Significant Decrease In HR Research Articles

Effect of Sacubitril / Valsartan Combination on Abnormal ECG Findings in Patients with Heart Failure with Reduced Ejection Fraction

Abstract Background The mortality rate of patients suffering from choronic heart failure is still high despite advantages in diagnosis and treatment. A new therapeutic class of agents acting on the renin angiotensin aldosterone system (RAAS) and neutral endopeptidase system has been developed, known as angiotensin receptor neprilysin inhibitors (ARNI). Recently, promising data from its administration have demonstrated a decrease in the mortality rate as compared to angiotensin receptor blocker alone. Aim of the Work The aim of this study is to asses effect of Sacubitril/Valsartan combination on abnormal ECG and ECHO parameters in patients with heart failure with reduced ejection fraction as a marker of reverse cardiac remodeling. Patients and Methods Our study was conducted at Ain Shams university hospitals and our target population was heart failure patients with reduced ejection fraction planned to initiate Sacubitril \ Valsartan combination therapy. 100 patients were collected from February 2022 to August 2022. It was an interventional study to follow up the effects of the drug on ECG parameters besides ECHO parameters 6 months after drug initiation. Results We found that in Sacubitril/Valsartan combination therapy there was significant decrease in HR, QRS width and QTc values which reflects the role of this combination to reduce ventricular arrhythmias and preventing SCD. There was significant increase in the EF which was correlated to the significant decrease in QRS width. There was significant improvement in diastolic dysfunction. There was significant decrease in the LA and LV dimensions giving an explanation of the role of the drug in reverse cardiac remodeling. There was significant improvement in NYHA class reflecting the role of the drug in improving quality of life. Conclusion HR, QRS width and QTc were significantly decreased with Sacubitril/Valsartan combination therapy through the follow up period reflecting the effect of the drug on ECG. EF, LA dimension and LVID were improving with Sacubitril/Valsartan combination therapy through the follow up period which give an explanation of the combination therapy for its role in reverse cardiac remodeling. NYHA class of our patients was improving through follow up period which means this drug improves quality of life and reduces hospitalization.

Comparison of esketamine versus dexmedetomidine for attenuation of cardiovascular stress response to double-lumen tracheal tube intubation: a randomized controlled trial.

The insertion of a double-lumen tracheal tube may cause a transient but more intense sympathetic response. We examined the effects of esketamine vs. dexmedetomidine as an adjuvant to anesthesia induction to blunt double lumen tracheal (DLT) intubation induced cardiovascular stress response. In a randomized, double-blind trial, 78 adult patients scheduled for elective thoracotomy under general anesthesia requiring DLT intubation were enrolled. The patients were randomly divided into three groups: each group received one of the following drugs prior to induction of anesthesia: dexmedetomidine 0.8 µg/kg (Group A), esketamine 0.5 mg/kg (Group B), or normal saline (group C). The primary outcome was the incidence of a DLT intubation-related cardiovascular stress response, defined as an increase in mean arterial pressure or heart rate of >30% above the baseline values. The secondary outcomes were changes in hemodynamic and cardiac function. The incidence of the response to cardiovascular stress was 23.1%, 30.8%, and 65.4% in groups A, B, and C, respectively. There was a significant decrease in intubation response in groups A and B in comparison with group C (P < 0.01); however, there was no significant difference between group A and group B (P > 0.05). Following the drug infusion and the induction of anesthesia, there was a significant decrease in HR and cardiac output in group A compared with group B. In contrast, no significant differences were observed in the left ventricular ejection fraction or in stroke volume between the three groups during induction of anesthesia. Esketamine 0.5 mg/kg and dexmedetomidine 0.8 µg/kg attenuate cardiovascular stress responses related to DLT intubation. As adjuvants to etomidate induction, they do not impair cardiac function (ChiCTR1900028030).

Effect of chair yoga on heart rate variability, perceived stress, and sleep quality among nursing professionals from a tertiary care hospital

