Mean Arterial Pressure Score Research Articles

Metabolic score and its components are associated with carotid plaque prevalence in young adults.

No study has comprehensively assessed the relationship of metabolic factors including insulin resistance, hypertension, hyperuricemia, and hypercholesterolemia with the development of carotid plaque. Therefore, we constructed metabolic scores based on the above metabolic factors and examined its association with carotid plaque in young and older Chinese adults. This study included 17,396 participants who underwent carotid ultrasound examinations, including 14,173 young adults (<65 years) and 3,223 older adults (≥65 years). Individual metabolic score was calculated using triglyceride-glucose (TyG) index, mean arterial pressure (MAP), uric acid, and total cholesterol (TC). Logistic regression models were conducted to examine the role of metabolic score and its components in the prevalence of carotid plaque. The nonlinear relationship was examined using restricted cubic spline regression. Meanwhile, subgroup, interaction, and sensitivity analyses were conducted. The multivariate logistic regression analysis showed that TyG (OR: 1.088; 95%CI: 1.046-1.132), MAP (OR: 1.121; 95%CI: 1.077-1.168), TC (OR: 1.137; 95%CI: 1.094-1.182) and metabolic score (OR: 1.064; 95%CI: 1.046-1.082) were associated with carotid plaque prevalence in young adults rather than older adults. The nonlinear association was not observed for metabolic scores and carotid plaque. Subgroup analyses showed significant associations between metabolic scores and carotid plaque prevalence in men, women, normal-weight, and overweight young adults. No interaction of metabolic score with sex and BMI were observed. The results support that control of TyG, MAP, TC, and metabolic scores is a key point in preventing the prevalence of carotid plaque in the young adults.

Plasma Copper and Metabolic Syndrome in Mesoamerican Children and Their Parents.

The role of copper in the etiology of metabolic syndrome (MetS) is uncertain. We evaluated associations of plasma copper concentrations with MetS and its components in a cross-sectional study of 198 children ages 7-12 years and 378 adult parents from eight Mesoamerican countries. In children, the outcome was a metabolic risk score based on waist circumference, insulin resistance, mean arterial pressure (MAP), and blood lipids. In adults, we defined MetS per Adult Treatment Panel III criteria. Plasma copper was not significantly related to MetS in children or adults; however, children with copper above the median had a MAP score 0.04 (95% CI, 0.002, 0.08; P = 0.04) adjusted units higher and a HDL-cholesterol score 0.07 (95% CI, - 0.13, - 0.003; P = 0.04) adjusted units lower than those with lower copper concentrations. In adults, copper was positively related to abdominal obesity. Longitudinal studies to confirm the deleterious role of copper on MetS components are warranted.

Efficacy of Combined Epidural-General Anaesthesia [CEGA] in Attenuating Hemodynamic Responses to Pneumoperitoneum in Laparoscopic Cholecystectomies: A Prospective Randomised Study

Background: Pnuemoperitonium in laparoscopy is associated with cardiorespiratory changes. Combination of epidural with General anaesthesia (GA) will offer benefit of hemodynamic control and perioperative analgesia. We aimed to study the efficacy of Combined Epidural- General Anaesthesia (CEGA) with pre-emptive activation over general anaesthesia in laparoscopic cholecystectomies.&#x0D; Methods: In this prospective double blind –randomised study, 90 surgical inpatients were studied in two study groups. Group GE-(n=45) received Lumbar Epidural analgesia with ropivacaine 0.2% along with GA and Group G (n=45) received only GA. Heart rate (HR), Mean arterial Pressure (MAP), systolic blood pressure (SBP), diastolic blood pressure (DBP), Capnogram (ETCO2), saturation (spo2), VAS score, Ramsay sedation score, requirement of propofol, muscle relaxants and analgesics were studied.&#x0D; Results: Statistical analysis was carried out with SPSS version 20. Statistical value of p&lt;0.05 was considered significant. We noted significant difference in MAP, SBP, DBP, muscle relaxants, Propofol, Fentanyl and lesser pain scores in Group GE than Group G i.e (p&lt;0.001).&#x0D; Conclusion: Combination of epidural and general anaesthesia technique with pre emptive activation has the benefit of better control of hemodynamics .It reduced requirements of analgesics and anaesthetic drugs and had faster recovery with less post operative pain in laparoscopic cholecystectomies.

