Mean Blood Pressure Measurements Research Articles

Blood pressure in preterm infants with bronchopulmonary dysplasia in the first three months of life.

Neonatal hypertension is common in preterm infants with bronchopulmonary dysplasia (BPD). Our study aimed to examine blood pressure variation in the first three months of life in preterm BPD patients. We conducted a retrospective, single-centre study at the Neonatal Intensive Care Unit of the University of Szeged, Hungary. We collected blood pressure data from 26 preterm infants (born at < 30weeks gestation) with moderate or severe BPD over three years (2019-2021). We calculated the BPD group's daily average blood pressure values and used previously defined normal blood pressure values from a preterm patient group born at < 30weeks gestation as a reference. We used 19,481 systolic, diastolic and mean blood pressure measurement data separately to calculate daily average blood pressures. We found a statistically significant correlation between the blood pressure values of the BPD patient group and the reference data. The difference between the blood pressure curve of the group with BPD and that of the reference group was also statistically significant. We also analysed individual patients' daily average blood pressure values and found that 11 patients (42%) had hypertensive blood pressure values for three or more days within the first 90days of life. Within this group, our statistical analysis showed a 25% chance of acute kidney injury. The blood pressure of the BPD group not only correlated with but also significantly differed from the reference data. Hypertension lasting three or more days occurred more frequently in patients with acute kidney injury accompanied by BPD.

Abstract P2142: Evaluation Of Novel A3 Adenosine Receptor Agonist In Hypertension

The search for alternative strategies for treatment of cardiovascular diseases, lead to the design and synthesis of N -acylhydrazone derivative, named LASSBio-2062, which is a new ligand of adenosine receptor and that is a possible therapeutic target to reduce blood pressure because of its vasodilatory action and antioxidant properties. This work investigated the effects of a new A 3 adenosine receptor agonist (LASSBio-2062) in spontaneously hypertensive rats (SHR). Animal Care and Use Committee at Universidade Federal do Rio de Janeiro approved the protocols (017/19). Vascular reactivity was evaluated using isometric tension recording of pre-contracted thoracic aorta from male Wistar rats after exposure to increasing concentrations of LASSBio-2062 (0.1 - 100 μM) in the absence or presence of antagonist of adenosine A 2A receptor, ZM-241385 (0.1 μM), an antagonist of adenosine A 3 receptor, MRE 3008F20 (0.1 μM), a blocker of K ATP channel, glibenclamide (10 μM), an inhibitor of Kv channels, 4-AP, inhibitor of BK Ca , TEA (3 mM). Mechanical removal of endothelium increased the EC 50 for vasodilation from 15.5 ± 6.5 to 49.4 ± 10.0 μM, indicating partial dependence on the functional integrity of vascular endothelium. Vascular relaxation was not altered by ZM-241385 but the concentration-response curve shifted to the right with MRE 3008F20 and reduced maximum relaxation from 72.1 ± 4.0 to 23.6 ± 7.7%, indicating that vasodilation occurred by activation of the adenosine receptor type A 3 , but not A 2A . Reduced maximum vascular response by glibenclamide, TEA and 4-AP suggests that activation of A 3 adenosine receptor promotes hyperpolarization as a result reduces intracellular calcium. Antihypertensive effect was investigated in spontaneously hypertensive rats (SHR, 12-15 wks old), through the measurement of mean blood pressure (MBP) after intravenous injection of 10 and 30 μmol/kg of LASSBio-2062. After intravenous administration of LASSBio-2062 (10 umol/kg) in SHR, systolic and diastolic pressures reduced from 155.1 ± 10.1 to 110.6 ± 8.0 and from 111.0 ± 9.1 to 63.9 ± 14.7 mmHg, respectively. HR was also changed from 248.1 ± 12.1 to 146.5 ± 21.0 bpm. In conclusion, the N -acylhydrazone, LASSBio-2062 is a potential therapeutic agent to treat arterial hypertension.

Blood pressure in healthy term and late preterm newborns in Mexico City.

Describe the measurements of systolic, diastolic and mean blood pressure in healthy term and late preterm newborns to establish normal values. Cross-sectional study carried out in the nursery of the Hospital Español, located in Mexico City. A sample of 551 healthy newborns were included in the study. Blood pressure (BP) measurements were taken within the first 48 hours of life with the oscillometric method. After the evaluation of normality, a descriptive analysis of the population and calculation of percentiles (25, 50 and 75) specific for each week of gestation was performed. All analyzes were performed in STATA v14.2. Male newborns had a mean SBP value of 64.6 mmHg at week 35 of gestation, this value increased to 69.8 mmHg at week 40; the systolic blood pressure (SBP) value was 42.6 mmHg at week 35 of gestation, which decreased to 40.8 mmHg at week 40. The mean SBP values in female newborns were 65.5 mmHg at week 35, increasing to 73.5 mmHg at week 40; the diastolic blood pressure (DBP) value at week 35 of gestation was 38 mmHg, increasing to 41.3 mmHg at week 40. The BP values in healthy newborns are modified by the gestational age and sex of the patients. These results can serve as a reference for other physicians located in countries or cities with a similar altitude than the one in Mexico City.

