Mean Respiratory Frequency Research Articles

Oral Transmucosal Fentanyl Citrate for Premedication in Adults

This study was designed to assess the efficacy of oral transmucosal fentanyl citrate (OTFC) for premedication in an adult population and to determine its effects on anxiety, sedation, gastric volume, and gastric fluid acidity. The fentanyl citrate is incorporated in a lozenge mounted on a handle (oralet). The effects of OTFC, placebo oralet, and no premedication were compared in a prospective, double-blind study on 90 adult ASA physical status I and II patients undergoing same-day admission surgery. Patients were randomly assigned to one of three groups: OTFC group (n = 30), placebo group (n = 30), and control group (n = 30). Arterial blood pressure, heart rate, respiratory frequency, and oxygen saturation determined by pulse oximetry were recorded before any premedication was given, and then every 10 min until the patient was taken to the operating room. Baseline anxiety and sedation levels were assessed to ensure group similarity immediately before premedication was given and at the more anxiety-provoking phase upon entering the operating room. Anxiety levels were rated using the Spielberger State-Trait Anxiety Inventory short form and sedation levels were assessed with the Ramsay scale. Side effects, as reported by the patients, were also recorded. Gastric contents were aspirated via an orogastric tube after induction of anesthesia and were measured for volume and pH. No significant differences were found among the three groups in mean arterial pressure, heart rate, or respiratory frequency. Initial oxygen saturation levels in all groups decreased after 30 min but not less than 96% except for one patient in the OTFC group, who decreased to 88%. On entering the operating room, the OTFC group demonstrated significantly higher levels of anxiolysis than the control group, but no significant differences were seen between the OTFC and the placebo groups or the placebo and control groups. Mean gastric volumes (OTFC, 29 mL; placebo, 26 mL; control, 24 mL) and pH (OTFC, 2.0; placebo, 1.8; control, 2.1) were similar in all groups. There were no significant differences among the groups in levels of sedation achieved. Mild dizziness or light-headedness was the most commonly reported side effect in 23% of the OTFC group. In the OTFC group, 71.4% like the premedicant effect as compared to 46.4% of the placebo group. Most of the groups found the oralet method of premedicant delivery very acceptable. This study demonstrates that the OTFC oralet is an effective anxiolytic in adults. It has minimal side effects and is prepared in an acceptable format. There was no measurable increase in gastric contents or acidity in the oralet groups, compared to those patients who were given nothing by mouth.

Oral Transmucosal Fentanyl Citrate for Premedication in Adults

This study was designed to assess the efficacy of oral transmucosal fentanyl citrate (OTFC) for premedication in an adult population and to determine its effects on anxiety, sedation, gastric volume, and gastric fluid acidity.The fentanyl citrate is incorporated in a lozenge mounted on a handle (oralet). The effects of OTFC, placebo oralet, and no premedication were compared in a prospective, double-blind study on 90 adult ASA physical status I and II patients undergoing same-day admission surgery. Patients were randomly assigned to one of three groups: OTFC group (n = 30), placebo group (n = 30), and control group (n = 30). Arterial blood pressure, heart rate, respiratory frequency, and oxygen saturation determined by pulse oximetry were recorded before any premedication was given, and then every 10 min until the patient was taken to the operating room. Baseline anxiety and sedation levels were assessed to ensure group similarity immediately before premedication was given and at the more anxiety-provoking phase upon entering the operating room. Anxiety levels were rated using the Spielberger State-Trait Anxiety Inventory short form and sedation levels were assessed with the Ramsay scale. Side effects, as reported by the patients, were also recorded. Gastric contents were aspirated via an orogastric tube after induction of anesthesia and were measured for volume and pH. No significant differences were found among the three groups in mean arterial pressure, heart rate, or respiratory frequency. Initial oxygen saturation levels in all groups decreased after 30 min but not less than 96% except for one patient in the OTFC group, who decreased to 88%. On entering the operating room, the OTFC group demonstrated significantly higher levels of anxiolysis than the control group, but no significant differences were seen between the OTFC and the placebo groups or the placebo and control groups. Mean gastric volumes (OTFC, 29 mL; placebo, 26 mL; control, 24 mL) and pH (OTFC, 2.0; placebo, 1.8; control, 2.1) were similar in all groups. There were no significant differences among the groups in levels of sedation achieved. Mild dizziness or light-headedness was the most commonly reported side effect in 23% of the OTFC group. In the OTFC group, 71.4% liked the premedicant effect as compared to 46.4% of the placebo group. Most of the groups found the oralet method of premedicant delivery very acceptable. This study demonstrates that the OTFC oralet is an effective anxiolytic in adults. It has minimal side effects and is prepared in an acceptable format. There was no measurable increase in gastric contents or acidity in the oralet groups, compared to those patients who were given nothing by mouth. (Anesth Analg 1996;82:158-61)

