Recovery Of Spontaneous Respiration Research Articles

Normalized Pulse Volume as a Superior Predictor of Respiration Recovery and Quantification of Nociception Anti-nociception Balance Compared to Opioid Effect Site Concentration: A Prospective, Observational Study

Background Quantifying pain and the balance between nociception and anti-nociception (NANB) in sedated patients is challenging. Traditional opioid titration methods overlook individual differences, while existing indices like the Noxious Stimulation Response Index (NSRI) lack correlation with effect-site concentration (Ce). The Normalized Pulse Volume (NPV), used in polygraphs, has potential for pain quantification but is underexplored. This study aimed to assess NPV’s efficacy as a pain monitoring tool compared to Ce and to explore its potential in various clinical settings. Methods The study included 39 patients undergoing surgery under total intravenous anesthesia from July 2013 to May 2014. Selection criteria were an American Society of Anesthesiologists physical status classification system (ASA score) of 1 or 2 and surgeries with minimal fluid resuscitation or blood loss. Exclusion criteria were significant posture changes, massive hemorrhage, and high perfusion index variation. NPV and Ce were measured using the Masimo SET adult SpO2 sensor. Results Out of 39 patients, 9 were excluded. NPV at recovery of spontaneous respiration (RoR) was 2.62 (95% CI: 2.26–2.98) with a coefficient of variation (CoV) of 36.3%, while total Ce was 1.48 ng/ml (95% CI: 1.14–1.84) with a CoV of 62.4%. NPV showed a narrower CoV than Ce (p < 0.05, 1.93*10−5), indicating less variability. NPV outperformed Ce in predicting RoR, suggesting a more accurate reflection of NANB balance. Its superiority in stable measurement underlines its potential as a reliable pain indicator. The study’s limitations include temporal differences in NPV and Ce calculations, affecting comparative analysis. Conclusion NPV demonstrates promise as an objective, reliable indicator of pain or NANB, showing a strong correlation with Ce. Its application could improve pain assessments in clinical settings, optimizing patient care and analgesic administration. Future research should integrate NPV with other vital signs for a comprehensive pain monitoring system.

Effects of lidocaine administration via the perforated outer cuff of a dual-cuff endotracheal tube and remifentanil administration on recovery from general anaesthesia for female patients undergoing thyroidectomy: a single centre, double-blind, randomised study

BackgroundCough caused by endotracheal tube (ETT) placement is ubiquitous and correlates with adverse outcomes. Remifentanil administration via target-controlled infusion (TCI) is one of the cough prevention measures used during recovery. In a pilot study, lidocaine administered via the perforated outer cuff of a dual-cuff endotracheal tube was also found to prevent cough due to ETT placement. We therefore compared these two cough prevention approaches during recovery after thyroidectomy in a single-centre, double-blind, randomised study conducted in China during the period from 09/10/2020 to 30/04/2021.MethodsNinety-eight female patients aged 18–65 years with American Society of Anaesthesiologists Physical Status scores of I and II were scheduled to undergo thyroidectomy. The ETT contained an internal cuff covered by a perforated outer cuff to allow for lidocaine delivery. Patients were randomised to receive either 4 ml of saline solution (Group R, n = 49) or 4 ml of 2% lidocaine in the outer cuff (Group L, n = 49) at the beginning of skin suturing. Remifentanil (2 ng/ml) was maintained in Group R until extubation, while remifentanil was maintained in Group L until the end of skin suturing. The primary outcome was cough during patient transfer, at 1 min before extubation, and at extubation. The secondary outcomes were haemodynamics and other recovery parameters.ResultsPrimary outcomes were compared between remifentanil vs. lidocaine application, namely, the incidence of cough during patient transfer (0% in Group R vs. 0% in Group L), at 1 min before extubation (22.45% in Group R vs. 4.08% in Group L; P = 0.015), and at extubation (61.22% in Group R vs. 20.41% in Group L; P < 0.001). Compared with remifentanil, lidocaine more effectively decreased heart rate elevation and hypoxemia at 5 min after extubation, the spontaneous respiration recovery time, the extubation time, the duration of post-anaesthesia care unit (PACU) stay, Richmond Agitation-Sedation Scale scores in the agitated range and Critical-Care Pain Observation Tool scores.ConclusionLidocaine administered via the perforated outer cuff of the ETT significantly improved recovery from general anaesthesia compared to remifentanil in female patients after thyroidectomy.Trial registrationChinese Clinical Trial Registry (No. ChiCTR2000038653), registered on 27/09/2020.