Perioperative Validation of the TensorTip™ MTX Device for Noninvasive Arterial Pressure Measurement: A Method Comparison Study.

The noninvasive TensorTip™ MTX measures blood pressure by interpreting blood diffusion color of the finger skin. In addition to blood pressure, the device is able to measure various vital signs: heart rate, oxygen saturation, stroke volume, and cardiac output. Studies about accuracy and precision thus far available have only been conducted by the manufacturer. The aim of our study was to investigate the accuracy and precision of the TensorTip MTX in comparison to invasive radial artery blood pressure values. Forty-one patients scheduled for elective surgery were enrolled in this study. Placement of the arterial catheter had to be part of the standard of care. Once hemodynamic stable conditions were achieved, blood pressure was measured. Three measurements with the TensorTip MTX were averaged and compared with one invasive blood pressure measurement using Bland-Altman plot and error grid analysis. Systolic, diastolic, and mean blood pressure had a bias of respectively 6.2, -6.9 and 4.4 mm Hg. Corresponding standard deviation were respectively 30.1, 17.0 and 22.2. Calculated percentage errors were 47.6%, 52.9% and 52.3%. Proportional bias was present in all Bland-Altman analyses. Error grid analysis showed 61.0% of systolic blood pressure measurements, and 46.3% of mean blood pressure measurements were in the clinical acceptable zone. The TensorTip MTX was not able to reliably measure blood pressure compared to blood pressure obtained with an arterial catheter and therefore, the measurement performance is not clinically acceptable. Moreover, a high malfunction rate makes the device unsuitable for use in perioperative period.

Bias Associated with Peripheral Non-Invasive Compared to Invasive Arterial Blood Pressure Monitoring in Healthy Anaesthetised and Standing Horses Using the Bionet BM7Vet.

To compare arterial blood pressure (ABP) measured invasively (IBP) to ABP measured non-invasively (NIBP) via oscillometry in healthy anaesthetised and standing horses using the Bionet BM7Vet. Fourteen horses were anaesthetised for elective procedures (anaesthetised group) and 10 horses were enrolled for standing blood pressure manipulation (standing group). In both groups, IBP and NIBP-corrected to heart level were measured every 3 min using the Bionet BM7Vet. The overall mean difference (bias), standard deviation and limits of agreement (LOA) were calculated for paired IBP and NIBP systolic (SAP), mean (MAP) and diastolic (DAP) blood pressure measurements. In anaesthetised horses, the NIBP cuff was placed at either the proximal tail base or the metacarpus. Invasive MAP was used to retrospectively characterise measurements into hypotensive (≤70 mm Hg), normotensive (71–110 mm Hg) or hypertensive (≥111 mm Hg) subgroups. In standing horses, the NIBP cuff was placed at the tail base only and invasive MAP was manipulated to achieve hypertension (≥126 mm Hg) and hypotension (≤90 mm Hg) using phenylephrine and acepromazine, respectively. When measuring NIBP at the tail in anaesthetised horses, the Bionet BM7Vet failed on 8/185 occasions and overestimated SAP, MAP and DAP during hypotension and normotension. The biases (lower, upper LOA) for MAP were −11.4 (−33.3, 10.5) and −6.0 (−25.8, 13.8) mm Hg, respectively. Hypertension could not be evaluated. When measuring NIBP at the metacarpus in anaesthetised horses, the Bionet BM7Vet failed on 24/65 occasions and underestimated SAP, MAP and DAP when all ABP subgroups were combined. The bias (lower, upper LOA) for pooled MAP was 3.6 (−44.3, 51.6) mm Hg. When measuring NIBP at the tail in standing horses, the Bionet BM7Vet failed on 64/268 occasions and underestimated SAP, MAP and DAP during hypotension, normotension and hypertension. The biases (lower, upper LOA) for MAP were 16.3 (−10.5, 43.1), 16.6 (−19.5, 52.7) and 30.0 (−8.1, 68.0) mm Hg, respectively. Monitoring NIBP on the Bionet BM7Vet in anaesthetised horses overestimated ABP at the tail and underestimated ABP at the metacarpus. The device inaccurately detected hypotension and should be used cautiously. In standing horses, the Bionet BM7Vet underestimated ABP at the tail, especially during pharmacologically induced hypertension.

