heart rate was significantly slower only 60 min after administration of atropine in the P group (n = 25) than in the nonDnonP group (p = 0.002). There were differences in the overall values of heart rate (including all the values from time 0 to 60 min) among the three groups (p = 0.026).ConclusionsThe positive chronotropic effects of atropine might be attenuated with the use of dexmedetomidine or propofol during spinal anaesthesia. Although atropine may be administered when bradycardia occurs, a dose of atropine might result in an insufficient effect against the bradycardia. The sufficient number of subjects may change the results of the investigation, and large-scale randomised controlled trials will be necessary.

Hypertrophic pyloric stenosis treated with co-administration of nitroglycerin and atropine sulfate

Abstract Hypertrophic pyloric stenosis (HPS) is a common infantile disease that causes a transit pyloric disorder. For the treatment of this disorder, intravenous atropine sulfate (AS) has been reported to be effective. However, AS treatment is ineffective in some cases, and these cases require surgical treatment. Recently, it has been reported that the co-administration of nitroglycerin (NTG) and AS is more effective than the administration of AS alone. Herein, we present two cases of infants with HPS treated using percutaneous NTG along with intravenous AS. Both cases were refractory to intravenous AS alone. After additional administrations of percutaneous NTG, their vomiting was rapidly resolved. These cases highlight the effectiveness of the co-administration of NTG and AS for HPS.

Hypertrophic pyloric stenosis following persistent pulmonary hypertension of the newborn: a case report and literature review

BackgroundAlthough persistent pulmonary hypertension of the newborn (PPHN) and infantile hypertrophic pyloric stenosis (HPS) are both well-known diseases that occur in early infancy, PPHN complicated by HPS is rare. As nitric oxide (NO) is an important mediator of biological functions, on both the vascular endothelium and smooth muscle cells, the decreased production of NO might play a role in the pathogenesis of both PPHN and HPS. We present the case of a neonate who developed HPS following PPHN, including a detailed review on research published to date, and we discuss the pathogenesis of PPHN and HPS.Case presentationA female neonate born at 38 weeks of gestation, weighing 3140 g, developed PPHN due to meconium aspiration syndrome. Intensive treatment with high frequency oscillations and inhaled NO were initiated, and sildenafil and bosentan were added. She gradually recovered. At 15 days of age, the patient developed recurrent vomiting after feeding and the diagnosis of HPS was made. Intravenous atropine therapy was started at 20 days of age, but the efficacy was clinically unsatisfactory. The coadministration with transdermal nitroglycerin improved the symptoms, and oral feeding was successfully re-introduced.ConclusionsOur patient recovered from both PPHN and HPS using NO-related medications. A decrease in NO synthesis is likely to be a common pathway for PPHN and HPS.

A pharmacological challenge predicts reversible rectal sensorimotor dysfunctions in women with fecal incontinence.

In order to understand the pathophysiology of rectal sensorimotor dysfunctions in women with fecal incontinence (FI) and rectal urgency, we evaluated the effects of a muscarinic antagonist and an adrenergic α2 agonist on these parameters. Firstly, rectal distensibility and sensation were evaluated with a barostat and sinusoidal oscillation at baseline and after randomization to intravenous saline or atropine in 16 healthy controls and 44 FI patients. Thereafter, FI patients were randomized to placebo or clonidine for 4wk; rectal compliance and sensation were revaluated thereafter. The effect of atropine and clonidine on rectal functions and the relationship between them were evaluated. At baseline, compared to controls, rectal capacity was lower (P=.03) while the mean pressure (P=.02) and elastance (P=.01) during sinusoidal oscillation were greater, signifying reduced distensibility, in FI. Compared to placebo, atropine increased (P≤.02) the heart rate in controls and FI and reduced (P=.03) the variability in rectal pressures during sinusoidal oscillation in controls. Clonidine increased rectal compliance (P=.04) and reduced rectal capacity (P=.03) in FI. The effects of atropine and clonidine on compliance (r=.44, P=.003), capacity (r=.34, P=.02), pressures during sinusoidal oscillation (r=.3, P=.057), pressure (r=.6, P<.0001), and volume sensory thresholds (r=.48, P=.003) were correlated. The effects of atropine and clonidine on rectal distensibility and sensation were significantly correlated. A preserved response to atropine suggests that reduced rectal distensibility is partly reversible, mediated by cholinergic mechanisms, and may predict the response to clonidine, providing a pharmacological challenge.