The effect of laughter yoga applied before simulation training on state anxiety, perceived stress levels, self-confidence and satisfaction in undergraduate nursing students: A pragmatic randomized controlled trial

AimThis study aimed to examine the effect of laughter yoga applied before simulation training on state anxiety, perceived stress levels, self-confidence and satisfaction in undergraduate nursing students. BackgroundClinical simulation-based teaching implied a revolution in nursing education. Along with the many opportunities that simulation offers, some disadvantages, such as anxiety and stress experienced during simulation scenarios, could affect students’ satisfaction and self-confidence in learning. Therefore, laughter yoga could be an alternative method that reduces students' anxiety and stress levels and increases their self-confidence and satisfaction with simulation training. DesignThe study was designed as a pragmatic randomized controlled trial. SettingThis study was conducted at a university in Turkey. ParticipantsA total of 88 undergraduate nursing students were randomized to the intervention group (n = 44) or control group (n = 44). MethodsThe intervention group participated in the laughter yoga sessions just before the clinical simulation scenario, while the control group only performed the simulation training. The researchers examined the effect of laughter yoga on state anxiety, perceived stress levels, self-confidence and satisfaction in learning before and after the intervention. Data were collected between January - February 2022. ResultsThis study showed that the mean scores of state anxiety, perceived stress, mean pulse rate and arterial pressure of the intervention group were significantly lower than those of the control group (p < 0.05). In addition, there was also a significant group*time interaction between the groups on state anxiety, perceived stress, pulse, respiratory and mean arterial pressure scores (p < 0.05). Moreover, the mean scores of student satisfaction and self-confidence in the learning of the intervention group were significantly higher than those of the control group (p < 0.05). ConclusionThe findings showed that laughter yoga helped nursing students reduce their state anxiety and perceived stress levels related to simulation training and improved their self-confidence and satisfaction with learning. Additionally, it enhanced the students' vital signs (including mean pulse rate and mean arterial pressure). These positive results are promising for using LY as an easy, safe and effective method to reduce undergraduate nursing students’ stress and anxiety levels and to improve their learning satisfaction and self-confidence levels in clinical skills training such as simulation training.

Intravenous Versus Wetting Solution Magnesium Sulphate to Counteract Epinephrine Cardiac Adverse Events in Abdominal Liposuction: A Randomized Controlled Trial.

The increased frequency of liposuction has resulted in more complications being reported. Adding epinephrine to the wetting solution could induce some cardiac adverse effects, some of which may be fatal. For instance, magnesium sulfate (MgSO4) is known for its cardioprotective effects. This study aimed to evaluate the efficacy of intravenous (IV) versus wetting solution containing MgSO4 in decreasing such cardiac adverse events during abdominal liposuction. This randomized controlled study included 129 adult cases undergoing abdominal liposuction under general anesthesia. The participants were divided into 3 groups: Group I (control group) was only subjected to the injection of the wetting fluid (1 mL 1/1000 epinephrine added to every 1000 mL of normal saline), group II was subjected to IV MgSO4 (40 mg/kg over 1 minute) at the same time of installing the wetting solution, and group III was subjected to MgSO4 (40 mg/kg) added to the wetting solution. Intraoperative isoflurane consumption, intraoperative heart rate (HR), mean arterial pressure (MAP), and postoperative pain scores were significantly lower in the MgSO4 groups (groups II and III) than group I. Cardiac adverse events (sinus tachycardia and premature ventricular contractions (PVCs)) were also significantly less frequent in groups II and III compared to group I. Adding MgSO4, either through IV or subcutaneous routes, is associated with lower intraoperative HR, MAP, and postoperative pain scores and a remarkable decrease in epinephrine-induced cardiac adverse events during liposuction.

A randomized-controlled trial comparing 20% albumin to plasmalyte in patients with cirrhosis and sepsis-induced hypotension [ALPS trial

The choice of resuscitation fluid in patients with cirrhosis and sepsis-induced hypotension is unclear. 5% albumin was superior to normal saline in the FRISC study. We compared the efficacy and safety of 20% albumin, which has greater oncotic properties, to plasmalyte in reversing sepsis-induced hypotension. Critically ill patients with cirrhosis underwent open-label randomization to receive either 20% albumin (0.5-1.0g/kg over 3 hours; n= 50) or plasmalyte (30ml/kg over 3 hours, n= 50). The primary endpoint of the study was the attainment of mean arterial pressure (MAP) above 65mmHg at 3 hours. Baseline characteristics were comparable in albumin and plasmalyte groups; arterial lactate (6.16±3.18mmol/L vs. 6.38±4.77mmol/L; p= 0.78), MAP (51.4±6.52mmHg vs. 49.9±4.45mmHg; p= 0.17) and SOFA score (10.8±2.96 vs. 11.1±4.2; p= 0.68), respectively. Most patients were alcoholics (39%) and had pneumonia (40%). In the intention-to-treat analysis, albumin was superior to plasmalyte in achieving the primary endpoint (62% vs. 22%; p <0.001). A faster decline in arterial lactate (p= 0.03), a reduced need for dialysis (48% vs. 62%; p= 0.16), and a longer time to initiation of dialysis (in hours) (68.13±47.79 vs. 99.7± 63.4; p= 0.06) were seen with albumin. However, the 28-day mortality rate was not different (58% vs. 62%, p= 0.57) and treatment had to be discontinued in 11 (22%) patients in the albumin group due to adverse effects compared to no discontinuations in the plasmalyte group. In patients with cirrhosis and sepsis-induced hypotension, 20% albumin leads to a faster improvement in hemodynamics and lactate clearance than plasmalyte, while 28-day survival was similar. However, patients on 20% albumin need to be closely monitored as it was more often associated with pulmonary complications. NCT02721238. The current randomized-controlled trial performed in critically ill patients with cirrhosis and sepsis-induced hypotension highlights that 20% albumin restores arterial pressure more quickly but causes more pulmonary complications than plasmalyte. The impact on renal functions was also modest. These effects did not result in improvement in survival at 28 days. Plasmalyte is safer and well-tolerated and can be considered for volume resuscitation in patients with cirrhosis and sepsis-induced hypotension.