Introduction and Aim: Health care professionals that provide treatment to individuals most prone to experience sadness and anxiety are experiencing public health difficulties due to the linked elevated death rate brought on by the COVID epidemic. The purpose of this study was to determine how Chair Yoga affected nursing professionals' Heart Rate Variability (HRV), a measure of autonomic functioning, stress level, and sleep quality index. Materials and Methods: The randomized controlled trial was conducted among 60 Nursing professionals in a tertiary care hospital aged &gt;=23 years for a period of 2 months and they were divided into two groups: control (n=30) and intervention (n=30) groups. A set of chair yoga sessions was taught by a professional yoga trainer to the intervention group for a duration of 20 minutes, 5 days a week for two months. Both groups' sleep quality and HRV were measured using the PHYSIOPAC-PP4 (MEDICAID SYSTEMS, Chandigarh) software, as well as their levels of stress using the Perceived Stress Scale. Results: After training of Chair yoga for 2 months, a significant decrease in HR, MAP and a significant increase in Mean RR, SDNN and PNN50 and a significant increase in TP and HFnu and a significant decrease in LFnu and LF/HF ratio in the intervention group was found. After doing chair yoga at work, the intervention group's stress levels dropped and their quality of sleep increased. Conclusion: The findings of the study concluded that the Chair yoga practice in Nursing professionals led to the improvement in parasympathetic activity. It is also beneficial for stress reduction and improvement of sleep quality in nursing professionals.

Heart Rate as a Correlate for the Emotional Processing of Body Stimuli in Anorexia Nervosa.

In anorexia nervosa, aberrant emotional reactions toward body stimuli have been discussed. We investigated heart rate as a physiological marker when viewing body stimuli and hypothesized altered HR reactions toward those highly significant and emotional stimuli in anorexia nervosa. In total, 37 anorexia nervosa patients and 43 control participants viewed pictures of women of five different weight categories, while their cardiac activity was recorded. R-R intervals following picture onset were determined, and means were calculated for three distinct time periods. The overall change in HR relative to baseline across all picture categories was greater in the patient group than in the control group (significant effect of "group", p = 0.002, partial η2 = 0.120). A significant decrease in HR 2 to 8 s after picture presentation was found for pictures of women of extreme weight in both participant groups (significant "category ∗ time segment interaction", p = 0.01, partial η2 = 0.037) and correlated with scores of sociocultural attitudes toward the appearance for the extremely underweight category (r = -0.33, p = 0.005). Therefore, differential HR reactions for anorexia nervosa patients and control participants were found for body stimuli in general. The highest HR decelerations in response to pictures of strongly underweight and overweight women may reflect emotional processes such as anxiety due to social comparison.

The place of diltiazem in the treatment of patients with stable angina in concomitant bronchial asthma

Introduction. In the treatment of stable angina in patients with concomitant bronchial asthma (BA), the bronchopulmonary system may be adversely affected by a number of drugs. Diltiazem may be the drug of choice when antianginal therapy with a pulseslowing effect is required, but β-blockers are contraindicated.Aim of the study. To compare the antianginal, pulse-slowing and vasoprotective effects of the calcium antagonist (CA) diltiazem, the calcium antagonist verapamil and the cardioselective beta-adrenoblocker (BAB) bisoprolol in the treatment of stable angina (SA) patients with concomitant BA.Materials and methods. The study included 60 patients with stable angina II-III FC with concomitant mild or moderate persistent BA. The patients were divided into three groups of 20 patients depending on antianginal drugs: Group 1 received betaadrenoblocker bisoprolol, Group 2 – calcium antagonist verapamil, Group 3 – calcium antagonist diltiazem. All patients underwent cardiography (Doppler EchoCG), external respiration function (ERF), endothelium-dependent vasodilation (EDVD) study at baseline and after 2, 4, 6 weeks of treatment.Results. No negative dynamics of FEV1 was found in patients of all groups during the study of ERF after 6 weeks of treatment. There was a statistically significant increase in FEV1 after 6 weeks of treatment in group 3 patients receiving diltiazem (p = 0.032). There was a statistically significant decrease in HR in all three groups during treatment, but in group 2 the dynamics were significantly lower when treated with verapamil. Analysis of mPAP of patients showed that it decreased in all groups after 6 weeks of treatment, but significant dynamics was noted only in Group 3. EDVD test after 6 weeks of treatment revealed positive dynamics, with a statistically significant increase in the index registered in patients of groups 1 and 3.Conclusions. In treatment of patients with stable angina with mild and intermediate persistent disease without exacerbation, antianginal therapy with the calcium antagonist diltiazem has marked antianginal, pulse-slowing action, has vasoprotective effect on the small and large circulatory vessels, improves the parameters of bronchial permeability.

Fluid bolus administration in children, who responds and how? A systematic review and meta-analysis.