Comparison of Invasive Arterial Blood Pressure Monitoring vs. Non-Invasive Blood Pressure Monitoring in Preterm Infants < 37 Weeks in the Neonatal Intensive Care Unit- A Prospective Observational Study.

Accurate measurement of blood pressure (BP) is extremely important in the management of sick preterm newborns. The primary objective of this study was to compare non-invasive blood pressure measurement (NIBP) with invasive blood pressure measurement (IBP) using peripheral arterial cannulation (PAC) in preterm neonates < 37 weeks in the neonatal intensive care unit. Preterm neonates needing PAC were prospectively enrolled in the study. NIBP measurements were taken in the same limb as that of peripheral arterial line. Initially IBP was recorded followed by NIBP within 1 min using the same monitor. These were called as paired measurements since they are taken within 1 min of each other. Seventy-three preterm infants with 1703 paired measurements were included in the final analysis (median gestational age 32 weeks, IQR 30-34 weeks, median birth weight 1540 g, IQR 1160-2100 g). In preterm infants not receiving vasoactive agents (n = 51, 1428 paired measurements, Bland-Altman analysis for agreement between invasive mean blood pressure (MBP) and non-invasive mean BP revealed a bias of -2.9123 mmHg (SD 7.8074). The 95% limits of agreement were from -18.2157 to 12.3893 mmHg. In preterm infants with hypotension, we detected a bias of -3.9176 mmHg (SD 5.1135) between invasive MBP and non-invasive MBP. The 95% limits of agreement were from -13.9401 to 6.1048 mmHg. In normotensive preterm infants receiving vasoactive agents, we detected a bias of -0.7629 mmHg (SD 8.0539) between invasive MBP and non-invasive MBP. The 95% limits of agreement were from -16.5485 to 15.02274 mmHg. There is poor level of agreement between IBP and NIBP measurements in sick preterm neonates, leading to overestimation or underestimation of blood pressure. The bias was less for mean BP measurements as compared with systolic BP measurements and also for normotensive neonates as compared with hypotensive neonates. Hence, NIBP may be used as a screening method in haemodynamically stable preterm infants, but infants who are haemodynamically unstable and need to be commenced on vasoactive agents should have IBP monitoring.

Study of Changes in Optic Nerve Sheath Diameter Following Tracheal Intubation Using Macintosh Laryngoscope or Fibreoptic-Guided Intubation Through Ambu Aura-I: A Randomised Controlled Study.

Background: Neuroanaesthesiologists are faced with managing and optimising the intracranial pressure in the perioperative period. Laryngoscopy and tracheal intubation are known to increase sympathetic activity that is well tolerated by healthy patients but may be detrimental to many comorbid patients. We, therefore, hypothesised that airway management and tracheal intubation through Ambu Aura-I (Ambu, Baltorpbakken 13, Denmark) may be associated with lesser changes in optic nerve sheath diameter (ONSD) compared to conventional tracheal intubation and designed a study to ultrasonographically measure the changes in optic nerve sheath diameter following tracheal intubation using Macintosh laryngoscope or fibreoptic-guided intubation through Ambu Aura-I in patients receiving endotracheal anaesthesia.Material and methods: This randomised controlled hospital-based clinical study was conducted on 60 patients divided into two groups: group 1 (n=30, tracheal intubation facilitated by direct laryngoscopy with Macintosh laryngoscope) or group 2 (n=30, fibreoptic-guided tracheal intubation through Ambu Aura-I), undergoing elective surgery under general anaesthesia requiring tracheal intubation.Results: Baseline parameters before induction of anaesthesia were recorded for further comparison. Baseline ONSD at 3 mm behind the globe in both eyes (before induction of anaesthesia), both in transverse and the coronal plane, was measured by transorbital sonography with the patient lying in the supine position using a portable Sonosite Turbo-M ultrasonography (Fujifilm Sonosite, Bothell, USA) machine. End-tidal carbon dioxide concentration (EtCO2) was also recorded at this time. Observations of HR, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), oxygen saturation (SpO2), EtCO2, and ONSD measurements were recorded immediately and at three and five minutes after intubation, and complications were recorded. Data collected were tabulated, and statistical analysis was done using SPSS 22.00 for windows (SPSS Inc, Chicago, USA). The ONSD increase peaked at 4.19±0.35 and 4.16±0.31 mm in right and left eyes. Like in group 1, the ONSD decreased slightly to 4.06±0,29 and 4.05±0.29 mm in right and left eyes in group 2 at 10 minutes after intubation. The changes in ONSD when compared to baseline values (before intubation) were statistically not significant (p>0.05). Between-group comparison in ONSD in both the eyes at different time intervals was statistically not significant (p>0.05).Conclusion: We conclude that fibreoptic-guided tracheal intubation through Ambu Aura-I is not superior to tracheal intubation using direct laryngoscopy with Macintosh laryngoscope in terms of its effect on intracranial pressure, as measured ultrasonographically by optic nerve sheath diameter.