Effects of Multimodal Analgesia Combined with Auricular Point Therapy on Physical and Mental Stress and Rehabilitation Quality of Patients with Meniscus Injury during the Perioperative Period.

Objective To investigate the effect of multimodal analgesia combined with auricular point therapy on physical and mental stress and rehabilitation quality of patients with meniscus injury during the perioperative period. Methods 148 patients in our hospital from October 2019 to October 2021 who were scheduled to undergo meniscus surgery were selected and grouped according to the order of file establishment, with 74 cases in each. The control group was given routine analgesia, and the observation group was given multimodal analgesia combined with auricular point therapy. The pain level (visual analogue scale (VAS)), physical and mental stress (heart rate (HR), mean arterial pressure (MAP), depression scale (PHQ-9), and anxiety scale (GAD-7)), complications, rehabilitation quality, and analgesia satisfaction were observed. Results The VAS scores of pain in the observation group were lower than those in the control group at 6 hours before operation and at 6 hours, 24 hours, and 72 hours after operation (P < 0.05). The MAP, HR, PHQ-9, and GAD-7 scores of the observation group were lower than those of the control group 6 hours before operation (P < 0.05). There was no significant difference in MAP, HR, PHQ-9, and GAD-7 scores between the two groups at 6 hours and 24 hours after operation (P > 0.05). The analgesic satisfaction of the observation group was better than that of the control group (P < 0.05). The incidence of complications in the observation group was 8.11% compared with 12.16% in the control group, which was not statistically significant (P > 0.05). The first exhaust, getting out of bed, and hospital stay in the observation group were shorter than those in the control group (P < 0.05). Conclusion Multimodal analgesia combined with auricular acupuncture therapy is effective in perioperative patients with meniscus injury. It can reduce perioperative pain, reduce physical and mental stress, and promote early postoperative recovery through a variety of analgesic mechanisms.

Effect of Preventive Analgesia with Nalbuphine and Dexmedetomidine in Endoscopic Sinus Surgery.

Background The study was to assess the efficacy and safety of nalbuphine combined with dexmedetomidine for preventive analgesia in endoscopic sinus surgery. Methods 110 patients with deviation of the nasal septum were randomized into the nalbuphine group (group N), dexmedetomidine combined with nalbuphine group (group DN), and saline group (group C). Fifteen minutes before the induction of anesthesia, patients in group N were injected nalbuphine 0.2 mg/kg intravenously; patients in group DN received intravenous infusion of dexmedetomidine 0.5 μg/kg and injection of nalbuphine 0.2 mg/kg; patients in group C received 0.9% saline. Mean arterial pressure (MAP), heart rate (HR), numerical rating scale (NRS) scores, quality of recovery-40 (QoR-40) scores, the need for remedial analgesia, the consumption of remifentanil and propofol, and the incidence of adverse reactions were recorded. Results MAP, HR, and NRS scores of the DN group were significantly lower and the QoR-40 scores were higher than those of groups N and C (P < 0.001). The need for remedial analgesia, the consumption of remifentanil and propofol, and the incidence of nausea in the DN group were the lowest among the three groups (P < 0.001). Conclusion Preventive analgesia with nalbuphine and dexmedetomidine in endoscopic sinus surgery can not only maintain hemodynamic stability but also reduce intraoperative anesthetic dosage, postoperative pain, and improve the quality of postoperative recovery without affecting the revival and extubation time.

Application effects of remimazolam and propofol on elderly patients undergoing hip replacement