Fluid boluses are frequently utilized in children. Despite their frequency of use, there is little objective data regarding the utility of fluid boluses, who they benefit the most, and what the effects are. This study aimed to conduct pooled analyses to identify those who may be more likely to respond to fluid boluses as well as characterize clinical changes associated with fluid boluses. A systematic review of the literature and meta-analysis was conducted to identify pediatric studies investigating the response to fluid boluses and clinical changes associated with fluid boluses. A total of 15 studies with 637 patients were included in the final analyses with a mean age of 650 days ± 821.01 (95% CI 586 to 714) and a mean weight of 10.5kg ± 7.19 (95% CI 9.94 to 11.1). The mean bolus volume was 12.14 ml/kg ± 4.09 (95% CI 11.8 to 12.5) given over a mean of 19.55 min ± 10.16 (95% CI 18.8 to 20.3). The following baseline characteristics were associated with increased likelihood of response [represented in mean difference (95% CI)]: greater age [207.2 days (140.8 to 273.2)], lower cardiac index [-0.5ml/min/m2 (-0.9 to -0.3)], and lower stroke volume [-5.1ml/m2 (-7.9 to -2.3)]. The following clinical parameters significantly changed after a fluid bolus: decreased HR [-5.6bpm (-9.8 to -1.3)], increased systolic blood pressure [7.7 mmHg (1.0 to 14.4)], increased mean arterial blood pressure [5.5 mmHg (3.1 to 7.8)], increased cardiac index [0.3ml/min/m2 (0.1 to 0.6)], increased stroke volume [4.3ml/m2 (3.5 to 5.2)], increased central venous pressure [2.2 mmHg (1.1 to 3.3)], and increased systemic vascular resistance [2.1 woods units/m2 (0.1 to 4.2)]. Fluid blouses increase arterial blood pressure or cardiac output by 10% in approximately 56% of pediatric patients. Fluid blouses lead to significant decrease in HR and significant increases in cardiac output, stroke volume, and systemic vascular resistance. Limited published data are available on the effects of fluid blouses on systemic oxygen delivery.

Effect of heart rate control with amiodarone infusion on hemodynamic and clinical outcomes in septic shock patients with tachycardia: a prospective, single-arm clinical study

BackgroundKeeping the heart rate within the normal range has improved the survival of septic shock patients. Amiodarone could target the underlying pathophysiology of sepsis-induced tachycardia. This study aimed to determine whether amiodarone is effective in controlling the heart rate in critically ill patients with septic shock and sustained tachycardia who were receiving vasopressor.MethodsIn this prospective, single-arm cohort study, 46 patients with septic shock and tachycardia were enrolled to receive a loading dose of amiodarone 150 mg, then continuous infusion of 1 mg/min. The primary outcome was the ability of amiodarone in rate control lower than 95 beats per minute (BPM) and maintaining it during 24-h study period. We also recorded the effect of amiodarone on hemodynamic indices as the secondary outcomes.ResultsThe results of the present study indicated a significant decrease in HR in septic shock patients for amiodarone, from 121.0 (116.5, 140.0) at baseline to 91.5(89.3, 108.0) at the end of the study period (p < 0.001). During the study period, a total of 26 (56.52%) of patients achieved the target heart rate lower than 95 BPM and maintained it during study period. Amiodarone decreased HR by 22.8 ± 13.7. While receiving amiodarone infusion, the values for heart rate, mean arterial pressure, cardiac index, norepinephrine infusion rate, and stroke volume index changed significantly between amiodarone initiation and 24-h follow-up (P < 0.001). Amiodarone was well tolerated, because this anti-arrhythmic agent did not increase the need for vasopressor and none of the patients experienced episodes of refractory hypotension.ConclusionThis study showed that amiodarone infusion successfully reduced the heart rate in sepsis-induced tachycardia. The patients had improved hemodynamic state as indicated by an increase in cardiac index and SVI.

Tranversus Abdominus Plane Block with or without Magnesium Sulphate on Postoperative Pain Control after Open Appendectomy Operation

Abstract Background Patients undergoing Open Appendectomy experience pain postoperatively, requiring a multimodal approach to analgesia. The transversus abdominis plane (TAP) block seems to be an ideal approach. This block may be achieved using bupivacaine with adjuvants such as magnesium sulfate, which we were used in this study. Aim of the Work to detect the efficacy and safety of magnesium sulphate as an adjuvant to the analgesia offered by local anesthetic in ultrasound guided TAP block in patients undergoing open appendectomy. Patients and Methods A prospective double blinded randomized controlled trial was conducted on 60 patients undergoing open appendectomy at Ain Shams University Hospital, Cairo, Egypt. Results Our study concluded that co administration of 500mg MgSo4 to 0.5 % bupivacaine in US guided TAP block lead to: Significant decrease in VAS pain score especially at 4hrs, 6hrs and 12hrs,1st rescue dose of nalbuphine was delayed. And number of patients require rescue doses of nalbuphine in 1st 4 hrs, while only 2 patients require rescue doses of nalbuphine between 4&amp;6 hrs.4 patients require rescue doses of nalbuphine between 6&amp;12 hrs, while 26 patients require rescue doses of nalubuphine between 12&amp;24hrs. we also cocluded that there were a significant decrease in HR and MABP especially at 4hrs and 6 hrs postoperative,. Conclusion MgSO4 as an adjuvant to bupivacaine in Ultra-sounded guided TAP block reduces post-operative pain scores, prolong the duration of analgesia and decreases demand for rescue analgesics.

