Postoperative Diastolic Blood Pressure Research Articles

Ultrasound Guided Pectoral Nerve Block (PEC I) versus Serratus Anterior Plane block (SAPB) for Postoperative Analgesia in Modified Radical Mastectomy

Abstract Background Breast cancer is the most common cancer in women both in the developed and less developed world. In 2012, it represented about 12 percent of all new cancer cases and 25 percent of all cancers in women. A procedure called Modified radical mastectomy is now a standard surgical treatment for early stage breast cancers. These procedures cause significant acute pain and may progress to chronic pain states in 25–60% of cases. Though various risk factors have been suggested, inappropriate acute postoperative pain management has been associated with the development of chronic postmastectomy pain, a complex post-surgical pain syndrome that may occur following any type of breast surgery. Objective To evaluate the effectiveness of ultrasound guided pectoral nerve block (PEC1) versus Serratus Anterior plane block (SAPB) for postoperative Analgesia in modified radical mastectomy Methods This is Randomized controlled double blind clinical trial was conducted in the operating theatres of Ain Shams University Hospitals for 6 months after approval of ethical committee of faculty of medicine, Ain Shams Univeristy on 64 female patients undergoing Modified Radical Mastectomy divided randomly into two groups, each group consisted of 32 patients group I in which patients received PEC 1 and group II in which patients received Serratus Anterior Plane Block (SAPB). Results There was a statistically significant decrease mean of group II compared to group I according to postoperative systolic blood pressure (mmHg) from 1 hr. to 6 hrs. While there was no statistically significant difference between groups according to postoperative diastolic blood pressure (mmHg). However, a statistically significant decrease mean of group II compared to group I according to postoperative heart rate (beat/min) from 1 hr. to 6 hrs was found. A statistically significant decrease mean of group II compared to group I according to numeric rating score for pain from 1 hr to after 6 hrs also was found. The current study shows highly statistically significant difference between groups according to time of first analgesia (hour), number of patients who received postoperative Diclofenac 75 mg and total consumption of Diclofenac 75 mg. Conclusion SAPB was effective in reducing postoperative pain scores for 6 -12 hours and lower total 24-h postoperative opioid and analgesic consumption after modified radical mastectomy under general anesthesia, compared to PEC 1 block.

Predictors and Impact of Low Diastolic Blood Pressure and Widened Pulse Pressure Following Transcatheter Aortic Valve Replacement

BackgroundThe association between post-operative diastolic blood pressure (DBP) and pulse pressure (PP) with outcomes following transcatheter aortic valve replacement (TAVR) remains unclear. We sought to assess the prevalence, predictors, and impact of post-operative DBP and PP on presence of post-procedural aortic insufficiency (AI) and mortality in adults undergoing TAVR. MethodsThe study population included 194 patients who underwent TAVR from 2016 to 2017 at an academic tertiary medical center, of which 176 had invasive arterial pressures available postoperatively. Low DBP and widened PP were defined as ≤40 mmHg and ≥80 mmHg respectively on invasive arterial line on post-operative day 1. Clinical outcomes of interest included post-procedural AI and 1-year all-cause mortality. ResultsPost-operative low DBP and widened PP were noted in 32.4% and 58.5% of the study population. No significant association between post-operative AI and low DBP (p = 0.82) or widened PP (p = 0.32) was noted. There was a trend toward higher rates of mortality in patients with low DBP (19.3% vs 9.2%, p = 0.06) but no difference in mortality in patients with widened PP (10.7% vs 15.1%, p = 0.39) or those with ≥1+ post-procedural AI (16.7% vs 10.7%, p = 0.32). In multivariable analysis, low DBP was associated with a trend toward higher rates of 1-year mortality [odds ratio (OR) 2.43, 95% confidence interval (CI) 0.97–6.11, p = 0.06]. When excluding patients with a post-operative invasive systolic blood pressure < 80 mmHg, low DBP was associated with significantly higher risk-adjusted mortality at 1 year [OR 2.75, 95% CI (1.07–7.07), p = 0.04]. ConclusionsIn this contemporary study of adults undergoing TAVR, low DBP and widened PP were widely prevalent post TAVR. Low DBP was associated with a trend toward higher rates of 1-year mortality but not with post-procedural AI.