Effects of different sedatives/analgesics on stress responses in patients undergoing craniotomy and bone flap decompression.

ObjectiveTo explore the effects of sedation and analgesia with dexmedetomidine and other drugs on the stress response in patients with cerebral hemorrhage after craniotomy hematoma removal and bone flap decompression and insertion of an indwelling endotracheal catheter.MethodsA total of 180 patients with cerebral hemorrhage with consciousness disturbance who underwent emergency surgery were included in this study. They were divided into six groups treated with propofol, dexmedetomidine, lidocaine, sufentanil, dezocine, and remifentanil, respectively. Intravenous medication was given after recovery of spontaneous respiration, and stress responses were compared among the group.ResultsSerum concentrations of norepinephrine, epinephrine, and cortisol and systolic blood pressure were significantly correlated with drug treatment. Serum norepinephrine concentrations differed significantly among the groups, except between the sufentanil and propofol groups. There were significant differences in serum epinephrine concentrations among all groups, and significant differences in serum cortisol concentrations among all groups, except the propofol, dexmedetomidine, and lidocaine groups.ConclusionDexmedetomidine can reduce the stress response in patients with intracerebral hemorrhage undergoing emergency craniotomy and bone flap decompression, and can reduce adverse events from an indwelling endotracheal catheter 3 hours post-operation.

Effect of Oxycodone hydrochloride combined with Dexmedetomidine on quality of recovery and stress response after general anesthesia in patients who had Laparoscopic Cholecystectomy.

Objective:To explore the effect of oxycodone hydrochloride combined with dexmedetomidine on the recovery quality and stress response during anesthesia in patients undergoing laparoscopic cholecystectomy (LC).Methods:Ninety patients who had LC in Cangzhou Hospital of Integrated TCM-WM of Hebei from December 2016 to December 2019 were selected and divided into dexmedetomidine group (DEX group), oxycodone hydrochloride group (Q group), dexmedetomidine + oxycodone hydrochloride group (DQ group) by a random number table method, with 30 cases in each group. At the time before anesthesia induction (T0), and immediately (T1), 1 min (T2), 10 min (T3) and 30 minutes (T4) after extubation, the general vital signs of three groups were observed, and plasma cortisol (COR), epinephrine (E), norepinephrine (NE) and blood glucose (GLU) were measured. The spontaneous respiration recovery time, wake-up time, VAS score of each time period after extubation, extubation quality score, and adverse event rate were recorded.Results:The vital signs at each time point of extubation, recovery time of spontaneous respiration, wake-up time, and extubation quality of DQ group were better than those of DEX group and Q group (P<0.05). The incidence of agitation, VAS score at T2 and T3, plasma concentrations of Cor, E, NE and Glu at T1, T3 and T4 in DQ group were significantly lower than those in Q group and DEX group (P<0.05).Conclusion:Oxycodone hydrochloride combined with dexmedetomidine can improve the recovery quality and reduce stress response in patients with LC after anesthesia, and can be safely used in patients with LC.

Comparative analysis of the effectiveness of Remifentanil versus Fentanyl anesthesia applied in urological laparoscopic surgery

