Mean Systolic Arterial Pressure Research Articles

Comparison of Hemodynamic Response to Endotracheal Intubation with Nebulized Lignocaine and Dexmedetomidine: a Prospective Randomized Controlled Trial

Background: Though different studies have compared intravenous (IV) lignocaine with dexmedetomidine for blunting laryngoscopic and intubation response, there is hardly any study comparing nebulized Lignocaine and dexmedetomidine for the same. This study compared the effectiveness of nebulized dexmedetomidine and Lignocaine for blunting hemodynamic response to laryngoscopy and intubation. Methods: This prospective randomized double-blinded study among 60 patients was divided into two equal groups of 30 (groups D and L). Group D patients were nebulized with 1 µg/kg of dexmedetomidine diluted in 0.9% saline to a total volume of 4 ml, and Group L patients were nebulized with 4ml of 4% Lignocaine hydrochloride in the preoperative room over 5 min. After induction of general anesthesia, laryngoscopy and intubation were performed, and hemodynamic changes were recorded for statistical analysis. A two-sample t-test was applied to compare means in two groups with a confidence interval of 95%. Result The Dexmedetomidine group demonstrated a significant difference, with lower values of mean heart, systolic, diastolic, and mean arterial pressure rate immediately before laryngoscopy till 10 minutes postintubation (recorded at 2 mins intervals till 10mins) compared to the lignocaine group. The p-values for all the parameters were < 0.001, underlining the robustness of our findings. Conclusion: Nebulised Dexmedetomidine before laryngoscopy is not just an alternative technique, but a superior one for blunting the hemodynamic response to laryngoscopy and endotracheal intubation. It outperforms Nebulised Lignocaine without significant adverse effects, such as postoperative sore throat and sedation, making a compelling case for its adoption in clinical practice.

A proof-of-concept study evaluating cardiac compression techniques for cardiopulmonary resuscitation in laying hens (Gallus gallus).

To determine in adult chickens which of 3 CPR techniques, sternal compressions (SC), SC with interposed caudal coelomic compressions (ICCC), or lateral compressions (LC), results in the highest mean systolic (SAP), diastolic (DAP), and mean arterial pressure (MAP) as measured directly from the carotid artery. Prospective, nonblinded, experimental crossover study. University teaching hospital laboratory. Ten retired laying hens. Birds were sedated, anesthetized, and placed in dorsal recumbency. A carotid artery catheter was placed to directly measure arterial pressure. Ventricular fibrillation was induced with direct cardiac stimulation using a 9-Volt battery. Each bird then received 2minutes of the 3 different cardiac compression techniques in a random order by 3 different compressors, with the compressor order also randomized. Birds were subsequently administered IV epinephrine, and transthoracic defibrillation was attempted. At the end of experimentation, each bird was euthanized, and simple gross necropsies were performed. Linear mixed models followed by pairwise paired t-tests were performed to evaluate differences in pressures generated by each technique. The primary study outcomes were SAP, DAP, and MAP over 2minutes of compressions for each compression technique. Pressures from ICCC (SAP: 27.6±5.3mmHg, DAP: 18.7±5.2mmHg, MAP: 21.7±5.2mmHg) were significantly higher than those from LC (SAP: 18.9±5.4mmHg, DAP: 11.6±4.1mmHg, MAP: 14.1±4.5mmHg). Pressures from SC (SAP: 24.5±6.4mmHg, DAP: 15.2±4.3mmHg, MAP: 18.3±5.0mmHg) were not significantly different from ICCC or LC. External compressions can generate detectable increases in arterial pressure in chickens with ventricular fibrillation. SC with ICCC generated significantly higher arterial pressures than LC. SC alone generated blood pressures that were not significantly different from those generated by SC with ICCC or LC.

Association of blood pressure with frequency of different blood groups and body mass index among medical students.