Effects of different anesthesia methods on maternal and neonatal outcomes in pregnant patients with pulmonary arterial hypertension: a meta-analysis.

To investigate the effects of different anesthesia methods on maternal and neonatal outcomes in pregnant patients with pulmonary arterial hypertension (PAH). We searched PubMed, Excerpta Medica Database (EMBASE), Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure (CNKI), Wanfang and QVIP for investigating the effects of general anesthesia (GA) and local anesthesia (LA) in pregnant patients with PAH. Results were expressed as weighted mean difference (WMD) or risk ratio (RR) with 95% confidence intervals (CIs). Publication bias was assessed by the Begg's test. Totally, 18 articles containing 628 LA and 481 GA patients were involved in our study. The postoperative blood oxygen saturation (WMD = - 4.040, 95%CI: - 5.505 to - 2.576) and maternal mortality rate (RR = 0.507, 95%CI: 0.300-0.858) were lower in LA group than those in GA group. The postoperative systolic blood pressure (WMD = 15.647, 95%CI: 13.294-18.000) and postoperative diastolic blood pressure (WMD = 6.758, 95%CI: 5.715-7.802) were high in LA group compared with those in GA group. The mechanical ventilation time (WMD = - 4.112, 95%CI: - 4.655 to - 3.569), ICU admission time (WMD = - 4.176, 95%CI: - 4.523 to - 3.828), length of stay (WMD = -7.289, 95%CI: -7.799-6.779) were shorter in LA group than those in GA group. All P values were < 0.05. LA is superior to GA in regards to the postoperative blood oxygen saturation, the postoperative systolic blood pressure, postoperative diastolic blood pressure, the mechanical ventilation time, ICU admission time, length of stay and the maternal mortality rate. osf.io/juybq ( https://osf.io/search/ ).

Immediate postoperative diastolic blood pressure as a prognostic factor in living donor kidney transplantation

Immediate postoperative diastolic blood pressure as a prognostic factor in living donor kidney transplantation

Patient\u2019s pre-operative dental anxiety is related to diastolic blood pressure and the need for post-surgical analgesia

In order to study the relationship of the patient’s anxiety level from Corah’s Dental Anxiety Scale (DAS) vs different physiological parameters: pre and post-operative blood pressure, and pre and post-operative heart rates, and subsequently, relate the results to the patient’s post-operative anti-inflammatory analgesic need, 185 patients requiring a simple dental extraction were recruited. They filled out the DAS in the waiting room prior to their procedure and once in the examination room, their preoperative blood pressure and heart rate was measured. Once the dental extraction had been completed, their blood pressure and heart rate were measured again. Before leaving the clinic, the patient was given an analgesic form in which they had to indicate whether or not they had required analgesia after the procedure. Diastolic blood pressure (DBP) showed statistically significant differences between pre-operative and post-operative (P = 0.001). DAS was related with pre-operative diastolic blood pressure (pre-DBP) (P = 0.001) and post-operative diastolic blood pressure (post-DBP) as well as pre-operative heart rate (pre-HR) (P = 0.027) and post-operative heart rate (post-HR) (P = 0.013). Patients with high levels of DAS tend to take more Ibuprofen 400 mg (P = 0.038). The different levels of anxiety will determine what type of anti-inflammatory analgesia the patient will take, if necessary.

The Effect of Conscious Sedation on Salivary Alpha-Amylase Levels During Third Molar Surgery

Aim: The aim of the present study was to investigate whether salivary alpha-amylase levels could be decreased by conscious sedation in the patients undergoing impacted third molar extraction. Material and methods: A total of 18 male patients were recruited. All patients were administered the Modified Dental Anxiety Scale test. Patients were divided into a test group (procedures under sedation) and a control group (procedures under local anesthesia). Systolic blood pressure, diastolic blood pressure, oxygen saturation, and heart rate were monitored at different study time-points. Five samples of saliva were taken from each patient: the first time the patient came to the clinic, the patient sat in the chair for extraction, before local anesthesia, immediately after extraction, at 4 h after extraction. Results: Although no statistically important difference was found for systolic blood pressure (p>0.05) between groups, postoperative diastolic blood pressure level of control group was statistically higher than the test group (p=0.030). Also, a statistically significant decrease was found in the oxygen saturation level in postoperative time compared to preoperative time (p<0.05). Conclusion: Even though conscious sedation may be a solution for dental anxiety and phobia, our results indicated that sedation did not affect acute stress levels during oral surgery.