Objective To compare the effectiveness of Remifentanil versus Fentanyl anesthesia applied in urological laparoscopic surgery. Methods A total of 78 patients undergoing urologic endoscopy in our hospital from July 2016 to December 2017 were recruited, and randomly divided into the Remifentanil group(n=39)with Remifentanil anesthesia and the Fentanyl group(n=39)with Fentanyl anesthesia.The changes in mean arterial pressure and heart rate, anesthetic effects and adverse reaction rates during anesthesia were compared between the two groups. Results The reduction of mean arterial pressure of premedication/induction of anesthesia(T0)was more pronounced in the Fentanyl group than in the Remifentanil group(t=2.855, P=0.003), but the heart rate was lower in the Remifentanil group than in the Fentanyl group(t=4.405, P=0.000). The changes of heart rate and mean arterial pressure were more significant in the Fentanyl group than in Remifentanil group immediately after tracheal intubation(T1), during incision of skin(T2), immediately after suture of the abdomen(T3)and immediately after removal of the tracheal tube(T4)(P<0.05). The spontaneous respiration recovery time, blinking time, extubation time, force recovery time and recovery time were shorter in the Remifentanil group than in the Fentanyl group(P<0.05). The incidence of anesthetic adverse reactions was lower in the Remifentanil group than in the Fentanyl group(10.3%, 4/39 vs.28.2%, 11/39, χ2=4.044, P=0.044). Conclusions Both Remifentanil and Fentanyl groups have good anesthetic effects in urological anesthesia, but Remifentanil has less fluctuations of perioperative blood pressure and heart rate, has higher recovery quality and less anesthetic adverse reactions.Therefore, Remifentanil anesthesia is worthy of promotion. Key words: Analyesics, opioid; Endoscopic surgery

Effects of intravenous anesthesia with sufentanil combined with propofol on hemodynamics and oxygen metabolism in patients with esophageal cancer under high altitude

Objective To investigate the effect of intravenous anesthesia with sufentanil combined with propofol on hemodynamics and oxygen metabolism in patients with esophageal cancer under high altitude. Methods 60 patients with esophageal cancer radical surgery was selected from March 2015 to March 2017 in our hospital and were divided into two groups according to the random number table, 30 patients in each group. Patients in the control group were given with fentanyl and propofol intravenous anesthesia, and patients in the observation group were given sufentanil combined with propofol anesthesia. The occurrence of restlessness during the recovery of anesthesia in the two groups were observed, the spontaneous breathing recovery time, extubation time and postoperative Mini-mental State Examination (MMSE) score were recorded, and the indexes of hemodynamics and oxygen metabolism were measured at the time of before induction of anesthesia (T0), tracheal intubation (T1), skin incision (T2), thoracotomy (T3), free esophagus (T4), esophageal catheter removal time (T5). Results The spontaneous respiration recovery time and extubation time of the observation group were significantly shorter than those of the control group (P<0.05). The degree of restlessness in the observation group was weaker than that in the control group (P<0.05). Mean arterial pressure (MAP) in the control group at T2-T4 were significantly higher than those in T0 (P<0.05), but MAP and heart rate (HR) in the observation group at T1-T5 were significantly lower than those of T0 (P<0.05). Compared with T0 group, oxygen saturation (SpO2), oxygen saturation of mixed venose blood (SvO2) and oxygen delivery (DO2) at T1-T5 were significantly decreased (P<0.05), oxygen consumption (VO2) at T2-T4 was significantly increased (P<0.05), especially in the control group (P<0.05). The MMSE scores of the two groups were significantly lower than those before the operation (P<0.05), and the scores in observation group was significantly higher than the control group (P<0.05). Conclusions The intravenous anesthesia with sufentanil combined with propofol is more helpful in maintaining hemodynamic stability and oxygen metabolism balance than intravenous anesthesia with fentanyl combined with propofol and has little effect on postoperative anesthesia recovery and cognitive function. Key words: Sufentanil/AD; Propofol/AD; Anesthesia, intravenous/MT/AE; Esophageal neoplasms/SU; Hemodynamics

IPSC‑MSC inhibition assessment in Raw 264.7 cells following oxygen and glucose deprivation reveals a distinct function for cardiopulmonary resuscitation.