Objective: To determine the association of blood pressure with frequency of different blood groups and body mass index among medical students. Study Design: Cross-Sectional study. Setting: Ameer-ud–Din Medical College /Postgraduate Medical Institute, Lahore, Pakistan. Period: May 2022 to August 2022. Material & Methods: Comprised 105 healthy both male and female medical students of 1st year and 2nd year MBBS. Participants were divided into groups following ABO blood grouping and body mass index criteria. Blood grouping was done by using conventional slide method. Manual auscultatory method consisting of mercury sphygmomanometer was used for estimation of blood pressure. Blood Pressure of female students was measured during follicular phase (days 7-11) of menstrual cycle to exclude role of emotional state and endocrinological factors for causing variation in blood pressure. Data was analysed by using SPSS 26. Results: There were 105 students with an overall mean age of 19.7±1.2 years. Blood group B&O found most predominant with equal prevalence of 35(33.3%). Prevalence of prehypertension among our study subjects was found 17.4%. Mean systolic, diastolic and mean arterial pressure were not found statistically significant among blood groups; p values 0.39, 0.28 and 0.25 respectively. No statistically significant difference of pre hypertensive subjects (n=18) were noted among ABO blood groups. (p=0.201). Statistical analysis showed significant association of DBP and MAP with BMI, p=0.014 and p=0.011 respectively. 38.5% of obese subjects were found prehypertensive. Highest percentage of obese subjects with pre-hypertension was noted among blood group O. Among underweight and normal weight subjects highest of pre- hypertensives were found to have blood group AB., but no significant association of pre-hypertensive subjects among different groups of BMI (p=0.184). Conclusion: B&O blood group were found predominant with equal prevalence. No statistically significant association of prehypertensive subjects were found among different ABO blood groups and different groups of BMI.

Blood pressure and electrocardiographic profile of children with sickle cell anaemia in steady-state and vaso-occlusive crisis.

To compare the cardiovascular features of patients with sickle cell anaemia (SCA) in steady-state with those in vaso-occlusive crisis (VOC) at the Wesley Guild Hospital (WGH). A descriptive cross-sectional, matched, case-control study among children with SCA at the WGH, a tertiary health facility in southwest Nigeria. The participants were recruited from the children's emergency unit and paediatric haematology clinic of the WGH. Consisted of 93 children with VOC (cases) and 93 age and sex-matched in steady state (controls), aged 5 - 15 years. Cardiovascular parameters, including pulse rate, blood pressure, and electrocardiographic profile, were assessed and compared using the appropriate statistical tests. The mean (SD) age of the cases and controls were 8.8 (3.2) years and 9.0 (3.1) years, respectively (p= 0.106). There was no significant difference in the mean height of the groups. The mean pulse rate, diastolic, systolic, and mean arterial pressures were significantly higher in the cases than in the controls. A significantly higher proportion of the cases than the controls also had a higher frequency of heart blocks, prolonged QTc interval, ST elevation or depression, and T wave abnormality (p = 0.018, 0.039, 0.041, 0.009, respectively). The prevalence of chamber enlargements was not significantly different between the two groups. Cardiovascular dysfunction is worse during VOC when compared with steady state. Physicians should look for these dysfunctions in SCA children with VOC to reduce mortality from the disease. None declared.

Continuous positive airway pressure ventilation in dogs with acute cardiogenic pulmonary edema is associated with improved clinical parameters and reduced diuretic and oxygen requirements.

To retrospectively compare efficacy of a continuous positive airway pressure (CPAP) helmet against standard oxygen supplementation (STD) administered by nasal cannulae in dogs with acute cardiogenic pulmonary edema (ACPE). 83 dogs (STD group, n = 41; CPAP group, 42) hospitalized for ACPE (January 2019 to April 2021). Mean respiratory rate, heart rate, systolic arterial pressure, and rectal body temperature were compared between and within groups before and at 1 (T1), 2 (T2), 3 (T3), 6 (T6), and 12 (T12) hours from the beginning of STD/CPAP therapy. Duration of oxygen supplementation, hospitalization time, total diuretic dose, additional pharmacological interventions and mortality rates were compared between groups. The veterinary bedside lung ultrasound in emergency score, thoracic radiographs, and arterial blood parameters were compared between and within groups before and at the end of CPAP/STD therapy. Within both groups, clinical parameters decreased during the observation period. Mean respiratory rate and heart rate were significantly lower in the CPAP group than the STD group at T1, T2, T3, T6, and T12. Mean systolic arterial pressure was significantly lower in the CPAP group than the STD group at T2, T3, T6, and T12. Mean oxygen supplementation duration, cumulative loop diuretic dose, and both veterinary bedside lung ultrasound in emergency score and arterial PaCO2 at the end of CPAP/STD therapy were significantly lower in the CPAP group than the STD group. No significant differences were observed in hospitalization time and mortality rates. The addition of helmet CPAP compared with standard oxygen administration showed a faster clinical improvement with lower cumulative loop diuretic and shorter oxygen supplementation in dogs hospitalized for ACPE.

