Significant Decrease In Heart Rate Research Articles

Comparison of rectal suppository and intramuscular morphine for management of patients with renal colic referred to the emergency department: A randomized double-blinded controlled trial

Objectives: To compare the analgesic effects of rectal suppository morphine (RSM) with intramuscular morphine (IMM) in patients suffered from renal colic referred to emergency ward (EW).
 Methods: In a controlled, randomized, clinical trial, 74/90 patients with renal colic referred to the EW between March 2016 and March 2017 were randomly enrolled into two groups of RSM (10 mg) and IMM (10 mg/mL). Vital signs and severity of pain were recorded at admission time (0), 15, 30 and 60 min after treatment.
 Results: The results showed that there was a significant decrease in VAS score of RSM group compared to IMM group after 30 and 60 min of administration (P˂0.05). Furthermore, no significant difference was recorded in vital signs, except there was a significant decrease in heart rate (15 and 60 min) and respiratory rate (60 min) of RSM group compared to IMM group (P˂0.05) and no side effects were recorded during the investigation.
 Conclusion: In conclusion, the use of rectal route of morphine had higher efficiency compared to the IM route of morphine in relieving pain of patients with renal colic. Although, decreased heart and respiratory rates were recorded, the values were in normal range. As well, no major complications were recorded for each method.

A synthetic porphyrin as an effective dual antidote against carbon monoxide and cyanide poisoning

Simultaneous poisoning by carbon monoxide (CO) and hydrogen cyanide is the major cause of mortality in fire gas accidents. Here, we report on the invention of an injectable antidote against CO and cyanide (CN-) mixed poisoning. The solution contains four compounds: iron(III)porphyrin (FeIIITPPS, F), two methyl-β-cyclodextrin (CD) dimers linked by pyridine (Py3CD, P) and imidazole (Im3CD, I), and a reducing agent (Na2S2O4, S). When these compounds are dissolved in saline, the solution contains two synthetic heme models including a complex of F with P (hemoCD-P) and another one of F with I (hemoCD-I), both in their iron(II) state. hemoCD-P is stable in its iron(II) state and captures CO more strongly than native hemoproteins, while hemoCD-I is readily autoxidized to its iron(III) state to scavenge CN- once injected into blood circulation. The mixed solution (hemoCD-Twins) exhibited remarkable protective effects against acute CO and CN- mixed poisoning in mice (~85% survival vs. 0% controls). In a model using rats, exposure to CO and CN- resulted in a significant decrease in heart rate and blood pressure, which were restored by hemoCD-Twins in association with decreased CO and CN- levels in blood. Pharmacokinetic data revealed a fast urinary excretion of hemoCD-Twins with an elimination half-life of 47 min. Finally, to simulate a fire accident and translate our findings to a real-life scenario, we confirmed that combustion gas from acrylic cloth caused severe toxicity to mice and that injection of hemoCD-Twins significantly improved the survival rate, leading to a rapid recovery from the physical incapacitation.

Changes in NT-proBNP levels in patients with sinus tachycardia after COVID-19

Aim. To evaluate the changes of the N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration in patients with sinus tachycardia after coronavirus disease 2019 (COVID-19) during ivabradine monotherapy or in combination with β-blockers (BBs) compared to BB monotherapy.Material and methods. This randomized comparative study included 90 patients discharged from the hospital after an acute period of COVID-19. The main group (n=60) included patients who received ivabradine monotherapy or in combination with BB in addition to standard therapy, while the control group (n=30) — standard therapy in combination with BB. The follow-up period lasted 24 weeks. Serum NT-proBNP concentration was determined by enzyme immunoassay at the first and last visit (0 and 24 weeks). Statistical processing was performed using STATISTICA 8.0 software. The level of statistical significance was p<0,05.Results. A significant decrease in heart rate (HR) and NT-proBNP concentration was noted in both groups. The achievement rate of maximum recommended BB doses was 9,1% in the main group and 20% in the control group. Among individuals who did not achieve the maximum recommended doses of BB, the HR and NT-proBNP concentration were significantly higher in the control group as follows: 72 [66; 75] vs 68 [66; 75] bpm (p=0,028) and 55,5 [47,3; 88,8] vs 43,3 [31,0; 55,5] pg/ml, respectively (p=0,041).Conclusion. We showed that therapy with ivabradine and betablockers helps to reduce the level of NT-proBNP against the background of HR decrease in patients after COVID-19, and ivabradine allows to achieve a more pronounced decrease in heart rate and NT-proBNP level in patients with failure to achieve the maximum recommended BB doses.