ObjectiveTo explore the anesthetic and analgesic effects of remimazolam and propofol in elderly patients undergoing hip replacement and their effects on respiratory and circulatory systems, stress and cognitive function.MethodsSixty elderly patients undergoing elective hip replacement in the hospital were selected as the research subjects, and they were divided into the remimazolam group and the propofol group according to the admission sequence of patients. The remimazolam group was anesthetized with remimazolam, and the propofol group was anesthetized with propofol. The anesthesia-related indicators, perioperative pain degree [Visual Analogue Scale (VAS)], circulatory indicators [heart rate, mean arterial pressure (MAP)] before anesthesia (T0), immediately before laryngeal mask insertion (T1), at 5 min after laryngeal mask insertion (T2), at 30 min after laryngeal mask insertion (T3) and at 5 min after laryngeal mask removal (T4), stress response indicators (plasma epinephrine, norepinephrine, cortisol) before anesthesia induction and at 24 h and 72 h after surgery, cognitive function [Mini-Mental State Examination (MMSE)] and adverse reactions were compared between the two groups.ResultsAmong the 60 enrolled patients, only 1 case was excluded due to withdrawal, thus 30 cases in the remimazolam group and 29 cases in the propofol group were included. There were statistically significant differences in the heart rate, MAP, plasma epinephrine, norepinephrine, cortisol and VAS score in the two groups from the aspects of interaction effect and time-point effect (P < 0.05). The heart rate and MAP at T1, T2 and T3 in the two groups were significantly decreased compared with those at T0, but the heart rate and MAP in the remimazolam group at T1, T2 and T3 were significantly higher than those in the propofol group (P < 0.05). There were no statistical differences in the anesthesia time, awakening time and extubation time between the remimazolam group and the propofol group (P > 0.05). The levels of plasma epinephrine, norepinephrine and cortisol in the two groups were significantly higher at 24 h and 72 h after surgery than those before anesthesia induction, and the above levels were significantly lower in the remimazolam group than those in the propofol group (P < 0.05). The VAS scores at each time point in the two groups were significantly reduced compared to before surgery, but there was no statistically significant difference between the two groups after surgery (P > 0.05). The MMSE scores of the two groups were significantly lower at 1 d and 3 d after surgery compared with those before anesthesia induction, but the score in the remimazolam group was significantly higher than that in the propofol group (P < 0.05). In addition, the incidence rates of adverse reactions were significantly lower in the remimazolam group compared to the propofol group (P < 0.05).ConclusionCompared with propofol, remimazolam can achieve equivalent anesthetic and analgesic effects in elderly patients undergoing hip replacement. However, the latter one can significantly relieve respiratory and circulatory suppression, stress response and cognitive dysfunction, with good safety.Trial registrationThis single-center, prospective, RCT has completed the registration of the Chinese Clinical Trial Center at 31/12/2021 with the registration number ChiCTR2100055039.

Comparison of Controlled Hypotension Due to the Use of Dexmedetomidine, Magnesium Sulfate, and Esmolol in Craniotomy Surgery

Introduction: Craniotomy includes the temporary removal of bone flap from calvarium to access the intracranial contents, which is usually used to reduce intracranial pressure. Induced or controlled hypotension is a method by which arterial blood pressure is predictably reduced, thus reducing bleeding. Therefore, the present study aimed to compare the dexmedetomidine, magnesium sulfate, and esmolol in controlled hypotension in craniotomy of patients with brain injury. Materials and methods: In this randomized double-blind clinical trial, 45 patients entered into study based on inclusion criteria. All patients were monitored when entering operating room. The questionnaire was completed by all groups, in which PR, MAP (Mean Arterial Pressure), mean bleeding score, mean of received packed cells, controlled hypotension and bradycardia, and survival of patients were recorded. Data were analyzed using spss software version 19, and ANOVA and T-Test were used for statistical significance analysis. Results: The mean age and standard deviations of the three groups of dexmedetomidine, esmolol and magnesium sulfate were 36.78±10.32, 34.47±10.58, and 39.67±11.99 years, respectively. There was no significant difference between the three groups in terms of age, gender, initial heart rate and baseline blood pressure (BP). The MAP and bleeding score (P=0.04 and P=0.0001) was significantly lower in the dexmedetomidine group than in the other two groups. Although the heart rate in the esmolol group was lower than the other two groups, the difference was not significant (P = 0.128). Unlike esmolol and magnesium sulfate groups, GOS did not decrease in the dexmedetomidine group. Conclusion: Comparison of the three groups in controlled hypotension in craniotomy surgery showed that the MAP and bleeding score of dexmedetomidine group was significantly lower than the other two groups, and the GOS didn’t decrease in this group. In general, dexmedetomidine would be a better choice for controlled hypotension in craniotomy.

Hemodynamics Changes in the Phase Before, During, and After Sleep Based on Patients’ Sleep Quality in High Care Unit