#5990 COMPLEMENT GENES PROFILE OF PATIENTS WITH SEVERE HYPERTENSION AND RENAL THROMBOTIC MICROANGIOPATHY

Abstract Background and Aims Hereditary or acquired complement system dysregulation found to be driving cause of endothelial damage in atypical haemolytic uremic syndrome (aHUS) – ultrarare life-threatening disease, that always manifests with renal thrombotic microangiopathy (TMA), resulting in poor outcome in absence of appropriate treatment. Nevertheless, several studies show high incidence of rare genetic variants of complement system in other TMA’s, including hypertension-induced TMA. Here we report results of complement genes screening in patients (pts) with histologically identified renal TMA and severe hypertension in Russia, at first diagnosed as hypertension-induced TMA. Method A total of 28 Caucasian pts diagnosed with renal TMA (confirmed by kidney biopsy in all cases) and severe hypertension enrolled in the study. The main characteristic of the clinical picture was the absence of microangiopathic hemolysis and thrombocytopenia in prevailing of the pts, thus most of the primary and secondary causes of TMA clinically excluded. Examination of DNA samples was performed in all pts using next generation sequencing (NGS) technology. For statistical analysis continuous variables were presented as Mean (±Standart deviation) or Median (interquartile range) as appropriate. Results Baseline demographic and clinical characteristics of group are listed in Table 1. 13 pts (46%) had malignant form of hypertension (MHT) confirmed by eye examination. Mean systolic arterial pressure (SAP) observed at the time of presentation was 210±29 mmHg, mean diastolic arterial pressure (DAP) was 122±19 mmHg. Kidney morphology revealed chronic TMA lesions in 12 pts (43%), acute and chronic alterations simultaneously detected in 13 pts (46%). Predominantly acute lesions with glomerular and extraglomerular thrombi found in 3 (11%) pts only. Complement genes abnormalities revealed in 7 (25%) out of 28 pts. Complement factor I (CFI) rare variants were found in 2 pts (CFI c. 772<A, CFI c.1217G>A), one of this pts also had additional variant in complement factor H related protein 4 (CFHR4 c.766G>A). Complement factor C3 rare variant was observed in 1 pt (C3 c.2203C>T), membrane cofactor protein (MCP or CD46) rare variant in 1 pt (CD46 c. 198A>T), complement factor H related protein 5 (CFHR5) variant detected in 1 pt (CFHR5 c.136C>T), homozygous deletion of CFHR1 and CFHR3 detected in 1 pt and heterozygous deletion of the same complement factor H related protein genes found in another pt. Conclusion A quarter of pts with TMA and severe hypertension may have genetic defects in the complement system. These results confirmed that complement-mediated HUS may be misdiagnosed as hypertension-induced TMA. Lack of convincing hematological signs of TMA is common in this group, making aHUS diagnosis more sophisticated.

A Preliminary Feasibility Study on Hemodynamic Changes Following Feyh-Kastenbauer Retractor Insertion During Transoral Robotic Surgeries.

Introduction Transoral robotic surgery (TORS) has become increasingly popular for the removal of pharyngeal and laryngeal cancers with the objective to improve functional and aesthetic outcomes. Feyh-Kastenbauer (FK) retractor is one such routinely used retractor during TORS. The setting up of this retractor has been seen to be accompanied by hemodynamic fluctuations. Methodology This prospective observational study was carried out on 30 patients undergoing TORS. All patients were administered general anesthesia using a pre-defined anesthesia protocol. The primary outcome was to compare hemodynamic fluctuations following endotracheal intubation with that after FK retractor insertion. Any requirement of a bolus dose of sevoflurane and fentanyl was recorded in response to hemodynamic fluctuations recorded in secondary outcomes. Results There was no statistically significant increase in mean heart rate, systolic, diastolic, and mean arterial blood pressure from baseline to endotracheal intubation and following retractor insertion (p=0.810, p=0.2, p=0.6, p=0.3 respectively). On subgroup analysis, hypertensive patients reported a greater rise in blood pressure following two minutes post FK retractor insertion compared to non-hypertensive patients (p=0.03). Out of 30 patients, five patients required a bolus dose of sevoflurane. Conclusion FK retractor insertion had a comparable hemodynamic response as endotracheal intubation during TORS. Hypertensive patients showed a rise in blood pressure at both endotracheal intubations and at FK retractor insertion.

Prediction of in-hospital mortality in patients with acute pulmonary embolism requiring invasive mechanical ventilation: comparation of risk scores