Aortic pH oscillations in conscious humans and anaesthetised cats and rabbits

Respiratory oscillations in arterial blood gas composition influence breathing in cats and dogs. Their role in the control of breathing in humans is less certain. To determine whether oscillations are very small or absent in mammals who are large or breathe fast, aortic pH oscillations, recorded with a tridodecylamine based hydrogen-ion selective electrode, were compared in humans ( n = 13), cats ( n = 7) and rabbits ( n = 4) over a wide range of ventilation. For comparison, data were analysed in terms of the ratio of tidal volume to functional residual capacity (VT/FRC). During spontaneous breathing in rabbits, cats and humans (mean respiratory frequency f r = 61, 20.4 and 17.5 min −1), mean V t/FRC were 1.35, 0.63 and 0.36 respectively. Corresponding pH amplitudes (pHamp) of 0.009 (0.004), 0.016 (0.006) and 0.013 (0.005) pH units (mean ± 1SD) were not significantly different. The pHamp decreased exponentially with increasing f r in each species and pHamp increased linearly with increasing V t in the 3 cats in which this was studied. The study confirms the dependence of pHamp on f r and V t and its comparability among species despite differences in body size. It also demonstrates that oscillations can be recorded in humans at f r in excess of 20 min −1.

Central effects of 5-HT on respiratory and hypoglossal activities in the adult cat

The activities of the diaphragmatic, internal intercostal and hypoglossal-innervated muscles were studied in adult decerebrate cats in response to 5-HT and related agents (8-OH-DPAT and DOI). The drugs were placed on the floor of the IVth ventricle. The mean respiratory frequency (Fi) increased (124–193% of the control value) within 3 min of the 5-HT application, and decreased thereafter (30–90%). The mean Ti and Te changed similarly, but opposite to Fi. With some delay, the hypoglossal-innervated muscles were tonically activated or exhibited increased activities. Methysergide pretreatment completely blocked the effect of 5-HT on all the respiratory parameters and the hypoglossal-innervated muscles activities. The responses to 8-OH-DPAT and DOI indicate that 5-HT modulates the respiratory frequency via activation of both 5-HT 1A and 5-HT 2 receptors. Nevertheless, the effect of 5-HT on both the expiratory and hypoglossal-innervated muscles seems to depend on 5-HT 2 receptors activation only.

Pressure sensitivity of flow oscillations in postocclusive reactive skin hyperemia.

Skin blood flow was monitored using a laser-Doppler (LD) flowmeter in 21 healthy volunteers after an occlusion of the digital arteries. The peripheral vascular bed was exposed to occlusion ischemia of varying duration (1, 4, or 8 min) and to a change in digital arterial pressure produced by different positions of the arm above heart level to characterize the pattern of LD flow oscillations in postocclusive reactive hyperemia (PRH) and to elucidate the relevance of metabolic and myogenic mechanisms in governing its fundamental frequency. The descending part of the hyperemic flow was characterized by the appearance of conspicuous periodic oscillations with a mean fundamental frequency of 7.2 +/- 1.5 cycles/min (SD, n = 9), as assessed by a Fourier transform frequency analysis of 50-s sections of flow. The mean respiratory frequency during the periods of flow frequency analysis was 17.0 +/- 2.2 (SD, n = 9), and the PRH oscillations remained during apnea in all tested subjects. The area under the maximum flow curve increased significantly with prolongation of the occlusion (paired t test, P < 0.001; n = 9), but showed no dependence on the estimated blood pressure in the digital arteries, which suggests the predominant role of a metabolic component in this part of the PRH response. In contrast, the fundamental frequency of PRH oscillations exhibited a significant decrease with a reduction in the estimated digital arterial pressure (linear regression, b = 0.08, P < 0.001; n = 12), but did not change with the prolongation of arterial occlusion despite a significant increase in mean LD flow (paired t test, P < 0.001; n = 9).(ABSTRACT TRUNCATED AT 250 WORDS)