BACKGROUND: Sleep is a human physiological need that must be fulfilled. Sleep disturbance is generally experienced by hospitalized patients and measured by sleep quality. Sleep disturbance can adversely affect hemodynamic parameters, physiological, and psychological outcome that contribute to the healing of patients. However, few literatures discussing the hemodynamic changes based on the patients’ sleep quality. AIM: The study aimed to describe the hemodynamic changes before, during, and after sleeping phases METHODS: This is an observational analytic quantitative study conducted between February and March 2019 and involved 45 patients. The samples were the conscious patients, aged between 18 and 60 years old (adult) and had been hospitalized for more than 2 days. The Richards-Campbell Sleep Questionnaire was utilized to measure the patients sleep quality, while hemodynamic values were observed by patients’ bedside monitor before, during and after sleep. Data analysis used the Friedman test to determine hemodynamic changes. RESULTS: The results showed that most respondents were female (75.6%), used oxygen (46.7%), sleep in supine position (55.6%), and average age of 35.47 (standard deviation [SD] = 9.581) years old. Patients’ sleep quality score was 44.27 (SD = 22.809), with the average days of treatment were 2.47 days (SD = 694). The average score of Hemodynamic Mean Arterial Pressure (MAP), Heart Rate (HR), and Oxygen saturation (SpO2) before sleeping was 97.64, 94.04, and 94.09, during sleeping was 89.87, 85.00, and 91.22 while after sleeping was 98.27, 97.56, and 97.89, respectively. There was a significant change in HR with p = 0.019, and there was no significant change in the MAP (p = 0.152) and SpO2 (p = 0.149) CONCLUSION: There were variations in hemodynamic score changes before, during, and after sleep, changes in MAP, HR, and SpO2 score within normal ranges. The high hemodynamic changes in the early phase, decrease during sleep, and rise again after sleep. HR is a hemodynamic parameter that significantly changes in those three phases. Monitoring of hemodynamic values in patients could be carried out in the before, during, and after sleep phases to determine the patients’ physiological and psychological condition so as to contribute the healing process.

Novel Use of a Disposable Vascular Pressure Device for Arterial Pressure Monitoring in Prehospital Critical Care

Introduction Arterial catheterization is a commonly performed procedure in intensive care units (ICUs) to guide the management of critically ill patients who require precise hemodynamic monitoring however this technology is not available in the prehospital setting due to cumbersome and expensive equipment requirements. We compared the accuracy and reliability of a disposable vascular pressure device (DVPD) to the “gold standard”, transducer-pressure bag invasive arterial monitoring system used in intensive care units to determine if the DVPD can be reliably used in place of the traditional pressure transducer set-up. Methods This study was a single-center, prospective, observational study performed in the adult ICUs of a large academic, university hospital. A convenience cohort of hemodynamically stable, adult critically ill patients with femoral, brachial or radial arterial catheters was recruited for this study. The Compass Pressure device is a disposable vascular pressure-sensing device used to assure venous access versus inadvertent arterial access during central line placement. The device is produced by Centurion Medical Products. The DVPD was attached to an in-situ arterial catheter and measures the mean intravascular pressure via an embedded sensor and displays the pressure via the integrated LCD screen. Using a three-way stopcock, the DVPD was compared to a standard arterial set-up. We compared the mean arterial pressure (MAP) in the standard setup to the DVPD using Bland Altman plots and methods that accounted for repeated measures in the same subject. Results Data was collected on 14 of the 15 subjects enrolled (DVPD malfunctioned on one subject). Five measurements were obtained on each patient comparing DVPD to standard arterial set-up at one-minute intervals over the course of five minutes. A total of 70 observations were made. Among the 15 subjects, most (10 (67%)) were radial or brachial sites. The average MAP scores and standard deviation values (SD) obtained by the standard set up were 83.5 mmHg (14.8) and 81.1 mmHg (19.3) by the DVPD. Just over half (51.4%) of measurements were within +/-5 mmHg difference. Using Bland Altman plotting methods, standard arterial measurements were 2.4 mmHg higher (95% confidence interval: 0.60, 4.1) than the DVPD. Differences between the two devices varied significantly across MAP values. The standard arterial line measurements were significantly higher than the DAPD at low MAP values, whereas at the DAPD was measurements were significant higher at high MAP values. Conclusions The DVPD provides an acceptable estimate of mean arterial pressure and may be suitable for arterial pressure monitoring in settings where standard monitoring set-ups are not available. The DVPD appears to provide “worst case” values as it underestimates low arterial BP and overestimates high arterial BP. Future trials should investigate the DVPD in hypotensive patients and patients with laminar flow/low pulsitility, such as ventricular assist devices and extracorporeal membrane oxygenation (ECMO).. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14

Accuracy and Reliability of a Disposable Vascular Pressure Device for Arterial Pressure Monitoring in Critical Care Transport