Abstract Funding Acknowledgements Type of funding sources: None. Introduction High-risk pulmonary embolism (PE) is a life-threatening disorder associated with high mortality and morbidity. Multiple scores are used to predict in-hospital mortality of patients admitted to intensive care units. The purpose of this study is to assess which risk score is best at predicting in-hospital mortality in a specific population of patients requiring invasive mechanical ventilation. Methods Retrospective analysis of 33 patients admitted for high-risk pulmonary embolism requiring invasive mechanical ventilation in a general intensive care unit during a period of 15 years. Clinical, analytical, and imaging parameters were evaluated. The PESI, Apache II, SAPS II, and SOFA scores were obtained at ICU admission. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of each score for in-hospital mortality. Results Mean age was 59,1±16 years; 55% were men. 27% presented with a cardiorespiratory arrest at admission. Mean values risk scores were: PESI 138±51, Apache II 23±9, SAPS II 49±23, and SOFA 8±3. In-hospital mortality was 45,4%. The mean duration of hospitalization was 14,8±17,9 days. Mean pulmonary systolic arterial pressure was 51,5±14,63mmHg. Mean values of maximum troponin I and d-dimers were 2,97±7,99 and 6603±5541 ng/mL, respectively. ROC curve analysis revealed that Apache II (AUC 0,752; p=0,02; CI 95% 0,58;0,92), SAPS II (AUC 0,718; p=0,04; CI 95% 0,52;0,91) and PESI (AUC 0,754; p=0,02; CI 95% 0,6;0,91) had best predictive performance for in-hospital mortality compared to SOFA (AUC 0,641; p=0,2; CI 95% 0,42;0,9). The following cut-off values were obtained: PESI of 130 (sensitivity (S)≈85% and specificity (E)≈53%), Apache II of 26 (S≈62% and E≈77%), and SAPS II of 52 (S≈69% and E≈70%). Conclusion In this population, PESI, Apache II, and SAPS II scores were better predictors of in-hospital compared to SOFA score.

Impact of General Anesthesia on Preeclamptic Women in a Tertiary Care Hospital

Background: General anesthesia can be necessary during delivery for women with preeclampsia, a serious pregnancy condition characterized by high blood pressure and organ damage. However, the impact of general anesthesia on pregnant women with preeclampsia is not well understood and studies show conflicting results. The decision to use general anesthesia in such cases should be carefully weighed by the healthcare provider, considering the individual circumstances and potential risks and benefits. Aim of the study: The aim of this study was to assess the impact of general anesthesia on preeclamptic women. Methods: This cross-sectional study was conducted in Department of Anaesthesiology, Holy Family Red Crescent Medical College Hospital, Dhaka, Bangladesh, during the period from January 2022 to January 2023. Total 120 pregnant women with preeclampsia were included in this study. Result: Demographic and clinical data of participants in the general anesthesia group showed a mean maternal age of 24.12 years, 63.3% of whom were primigravida, and a mean weight of 76 kg. Pulse rate decreased from 97.8 before anesthesia to 91.1 after 1 hour, while systolic blood pressure decreased from 152.3 to 135.5 and diastolic blood pressure decreased from 92.5 to 79.4. The mean time from skin incision to delivery was 5.8 minutes and surgery lasted 43.5 minutes. Adverse events included surgical site infections (5.0%), anesthesia complications (7.5%), pulmonary edema (14.2%), and 1 death (0.8%). The mean postoperative pain score was 7.2. In this study, 29.2% patient were admitted to critical care unit. Newborns had a mean systolic arterial pressure of 55 mm Hg, heart rate of 141 beats per minute, and weight of 2.3 kg. Apgar score was below 6 for 20% at 1 minute and 10% at 5 minutes, with 52.5% of newborns admitted to the NICU. Conclusion: The present study provides important insights into the impact of general anesthesia on pregnant women with preeclampsia. While general anesthesia ......

Early Hypocalcemia in Severe Trauma: An Independent Risk Factor for Coagulopathy and Massive Transfusion.

The rapid identification of patients at risk for massive blood transfusion is of paramount importance as uncontrolled exsanguination may lead to death within 2 to 6 h. The aim of this study was to analyze a cohort of severe trauma patients to identify risk factors associated with massive transfusion requirements and hypocalcemia. All major trauma (ISS > 16) presented directly from the scene to the Niguarda hospital between 1 January 2015 and 31 December 2021 were analyzed. A total of 798 patients were eligible out of 1586 screened. Demographic data showed no significant difference between hypocalcemic (HC) and normocalcemic (NC) patients except for the presence of crush trauma, alcohol intake (27% vs. 15%, p < 0.01), and injury severity score (odds ratio 1.03, p = 0.03). ISS was higher in the HC group and was an independent, even if weak, predictor of hypocalcemia (odds ratio 1.03, p = 0.03). Prehospital data showed a lower mean systolic arterial pressure (SAP) and a higher heart rate (HR) in the HC group (105 vs. 127, p < 0.01; 100 vs. 92, p < 0.001, respectively), resulting in a higher shock index (SI) (1.1 vs. 0.8, p < 0.001). Only retrospective studies such as ours are available, and while hypocalcemia seems to be an independent predictor of mortality and massive transfusion, there is not enough evidence to support causation. Therefore, randomized prospective studies are suggested.