Reduced parasympathetic cardiac control in patients with hypertension at rest and under mental stress

The neurogenic component in the pathogenesis of essential hypertension has predominantly been analyzed with regard to the sympathetic part of the autonomous nervous system; the parasympathetic branch has largely been neglected. We investigated whether 54 normotensive (mean casual blood pressure [cBP]: 125 ± 6 82 ± 4 mm Hg), 41 borderline hypertensive (cBP: 134 ± 8 90 ± 5 mm Hg), and 34 hypertensive men (cBP: 152 ± 13 101 ± 5 mm Hg) without secondary target organ damage differed in parasympathetic cardiac control. Parasympathetic cardiac control was assessed via the amount of fast fluctuations (0.15 to 0.40 Hz; vagus band) and by the amount of respiratory-linked fluctuations (mean respiratory frequency ± 0.03 Hz) in the power spectra of continuously registered interbeat intervals under the following conditions: mean of three rest phases with 10, 5, and 5 minutes' duration (REST); mean of two modes of a reaction time task with 10 and 5 minutes' duration (RTT); mean of 5 minutes' mental arithmetic plus noise (MA). Analysis of variance (ANOVA) shows that spectral energy in the so-called vagus band reveals the most prominent differences between blood pressure groups under all conditions: REST = normotensive, 2.70 ± 0.31; borderline hypertensive, 2.55 ± 0.33; and hypertensive, 2.43 ± 0.43 (F[2.126] = 6.19; p < 0.01). RTT = normotensive, 2.41 ± 0.35; borderline hypertensive, 2.19 ± 0.33; and hypertensive, 2.17 ± 0.46 (F[2.126] = 6.04; p < 0.01); MA = normotensive, 2.69 ± 0.34; borderline hypertensive, 2.52 ± 0.33; and hypertensive, 2.38 ± 0.46 (F[2.126] = 7.04; p < 0.01). The ratio between the midfrequency band around 0.10 Hz and the vagus band, tentatively representing sympathovagal balance, is increased in both nonnormotensive groups, indicating a relative preponderance of sympathetic efferents. The results demonstrate that a reduction in parasympathetic cardiac control significantly contributes to a disturbance in sympathetic and parasympathetic cardiovascular control in hypertension.

Effects of airway anesthesia on ventilatory responses to graded dead spaces and CO2.

Ventilatory response to graded external dead space (0.5, 1.0, 2.0, and 2.5 liters) with hyperoxia and CO2 steady-state inhalation (3, 5, 7, and 8% CO2 in O2) was studied before and after 4% lidocaine aerosol inhalation in nine healthy males. The mean ventilatory response (delta VE/delta PETCO2, where VE is minute ventilation and PETCO2 is end-tidal PCO2) to graded dead space before airway anesthesia was 10.2 +/- 4.6 (SD) l.min-1.Torr-1, which was significantly greater than the steady-state CO2 response (1.4 +/- 0.6 l.min-1.Torr-1, P less than 0.001). Dead-space loading produced greater oscillation in airway PCO2 than did CO2 gas loading. After airway anesthesia, ventilatory response to graded dead space decreased significantly, to 2.1 +/- 0.6 l.min-1.Torr-1 (P less than 0.01) but was still greater than that to CO2. The response to CO2 did not significantly differ (1.3 +/- 0.5 l.min-1.Torr-1). Tidal volume, mean inspiratory flow, respiratory frequency, inspiratory time, and expiratory time during dead-space breathing were also depressed after airway anesthesia, particularly during large dead-space loading. On the other hand, during CO2 inhalation, these respiratory variables did not significantly differ before and after airway anesthesia. These results suggest that in conscious humans vagal airway receptors play a role in the ventilatory response to graded dead space and control of the breathing pattern during dead-space loading by detecting the oscillation in airway PCO2. These receptors do not appear to contribute to the ventilatory response to inhaled CO2.