Опыт применения 3-суточного мониторирования электрокардиограммы по Холтеру с телеметрией (3G) на примере обследования детей с гипертрофической кардиомиопатией

Objective. To evaluate the results of 72-hour monitoring of Holter electrocardiograms with telemetry in children with hypertrophic cardiomyopathy (HCM). Patients and methods. A randomized retrospective study of 55 children with the confirmed diagnosis of HCM was conducted on the basis of the Federal State Autonomous Institution of the Ministry of Health of Russian Federation "National Children Medical Research Center"; all patients were hospitalized in the cardiology department for the examination and treatment in the period 2021–2023. The study included 33 boys and 22 girls aged 6 to 17.8 years; age and documented functional limitations in both groups were comparable. All patients underwent electrocardiography (ECG) on the 12-channel electrocardiograph; 3-channel 3-day monitoring of Holter electrocardiograms with telemetry using the Astrocard-Telemetry 3G complex (Meditek, Russia); magnetic resonance imaging (MRI) of the heart with intravenous contrast. Parents of 43 patients filled out questionnaires identifying direct and indirect signs of sleep disorders. The obtained data were presented in fractions, as well as as M ± m; minimum, Q1, Q3, maximum; and the Kendall rank correlation coefficient and the Friedman criterion were calculated daily. The differences were considered significant at p < 0.05. The work has been approved by an independent local ethics committee. All parents (or legal representatives) of the children signed the voluntary informed Results. 12-channel ECG revealed various and non-specific disorders (arrhythmias, signs of overload of the heart chambers) in 50 (90.9%) patients. Long-term (3-day) Holter monitoring revealed practically no significant differences in the mean values of the studied indicators between days; by the 3rd day of the study, two trends were revealed: an increase in the average number of episodes of ventricular tachycardia (p = 0.058) and an elongation of the QTc interval in boys (p = 0.053). The significant decrease in heart rate was recorded in girls on the 3rd day of the study (p = 0.011). According to the results of MRI, intramyocardial fibrosis was detected in 37 (67.3%) cases: in 23 (69.7%) boys and 14 (63.6%) girls. In 16 (29.1%) patients, the volume of myocardial lesion was ≥10%. Direct and/or indirect signs of respiratory disorders during sleep were recorded in 28 (65.1%) children. In children with signs of sleep disorders, significant positive correlations were found with the number of supraventricular and ventricular extrasystoles and episodes of ventricular tachycardia. Signs of an increased risk of sudden vascular death were recorded in 8 (14.5%) children. Conclusion. Long-term (3-day) Holter monitoring of electrocardiograms is well adapted to children; all major rhythm disturbances were detected during the first 24 hours. Prolongation of the study may be recommended to solve certain clinical problems (diagnosis of syncopal conditions, paroxysms of unclear etiology, sleep apnea). In children with HCM, it is necessary to identify direct and indirect signs of sleep disorders that have significant correlations with cardiac arrhythmias, including those that are an integrative indicator of the risk of sudden cardiac death. Key words: sudden cardiac death, hypertrophic cardiomyopathy, children, multi-day monitoring of electrocardiogram with telemetry, rhythm disturbances, sleep disorders

Effects of osteopathic manual therapy on the autonomic and immune systems and the hypothalamus-pituitary-adrenal axis in the horse

Manual therapies, physiotherapy, and modalities are often used as a treatment and prophylactic method for preventing various injuries, as well as a rehabilitation tool in the post-operative, traumatic period for horses. Significant results have been achieved with these therapies: increased joint range of motion, tissue extensibility, and reduced pain and inflammation. This study evaluated the effect of osteopathic manual therapy (OMT) on the nervous and immune systems, as well as on the hypothalamus-pituitary-adrenal (HPA) axis. To assess changes in these systems, non-invasive biomarkers were chosen: the heart rate (HR), respiratory rate (RR), temperature (T), as well as objective measurements: blood serum cortisol (BSC) concentration and white blood cell (WBC) count. A total of 30 thoroughbred horses were randomly divided into an experimental group (n = 15) and a control group (n = 15). Blood samples and physiological indicator measurements such as HR, RR, T, BSC and WBC were taken before (p0), after (p1) and one hour after (p2) the OMT treatment for the experimental group. Analogical sequence was performed for the control group without OMT. A significant increase of BSC by 0.94 µg/dl after OMT suggest a direct influence on the HPA axis. Also, a substantial decrease of WBC by 0.57 × 109/l indicates the immune system’s response to the treatment. Moreover, an observed significant decrease in HR and RR shows that the autonomic nervous system was affected by activating the parasympathetic nervous system. Based on the results obtained, it is concluded that OMT has an effect on the HPA axis and on the nervous and immune systems.