Perioperative Hemodynamic Monitoring: An Overview of Current Methods.

Perioperative hemodynamic monitoring is an essential part of anesthetic care. In this review, we aim to give an overview of methods currently used in the clinical routine and experimental methods under development. The technical aspects of the mentioned methods are discussed briefly. This review includes methods to monitor blood pressures, for example, arterial pressure, mean systemic filling pressure and central venous pressure, and volumes, for example, global end-diastolic volume (GEDV) and extravascular lung water. In addition, monitoring blood flow (cardiac output) and fluid responsiveness (preload) will be discussed.

MACHINE LEARNING CLUSTERING FOR BLOOD PRESSURE VARIABILITY: VALIDATION FROM THE SPRINT TO THE HONG KONG COMMUNITY COHORT

Objective: Visit-to-visit BPV is associated with risks of cardiovascular diseases. Our aim is to investigate the classification methods of patients with varying levels of BPV using different machine learning algorithms. Design and method: Two sets of visit-to-visit blood pressure (BP) readings were extracted from (i) SPRINT in the United States and (ii) BP cohort in Hong Kong (HK). BPV were defined as the mean absolute residuals of regression trends on BP over time. Patients were clustered into low, medium and high levels of BPV with the traditional quantile clustering and five machine learning algorithms, including K-means clustering, Partitioning Around Medoids (PAM), Spectral clustering, Ward's method and Expectation Maximization. Clustering methods were assessed by the Stability Index, and similarities were assessed by the Davies-Bouldin Index (DBI) and the Silhouette Index. Regression models were fitted to compare the risk of stroke. Results: Results: A total of 8,133 participants were included from SPRINT with the mean BP measurement 14.7 times in 3.28 years of follow-up, and1,094 participants were recruited from HK cohort with the mean BP measurement 165.4 times in 1.37 years. Quantile clustering assigned one-third participants as the high level of BPV, but machine learning methods only assigned 10 to 27%. Quantile clustering is the most stable method (Stability Index: 0.982 in the SPRINT and 0.948 in the HK cohort) but shown to have certain levels of cluster similarities (DBI: 0.752 and 0.764, respectively) (Table 1). Across the machine learning algorithms, K-means clustering is the most stable method (Stability Index: 0.975 and 0.911, respectively) with lowest similarities on cluster classification (DBI: 0.653 and 0.680, respectively). Patients with high level of BPV under the machine learning models showed stronger association with stroke. Conclusions: Among the machine learning algorithms, K-means clustering shows the most stable and reliable results. One-seventh of the population with high level of BPV had elevated risk of stroke compared to conventional BPV classification. Machine learning can be potentially used in the electronic health system for better patient management.

Prevalence and factors associated with hypertension among people living with HIV/AIDS on antiretroviral therapy in Uganda.

Introductionantiretroviral therapy (ART) has improved survival of People Living with HIV (PLWH); however, this has resulted in an increasingly high prevalence of non-communicable diseases (NCD) like hypertension. Hypertension is a major risk factor for cardiovascular and cerebral vascular disease, which are both associated with high morbidity and mortality rates. We studied the prevalence and factors associated with hypertension among PLWH on ART.Methodswe conducted a retrospective data analysis of PLWH on ART enrolled between 2011 and 2014 into a randomized double-blinded placebo-controlled trial investigating the safety of discontinuing cotrimoxazole prophylaxis (COSTOP) among PLWH in Central Uganda. We used the mean blood pressure (BP) measurements of the first four monthly clinic visits to define hypertension. Patients were categorised as: having normal BP (≤120/80mmHg), elevated BP (systolic >120-129, and diastolic ≤80), Stage 1 hypertension (systolic 130-139, or diastolic >80-89) and Stage 2 hypertension (systolic ≥140 or diastolic ≥90). Multiple logistic regression was used to evaluate factors associated with hypertension.Resultsdata from 2026 COSTOP trial study participants were analysed, 74.1% were women and 77.2% were aged 35 years and above. The overall prevalence of hypertension was 29%, of whom 19.5% had Stage 1 hypertension and 9.5% had Stage 2 hypertension. About 21.4% were overweight or obese. Factors independently associated with hypertension among PLWH on ART included increasing age (p≤0.001) and high body mass index (p≤0.001). Efavirenz (p≤0.001) and lopinavir/ritonavir (p=0.036) based regimen had lower odds of hypertension than Nevirapine based regimens.ConclusionPLWH on ART have a high prevalence of hypertension, which rises with increasing age and body mass index (BMI) and among those on nevirapine-based ART. Implementation of hypertension prevention measures among PLWH on ART and integration of NCD and HIV care to improve patients’ management outcomes are required.