Actions of centrally administered neuropeptides on rat intestinal transport: enhancement of ileal absorption by angiotensin II

Recent evidence suggests that opioids and other peptides may act within the CNS to modulate intestinal fluid and ion transport. In this study, the brain peptides bombesin and angiotensin II were examined for their ability to alter water flux across the small intestine after their intracerebroventricular (i.c.v.) administration to rats. In addition, changes in mean arterial pressure and respiratory frequency were determined after peptide treatment to assess the physiological specificity of their CNS actions. Bombesin, administered by i.c.v. bolus injections (10–1000 ng/rat) or continuous infusion (100 ng/min), rapidly elevated blood pressure and respiration, but had no significant effect on water transport in proximal jejunum or distal ileum in situ (as measured by single-pass perfusion with [ 14C]polyethylene glycol as non-absorbed water marker). Angiotensin II rapidly increased blood pressure and enhanced ileal absorption 30 min after its i.c.v. bolus injection at 0.1–1 μg, but had no effect on jejunal transport or respiration. These effects were inhibited in rats pretreated with either the angiotensin antagonist [Sar 1, Val 5, Ala 8]angiotensin II (5 μg i.c.v.) or the α-adrenoceptor antagonist, phentolamine (1 mg/kg i.v.). In contrast, atropine methylnitrate (0.1 mg/kg i.v.) pretreatment inhibited the proabsorptive, but not the pressor effects of angiotensin. These results indicate for the first time that angiotensin II promotes fluid absorption in the rat intestine by an action within the CNS. The mechanisms underlying this novel action of angiotensin appear to differ from those responsible for its hypertensive action.

Increased respiratory frequency and variability in high risk babies who die of sudden infant death syndrome.

We have tested the hypothesis that autonomic instability, reflected in increased variability of heart rate and respiratory frequency, characterized high risk babies who died of sudden infant death syndrome. Using computer-based methods, we compared the power spectra of instantaneous heart rate and respiration on coded tape recordings from seven asymptomatic siblings and 10 babies with symptomatic apnea who died of sudden infant death syndrome to 34 age- and sex-matched controls. We confirmed our previous observation of increased respiratory bandwidth, an index of variability in respiratory frequency (p = 0.009) but failed to confirm our finding of increased low frequency fluctuations in heart rate (p = 0.18). In addition, we found an increase in mean respiratory frequency during quiet breathing (p = 0.001) and a significant relationship between respiratory bandwidth and mean respiratory frequency (r = 0.604, p = 0.0002). These variables along with those from a previous analysis of the same data base yield a discriminant function with 82% sensitivity and 100% specificity. These results confirm previous suggestions that high risk babies who die of sudden infant death syndrome exhibit autonomic instability.

Respiratory variations in arterial blood pressure and heart rate in normotensive and renal hypertensive dogs.

Respiratory sinus arrhythmia (RSA), systolic and diastolic respiratory blood pressure waves (RBPWsyst, RBPWdiast), mean heart rate (HR), mean respiratory frequency (RF) and the heart beat to respiratory cycle ratio (HB/RC) were measured in 23 spontaneously breathing, normotensive or renal hypertensive dogs under light anaesthesia. No significant differences were found between conditions of normal and chronically elevated blood pressure. All these parameters were analyzed statistically by means of linear regression analysis and rank correlation coefficient (rs). A correlation was found to exist between RSA and mean systolic blood pressure (negative), RF (negative), RBPWsyst (positive), RBPWdiast (positive). RF correlated with both HB/RC (negative) and RBPWsyst (negative). A correlation was also seen between PA and both BPsyst (positive) and BPdiast (positive), BPsyst and BPdiast (positive) and between HR and RBPWdiast (negative); however, all the remaining, theoretically possible correlations were not significant. The results may be referred to resonance mechanisms in a common nervous oscillator system.

Respiratory changes induced by prolonged laryngeal stimulation in awake piglets.