Predictors of Acute Kidney Injury After Hip Fracture in Older Adults.

Introduction:This study aimed to investigate the prevalence of acute kidney injury (AKI) following hip fracture surgery in geriatric patients and to identify predictors for development of AKI with a focus on possible preventable risk factors.Methods:In this retrospective cohort study, we reviewed electronic medical records of all patients above 65 years of age who underwent hip fracture surgery at Copenhagen University Hospital, Bispebjerg, Denmark, in 2018. Acute kidney injury was assessed according to the Kidney Disease Improving Global Outcomes guidelines. Multivariate logistic regression analyses were used to identify independent risk factors for AKI.Results:Postoperative AKI developed in 28.4% of the included patients (85/299). Acute kidney injury was associated with increased length of admission (11.3 vs 8.7 days, P < .001) and 30-day mortality (18/85 vs 16/214, P = .001). In multivariable analysis, higher age (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.01-1.08, P = .004), heart disease (OR: 1.78, 95% CI: 1.01-3.11, P = .045), and postoperative blood transfusion (OR: 1.84, 95% CI: 1.01-3.36, P = .048) were associated with AKI. Moreover, a higher postoperative C-reactive protein (199.0 ± 99.9 in patients with AKI, 161.3 ± 75.2 in patients without AKI) and lower postoperative diastolic blood pressure were observed in patients developing AKI.Discussion and Conclusion:Acute kidney injury was common following hip fracture surgery and associated with longer admissions and increased mortality. Patients developing AKI were older and showed several postoperative similarities, including higher C-reactive protein, lower postoperative diastolic pressure, and the need for blood transfusion.

Pulmonary artery growth after Modified Blalock-Taussig shunt: A single center experience

This study evaluates growth of pulmonary artery (PA) between different age groups after Modified Blalock-Taussig shunt (MBTS) based on a single center experience. We retrospective analyzed outcomes of 90 patients undergoing MBTS in our institute from January 1, 2010 to May 1, 2018. Patients were divided into three groups: Group 1, ≦2 months, Group 2, >2 months, ≦24 wmonths, Group 3, >24 months. The outcome included PA growth, overall survival rates and postoperative complications. 23 patients were involved in Group 1, while 49 in Group 2 and 18 in Group 3. The diameter of the PA, McGoon ratio, Nakata index and the oxygen saturation increased significantly after MBTS. Compared to pre-MBTS, there was no statistically significant increase of McGoon ratio in Group 3 after performing MBTS, but it witnessed less secondary cardiac surgery rate compared with Group 2 (11.11% vs. 48.98%, P=0.005). Cumulative survival rates of three groups were 60.53%, 85.70%, 94.40% at 1 year; 60.53%, 78.30%, 87.75% at 3 years and 60.53%, 78.30%, 87.75% at 5 years. Multivariable analysis showed diastolic blood pressure <30mmHg [OR 14.14 (1.92-104.32), P=0.009], cardiopulmonary bypass use [OR 16.79 (2.05-137.67), P=0.009] and single ventricle anomaly [OR 8.80 (1.18-65.54), P=0.034] were predictors of perioperative mortality. MBTS in our institute is a conventional and effective procedure for growth of PA especially for patients younger than 24 months. Patients with biventricular anomaly, no cardiopulmonary bypass use in surgery and relatively high postoperative diastolic blood pressure will likely offer a good prognosis.

Perceived Pain during Cataract Surgery with Topical Anesthesia: A Comparison between First-Eye and Second-Eye Surgery.