Heart rate and diastolic arterial pressure in cardiac arrest patients: A nationwide, multicenter prospective registry.

Guidelines have recommended monitoring mean arterial pressure (MAP) and systolic arterial pressure (SAP) in cardiac arrest patients, but there has been relatively little regard for diastolic arterial pressure (DAP) and heart rate (HR). We aimed to determine the prognostic significance of hemodynamic parameters at all time points during targeted temperature management (TTM). We reviewed the SAP, DAP, MAP, and HR data in out-of-hospital cardiac arrest (OHCA) survivors from the prospective multicenter registry of 22 teaching hospitals. This study included 1371 patients who underwent TTM among 10,258 cardiac arrest patients. The hemodynamic parameters were recorded every 6 hours from the return of spontaneous circulation (ROSC) to 4 days. The risks of those according to time points during TTM were compared. Of the included patients, 943 (68.8%) had poor neurological outcomes. The predictive ability of DAP surpassed that of SAP and MAP at all time points, and among the hemodynamic variables HR/DAP was the best predictor of the poor outcome. The risks in patients with DAP < 55 to 70 mmHg and HR > 70 to 100 beats/min were steeply increased for 2 days after ROSC and correlated with the poor outcome at all time points. Bradycardia showed lower risks only at 6 hours to 24 hours after ROSC. Hemodynamic parameters should be intensively monitored especially for 2 days after ROSC because cardiac arrest patients may be vulnerable to hemodynamic instability during TTM. Monitoring HR/DAP can help access the risks in cardiac arrest patients.

A Ten Year Retrospective Study on Cor Triatriatum Sinister Associated Heart Failure in Dogs

Background: Although cortriatriatumsinister (CTs) represents a well-known and widely described cardiac malformation in humans, its description in the canine population is rare. The aim of this ten-year study is to place on record about the most unusual congenital cardiac malformation, cortriatriatum sinister that was sporadically reported among veterinary patients. Methods: The dogs were examined clinically, physically and later subjected for chest radiograph and echocardiography to confirm CTs. All were showing regular femoral pulse that was strong and synchronous to the heart beat, pale mucosa, mean systolic arterial blood pressure of 145 mm Hg and with normal hemato-biochemical parameters. Cardiomegaly with increased sternal contact, elevated trachea, pulmonary congestion and engorged caudal vena cava were radiographic findings. 2d-echocardiography revealed a left atrium that was subdivided by a transverse membrane into two distinct compartments, one proximal and one distal, thus confirming the cortriatriatum sinister. Result: Cor triatriatum sinister (CTs) was diagnosed in 4 dogs with a prevalence of 4.59% amongst those suffering from congenital heart anomalies, that were aged between 5y-7y and the breeds include Boxer, Doberman and Cocker spaniel. All these dogs were presented with similar signs suggestive of heart failure viz., exercise intolerance, dyspnoea at rest, cough that was dry nocturnal type, generalised weakness and syncope. All of these patients were successfully managed with frusemide, benazapril and pimobendan. Hence, it may be concluded that the CTS, a rare congenital cardiac anomaly in dogs should also be included in the differential diagnosis of heart failure, particularly if presented at early life, which also helps to prevent further breeding from such stock.

Catheter-based renal sympathetic nerve denervation on hypertension management outcomes.

BACKGROUNDRenal sympathetic denervation (RSD) provides a minimally invasive interventional treatment modality for patients with resistant hypertension. However, the post-operative outcomes remain a key area of investigation since its earliest clinical trials. AIMTo evaluate patient outcomes after RSD intervention among peer-reviewed patient cases.METHODSA systematic review of literature on MEDLINE, Google Scholar, and the Cochrane Database of Systematic Reviews for RSD case studies to assess post-operative hypertension readings and medical management.RESULTSAmong 51 RSD cases, the post-operative RSD patients report an apparent reduction with a mean number of 3.1 antihypertensive medications. The mean systolic arterial blood pressure 1 year following RSD was 136.0 mmHg (95%CI: 118.7-153.3).CONCLUSIONThe apparent improvements in office systolic blood pressure after 12 month post-operative RSD can support the therapeutic potential of this intervention for blood pressure reduction. Additional studies which utilized a uniform methodology for blood pressure measurement can further support the findings of this systematic review.