To examine the role of the laryngeal reflex in modulating cardiorespiratory function, we stimulated the superior laryngeal nerves (SLN) bilaterally in unanesthetized, chronically instrumented piglets (n = 10, age 5-14 days). The SLN were placed in cuff electrodes and wires were exteriorized in the neck for stimulation. A cannula placed in the aorta was used for blood pressure recording and arterial blood sampling. During each experiment, 1-2 days after surgery, ventilation was recorded using whole-body plethysmography, and electroencephalogram and electrocardiogram were recorded after acute subcutaneous electrode placement. After base-line recordings, the SLN were electrically stimulated for 1 h. During this period, mean respiratory frequency decreased by 40-75% and apneas of 10-15 s were regularly interspersed between single breaths or clusters of breaths. Periods of breathing were always associated with opening of the eyes and generally with head and body movements, an awakening that occurred every 10-15 s. At 1 h into the stimulus period, minute ventilation had decreased by 57 +/- 7% (mean +/- SE), arterial partial pressure of O2 (PaO2) by 68 +/- 3 Torr, and arterial partial pressure of CO2 (PaCO2) had increased by 19 +/- 2 Torr. Throughout the entire stimulus period, mean blood pressure and average heart rate were maintained within 12% of base line. We suggest that: low-threshold SLN afferents exert primarily respiratory effects and only minor cardiovascular effects; breathing during laryngeal reflex activation is sustained by an arousal system; and the laryngeal reflex does not pose an imminent threat to the unanesthetized, awake, young animal.

The guinea pig model of diisocyanate sensitization: II. Physiologic studies

The qualitative and quantitative properties of diisocyanate-specific IgE antisera derived from an IgE-susceptible strain of guinea pigs were investigated by passive sensitization of immunologically virgin recipient animals. These animals received infusions of antisera 48 hr before intravenous challenge with specific ligands conjugated to an unrelated carrier protein, human transferrin. The pulmonary response was sublethal and could be measured by physiologic methods. Various measurements were obtained in anesthetized guinea pigs placed in a whole-body pressure plethysmograph. Tidal volume (V t), dynamic compliance (C L dyn), and pulmonary conductance (G L) were calculated from simultaneous recordings of transpulmonary pressure. V t, and flow. Frequency at 1 and 2 min after intravenous challenge were also measured. Mean respiratory frequency was significantly increased in experimental animals 1 min after challenge with homologous hapten-protein conjugates, while maximum changes of V t, c L dyn, and G L occurred 2 min after intravenous challenges. A preponderant number of physiologic abnormalities occurred in animals challenged with homologous hapten-protein conjugates. The mean percent change of V t and C L dyn from baseline levels was significantly decreased after intravenous challenges with homologous ligands in animals passively sensitized with both hexamethylene diisocyanate—(HDI) and toluene diisocyanate-specific antisera. However, decrease of mean G L after challenge with homologous hapten-protein conjugates was significant only in animals passively sensitized with HDI-specific antisera. When the number of positive postchallenge pulmonary function responses was compared with the mean geometric titers of IgE antisera, it was observed that moderate or severe physiologic responses were associated with infusions of IgE antisera having titers of 160 or greater. These experiments suggest that antibody concentration may be a critical determinant in distinguishing between clinical, subclinical and nonreactive states induced by diisocyanate sensitization.

A refrigerated treadmill apparatus for exercising dogs.

To prevent overheating and panting in exercising dogs, a refrigerated enclosure was constructed on a standard laboratory treadmill to regulate skin and body temperature of exercising beagles. The enclosure temperature is controlled by a computer software algorithm that analyzes the exercising dog's skin and rectal temperatures and stabilizes rectal temperature to within +/- 0.1 degree C of a preselected resting level. Refrigeration is activated depending on the skin and rectal temperature dynamics lowering enclosure temperature as skin temperature and rectal temperature increase. The system has been used extensively to inhibit panting in exercising beagles, maintaining a mean and standard deviation respiratory frequency of 32 +/- 5 breaths/min during exercise at 5 km/h, 0% grade. These respiratory rates can be compared with reported respiratory frequencies of 95 +/- 57 breaths/min for beagles exercising at the same work load but at room temperature (Mauderly and Pickrell, Research Animals in Medicine, DHEW Publ. 72-333, 1973). This reduction in respiratory frequency is also accompanied by a reduced and repeatable expired minute ventilation and O2 consumption of 9.40 +/- 1.0 1/min (BTPS) and 0.331 +/- 0.031 1/min (STPD), respectively, and can be compared with 24.84 +/- 6.44 1/min (BTPS) and 0.440 +/- 0.0831 1/min (STPD) reported for beagles exercising at room temperature.