Choroidal Vascularity Index in Patients with Type-1 Diabetes Mellitus without Diabetic Retinopathy

ABSTRACT Purpose: This study aims to assess choroidal vascularity index (CVI) and choroidal thickness (CT) in patients diagnosed with type 1 diabetes mellitus (DM) and compare them with healthy control subjects. Methods: This retrospective and cross-sectional study includes 43 patients diagnosed with type 1 DM and 43 healthy age/gender-matched subjects as the control group. Enhanced depth imaging optical coherence tomography (EDI-OCT; Spectralis, Heidelberg Engineering GmbH, Heidelberg, Germany) images of all participants were analyzed. CT measurements of five different points (subfoveal, 500 µm temporal, 1500 µm temporal, 500 µm nasal, and 1500 µm nasal to the fovea) were obtained. Choroid images were divided into luminal (LA) and stromal areas (SA) determined by image binarization method. Choroidal vascularity index (CVI) was defined as the ratio of LA to total choroid area (TCA). The effects of age, HbA1c, fasting plasma glucose, duration of DM, mean blood pressure, intraocular pressure, and axial length measurements on CVI were investigated. Results: There was no significant difference between any of the CT measurements of the groups (all p > .05). There was no significant difference between the groups according to TCA (0.82 ± 0.24 vs. 0.80 ± 0.19; p = .065), LA (0.54 ± 0.17 vs. 0.55 ± 0.16; p = .123) and SA (0.28 ± 0.06 vs. 0.25 ± 0.07; p = .068). However, patients had significantly lower CVI compared to control subjects (66.07 ± 3.19 vs. 68.89 ± 2.85, p < .001). Univariate linear regression model revealed that there was a negative correlation between disease duration and CVI (standardized beta coefficient: -0.416, p = .006). Conclusion: According to our findings, reduced CVI may indicate subclinical dysfunction in choroid of patients with type 1 DM.

Continuous Non-Invasive Arterial Pressure Monitoring (ClearSight System) and Ankle Blood Pressure Measurements as Alternatives to Conventional Arm Blood Pressure.

Measuring blood pressure (BP) via a pneumatic cuff placed around the arm has long been the standard method. However, in clinical situations where BP monitoring at the arm is difficult, the ankle is frequently used instead. We compared continuous non-invasive blood pressure (CNBP) measurements obtained at the finger, ankle BP and arm BP in patients undergoing breast cancer surgery. Arm BP, ankle BP (both obtained with a conventional pneumatic cuff) and CNBP measurements were obtained every 2.5 min during surgery. Correlation and Bland–Altman analyses were performed and differences among measurements were analyzed using a linear mixed model. A total of 245 sets of BP measurements were obtained from 10 patients. All systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean blood pressure (MBP) measurements of ankle BP and CNBP were positively correlated with the arm BP measurements (Spearman rho 0.688–0.836, p < 0.001 for each correlation). The difference between CNBP and arm SBP was significantly smaller (least squares mean (95% confidence interval): −6.03 (−11.40, −0.67)) compared to that between ankle and arm SBP (least squares mean (95% CI): −15.32 (−20.69, −9.96), p = 0.019). However, this significant difference was not observed in DBP and MBP (−1.23 vs. 1.75, p = 0.190 and −3.85 vs. −2.63, p = 0.604, respectively). Ankle SBP measurements showed larger differences from arm SBP measurements than did CNBP SBP measurements in patients undergoing breast cancer surgery. CNBP could serve as a useful alternative to ankle BP when standard arm BP measurements cannot be obtained.

Relationship among Left Ventricular Hypertrophy, Cardiovascular Events, and Preferred Blood Pressure Measurement Timing in Hemodialysis Patients.

This study aimed to identify the ideal timing and setting for measuring blood pressure (BP) and determine whether the left ventricular mass index (LVMI) is an independent risk factor associated with increased cardiovascular events in hemodialysis (HD) patients. BP and LVMI were measured at baseline and at 6 and 12 months after HD initiation. BP was monitored and recorded at nine different time points, including before and after HD over a one-week period (HDBP). The mean BP measurement was calculated as the weekly averaged BP (WABP). LVMI was significantly correlated with home BP, in-office BP, HDBP, and WABP. Receiver operating characteristic analysis indicated that the cutoff LVMI value for cardiovascular events was 156 g/m2. LVMI and diabetes mellitus were significant influencing factors for cardiovascular events (hazards ratio (95% confidence interval): diabetes mellitus, 2.84 (1.17,7.45); LVMI > 156 g/m2, 2.86 (1.22,6.99)). Pre-HDBP, post-HDBP, and WABP were independently associated with higher LVMI in the follow-up periods. Hemoglobin and human atrial natriuretic peptide (hANP) levels were associated with LVMI beyond 12 months after HD initiation. Treatment of hypertension, overhydration based on hANP, and anemia may reduce the progression of LVMI and help identify HD patients at high risk for cardiovascular events.