Comparison between Magnesium Sulphate and Ketorolac Intravenous Infusion on Characteristics of Spinal Anesthesia

AbstractBackground: Spinal anesthesia is used widely for many procedures, many adjuvants had been used to prolong duration of sensory and motor block and improve post-operative pain.Aim of Study: The aim of this study is to compare the effect of magnesium sulphate and ketorolac intravenous infusion on sensory and motor blockage, hemodynamic pa-rameters, duration of analgesia and side effects during spinal anesthesia.Patients and Methods: Patients were classified randomly into three groups (30 patients each) Group M (Magnesium sulphate Group), Group K (Ketorolac Group), Group C (Con-trol Group). Group M patients received a loading dose of magnesium sulphate 40mg/kg IV over 10min followed by 15mg/kg/h IV infusion, Group K patients received a loading dose of ketorolac (0.4mg/kg) (IV) over 10min followed by 0.8mg/kg/h IV infusion. Group C received 50ml of saline (IV) over 10min followed by saline infusion. After ensuring free flow of cerebrospinal fluid, 3mL of bupivacaine (0.5%) injected Pulse rate, electrocardiography, non-invasive blood pressure and SpO2 monitored continuously. Measurements: Demographic data (age, weight, BMI, ASA physical status). Hemodynamic (HR, MAP, SpO2) before giving study drugs, 10min after giving study drugs and after reaching the maximal level of spinal anesthesia and then every 30min till end of surgery. Onset of sensory blockade has been assessed by pinprick method. Onset of motor blockade has been assessed by modified Bromage Scale. Level of sensory and motor blockade has been checked at 3, 5, 10 and 15min after spinal anesthesia and then every 20min throughout the surgery. Time to achieve complete regression from sensory and motor blockade has been noted. All the durations were calculated considering the time of spinal injection as zero time. Post-operatively analgesia has been assessed by the Visual Analog Scale (VAS). The time at which analgesia was first received and total analgesic requirement in 24h was recorded. Patients observed for any adverse effects such as nausea, hypotension.Results: There were insignificant changes between the three groups in HR and MAP but there was significant decrease in HR and MAP in each group at 10min, maximal level and 30min in comparison with base line. There were insignificant changes in onset and duration of sensory and motor block in the three studied groups.The total dose of analgesic consumption (pethidine (mg)) showed significant decrease in Group M in comparison with Group K & Group C with insignificant change between Group K & Group C.The time of first rescue analgesia showed significant increase in Group M in comparison with Group K & Group C and insignificant changes in Group K in comparison with Group C.Conclusion: Addition of intravenous magnesium sulphate with spinal anaesthesia provides significant decrease in post-operative analgesic requirements and prolongs the time of the first rescue analgesia as compared to intravenous ketorolac with spinal anaesthesia.

Correlation between Carbon Dioxide Production and Mean Arterial Blood Pressure in Fluid Response in Mechanically Ventilated Patients

AbstractBackground: Volume expansion through fluid administra-tion is one of the simplest approaches for initial treatment of hemodynamic instability. In the Intensive Care Unit (ICU) a newly available technique called volumetric capnography (Vcap) allows measurement of carbon dioxide production (VCO2) on a regular basis at the bedside.Aim of Study: The aim of the study was to evaluate VCO2 as an endpoint predictor for fluid resuscitation in mechanically ventilated patients.Methods and Material: This prospective cohort study was carried out on 70 patients in Tanta University Hospitals at surgical ICU from August 2017 till August 2018. All patients included in the study were on controlled mechanical ventilation with tidal volume 6-8ml.kg–1 ideal body weight. Wide bore intravenous lines were inserted and patients were completely sedated and monitored by; pulse oximeter, non-invasive blood pressure monitoring, ECG all connected to monitor (infinium medical-OMNI lll-FL33773-USA). Volumetric capnogram, end tidal capnogram, detected by Y-Piece and sample line connected to (GE Healthcare Finland Oy, E-sCOVX-00- Finland). Bispectral Index (BIS) to assess the depth of sedation (should be between 40-60). Intravenous fluids were given after hypotension till MAP >65mmHg.Results: There was significant increase in MAP and VCO2 and significant decrease in HR after fluid resuscitation and there was no significance difference in BIS, SpO2. There was positive correlation between VCO2 and MAP with sensitivity of VCO2 for fluid responsiveness 92%.Conclusions: VCO2 and EtCO2 are good monitoring toolswhichare well correlated with hemodynamic changes, thus can be used as an indicator for fluid responsiveness and endpoint prediction ofresuscitation.