IMPROVED OXYGENATION IN PATIENTS WITH ACUTE RESPIRATORY FAILURE

DOUGLAS, W. W.; REHDER, K.; BEYNEN, F. M.; SESSLER, A. D.; MARSH, H. M. Author Information

Inhibition of thermal tachypnoea in rabbits following exposure to cold and water deprivation.

1. Rabbits were clipped and exposed in turn to four environmental conditions: control (C), cold exposure (CE), water deprivation (WD) and water deprivation and cold exposure together (WD/CE). 2. Following each type of treatment, the rabbits were exposed for 1 hr to an ambient temperature (Ta) of 35 degrees C. During this time, respiratory frequency (RF), rectal temperature (Tre), activity and oxygen consumption (V02) were recorded. 3. It was found that under both cold exposure and water deprivation conditions, the mean respiratory frequency during the first 30 min of heat exposure was reduced when compared with controls. This was associated with a delay in the onset of thermal tachypnoea. Under conditions of water deprivation and cold exposure together, the mean respiratory frequency was further reduced and the length of the delay was increased. 4. Previous cold exposure led to an increase in the V02 measured at 35 degrees C, whereas the V02, after water deprivation and water deprivation and cold exposure together were not significantly different from the control. 5. Neither the initial Tre nor the change in the Tre during the course of the heat exposure were significantly different from the controls under any of the experimental conditions. 6. It is concluded that both water deprivation and previous cold exposure cause a block to panting in the heat and that the blocking mechanisms involved are closely interrelated. It is also concluded that neither the metabolic rate of the animal nor its initial or final Tre are important factors in determing the degree to which thermal tachypnoea is inhibited.

Measurement of respiratory volume for virus retention studies in mice.

A pressure plethysmograph for measuring respiratory volume in mice during exposure to virus aerosols is described. The respiratory frequency and tidal volume were measured, and from these data the minute ventilation was calculated. The mean respiratory frequency of adult, male mice was 255 per min; the mean tidal volume of 0.18 ml was inversely related to respiratory frequency. The standardized mean minute ventilation rate was 1.46 ml per g of body weight. The respiratory frequency and tidal volume of CD-1 and HA/ICR strains of mice of the same age were similar. The respiratory retention rate for a 2.7-mum aerosol of vesicular stomatitis virus was 41%, and 58% of the virus retained was found in the trachea and lung.

Measurement of Respiratory Volume for Virus Retention Studies in Mice

A pressure plethysmograph for measuring respiratory volume in mice during exposure to virus aerosols is described. The respiratory frequency and tidal volume were measured, and from these data the minute ventilation was calculated. The mean respiratory frequency of adult, male mice was 255 per min; the mean tidal volume of 0.18 ml was inversely related to respiratory frequency. The standardized mean minute ventilation rate was 1.46 ml per g of body weight. The respiratory frequency and tidal volume of CD-1 and HA/ICR strains of mice of the same age were similar. The respiratory retention rate for a 2.7-mum aerosol of vesicular stomatitis virus was 41%, and 58% of the virus retained was found in the trachea and lung.

PATTERN OF VENTILATION IN YOUNG ADULTS.

The ventilatory pattern at rest was examined in 28 healthy human volunteers by recording pneumograph tracings for a 1-hr period. The mean respiratory frequency was 19/min in females, 16/min in males, but with considerable variation both within and among subjects. The mean inspiratory phase accounted for one-third of the respiratory cycle, but this fraction increased with increasing respiratory frequency and decreased when the frequency slowed. Tidal volumes varied greatly, and sighing (breaths larger than three times the average tidal volume) occurred at an average rate of 10/hr for females, 9/hr for males. The possible physiologic role of periodic deep breaths, or sighs, in providing reinflation of atelectatic areas is discussed. respiratory cycle at rest; respiratory frequency and tidal volumes; periodic deep breaths (sighing); inspiratory phase as related to expiratory phase; normal breathing; hyperinflation; respiration; rate of respiration; pneumographic tracings Submitted on November 8, 1962