Akut iskemik serebrovasküler olay geçiren hastalarda aritmi sıklığının holter elektrokardiyografi ile değerlendirilmesi

Amaç: Akut iskemik serebrovasküler olaydan (SVO) sonra yüksek riskli hastaların belirlenmesi, uygun kardiyak izlem ve aritmilerin saptanması, kardiyak morbidite ve mortalitenin önlenmesi açısından önemlidir. Çalışmamızın amacı, akut iskemik SVO nedeniyle kardiyoloji kliniğine yönlendirilen hastalarda, altta yatan etiyolojinin belirlenmesi ve 24 saatlik holter elektrokardiyografi (EKG) ile aritmi sıklığının saptanmasıdır. Gereç ve Yöntem: Çalışmaya Ocak 2019-Haziran 2021 tarihleri arasında akut iskemik SVO geçiren ve bazal EKG’ si sinüs ritminde olan ardışık 135 hasta alındı. Çalışmamız, retrospektif kesitsel bir çalışmadır. Bulgular: Hastaların ortalama yaşı 72.02±11.02 yıl, ortalama sistolik arteryal kan basıncı 138,84±20.45 mmHg ve ortalama kalp hızı 81.63±16.18 atım/dk idi. Hastalarda en sık görülen komorbid hastalıklar hipertansiyon (n=67, %49,6) ve koroner arter hastalığıydı (n=55, %40,7). Hastaların %5.9’unda protez kalp kapağı ve %5.2‘sinde kalıcı kalp pili vardı. 5 (%3,7) hastada intrakardiyak trombüs tespit edildi. Ortalama sol ventrikül ejeksiyon fraksiyonu %54,4±9,1 idi. Karotis dopler ultrasonografide (USG) hastaların 27 (%20)’ sinde tek taraflı ve 17’sinde (%12,6) iki taraflı ciddi karotis arter darlığı mevcuttu. Holter EKG’ de en sık tesbit edilen aritmiler ventriküler ekstrasistol (n=34, %25,2) ve paroksismal atrial fibrilasyondu (n=31, %23). Ayrıca 6 (%4,4) hastada non-sustained ventriküler taşikardi saptandı. Sonuç: Akut iskemik SVO geçiren hastalarda alta yatan etiyolojiyi tesbit etmek hastalığın tedavisi açısından önem arz etmektedir. Bu hasta grubunda tedavi edilmesi gereken aritmi sıklığı göz ardı edilmeyecek kadar yüksektir.

COMPARISON OF DEXMEDETOMIDINE AND FENTANYL ON AIRWAY RESPONSE AND HEMODYNAMICS DURING TRACHEAL EXTUBATION

Background: Extubation is associated with various circulatory and airway responses. Various pharmacological measures including fentanyl and dexmedetomidine have been used to blunt the reflex without compromising the spontaneous respiration. In this study we wanted to compare dexmedetomidine and fentanyl on airway response, smoothness of extubation and hemodynamic changes.&#x0D; Methodology: A total of 68 patients undergoing surgery under general anesthesia with endotracheal intubation, were randomized into two groups. Group A received dexmedetomidine 0.5 mcg/kg and Group B received 1 mcg/kg of fentanyl with the start of skin suturing over a period of 10 minutes via syringe pump. Airway reflex during suction and smoothness of extubation were assessed. Level of sedation during suction, extubation and then every 5 minutes post extubation for 15 minutes were recorded. Hemodynamic parameters were assessed every 5 minutes with start of test solution till extubation and then every 5 minutes for 15 minutes.&#x0D; Results: A total of 68 patients were evaluated in the study. In dexmedetomidine group, 67.6% of patients had no cough on extubation while in fentanyl group 35.3% of patients had no cough on extubation which was statistically significant (p value 0.015). Mean heart rate during extubation increased in both the groups but the increase was 39% in Group B and 11% in Group A from baseline which was statistically significant (p value &lt; 0.001). There was rise in mean systolic and mean arterial pressure during extubation in both the groups but the increase was significantly higher in fentanyl group. Patients in dexmedetomidine group were more sedated but there were no any adverse events.&#x0D; Conclusion: With the results obtained from the study, it is concluded that dexmedetomidine 0.5 mcg/kg over 10 minutes before extubation is effective in alleviating airway response and haemodynamics compared to fentanyl 1 mcg/kg.

Blood Pressure Profile and Trends in the Neonatal Transitioning Period: A Comparative Study of Term Asphyxiated and Healthy Newborns.

Background. Extra-uterine transition difficulties including BP abnormalities have been documented following perinatal asphyxia. Aim. The study aimed to determine the BP changes in the early neonatal transitioning period. Method. This comparative, cross-sectional study was conducted at the Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria. Result. A total of 246 term babies were analyzed. Their mean (standard deviation) systolic, diastolic and mean arterial blood pressures (SBP, DBP, and MBP) at birth were 68.2 (9.0), 39.9 (7.0), and 49.4 (6.9) mmHg and 67.4 (7.9), 37.1 (6.1), and 47.2 (5.8) mmHg, respectively. Asphyxiated neonates had significantly higher initial DBP (P < .001) and MAP (P = .008), lower SBP (P < .001) and MAP (P = .024) at 6 hours and lower SBP at 12 hours after birth, statistically. Conclusion. This study showed that while the BP of healthy neonates steadily increases in the first 48 hours after birth, it fluctuated markedly within the first 12 hours of birth among asphyxiated babies.