Blood pressure measurements with the OptiBP smartphone app validated against reference auscultatory measurements

Mobile health diagnostics have been shown to be effective and scalable for chronic disease detection and management. By maximizing the smartphones’ optics and computational power, they could allow assessment of physiological information from the morphology of pulse waves and thus estimate cuffless blood pressure (BP). We trained the parameters of an existing pulse wave analysis algorithm (oBPM), previously validated in anaesthesia on pulse oximeter signals, by collecting optical signals from 51 patients fingertips via a smartphone while simultaneously acquiring BP measurements through an arterial catheter. We then compared smartphone-based measurements obtained on 50 participants in an ambulatory setting via the OptiBP app against simultaneously acquired auscultatory systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean blood pressure (MBP) measurements. Patients were normotensive (70.0% for SBP versus 61.4% for DBP), hypertensive (17.1% vs. 13.6%) or hypotensive (12.9% vs. 25.0%). The difference in BP (mean ± standard deviation) between both methods were within the ISO 81,060–2:2018 standard for SBP (− 0.7 ± 7.7 mmHg), DBP (− 0.4 ± 4.5 mmHg) and MBP (− 0.6 ± 5.2 mmHg). These results demonstrate that BP can be measured with accuracy at the finger using the OptiBP smartphone app. This may become an important tool to detect hypertension in various settings, for example in low-income countries, where the availability of smartphones is high but access to health care is low.

Ultrasound-guided transversus abdominis plane block using ropivacaine and dexmedetomidine in patients undergoing caesarian sections to relieve post-operative analgesia: A randomized controlled clinical trial.

Dexmedetomidine, which is a highly selective α2 adrenoreceptor agonist, enhances the analgesic efficacy and prolongs the analgesic duration when administered in combination with local anesthetics. The current study aimed to evaluate the effects of dexmedetomidine combined with ropivacaine in ultrasound-guided transversus abdominis plane (TAP) block on post-operative analgesia following cesarean section (CS). A total of 70 patients scheduled for CS were divided randomly into 2 groups: The ropivacaine (R) group, in which patients were administered bilateral 20 ml 0.3% ropivacaine and 2 ml 0.9% normal saline, and the dexmedetomidine (RD) group, in which patients were administered bilateral 20 ml 0.3% ropivacaine and 2 ml dexmedetomidine (0.5 µg/kg). The primary outcome was pain-free duration, and secondary outcomes included heart rate (HR) and mean blood pressure (MBP) measurements, visual analogue scale (VAS) pain scores, number of patients who required rescue analgesic, time to first request for analgesia and patient satisfaction. There was no significant difference in HR and MBP between the two groups at 1 h post-surgery (P>0.05). However, VAS pain scores decreased at 6 and 8 h post-surgery [2 (1-2) vs. 0 (0-0.25) and 2 (2-3) vs. 0 (0-1), respectively; P<0.05], pain-free duration was prolonged (5.91±1.08 vs. 9.62±1.46 h; P<0.05), the number of patients who required rescue analgesic was reduced (19 vs. 9; P<0.05), the time to first request for analgesia was prolonged (7.10±1.21 vs. 11.60±2.11 h; P<0.05) and patient satisfaction was improved [3.5 (3-4) vs. 4 (4-5); P<0.05] in the RD group compared with the R group. Furthermore, no bradycardia or hypotension was observed. In conclusion, the results of the present study demonstrated that adding 0.5 µg/kg dexmedetomidine to 0.3% ropivacaine used in TAP block in patients undergoing CS prolonged pain-free duration, decreased VAS pain scores, reduced the number of patients who required rescue analgesic, prolonged the time to first request for analgesia and improved the patient satisfaction without serious side effects.

Moderate Correlation between Central Aortic Pressure and Non-Invasive BP Monitoring in Patients Supported with Left Ventricular Assist Device Therapy