Purpose. To compare pain scores between first-eye and second-eye cataract surgery and to determine the affecting factors. Methods. 106 first-eye and 53 second-eye cataract surgery patients (mean age: 67 ± 13 and 69 ± 10 years, resp.) were enrolled. The patients completed simplified State-Trait Anxiety Inventory and visual analog scale (VAS) for anxiety questionnaires before surgery, and VAS for pain and Wong-Baker Faces Pain Rating Scale questionnaires after surgery. Blood pressure (BP) and heart rate (HR) were recorded perioperatively. Results. A greater proportion of patients who underwent second-eye surgery reported intraoperative pain compared with first-eye surgery patients (85% versus 35%, P < 0.001). The pain scores were higher in second-eye surgery, while the VAS anxiety score was lower in second-eye surgery. Moreover, 31 patients reported greater pain during second-eye surgery than their first one, with higher pain scores than other 22 patients (P = 0.032 and 0.003, resp.). The VAS pain score of these 31 patients was positively correlated with the differences between the intraoperative and postoperative diastolic BP, mean arterial pressure, and HR. Conclusions. Cataract patients were likely to have more pain during second-eye surgery, which may be related to lower preoperative anxiety. Monitoring perioperative BP and HR may help to identify patients with intraoperative pain.

Impact of afterload reduction strategies on regional tissue oxygenation after the Norwood procedure for hypoplastic left heart syndrome

Low cerebral tissue oxygenation saturations have been observed by near-infrared spectroscopy (NIRS) after the Norwood procedure. Altered cerebral vascular resistance and pharmacological afterload reduction redirecting blood flow away from the cerebral circulation are possible mechanisms. Two different afterload reduction strategies were evaluated in patients with hypoplastic left heart syndrome or variants after the Norwood procedure. In patients of Group 1 (n=34), afterload reduction was controlled with sodium nitroprusside or with the α-blocker phentolamine. In addition, a phosphodiesterase-III inhibitor was administered. Patients of Group 2 (n=34) received a phosphodiesterase-III inhibitor only. Cerebral and somatic tissue oxygenation saturations and routine intensive care monitoring data were recorded for 24 h before and 48 h after the Norwood procedure. Mean values of the last 4 preoperative (baseline) and of the first and last 4 postoperative hours (early and late course) were calculated. Baseline, early and late cerebral saturations were 58±7, 52±9 and 60±6% for Group 1 and 58±7, 52±12 and 61±7% for Group 2 and somatic saturations were 59±8, 76±10 and 67±9% and 58±9, 78±8 and 69±10%, respectively. Regional saturations were not different between groups. The postoperative cerebral tissue oxygen saturation was below 40% for 50 (0-1040) min in Group 1 and for 45 (0-720) min in Group 2 (P=1.00). Preoperative cerebral NIRS values (OR 0.85 [0.76-0.96], P=0.007), age at operation (OR 1.39 [1.02-1.88], P=0.034) and early postoperative diastolic blood pressure (OR 0.88 [0.78-0.99], P=0.038) were associated with cerebral tissue oxygen saturations below 40% for more than 60 min. Patients with a prolonged period of low cerebral tissue oxygen saturation had longer duration of mechanical ventilation (69 (37-192) vs 60 (33-238) h, P=0.039) and afterload reduction therapy was terminated later (95 (47-696) vs 74 (39-650) h, P=0.006). Early mortality was 9.4% (3 of 32) compared with 2.8% (1 of 36) in the remainder (P=0.336). The postoperative decline of cerebral tissue oxygen saturation was observed with both afterload reduction strategies. The difference between cerebral and somatic NIRS values may indicate a mismatch between cerebral and splanchnic oxygenation. Other strategies to improve cerebral tissue oxygenation are warranted.

Renovascular operations in patients with chronic renal insufficiency: Do the benefits justify the risks?