Comparative evaluation of ropivacaine, ropivacaine- dexmedetomidine and ropivacaine – clonidine combinations for epidural analgesia in cattle

Eighteen animals with various surgical conditions were divided into three groups of six animals each. Group I received ropivacaine (0.75%) @ 0.25 mg/kg b.wt at sacrococcygeal space. Group II animals received ropivacaine (0.75%) @ 0.25 mg/kg b.wt and dexmedetomidine at 5 µg/kg b.wt in the sacrococcygeal space. Group III animals received ropivacaine (0.75%) @ 0.25 mg/kg b.wt and clonidine @ 2 µg/kg b.wt at sacrococcygeal space. The fastest onset of analgesia was produced by ropivacaine-dexmedetomidine combination followed by ropivacaine-clonidine. RT showed non significant decrease in all groups during post epidural analgesia. A non significant increase in RR was observed in cattle following ropivacaine and ropivacaine-clonidine epidural analgesia. Where as a non significant fall in RR was noticed during ropivacaine-dexmedetomidine combination. A non significant increase in HR was recorded after epidural administration of ropivacaine in group I animals. Whereas group II and III animals showed a non significant decrease in HR throughout the period of study. ECG studies did not reveal any abnormalities except sinus arrhymia in all animals. In group I and III non significant increase in Hb and PCV was observed in the present study. Non significant decrease in Hb and PCV values were recorded in animals subjected to ropivacaine-dexmedetomidine analgesia. A non significant increase in AST, ALT was noticed in all groups of animals. The study suggests that dexmedetomidine is a better adjuvant than clonidine in epidural analgesia as far as cardio-respiratory and Haemato-biochemical parameters are concerned.

Effects of heart rate reduction with ivabradine on the international ındex of erectile function (IIEF-5) in patients with heart failure

Introduction: The presence of concomitant erectile dysfunction (ED) with heart failure (HF) is not surprising, because endothelial dysfunction is pathophysiologic signature of both ED and HF. ED significantly and adversely affects quality of life in patients with HF. It was demonstrated that ivabradine treatment can improve endothelial function and ED in experimental models. In this study, we aimed to determine the effect of ivabradine treatment on ED in patients with HF via International Index of Erectile Function (IIEF-5) questionaire.Material and methods: Consequently, 29 patients, between 18 and 70 years of age, male with chronic HF known for at least 1 year, New York Heart Association functional class I–II, left ventricule ejection fraction less than 40%, in sinus rhythm with a resting HR of at least 70 beats per minute (b.p.m.), who were intended to be treated with ivabradine according to the decision of their physicians were evaluated to determine ED. We used the Turkish version of the IIEF-5 questionnaire to evaluate ED on the last 6-month period. Twenty-four of 29 patients who scored ≤21 were considered to have ED and included to the study. IIEF-5 scores for each question and domains were calculated for all responders at baseline and at 6-month follow-up visit in order to determine any effect of ivabradine treatment on ED in patients with HF.Results: According to the data of survey, Cronbach's alpha coeffient for all of the patients who were included into the study were 0.84 and detected highly reliable. IEFF-5 questionnaire scores increased significantly (p = .003) after the ivabradine treatment, on the contrary, significant decrease in HR was revealed as expected. HR is decreased steadily after ivabradine treatment and mean decrease in HR was 11.5 ± 9.4 in this study population. Likewise, negative correlation was demonstrated between decrease in HR (p < .001) and increase in IEFF-5 scores (p = .003).Conclusion: Although lack of patients with HF have been evaluated in this study population, initial results seem promising that ivabradine has favorable effects on ED. These findings were postulated to be dependent exclusively on HR reduction. As a sequel, cardiologist should avoid neglecting ED to improve medical compliance as well as quality of life in patients with heart failure. This pilot study provide some data for further randomized controlled studies.