Hypoxia is a serious stress state. The nervous system is less tolerant to hypoxia, and cell death due to hypoxia is irreversible. With the incidence of cardiovascular disease gradually increasing, the sudden cardiac death rate is additionally increasing. Although cardiopulmonary resuscitation (CPR) is an important development, recovery is frequently poor. In a successful recovery population, ~40% of the population was in a vegetative state or subsequently succumbed to their condition, and ~20% had brain damage. Therefore, the recovery of the brain is of particular importance in CPR. Immune disorders are one of the major mechanisms of cerebral resuscitation following CPR. Studies have demonstrated that induced pluripotent stem cell-derived mesenchymal stem cells (IPSC-MSCs) have a strong immune regulatory effect during tissue repair and anti-inflammatory effects. IPSC-MSCs may inhibit the inflammatory response by means of the inflammatory reaction network to improve brain function following CPR, although the cellular and molecular mechanisms remain unclear. Macrophages are a bridge between innate immune and specific immune responses in the body; therefore, it was hypothesized that macrophages may be the important effector cell of the role of IPSC-MSCs in improving brain function following recovery of spontaneous respiration and circulation subsequent to cardiopulmonary resuscitation. In the present study, IPSC-MSCs were applied to the oxygen and glucose deprivation (OGD) model. It was observed that intervention with IPSC-MSCs was able to alter the polarization direction of macrophages. The difference in the proportions of M1 and M2 macrophages was statistically significant at 6, 12, 24 and 48 h (P=0.037, P<0.05) in the OGD + IPSC-MSCs group (M1, 33.48±5.6%; M2, 50.84±6.9%) and in the OGD group (M1, 83.55±7.3%; M2, 11.41±3.2%), and over time this trend was more obvious. The polarization direction of macrophages is associated with the neurogenic locus notch homolog protein 1 (Notch-1) signaling pathway. In conclusion, it was observed that IPSC-MSCs may be associated with altered macrophage polarization, which may be accomplished by inhibiting the Notch-1 signaling pathway.

Effects of adoptive support ventilation modes of mechanical ventilation on respiratory, blood gas and inflammatory response in COPD patients with type II respiratory failure

Objective To analyze the effect of adaptive ventilation mode ventilation on respiratory, blood gas and inflammatory response in COPD patients with type Ⅱ respiratory failure. Methods 90 COPD patients with type Ⅱ respiratory failure who were treated in our hospital from January 2015 to December 2016 were selected as the subjects.The patients were divided into observation group and control group according to the random number table method, 45 cases in each group.The patients in the observation group were treated with adaptive ventilation mode, and the control group was treated with synchronous and intermittent arterial ventilation combined with pressure-supported ventilation mode for mechanical ventilation.The use of ventilator, respiratory parameters, blood gas and inflammatory response were observed in both two groups. Results The respiration rate and ventilation time[(14.21±0.72)times/min, (13.97±3.61)d]in the observation group were lower than those in the control group[(16.85±0.94)times/min, (16.24±3.96)d], the tidal volume[(612.58±49.47)mL]in the observation group was higher than that in the control group[(526.35±30.29)mL], the differences were statistically significant(t=14.956 7, 2.841 8, 9.972 1, all P 0.05). The levels of CRP, α1-AGP, PCT, IL-6 and TNF-α in the observation group were (90.71±29.68)mg/L, (1.26±0.52)g/L, (2.27±1.03)pg/L, (115.79±24.54)mg/L, (45.65±4.39)mg/L, which were lower than those in the control group[(123.54±40.62) mg/L, (3.73±1.12)g/L, (6.49±1.36)pg/L, (127.43±28.91)mg/L, (53.78±5.65)mg/L], the differences were statistically significant(t=4.377 6, 13.418 3, 16.593 4, 2.059 1, 7.622 3, all P<0.05). Conclusion Adoptive ventilation mode can improve the ventilation status of COPD patients with type Ⅱ respiratory failure, promote the recovery of spontaneous respiration, reduce the ventilation time and reduce the inflammatory response.It is suggested to be widely used in clinical practice. Key words: Mechanical ventilation; Pulmonary disease, chronic obstructive; Type Ⅱ respiratory failure; Inflammation

Effects of Electrical Stimulation of Respiratory Center in the Event of Termination of Its Natural Rhythmic Activity

The possibility of restoration of the natural rhythmic activity of the respiratory system by transcutaneous electrical stimulation of the respiratory center after termination of spontaneous respiratory movements caused by narcosis was shown in experiments on mongrel cats of both sexes under nembutal anesthesia. Natural rhythmic activity of respiratory center was stopped by additional administration of sodium thiopental. The proposed method of electrical stimulation of the respiratory center allows maintaining the rhythmic respiratory movements and their recovery after narcotic apnea up to complete recovery of spontaneous respiration.