568 Echocardiography and impedance cardiography as determinants of successful slow Levosimendan infusion in patients with acute advanced heart failure

Abstract Aims Despite new therapeutic options, patients with heart failure (HF) still progress to advanced stage. Among new therapeutic options, Levosimendan was recently approved in order to treat patients hospitalized for acute decompensated heart failure (ADHF) with severe systolic dysfunction. The pharmacological effects of Levosimendan consist of inotropy, vasodilatation, and cardioprotection through the increase of calcium sensitivity. These effects should be monitored with echocardiography and in particular with speckle tracking and tri-dimensional echocardiography which appear to be useful in LV systolic function detection and monitoring. In this study we aim to evaluate the effect of slow infusion of Levosimendan on the non-invasive measurement of cardiac output, the speckle tracking parameters and the tri-dimensional echocardiography measurements in advanced ADHF patients. Methods and results This is a prospective observational study evaluating Levosimendan efficacy through advanced echocardiography. We enrolled 11 patients with diagnosis of ADHF who respect the recent ESC criteria of ‘advanced heart failure’. Patients underwent to blood sample examination to measure electrolytes, creatinine, and NTproBNP. Patients underwent to advanced echocardiography examination (performed for each patient pre- and post-Levosimendan infusion) with tri-dimensional echocardiography and global longitudinal strain assessment. Furthermore patients underwent to non-invasive cardiac output and cardiac index collection through impedance cardiography pre- and post-Levosimendan infusion. All patients were followed for 30 days after discharge for all cause of mortality and HF re-hospitalization. A total of 11 patients affected by advanced ADHF were included in this study. Mean age was 73.8 ± 4.7 years. 72.7% (n 8) patients were men. 81.9% (n 9) of patients recognize ischaemic heart disease as HF etiology. At admission mean systolic arterial pressure was 100 ± 17 mmHg, mean NTproBNP was 24 445 ± 12 194 pg/ml and mean serum creatinine was 1.55 ± 0.84 mg/dl. At tri-dimensional echocardiography mean LV ejection fraction (LVEF) was 19.7 ± 5.7% and at bi-dimensional echocardiography mean tricuspid anular plane systolic excursion (TAPSE) and pulmonary arterial systolic pressure (PASP) were, respectively, 12.5 ± 2.7 mm and 48 ± 16 mmHg. Mean LV global longitudinal strain (GLS) was −3.0 ± 1.8. Mean furosemide in-hospital infusion was 306 ± 102 mg/die and mean urine output 1436 ± 496 ml. None developed significant ventricular or supraventricular arrhythmias. All patients were treated with betablockers during infusion. At 30 days of follow-up two patients died and 1 patient was re-hospitalized. Evaluating the differences among our variables pre- and post-Levosimendan infusion, we found that NTproBNP was significantly reduced post-Levosimendan infusion (P = 0.01). Among ICG non-invasive measurement, we found significant differences in stroke volume (SV) and cardiac output (CO) in terms of significant improvement (P = 0.001 for both). Analysing tri-dimensional echocardiography variables, we observed a significant improvement of LVEF (P = 0.003), SV (P = 0.03) and 3-D LV GLS (P = 0.002). Furthermore, we observed a significant reduction in end-systolic volume (ESV) post-Levosimendan infusion (P = 0.02). Among bi-dimensional echocardiography measurements, there was a significant reduction in end-diastolic diameter of right ventricle (EDDRV) and in B-lines count (respectively, P = 0.02 and P = 0.002). Moreover, we observed a significant improvement in TAPSE (P = 0.003) and in LV GLS (P = 0.004). Conclusions Our study showed that slow Levosimendan infusion (12.5 mg at velocity of 0.05–1 mcg/kg/min) without bolus could be considered in advanced ADHF patients to improve cardiac performance without severe adverse events. ICG and echocardiography in-hospital evaluation seemed to be necessary to understand treatment success and patients status improvement as well as cardiac function benefit.