The Effects of Dexmedetomidine or Remifentanil Continuous Infusion on End- Tidal Sevoflurane Concentration in Patients Undergoing Laparoscopic Cholecestectomies, Monitored by Bispectral Analysis

Background and Objective: Owing to the hemodynamic response to pneumoperitoneum, laparoscopic is not devoid of risk; adjuvants have been used to decrease the dose of volatile agents and their side effects and to blunt the hemodynamic response. This study was designed to compare the effect of dexmedetomidine and remifentanil on sevoflurane expired fraction concentration (EF sevo) in general anesthesia, monitored by BIS. Hemodynamic response, postoperative recovery profile, analgesic requirements and PONV were also recorded. Patients and methods: General anesthesia induction with propofol 2.5 mg/kg rocuronium bromide 0.6 mgkg and sevoflurane 1-1.5 MAC. Tracheal intubation was performed and patients were mechanically ventilated. Patients were allocated to Groups D or R. Group D (≤ 40) was the dexmedetomidine group, they received dexmedetomidine diluted with 0.9% NaCl to a concentration of 4 ugmL in 50 mL (an initial loading dose of 0.7 ug/kg given for a 10 min period followed by 0.5 ug/kg/h). Group D (n=40) was the dexmedetomidine group, they received dexmedetomidine (Precedex, 200 ug per 2 mL; Abbott, USA) (an initial loading dose of 0.7 ug/kg given for a 10 min period followed by 0.4 ug/kg/h). Group R (n=40) was the remifentanil group and received an intravenous (i.v.) remifentanil (an initial loading dose of 0.7 ug/kg given for a 10 min period followed by 0.2 ug/kg/h). The infusion was stopped 15 min before the end of surgery. sevoflurane concentration adjusted to maintain BIS between 40 and 60. The parameters evaluated (BIS, SBP, DBP, MAP, HR, and EF sevo) were expressed as mean and standard deviation at 15 min before induction, during induction of anesthesia, 15 min later, during pneumperitonium, after release of insufflation and 15 min after release of insufflation. Statistical analysis: Student’s t-test is a test of significance used for comparison of quantitative variables between two groups of normally distributed data, while Mann Whitney's test was used for comparison of quantitative variables between two groups of not normally distributed data. Chi-square test (χ2) was used to study association between qualitative variables. Whenever any of the expected cells were less than five, Fischer’s Exact test with Yates correction was used. P-value of <0.05 was considered statistically significant. Results: No patients had marked hypotension MAP less than 60 mmHg or bradycardia HR less than 45 in both groups but there were significant decrease in HR and MAP between the two groups during induction, 15 min after induction, during pneumperitonium, aftert release of insufflation and 15 min after release of insufflation, extubation time, spontaneous eye movement, eye movement to verbal stimuli, spontaneous arm movement, purposeful movement and time of discharge to recovery room were significantly lower in group R than group D, However group R showed significantly higher EF sevo 15 min after induc, BSI during insufflation of CO2, EF sevo during insufflation of CO2, BSI after release. CO2, EF sevo after release of CO2, BSI before end of surgery and EF sevo before end of surgery than group D. Conclusion: Both dexmedetomidine and remifentanil reduce the anesthetic requirement and depress the hemodynamic response during pneumoperitoneum with more significant decrease in EF sevo in the D group, however dexmedetomidine provides better postoperative analgesia and less incidence of PONV.

Electrocardiographic Studies in Propofol and Ketofol Anaesthesia Following Atropine, Diazepam and Fentanyl Premedication in Dogs

Twelve dogs of either sex presented to the college clinic with surgical were utilized to study the effect of ketofol and propofol after premedication with atropine sulphate, diazepam and fentanyl. The animals were divided into two groups of six animals each. Ketofol (1:1) combination was given intravenously in group I dogs. Propofol @ 6 mg/kg b.wt. intravenously was given in group II dogs. Induction quality was excellent, smooth and attained sternal recumbency rapidly without struggling in all animals in both groups. Recovery from anaesthesia was smooth and excitement free in both groups. However, slightly prolonged recovery was a consistent observation in propofol group. Non significant increase in HR was recorded in group I dogs. A significant decrease in HR was observed in dogs subjected to propofol anaesthesia. ECG studies did not reveal any abnormality except increase in amplitude of QRS complex duration in both groups. Ketofol with atropine, diazepam and fentanyl premedication provided better surgical anaesthesia with smooth induction and rapid, safe and smooth recovery in dogs.