BackgroundThe present gold standard for non-invasive measurement of blood pressure in patients supported on continuous-flow left ventricular assist device (CF-LVAD) therapy is Doppler sphygmomanometry. However, the relationship with central aortic pressures is unknown.HypothesisNon-invasive blood pressure measurements will systematically underestimate central aortic pressures.MethodsWe evaluated patients on CF-LVAD therapy undergoing left heart catheterization at our institution between 2015 and 2018 for any indication. We correlated non-invasive mean blood pressure measurements (NIBP-MAP) with catheter-derived mean central aortic pressures (Ao-MAP), and attempted to stratify by putative variables.ResultsIn a cohort of 55 patients with available NIBP data, we found a NIBP-MAP of 81.1 ± 12.5 mmHg and an Ao-MAP of 81.3 ± 10.8 mmHg. There was a significant albeit moderate correlation between NIBP and AoP (R2 = 0.52, p < 0.0001) with a tendency of NIBP to underestimate Ao-MAP at high and low Ao-MAP values. This association did not vary by pump type (R2 = 0.55 for HM2 and R2 = 0.47 for HW, both with p<0.001). The mean absolute difference between NIBP-MAP and Ao-MAP was 7.4 ± 4.8 mmHg, and the range of differences between Ao-MAP and NIBP-MAP values was -20 mmHg to +18 mmHg. A narrower aortic pulse pressure weakened the correlation but narrower pulse pressure on NIBP did not affect the correlation. Disagreement between NIBP-MAP and Ao-MAP was not affected by age, gender, BMI, aortic valve opening, LVAD type, or speed (p=ns for all).ConclusionsCorrelations between NIBP measurements and AoP pressures are moderate but NIBP does not systematically over- or underestimate central pressures. Further work should seek to improve on current methods of measuring blood pressure and determine the role of invasive monitoring for longitudinal management. The present gold standard for non-invasive measurement of blood pressure in patients supported on continuous-flow left ventricular assist device (CF-LVAD) therapy is Doppler sphygmomanometry. However, the relationship with central aortic pressures is unknown. Non-invasive blood pressure measurements will systematically underestimate central aortic pressures. We evaluated patients on CF-LVAD therapy undergoing left heart catheterization at our institution between 2015 and 2018 for any indication. We correlated non-invasive mean blood pressure measurements (NIBP-MAP) with catheter-derived mean central aortic pressures (Ao-MAP), and attempted to stratify by putative variables. In a cohort of 55 patients with available NIBP data, we found a NIBP-MAP of 81.1 ± 12.5 mmHg and an Ao-MAP of 81.3 ± 10.8 mmHg. There was a significant albeit moderate correlation between NIBP and AoP (R2 = 0.52, p < 0.0001) with a tendency of NIBP to underestimate Ao-MAP at high and low Ao-MAP values. This association did not vary by pump type (R2 = 0.55 for HM2 and R2 = 0.47 for HW, both with p<0.001). The mean absolute difference between NIBP-MAP and Ao-MAP was 7.4 ± 4.8 mmHg, and the range of differences between Ao-MAP and NIBP-MAP values was -20 mmHg to +18 mmHg. A narrower aortic pulse pressure weakened the correlation but narrower pulse pressure on NIBP did not affect the correlation. Disagreement between NIBP-MAP and Ao-MAP was not affected by age, gender, BMI, aortic valve opening, LVAD type, or speed (p=ns for all). Correlations between NIBP measurements and AoP pressures are moderate but NIBP does not systematically over- or underestimate central pressures. Further work should seek to improve on current methods of measuring blood pressure and determine the role of invasive monitoring for longitudinal management.

Antiemetic effect of oral maropitant treatment before the administration of brimonidine ophthalmic solution in healthy cats.

The aim of this study was to investigate the antiemetic, behavioural and physiological effects of oral maropitant treatment before the administration of brimonidine ophthalmic solution in healthy cats. Five cats received oral maropitant 8 mg or no treatment (control) 18 h before the administration of one drop of brimonidine solution in both eyes. Each cat was administered each of the two treatments, with a washout period of 1 week. The incidence of emesis, retching, sialorrhoea and lip-licking after brimonidine administration was recorded, while behavioural and physiological parameters, including heart rate, mean blood pressure, respiratory frequency and rectal temperature, were recorded before and 0, 30, 60, 90, 120, 180 and 240 mins after brimonidine administration. Emesis and retching were not observed when maropitant was administered. However, 4/5 cats exhibited vomiting and retching in the absence of maropitant pretreatment. The incidence of emesis and retching after brimonidine administration was significantly lower in the treatment group than in the control group. Sialorrhoea occurred in one cat in the control group, while all cats showed lip-licking after brimonidine administration. There were no significant differences in the incidence of sialorrhoea and lip-licking between the two groups. Although behaviour scores were comparable between the two groups, those obtained during heart rate, mean blood pressure and respiratory frequency measurements were significantly lower than the baseline scores; this indicated a sedative effect after brimonidine administration. The heart rate and mean blood pressure significantly decreased after brimonidine administration in both groups, while there were no intergroup differences in the heart rate, mean blood pressure, respiratory frequency and rectal temperature. Oral maropitant treatment before the administration of brimonidine ophthalmic solution in cats can alleviate emesis and retching without affecting the sedative effects of brimonidine and important physiological parameters.