Heart rate variability in athletes with symptoms of non-functional overload

The article examines the effect on heart rate variability (HRV) indices in athletes depending on training status, different types of physical exertion, gender and age, presented in both cross-sectional and longitudinal studies. Also included is the predictability of HRV during overtraining, athletic condition, and athletic performance. Heart rate variability (HRV) has long been used as a diagnostic marker of overexertion and overtraining. A large body of evidence shows that in athletes of all ages, regular aerobic training usually results in significant improvements in total and instantaneous HRV. These changes, which are accompanied by a significant decrease in heart rate both at rest and during submaximal exercise, reflect an increase in autonomic efferent activity and a shift in favor of enhanced vagal modulation of heart rate. At present, the available data do not allow us to draw definitive conclusions about the usefulness of traditional HRV indices for evaluating the performance of physical exercises and monitoring the training load. The discrepancies in the results published so far are due to several factors, including insufficient study size and design, and different HRV methods. It also remains to be seen whether traditional HRV indices will be useful for diagnosing overexertion and overtraining.

Influence of Constant Rate Infusions of Fentanyl Alone or in Combination With Lidocaine and Ketamine on the Response to Surgery and Postoperative Pain in Isoflurane Anesthetized Dogs Undergoing Unilateral Mastectomy: A Randomized Clinical Trial

The aim of this study was to compare the effects of constant rate infusions (CRI) of fentanyl alone or combined with lidocaine and ketamine (FLK), on physiological parameters, isoflurane requirements and the number of postoperative analgesic rescues in dogs undergoing unilateral mastectomy. Twenty-two dogs were premedicated with acepromazine 0.02 mg/kg and morphine 0.5 mg/kg and anesthetized with propofol and isoflurane. Dogs were randomly assigned to 1 of 2 groups: Fentanyl group (fentanyl 5 µg/kg loading dose [LD] and 9 µg/kg/h CRI; n = 11); FLK group (fentanyl [same doses]; lidocaine 2 mg/kg LD and 3 mg/kg/h CRI; ketamine 1.0 mg/kg LD and 0.6 mg/kg/h CRI; = 11). Intraoperative evaluations were performed before the start of surgery and administration of the treatments (T0); three minutes after the LD (T1); during incision and tissue divulsion (T2); during closure of the surgical wound (T3). Meloxicam (0.1 mg/kg) was administered at T3. Blood samples were collected for determination of plasma concentrations of fentanyl, lidocaine and ketamine. Pain scores and the number of postoperative analgesic rescues with morphine (0.5 mg/kg) were evaluated for 24 hours postoperatively using the short form of the Glasgow Composite Measure Pain Scale. Compared to T0, significant decreases in heart rate (from 84 ± 28 to 53 ± 16 bpm in the Fentanyl group and from 93 ± 16 to 63 ± 15 bpm in FLK) and mean arterial pressure (from 61 ± 5 to 49 ± 10 mmHg in Fentanyl and from 59 ± 3 to 38 ± 6 mmHg in FLK) were observed at T1. Arterial hypotension was transient, with normalization of values at T2 and T3. The expired fraction of isoflurane did not differ significantly between the groups. Plasma concentrations of fentanyl, lidocaine and ketamine remained within the therapeutic range. Postoperatively, the number of dogs requiring analgesic rescue was significantly lower in the FLK (0/11, 0%) than in the Fentanyl group (5/11, 45%). In dogs administered morphine and meloxicam as part of the anesthesia protocol, an intraoperative CRI of FLK abolished the requirement for postoperative analgesic rescue for 24 hours in dogs undergoing mastectomy.

Analysis of Progressive Muscle Relaxation on Psychophysiological Variables in Basketball Athletes.

The purpose of this study was to evaluate the effects of a progressive muscle relaxation program on psychological (stress levels, anxiety, and mood states) and physiological (blood pressure and heart rate) variables in basketball athletes. Fifty-nine basketball players, aged 14 to 19 years, and members of Bauru Basket team, were recruited for this study and grouped into control group (CG, n = 30) and intervention group (IG, n = 29). The participants were evaluated, before and after the intervention, by the following means: Competitive State Anxiety Inventory-2 (CSAI-2), to measure the pre-competitive anxiety state, i.e., how anxious each athlete felt just before the competition; Brunel Mood Scale (BRUMS), an instrument for early detection of overtraining syndrome; Recovery-Stress Questionnaire for Athletes (RESTQ-Sport), to identify the extent to which each athlete was physically or mentally stressed and the athlete's current capability for recovery; Athlete Burnout Questionnaire (ABQ), specifically developed for athletes. The IG athletes participated in 12 progressive muscle relaxation sessions, a practice for tensing or tightening a specific muscle until an ideal state of relaxation is reached. Each participant had blood pressure and heart rate measured before and after every session. The CG athletes were evaluated similarly to those in the IG but without relaxation. The results showed statistically significant differences in cognitive anxiety (p = 0.039) and specific stress (p = 0.016) between CG and IG before the intervention; in addition, a significant heart rate decrease (p < 0.01) between IG and CG was noted.