Effects of VA Facility Dog on Hospitalized Veterans Seen by a Palliative Care Psychologist: An Innovative Approach to Impacting Stress Indicators

The United States is home to 23 million veterans. In many instances, veterans with serious illness who seek healthcare at the VA receive care from a palliative care service. Animal-assisted intervention (AAI) is gaining attention as a therapeutic stress reducing modality; however, its effects have not been well studied in veterans receiving palliative care in an acute care setting. A crossover repeated-measures study was conducted to examine the effects of an animal-assisted intervention (AAI) in the form of a therapy dog on stress indicators in 25 veterans on the palliative care service at the VA Eastern Colorado Healthcare System in Denver, CO. Veterans had a visit from a therapy dog and the dog's handler, a clinical psychologist (experimental condition) and an unstructured visit with the clinical psychologist alone (control condition). Blood pressure, heart rate, and the salivary biomarkers cortisol, alpha-amylase, and immunoglobulin A were collected before, after, and 30-minutes after both the experimental and control conditions. Significant decreases in cortisol were found when the before time period was compared to the 30-minutes after time period for both the experimental ( p = 0.007) and control condition ( p = 0.036). A significant decrease in HR was also found when the before time period was compared to the 30-minutes after time period for both the experimental ( p = 0.0046) and control ( p = 0.0119) condition. Results of this study supported that a VA facility dog paired with a palliative care psychologist had a measurable impact on salivary cortisol levels and HR in veterans.

Methylene blue compared to norepinephrine in the management of vasoplegic syndrome in pediatric patients after cardiopulmonary bypass: a randomized controlled study

Background and aimVasoplegic syndrome (VS) is a frequent complication following cardiopulmonary bypass (CPB) requiring escalating dose of vasopressor support. The guanylate cyclase inhibitor methylene blue (MB) could be an attractive alternative treatment in such cases. This study examines the efficacy and safety of using MB compared to the commonly used norepinephrine in VS in pediatric population following CPB.MethodsForty patients of pediatric age group who developed VS following CPB for elective corrective cardiac surgeries received 0.5 μg/kg/min norepinephrine intravenous infusion for 5 min without improvement (Time 1). Patients were randomly assigned to two equal groups. Group MB received 1.5 mg/kg methylene blue by intravenous infusion over 20 min. Group N did not receive MB. Norepinephrine infusion was continued in both groups and titrated according to the response of patients with a maximum dose of 2 μg/kg/min (Time 2). Heart rate, mean arterial pressure (MAP), central venous pressure (CVP), cardiac output (CO), cardiac index (CI), mean pulmonary artery pressure (MPAP), systemic vascular resistance (SVR) and systemic vascular resistance index (SVRI) were calculated in both groups. Side effects related to the study drug were recorded.ResultsTime 2 values of norepinephrine dose were significantly lower in MB group compared to N group. Time 2 values of MAP were significantly higher in MB group compared to N group with a significant decrease in HR in MB group compared to N group. No change in the rhythm was detected in the two groups. Time 2 values of CVP were higher in MB group compared to N group. Time 2 values of CO and CI were significantly lower in MB group compared to N group and SVR and SVRI were significantly higher in MB group compared to N group. Time 2 values of MPAP were comparable in both groups and showed no significant change. No side effects from using MB were recorded as pulmonary edema and respiratory distress.ConclusionIn this study, MB showed superior efficacy and safety in managing VS in pediatrics following CPB compared to the conventionally used norepinephrine.

Energy Imbalance and Physiological Changes During Detomidine Hydrochloride Constant Rate Infusion in Standing Horses

Detomidine is an alpha-2-adrenergic agonist widely used in horses. To evaluate changes in muscular energy metabolism caused by detomidine continuous rate infusion in standing horses, six adult animals were submitted to 1 hour 20 μg/kg/hr IV constant rate infusion detomidine. Heart rate, respiratory rate (RR), mean arterial blood pressure, systolic blood pressure, diastolic blood pressure, capillary refill time, rectal temperature, plasma glucose, blood lactate, total plasma protein, packed cell volume (PCV), hemoglobin (Hb), partial arterial pressure of oxygen, partial arterial pressure of carbon dioxide (PaCO2), arterial oxygen saturation, bicarbonate (HCO3−), sodium, potassium, ionized calcium (iCa), arterial oxygen content (CaO2), muscle glycogen, and muscle lactate were recorded before the infusion, after 20, 40, and 60 minutes, when it was discontinued. One last sample was obtained 1 hour after infusion was finished. Four animals were submitted to 1 hour saline infusion as a control group. Constant rate infusion detomidine resulted in significant decrease in HR, RR, PCV, Hb, iCa, CaO2, and muscle glycogen in comparison with both baseline and control groups and significant increase in PaCO2, blood lactate, and HCO3−. Detomidine 20 μg/kg/hr produces minimal clinically significant changes in horses, and it does interfere with energy metabolism through mobilization of muscle glycogen and increase in blood lactate.