To define the benefits and risks of renal revascularization or nephrectomy in patients with both severe hypertension and chronic renal insufficiency, we analyzed 98 patients who underwent renovascular operations after serum creatinine levels exceeded 2 mg/dl. This subset of patients was selected from a retrospective review of 652 renal operations performed at the Mayo Clinic for renovascular disease between 1970 and 1981. Special attention was given to the type of operations, their effect on hypertension and renal function, specific factors that affected operative deaths, and late survival. Unilateral renal operations were performed in 48 patients with bilateral procedures in 50. Simultaneous aortic reconstruction was necessary in 55 patients (56%). Postoperative diastolic blood pressure was less than 90 mm Hg in 55% of patients and 90 to 100 mm Hg in an additional 33%. Seventy-six percent of patients required less antihypertension medication. Serum creatinine improved or stabilized in 69%. Ninety percent of patients avoided any early or late renal dialysis. The operative mortality rate was 7.1% and tended to be higher in patients with a serum creatinine greater than 3 mg/dl and in those with past myocardial infarction (p = 0.05). The late survival rate was 64% at 5 years. The main cause of operative and late death was myocardial infarction. In conclusion, most patients with renovascular hypertension and early chronic renal insufficiency can be benefited by surgical revascularization or nephrectomy. Future improvement in early and late survival may require a more aggressive approach to the identification and correction of significant coronary artery disease.

Effect of primary renal disease in patients with renovascular insufficiency.

The effect of laboratory evidence of renal parenchymal abnormality on the results of renal revascularization in 83 patients with renovascular hypertension was determined. Primary renal disease (PRD) was defined as an abnormal urinalysis (proteinuria, hematuria, or casts) in the absence of urinary infection, or decreased renal function (elevated serum creatinine level greater than 1.5 mg/dl and/or decreased creatinine clearance). All patients were hypertensive on medical therapy preoperatively. Patients were defined as cured if postoperative diastolic blood pressure (BP) was less than 90 mm Hg on no medication and improved if BP less than 90 mm Hg on medication. Sixty-six patients (80%) were cured or improved following revascularization. Of 45 patients (63%) with evidence of PRD preoperatively, 28 (62%) were cured or improved compared with 33 patients without PRD, of whom all (100%) were cured or improved (p less than 0.001). Each of five patients with transplant renal artery stenosis had two operations; four were cured or improved. The serum creatinine level was elevated preoperatively in 37 cases. Eighteen of the 37 (49%) improved to within normal limits following operation. Fifteen patients had simultaneous bilateral renal artery revascularization, and 12 (80%) were cured or improved. Fourteen patients (17%) had concomitant vascular procedures: aortobifemoral bypass (seven), abdominal aneurysm resection (five), femoral endarterectomy (one), and aortoiliac bypass (one). Twelve of these 15 patients had PRD, and 8 of the 12 (67%) were cured or improved. Only one death occurred in the perioperative period. Thirty-eight patients (46%) had been treated for hypertension for more than 12 months before referral.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of primary renal disease in patients with renovascular insufficiency

The effect of laboratory evidence of renal parenchymal abnormality on the results of renal revascularization in 83 patients with renovascular hypertension was determined. Primary renal disease (PRD) was defined as an abnormal urinalysis (proteinuria, hematuria, or casts) in the absence of urinary infection, or decreased renal function (elevated serum creatinine level >1.5 mg/dl and/or decreased creatinine clearance). All patients were hypertensive on medical therapy preoperatively. Patients were defined as cured if postoperative diastolic blood pressure (BP) was <90 mm Hg on no medication and improved if BP <90 mm Hg on medication. Sixty-six patients (80%) were cured or improved following revascularization. Of 45 patients (63%) with evidence of PRD preoperatively, 28 (62%) were cured or improved compared with 33 patients without PRD, of whom all (100%) were cured or improved (p < 0.001). Each of five patients with transplant renal artery stenosis had two operations; four were cured or improved. The serum creatinine level was elevated preoperatively in 37 cases. Eighteen of the 37 (49%) improved to within normal limits following operation. Fifteen patients had simultaneous bilateral renal artery revascularization, and 12 (80%) were cured or improved. Fourteen patients (17%) had concomitant vascular procedures: aortobifemoral bypass (seven), abdominal aneurysm resection (five), femoral endarterectomy (one), and aortoiliac bypass (one). Twelve of these 15 patients had PRD, and 8 of the 12 (67%) were cured or improved. Only one death occurred in the perioperative period. Thirty-eight patients (46%) had been treated for hypertension for more than 12 months before referral. Twenty-six (68%) were cured or improved compared with 41 of 45 patients (90%) referred in less than 12 months (p < 0.01). This argues strongly for timely diagnosis and referral of patients with renovascular hypertension. Laboratory evidence of renal parenchymal abnormality is associated with a significantly worse BP response to renal revascularization.