A prospective, multicenter, epidemiological study of the prevalence of cardiovascular risk factors in hypertensive patients in Greece, the WIN-HAZARD study

Abstract Background/Introduction Arterial hypertension (AH) is a major, common, modifiable, risk factor for cardiovascular disease. It is strongly associated with cardiovascular disease (CVD), the leading cause of death globally, according to World Health Organization. In addition to elevated blood pressure (BP), many hypertensive patients have other risk factors that increase the overall cardiovascular risk. The calculation of the total cardiovascular (CV) risk is necessary for selecting the proper treatment strategy and guide timely treatment decisions and interventions. Purpose This prospective, multicenter, epidemiological, non-interventional, nationwide study aimed to evaluate the type and number of total CVD risk factors in hypertensive patients in Greece, according to the 2013 guidelines of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC), applicable at the time of the study conduct. Methods Overall, 3 Cardiology Hospital sites and 167 private Cardiologists, Internists, Endocrinologists and General Practitioners nationwide participated in the study, enrolling consecutive adult patients with hypertension under treatment. Total CV risk was assessed by 2013 ESH/ESC criteria, and the European Systematic Coronary Risk Evaluation (SCORE) algorithm. It involved a single visit, with no screening period for the patients. The study has been conducted in compliance with ICH/GCP standards, from March 2017 to April 2019. Results In total 1309 patients with AH under treatment were enrolled (59% male, mean age 60.6 years, mean BMI 28.2). The median time from AH diagnosis was 3.7 years. The most common CV risk factors were dyslipidaemia (76.4%), male gender (59%), advanced age (58.1%) and abdominal obesity (46.1%). The incidence of the remaining total CV risk factors per category was asymptomatic target organ damage (20.8%), diabetes (11.3%) and established CV or renal disease (5.8%). The majority of the study patients (71.6%) had concomitantly ≥3 total CV risk factors (table 1 and table 2). The mean (±SD) systolic arterial pressure was 143.5±14.7 mmHg and the mean (±SD) diastolic 85.5±8.6 mmHg. More than half of the patients (51.8%) received one antihypertensive drug, with angiotensin II receptor blockers (ARBs) being the most commonly reported drug class (23.9%), followed by calcium channel blockers (15.8%). Conclusion This real-world study with its broad geographical coverage and phycisians' specialty range, contributed significant epidemiological data pertaining to prevalence of cardiovascular risk factors in adult hypertensive patients and their current treatment status in Greece. The value of this observational study lies in supporting the proper deployment of current guidelines, as well as, the implementation of future preventive healthcare programmes. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): WIN MEDICA S.A. Table 1Table 2

Isoflurane sedation in patients undergoing VA-ECMO treatment for cardiogenic shock

Abstract Funding Acknowledgements Type of funding sources: None. Objectives (Background): The feasibility and hemodynamic effects of isoflurane sedation in cardiogenic shock in the presence of extracorporeal membrane oxygenation (VA-ECMO) treatment is currently unknown. Design Retrospective single-center study Patients/subjects: Cardiogenic shock patients with VA-ECMO treatment under sedation with volatile isoflurane between November 2018 and October 2019 have been enrolled in this study and were matched by propensity score in a 1:1 ratio with intravenously (IV) sedated patients treated between January 2013 and November 2018 from the cardiogenic shock registry of our university hospital. Measurements and Main Results: Isoflurane sedation was used in 32 patients with cardiogenic shock and VA-ECMO treatment. The mean age of conventionally sedated patients was 58.4 ± 13.8 years and 56.3 ± 11.5 years for patients with isoflurane sedation (p = 0.51). Administration of isoflurane was associated with lower IV sedative drug use during VA-ECMO treatment (86% vs. 32%, p = 0.01). Mean systolic arterial pressure was similar (94.3 ± 12.6 mmHg versus 92.9 ± 10.5 mmHg, p = 0.65), but mean heart rate was significantly higher in the conventional sedation group, when compared to the isoflurane group (85.2 ± 20.5 /min vs. 74.7 ± 15.0 /min; p = 0.02). Catecholamine doses, VA-ECMO blood and gas flow, ventilation time (304 ± 143 h vs. 398 ± 272 h,p = 0.16), bleeding complications BARC3a or higher (59.3% vs. 65.3%, p = 0.76) and 30 day-mortality (59.2% vs. 63.4%, p = 0.80) were similar in both groups. The overall sedation costs per patient were significantly lower in the conventional group, when compared to the isoflurane group (537 ± 624 € vs. 1280 ± 837 €, p &amp;lt; 0.001). Conclusions Volatile sedation with isoflurane is feasible – albeit at higher costs - in patients with cardiogenic shock and VA-ECMO treatment and was not associated with higher catecholamine dosage or ECMO flow rate compared to IV sedation.

Decreased 11β-Hydroxysteroid Dehydrogenase Type 2 Expression in the Kidney May Contribute to Nicotine/Smoking-Induced Blood Pressure Elevation in Mice.

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