Anodal high-definition transcranial direct current stimulation reduces heart rate and modulates heart-rate variability in healthy young people: A randomized cross-controlled trial.

To investigate whether anodal high-definition transcranial current stimulation (HD-tDCS) over the left dorsolateral pre-frontal cortex (DLPFC) could modulate the heart rate (HR) and heart-rate variability (HRV) in healthy young people. Forty healthy young people were enrolled in this randomized crossover trial. The participants were randomized to receive anodal HD-tDCS (n = 20) or sham HD-tDCS (n = 20) over the left DLPFC with a washout period of 1 week. Electrocardiogram (ECG) data were continuously recorded 20 min before the stimulation, during the session (20 min), and 20 min after the session. HR and the time- and frequency-domain indices of the HRV were measured to investigate the activity of the sympathetic and parasympathetic nervous systems. Anodal HD-tDCS over the left DLPFC induced a significant decrease in HR and a significant increase in the average of normal-to-normal intervals (AVG NN), low-frequency (LF) power, total power (TP), and LF/high-frequency (HF) ratio in comparison with the sham stimulation and the baseline. However, sham HD-tDCS over the left DLPFC had no significant effect on HR or HRV. Anodal HD-tDCS over the left DLPFC could reduce HR and modulate the HRV in healthy young people. HD-tDCS may show some potential for acutely modulating cardiovascular function.

Acute effects of regional heat stimulation by indirect moxibustion on cardiovascular responses

Moxibustion is a traditional East Asian medicine treatment that involves burning moxa directly or indirectly on or near the skin at a specific site of the body, called an acupoint. However, whether moxibustion induces cardiovascular responses by modulating autonomic nervous activity remains unknown. The purpose of this study was to elucidate the effects of indirect moxibustion on cardiovascular responses and autonomic nervous activity. Fifteen healthy volunteers participated in the study. Each subject received regional heat stimulation by indirect moxibustion at the lower leg acupoint. Heart rate, RR intervals, blood pressure and skin temperature were measured continuously for 3 min at rest and 5 min during indirect moxibustion. Local skin temperature increased reaching a peak (45.3 ± 3.3 °C) at 2 min after moxibustion was started, and was accompanied by a significant decrease in heart rate (63.0 ± 7.8 to 60.8 ± 7.8 bpm, p < 0.05) together with a significant increase in root mean square difference of successive RR intervals. Regional heat stimulation by indirect moxibustion induced bradycardic response, which was modulated by autonomic nervous system.

Effect of Dexmedetomidine Low Doses with or without Midazolam in Cats: Clinical, Hemodynamic, Blood Gas Analysis, and Echocardiographic Effects.

The aim of the study is to compare the sedative, cardiorespiratory, echocardiographic, and blood gas effects of dexmedetomidine and methadone associated or not with midazolam for restraint chemistry in cats. Eighteen healthy young cats (4.06 ± 0.48 kg) were randomly sedated with two protocols, through the intramuscular route: dexmedetomidine (5 µg.kg-1), methadone (0.3 mg. kg-1) and midazolam (0.3 mg. kg-1) (DMTM, n = 9), or dexmedetomidine (7.5 µg.kg-1) and methadone (0.3 mg. kg-1) (DMT, n = 9). The cardiorespiratory parameters were measured at baseline, 5 and 10 minutes after pharmacological latency. The sedation, analgesia, and muscle relaxation scores were assessed before and 5 minutes after pharmacological latency, while arterial blood gas analysis and echocardiography were assessed before and after 10 or 15 minutes, respectively. There was no difference between the protocols regarding the cardiorespiratory, blood gas, and echocardiographic parameters used. The scores for sedation, analgesia, and muscle relaxation also did not differ between the protocols, with the degree of sedation, analgesia, and myorelaxation considered satisfactory in both groups. A significant decrease in heart rate (HR) was observed after administration of the sedative protocols, reaching a maximum reduction at T10 (46% and 53% reduction in the DMT and DMTM groups, respectively). The reduction in HR had an impact on echocardiographic parameters such as CO, which decreased 53% and 56% in the DMT and DMTM groups, respectively. There was a significant reduction in PaO2, SaO2, ejection fraction, and fractional shortening in both protocols. SpO2 decreased significantly after 5 minutes of sedation in the DMT group, but with a minimum mean SpO2 of 92% in T5. The respiratory rate decreased significantly at 5 and 10 minutes in the DMTM group, while PaCO2 increased in both groups, indicating respiratory depression caused by the drugs. Conclusions and Relevance. The study pointed out that both sedative protocols can be recommended for clinical sedation of young and healthy cats in the doses used. However, both protocols resulted in cardiorespiratory depression in cats and also the particularities of the animals should be evaluated regarding reducing cardiac output by more than 50%.