Modulation of Sympathovagal balance after chandranadi Pranayama in Healthy Volunteers

Background and objectives: Regardless of prevailing advances in yoga research, the immediate benefit of chandranadi pranayama (CNP) on heart rate variability was not explored. Therefore, in this study, we planned to study the immediate effect of CNP on heart rate, blood pressure and HRV. Methods: One hundred and ten medical students were randomly divided into two groups; control group (n=55) and CNP group (n=55). CNP group participants were individually trained to perform CNP by an experienced yoga instructor with a regularity of 6 breaths/min for five minutes. CG volunteers didn’t undergo CNP, Pre and post intervention HR, BP measurements and spectral analysis of HRV was done in both the groups. The paired student’s t test was used to determine significant differences. Results: There was a significant decrease in HR (p<0.01), BP (p<0.05), LFnu (p<0.05), LF/HF (p<0.001) and increase in HFnu (p<0.01) followed by five minutes of CNP in CNP group. Further, HR, SBP, DBP was reduced by 9.10%, 4.80%, 7.75 % respectively. HRV results showed 7.59% reduction in LFnu, 17.8% reduction in LF/HF and HF was increased by 12.37%. There were no significant changes in CG. Conclusion: It is concluded that CNP is beneficial in reducing HR, BP and to improve Sympathovagal balance. We advise that this effective method be included with the management protocol of hypertension and utilized when immediate reduction of blood pressure is required in day-to-day as well as clinical situations.

Dexmedetomidine; an adjuvant drug for fast track technique in pediatric cardiac surgery

BackgroundSimple surgical procedures in pediatric open cardiac surgery can be planned for early extubation by using dexmedetomidine alpha2 agonist. Early extubation is associated with shortening of postoperative ventilation and intensive care unit length of stay. The aim of this study was to examine the effects of dexmedetomidine on recovery profile, ICU length of stay, analgesic needs, and hospital stay in pediatric patients undergoing elective correction of congenital heart diseases using CPB.MethodsForty patients with age ranging from 2–10 years of either sex submitted for elective correction of simple congenital heart diseases undergoing CPB. All patients were premedicated in preoperative area with intramuscular 0.1 mg/kg midazolam and 0.015 mg/kg atropine sulfate. Patients were randomly classified into one of two equal groups (n = 20). In the Dex group, patients received an initial bolus dose of dexmedetomidine (0.4 μg/kg) over 10 min, followed by continuous infusion of 0.5 μg/kg/hr. In the control group, patients received an initial bolus dose of saline over 10 min, followed by continuous infusion of 0.5 μg/kg/hr.ResultsMAP, HR, the total dose of intra-operative fentanyl, vasodilator needs, time of extubation, pain score, ICU length of stay and hospital stay were significantly higher in the control group when compared with DEX group. Also in control group these were significant decrease in HR and MAP relative to baseline. There was significant increase in duration of inotropic support in control group than DEX group.ConclusionDexmedetomidine is a short-acting alpha2-adrenoceptor agonist with many desirable clinical benefits that encourage its use in the perioperative period. Dexmedetomidine has anesthesia-sparing effects, it decreases MAP, HR and with reasonable analgesic effect.

Interactive effects of trigeminal nerve stimulation and muscle metaboreflex activation on muscle sympathetic nerve activity in healthy humans (1170.5)

We investigated the independent and interactive effects of trigeminal cutaneous receptor stimulation and activation of metabolically sensitive skeletal muscle afferents (muscle metaboreflex) on muscle sympathetic nerve activity (MSNA). Heart rate (HR; ECG), blood pressure (BP; Finometer) and MSNA (microneurography) were continuously recorded in eight healthy men (29±2 yr) during three experimental conditions; 1) facial cooling [0°C, trigeminal stimulation, TGS], 2) muscle metaboreflex activation by post‐exercise ischemia [PEI] following isometric handgrip at 30% maximum voluntary contraction, and 3) simultaneous TGS and PEI. Trials were counterbalanced and respiratory rate and tidal volume controlled at baseline, TGS, PEI and TGS+PEI. TGS produced a significant decrease in HR (Δ‐5±2 bpm; mean±SE), and increase in mean BP (Δ14±3 mmHg) and MSNA total activity (Δ353±118% AU). During PEI, HR remained at resting levels (Δ3±2 bpm; mean±SE), while mean BP (Δ25±3 mmHg) and MSNA total activity (Δ234±83% AU) increased. Finally, during combined TGS and PEI, HR was unchanged (Δ0±2 bpm; mean±SE), while mean BP (Δ30±3 mmHg) and MSNA total activity (Δ331±100% AU) were increased. Thus, excitatory inputs from the trigeminal nerve and metabolically sensitive skeletal muscle afferents do not appear to summate algebraically in determining a MSNA response, but rather exhibit neural occlusion.Grant Funding Source: Supported by CAPES, CNPq, FAPERJ.