Clinical features and neurophysiological follow-up in a case of Brown-Vialetto-Van Laere syndrome

Brown-Vialetto-Van Laere syndrome is a rare disease of unknown origin commonly considered as part of the large group of motor neuron diseases. The course is quite variable: it may be quickly fatal or protracted, with relapsing phases followed by periods of arrest and even partial improvement. We describe a case of Brown-Vialetto-Van Laere syndrome with strong family history for sensorineural hearing impairment. The patient came to our medical attention for severe respiratory failure and leg weakness. The clinical conditions partially improved with recovery of spontaneous respiration and mild increase in muscle strength. The neurophysiological studies performed on our patient showed evidence of nerve damage with subsequent improvement. Our study raises the possibility that the disorder is due to primary nerve damage, which can better justify the intermittent course of the disease, the partial clinical regression and the neurophysiological improvement, never detected in typical motor neuron disorders.

955 LARYNGEAL INDUCED APNEA IN THE CHEMODENERVATED PIGLET

Laryngeal instillation of certain fluids in the piglet elicits reflex apnea, bradycardia, and hypertension. Chemosensitive receptors at the laryngeal entrance have their afferent pathway in the superior laryngeal nerve. Their stimulation may cause asphyxial death often in the newborn, but rarely in the older piglet. We studied the influence of the peripheral arterial chemoreceptors in modulating laryngeal responses in air-breathing pentobarbital-anesthetized newborn (N=9, age 7.0±0.9d) and older piglets (N=9, age 37.8±4.9d). The change in minute ventilation of exposure to 10% 02 in N2 was 19.3±10.6% (NS) in the newborn and 29.4±11.2% (p<.05) in the older piglets. Pure oxygen transiently depressed ventilation by 53.1±5.1% (p<.001) in the newborn and 51.4±6.3% (p<.001) in the older piglets, indicating that the peripheral chemoreceptors are fully active in the newborn. The duration of the net apnea (water minus saline) was similar in the intact newborn, 9.27±1.48 sec (p<.001) and older piglet,9.73±1.23 sec (p<.001). Carotid chemodenervation abolished the ventilatory response to oxygen but had negligible effect on the duration of laryngeal apnea. We conclude that recovery of spontaneous respiration after laryngeal induced apnea is independent of peripheral chemoreceptor activity. Our findings may have relevance to the clinical problem of sudden infant death, in which pathological abnormalities of the carotid body have recently been described.

The degree of recovery and the biochemical changes in the brains of rats during cooling and recovery from hypothermic cardiac arrest

Abstract Once rats in hypothermic cardiac arrest have been induced to restart spontaneous respiration on rewarming, they can be made to recover completely by judicious and time-consuming nursing (Hillman, Loupekine & Fullbrook, 1972). Since the recovery of spontaneous respiration is so critical, it has previously been used as a criterion of complete recovery (Hillman & Rogers, 1969; Rogers & Hillman, 1970; Hillman, Stollery, Fullbrook & Sanders, 1972; Rogers & Hillman, 1972). In this paper the incidence of recovery of cardiac activity, spontaneous respiration and complete clinical recovery is examined in rats after rewarming with artificial respiration under optimum conditions. Brain biochemistry has been investigated under these conditions.

Increased recovery of anaesthetized hypothermic rats induced by intracarotid infusion.

WE have shown previously that if rats were cooled to cardiac arrest without assisted ventilation, held thus for 30 min, and rewarmed with artificial ventilation, only 9 per cent of them recovered1,2. This incidence could be increased to 45 per cent if their abdomens were pumped before rewarming3,4. In these experiments, if the abdominal pumping had failed to restart the heart, spontaneous respiration did not subsequently recover. We now report new measures which further increased the incidence both of the hearts restarting and the recovery of spontaneous respiration.