ObjectiveArterial catheterization is a commonly performed procedure in intensive care units to guide the management of critically ill patients who require precise hemodynamic monitoring; however, this technology is not always available in the transport setting because of cumbersome and expensive equipment requirements. We compared the accuracy and reliability of a disposable vascular pressure device (DVPD) with the gold standard (ie, the transducer pressure bag invasive arterial monitoring system) used in intensive care units to determine if the DVPD can be reliably used in place of the traditional pressure transducer setup. MethodsThis study was a single-center, prospective, observational study performed in the adult intensive care unit of a large academic university hospital. A convenience cohort of hemodynamically stable, adult critically ill patients with femoral, brachial, or radial arterial catheters was recruited for this study. The Compass pressure device (Centurion Medical Products, Williamston, MI) is a disposable vascular pressure-sensing device used to assure venous access versus inadvertent arterial access during central line placement. The DVPD was attached to an in situ arterial catheter and measures the mean intravascular pressure via an embedded sensor and displays the pressure via the integrated LCD screen. Using a 3-way stopcock, the DVPD was compared with the standard arterial setup. We compared the mean arterial pressure (MAP) in the standard setup with the DVPD using Bland-Altman plots and methods that accounted for repeated measures in the same subject. ResultsData were collected on 14 of the 15 subjects enrolled. Five measurements were obtained on each patient comparing the DVPD with the standard arterial setup at 1-minute intervals over the course of 5 minutes. A total of 70 observations were made. Among the 15 subjects, most (10 [67%]) were radial or brachial sites. The average MAP scores and standard deviation values obtained by the standard setup were 83.5 mm Hg (14.8) and 81.1 mm Hg (19.3) using the DVPD. Just over half (51.4%) of the measurements were within a ± 5–mm Hg difference. Using Bland-Altman plotting methods, standard arterial measurements were 2.4 mm Hg higher (95% confidence interval, 0.60-4.1) than with the DVPD. Differences between the 2 devices varied significantly across MAP values. The standard arterial line measurements were significantly higher than the DVPD at low MAP values, whereas the DVPD measurements were significantly higher than the standard arterial line at high MAP values. ConclusionThe DVPD provides a reasonable estimate of MAP and may be suitable for arterial pressure monitoring in settings where standard monitoring setups are not available. The DVPD appears to provide “worst-case” values because it underestimates low arterial blood pressure and overestimates high arterial blood pressure. Future trials should investigate the DVPD under different physiological conditions (eg, hypotensive patients, patients with ventricular assist devices, and patients on extracorporeal membrane oxygenation), different patient populations (such as pediatric patients), and in different environments (prehospital, air medical transport, and austere locations).

Impact of Pre-Emptive Intravenous Ibuprofen on Perioperative Analgesia in Patients Undergoing Third Molar Extraction: A Randomised Controlled Study

The aim of the present study was to evaluate the analgesic efficacy of pre-emptive intravenous (iv) ibuprofen on pain during and after the mandibular third molar surgery. A total of 60 patients were included in the study. They were allocated as ibuprofen 800 mg iv+dexketoprofen 50 mg (group 1), ibuprofen 800 mg iv alone (group 2) or placebo (group 3). A local anaesthetic infiltration was administered to all patients. In all patients, haemodynamic values (mean arterial pressure (MAP) and heart rate (HR)) were recorded preoperatively, and infusions were started. State-Trait Anxiety Inventory (STAI) scale was used to assess anxiety states. Surgery started 15 min after the infusion. Haemodynamic values and pain scores with visual analogue scale (VAS) were recorded. Pain scores were recorded postoperatively at rest (VASR) and swallowing (VASS). There was no significant difference in the preoperative STAI values between the groups (p>0.05). HR, MAP and VAS pain scores were significantly higher in group 3 than in groups 1 and 2 (p<0.05). VASR and VASS scores were significantly higher in group 3 than in group 1 in the first 4 h postoperatively (p<0.05). VASS scores were significantly higher in group 3 than in group 2 at 1-4 h postoperatively (p<0.05), but there was no difference in VASR and VASS scores at 48 h after surgery. Ibuprofen alone or in combination with dexketoprofen provided similar analgesia in the perioperative period when administered pre-emptively.

The influence of clinical variables on the risk of developing chronic conditions in ICU survivors

PurposeTo assess the association of clinical variables and the development of specified chronic conditions in ICU survivors. Materials and methodsA retrospective cohort study, combining a national health insurance claims database and a national quality registry for ICUs. Claims data from 2012 to 2014 were combined with clinical data of patients admitted to an ICU during 2013. To assess the association of clinical variables (ICU length of stay, mechanical ventilation, acute physiology score, reason for ICU admission, mean arterial pressure score and glucose score) and the development of chronic conditions (i.e. heart diseases, COPD or asthma, Diabetes mellitus type II, depression and kidney diseases), logistic regression was used. Results49,004 ICU patients were included. ICU length of stay was associated with the development of heart diseases, asthma or COPD and depression. The reason for ICU admission was an important risk factor for the development of all chronic conditions with adjusted ORs ranging from 2.05 (CI 1.56; 2.69) for kidney diseases to 5.14 (CI 3.99; 6.62) for depression. ConclusionsClinical variables, especially the reason for ICU admission, are associated with the development of chronic conditions after ICU discharge. Therefore, these clinical variables should be considered when organizing follow-up care for ICU survivors.

O-GlcNAc stimulation, a new hope for children in sepsis?