Comparative Assessment of Body Mass Index, Blood Pressure and Blood Sugar levels among Residents in Gas-Flaring and Non-Gas-Flaring Communities in Imo State

Aim: The purpose of this study was to evaluate the effects of gas flare and air pollution on body mass index, blood pressure and blood sugar measures in individuals living in Niger Delta states of Nigeria. Methodology: Two communities (a test and a control) were used for the study in Niger Delta communities in Imo State. The study was carried out among randomly selected chronically exposed and non-exposed residents. People of different occupations and sex were used for the study. Blood pressure was measured using manual mercurial sphygmomanometer in sitting position after about 10 minutes rest while random blood sugar was measured using Accu-CHEK glucometer. Body mass index(BMI) was calculated in kg/m2 as a ratio of body weight and height squared. Results: Results showed that the mean BMI of the test group (27.88 ± 0.23) was significantly higher (P&lt;0.05) than that of the control (23.16 ± 0.18). Also, generally, the mean blood pressure measurements (systolic blood pressure, diastolic blood pressure, pulse pressure, mean arterial blood pressure) and blood sugar of both males and the females were significantly higher (P&lt;0.05) when compared with the control. Blood pressure measures were higher in males while blood sugar was higher in females. Irrespective of occupation, blood pressure and blood sugar measurements showed a statistically significant increase (P&lt;0.05) in the test group when compared with the control. Conclusion: In conclusion, long-term exposure to oil/gas flares increased blood pressure, blood sugar and BMI all of which are risk factors for cardiovascular diseases. Keywords : Gas flaring, Blood pressure, Diabetes mellitus, Body mass index

Indirect evaluation method and parameters of blood pressure and its indexes in dogs

The article presents the results of studies on the adaptation of the automatic tonometer Longevita BP–1305 with replaceable marking cuffs I(C1I) and C(C1C) for the oscillometric method of blood pressure measuring in dogs of different sizes. Reference indicators are defined. The proposed method is indirect and is based on the measurement of air pressure required to compress the artery and stop the blood flow in it. The initial recorded tone displays the maximum, or systolic, pressure (Sys). The process of stopping the registration of pulse tremors occurs at the time of restoration of the artery lumen and corresponds to the minimal, or diastolic, blood pressure (Dia). The use of the oscillometric method completely eliminates the human factor for the measurements. These cuffs allow to cover the whole range of the dogs circles subulnar zone of different breeds. The ratio of width to circumference is 42–45%, which is the optimal value. The cuff of the device was applied to the left forearm area. Measurements were carried out three times, calculating the arithmetic mean of the results to account for the error caused by the stress state of animals. Experienced dogs were in the usual lying position. All healthy animals were monitored for blood pressure in the morning (9–10 hours), afternoon (14–15 hours) and evening (19–20 hours). Under the influence of aggressive factors of excessive force, inadequate violent chaotic reactions of the body occur, which leads to a state of shock. Periodic measurement of mean blood pressure in combination with other routine studies can identify patients at risk of decompensation at the stage when resuscitation is still possible. Systolic, diastolic blood pressure and pulse rate were measured. The mean blood pressure and Allgover shock index were calculated. We did not find a significant difference in blood pressure depending on body weight. Also, these figures fluctuate unreliably during the day and are the largest in the morning with a tendency to decrease in the evening. We have established the reference values of blood pressure of clinically healthy dogs at the level of the narrowed norm (M ± σ), taking into account the permitted number of the studied animals (n = 120). The shock index of Allgover in healthy animals is in the range of 0.6–0.9. The growth of the indicator indicates an increase in shock phenomena.

Effect of the menstrual cycle on circulation during combined spinal-epidural anaesthesia

BackgroundFrom adolescence to menopause, hormone levels during the menstrual cycle affect various body systems, from the cardiovascular system to the water and electrolyte balance. This study investigated the effect of different phases of the menstrual cycle on circulatory function relative to changes in body position and combined spinal-epidural anaesthesia (CSEA).MethodsForty-six women were selected who underwent scheduled gynaecological surgery, were classified as American Society of Anesthesiology (ASA) I-II, and met the test criteria. The sample was divided into the follicular and corpus luteal groups. Preoperative heart rate and blood pressure measurements were taken from the supine and standing positions. Heart rate measurements as well as systolic, diastolic, and mean blood pressure measurements were taken upon entering the operating room, at the beginning of the spinal-epidural anaesthesia, and 10, 20, and 30 min after anaesthesia was administered.ResultsThe heart rates of patients in the corpus luteal group were higher than those of patients in the follicular group both before and after anaesthesia (P < 0.05). Significantly more ephedrine was used during the first 30 min of CSEA in the corpus luteal group than in the follicular group (P < 0.05).ConclusionsAlthough the effect was slight, women in the follicular phase were better able to compensate and tolerate circulatory fluctuations than those in the luteal phase.