O-GlcNAc stimulation, a post-translational modification, at the early phase of septic shock has been shown to be a potent new therapeutic strategy for adult. Young population is particularly at risk of septic shock but is rarely studied. O-GlcNAc level are regulated by cell metabolism through the hexosamine biosynthetic pathway (HBP). Metabolism evolves throughout development with a potential impact on O-GlcNAc level, hence responses to O-GlcNAc stimulation could be different in young. To evaluate O-GlcNAc level from birth to adulthood in heart and evaluate if an increase in protein O-GlcNAcylation could improve sepsis outcomes in young. Hearts were harvested from Wistar rats at day 0 - D0 (newborn), D12, D28 (before/after weaning) and D84 (adulthood) to evaluate O-GlcNAc, GFAT (the rate limiting enzyme of HBP), OGA (O-GlcNAcase) and OGT (O-GlcNAc transferase) levels. To induce an endotoxemic shock, D28 rats received an I.V. LPS injection (O111:B4-20 mg.kg-1) and 1 h after, fluidotherapy (LPS + R) ± NButGT (NButGT-10 mg.kg-1). 2 h later, physiological function (arterial blood pressure, heart and respiratory rate) and plasmatic markers of severity were measured. O-GlcNAc level decreased from D0 to D84 (6 fold) along with GFAT (30 fold) and OGT (5 fold) while the OGA is absent at D0 and increase progressively. LPS induced an alteration of physiological parameters (mean arterial pressure (MAP): CTRL: 67,2 ± 1,9; LPS: 50,7 ± 2,1 mmHg; P < 0,05), biological parameters (lactates: CTRL: 3,92 ± 0,26; LPS: 6,42 ± 0,45 mmol.l-1; troponin: CTRL: 19,7 ± 4,0; LPS: 45,4 ± 11,4 ng.l-1; P < 0,05) and in adapted-PRISM Score. NButGT restored MAP (NButGT: 72.2 ± 4.0 mmHg; P < 0.05) and adapted-PRISM Score (NButGT: 9.7 ± 0.6; P < 0.05). Despite higher O-GlcNAc level in young population and that high O-GlcNAc level are commonly deleterious, an acute O-GlcNAc stimulation is beneficial and is a potential new therapeutic target for septic shock in young.

The influence of angiotensin I-converting enzyme (ACE) I/D gene polymorphism on cardiovascular and muscular adaptations following 8 weeks of isometric handgrip training (IHG) in untrained normotensive males.

We examined the association between the angiotensin I-converting enzyme (ACE) I/D gene polymorphism and isometric handgrip (IHG) training on cardiovascular and muscular responses among normotensive males. Thirty (II = 10, ID = 10, and DD = 10) normotensive untrained males underwent IHG training at 30% of their maximal voluntary contraction 3 days per week for 8 weeks. Cardiovascular and muscular variables were measured before IHG, after a session of IHG and after 8 weeks of IHG. No significant interaction effect was found between ACE I/D genotype and IHG training session on all dependent variables (all p > 0.05). There was a significant main effect of IHG training session on systolic blood pressure (SBP) (p = 0.002), mean arterial pressure (MAP) (p = 0.015) and handgrip strength (HGS) (p = 0.001) scores, while no difference in diastolic blood pressure (DBP), pulse pressure, or heart rate scores was found. A greater improvement in cardiovascular parameters following 8 weeks of IHG training was observed in participants with the D allele than the I allele (SBP reduction: ID+DD genotype group (-5.53 ± 6.2 mmHg) vs. II genotype group (-1.52 ± 5.3 mmHg)); MAP reduction: ID + DD genotype group (-2.80 ± 4.5 mmHg) vs. II genotype group (-1.45 ± 3.5 mmHg). Eight weeks of IHG training improved cardiovascular and muscular performances of normotensive men. Reduction in SBP and MAP scores in D allele carriers compared to I allele carriers indicates that the ACE I/D polymorphism may have an influence on IHG training adaptation in a normotensive population.

Contribution of Ultrasound-Guided Ilioinguinal/Iliohypogastric Block To Intraoperative Anesthesia In Children - Randomized Controlled Study

Objectives: The aim of this study was to investigate the effect of ilioinguinal/iliohypogastric nerve block (II/IH) only supported by ketamine sedation on intraoperative anesthesia and analgesia. Methods: A total of 60 patients aged between 2 and 6 years, were included in the study. The patients were divided into three groups: 1) the II/IH block and ketamine group, 2) the II/IH block by inserting the laryngeal mask (LMA) and sevoflurane group, and 3) the LMA and sevoflurane group. Peroperative heart rate (HR), mean arterial pressure (MAP), amount of sevoflurane used, postoperative pain scores, number of children needing rescue analgesia, and time required for the first analgesia were recorded. Results: The patients, consisting of 34 males and 26 females had an average age of 4 ± 1.3 years. There was no difference in terms of HR and MAP between the ketamine + block applied group and LMA + block applied group; however, HRs were higher and MAPs were lower in the group in which no block was added but only sevoflurane maintenance was provided and the amount of sevoflurane used significantly decreased in the group supported by (II/IH) block (P < 005). In the postoperative period, the HR, MAP and pain scores were higher in the group with no added block but this difference was significant in the first 6 hours (P < 0.05). Rescue analgesia was applied to a fewer of patients in the groups with added blocks and nausea-vomiting occurred only in the group without block. It was observed that analgesia was needed in average for 6.1 hours in the block group to which ketamine was applied; 4.7 hours in average in the block group to which LMA was applied; and for 2.1 hours in average in the group not supported by block (P < 0.05). Conclusion: In this study, it was determined that II/IH block added to general anesthesia or sedation in pediatric lower abdominal surgery reduced the need for intraoperative anesthesia, provided a more stable intraoperative hemodynamics and analgesia, and provided less pain scores, longer analgesia duration, and shorter analgesia need in the postoperative period.

Risk factors and early diagnosis of acute kidney injury in patients with sepsis

To analyze related risk factors of sepsis complicated acute kidney injury (AKI), and to explore the precaution equation for early clinical diagnosis. A retrospective review of patients with sepsis complicating AKI admitted to intensive care unit (ICU) of Affiliated Hospital of Binzhou Medical University from April 2011 to April 2013 were enrolled. Fifty-eight sepsis patients without AKI were enrolled as control. Eleven indexes including age, mean arterial pressure (MAP) score, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II) score, 24-hour urine volume, 24-hour net liquid intake score, serum creatinine (SCr) score, blood urea nitrogen (BUN), oxygenation index, blood lactic acid score and plasma albumin were collected as possible risk factors for AKI in sepsis patients. The risk factors and calculation of the critical value were analyzed by multiple factor logistic regression analysis. Nine factors with statistical significance for AKI in sepsis patients analyzed with univariate analysis were substituted in logistic regression model including MAP score, SOFA score, APACHEII score, 24-hour urine volume, 24-hour net liquid intake score, SCr score, BUN, oxygenation index, blood lactic acid score. After variable screening SCr score, MAP score, 24-hour net liquid intake score and blood lactic acid score were substituted in regression equation: Y=0.237X1 + 0.139X2 + 0.057X3 + 0.051X4 (X1, X2, X3, X4 typified SCr score, MAP score, blood lactic acid score and 24-hour net liquid intake score), F=125.897, P=0.000. The diagnostic cutoff appeared as 0.778. The sensitivity, the specificity, the Youden index, positive predictive value and negative predictive value were 80%, 100%, 0.8, 100% and 74%, respectively. SCr score, MAP score, blood lactic acid score and 24-hour net liquid intake score were risk factors of sepsis complicating AKI. When the value higher than 0.778 from regression equation Y=0.237X1 + 0.139X2 + 0.057X3 + 0.051X4, it hinted there was risk related to AKI in sepsis patients. The equation can help the clinicians diagnose sepsis and AKI earlier.

Safety and Efficacy of Dexmedetomidine in Children With Heart Failure

This retrospective observational study aimed to evaluate the safety and efficacy of dexmedetomidine (DEX) for children with heart failure. The study was conducted in the cardiovascular intensive care unit (CVICU) of a single, tertiary care, academic children's hospital. A retrospective review of the charts for all children (up to 18 years of age) with signs and symptoms consistent with congestive heart failure who received DEX in our CVICU between April 2006 and April 2011 was performed. The patients were divided into two groups for study purposes: the DEX group of 21 patients, who received a DEX infusion together with other conventional sedation agents, and the control group of 23 patients, who received conventional sedation agents without the use of DEX. To evaluate the safety of DEX, physiologic data were collected including heart rate, mean arterial pressure (MAP), and inotrope score. To assess the efficacy of DEX, the amount and duration of concomitant sedation and analgesic infusions in both the DEX and control groups were examined. The numbers of rescue boluses for each category before the initiation of sedative infusion and during the sedative infusion also were examined. The baseline characteristics of the patients in the two groups were similar. There was no effect of DEX infusion on heart rate, MAP, or inotrope score at the termination of infusion. The daily amount of midazolam administered was significantly less during the last 24 h of DEX infusion in the DEX group than in the control group (p = 0.04). The daily amount of morphine infusion did not differ between the DEX and control groups during any period. The numbers of sedation and analgesic rescue boluses were lower in DEX group throughout the infusion. No other significant side effects were noted. Two patients in the DEX group had a 50 % or greater drop in MAP compared with baseline in the first 3 h after initiation of DEX infusion, whereas one patient had a 50 % or greater drop in heart rate compared with baseline in the first 3 h after initiation of DEX infusion. Administration of DEX for children with heart failure appears to be safe but should be used cautiously. Furthermore, DEX use is associated with a decreased opiate and benzodiazepine requirement for children with heart failure.