Effects of Toxic Lithium Levels on ECG-Findings from the LiSIE Retrospective Cohort Study.

(1) Background: Few studies have explored the impact of lithium intoxication on the heart. (2) Methods: We examined electrocardiogram (ECG) changes associated with lithium intoxication in the framework of the LiSIE (Lithium—Study into Effects and Side Effects) retrospective cohort study. We analysed ECGs before, during, and after intoxication. (3) Results: Of the 1136 patients included, 92 patients had experienced 112 episodes of lithium intoxication. For 55 episodes, there was an ECG available at the time; for 48 episodes, there was a reference ECG available before and/or after the lithium intoxication. Lithium intoxication led to a statistically significant decrease in heart rate from a mean 76 beats/min (SD 16.6) before intoxication to 73 beats/min (SD 17.1) during intoxication (p = 0.046). QTc correlated only weakly with lithium concentration (ρ = 0.329, p = 0.014). However, in 24% of lithium intoxication episodes, there were QT prolongations. In 54% of these, QTc exceeded 500 ms; patients with chronic intoxications being more affected. (4) Conclusions: Based on summary statistics, effects of lithium intoxication on HR and QTc seem mostly discrete and not clinically relevant. However, QT prolongation can carry a risk of becoming severe. Therefore, an ECG should always be taken in patients presenting with lithium intoxication.

EFFICACY OF IVABRADINE (CORAXAN) IN PATIENTS WITH POST-COVID TACHYCARDIA

The coronavirus pandemic showed not only an increase in levels of excess morbidity and mortality in the acute phase of an infection, but also the presence of persisting symptoms four weeks after the onset of the disease. A review of the international studies on the prevalence and diversity of the manifestation of the post-covid syndrome is presented. The data on such manifestations of post-covid syndrome as postural orthostatic tachycardia syndrome is being accumulated.In the trial, there were observed 27 patients with post-covid postural orthostatic tachycardia syndrome. All of them were treated by Ivabradine (Coraxan) in dose of 5 mg twice a day per os - during 8 weeks. The results of Holter monitoring in these patients showed a significant decrease of heart rate during the treatment with Coraxan. Functional indicators of the left ventricle contractility (such as EF, EDV and ESV) also were improved. There were revealed clinical improvements including the reduction of heart palpitation, increase of the quality of life and perfection of mood.The author puts forward the future prospects of using Ivabradine (Coraxan) in treatment of post-covid postural orthostatic tachycardia on the basis of literature data and her own clinical experience.

Rocuronium versus Cisatracurium for Rapid Sequence Induction of Anesthesia in Morbidly Obese Patients

Introduction and Aim: Obesity is a challenging problem for anesthetists. Difficult airway with risk of aspiration and regurgitation increases with obesity. Therefore, the need for effective and safe drug for rapid induction of anesthesia is crucial to ensure fast good intubation condition. The aim of this study is to assess Rocuronium versus Cisatracurium for rapid sequence induction of anesthesia in morbidly obese patients.&#x0D; Patients and methods: This study included 60 patients with ASA physical status II, aged 21-40 years, BMI 35-40 kg/m2 and scheduled for elective surgery under general anesthesia. Patients were classified into two equal groups: Group (R): received Rocuronium bromide (Esmeron) in a dose of 0.9 mg/kg (lean body mass) for intubation; Group (C): received Cisatracurium besylate (Nimbex) in a dose of 0.15 mg/kg (LBM) for intubation. Timing of intubation in seconds, intubation score (excellent, good, poor, or inadequate), and hemodynamic variables before induction (baseline), after induction and before injection of Neuro-muscular blocker (NMB), after injection of NMB and before endotracheal intubation and just after intubation were assessed and measured.&#x0D; Results: There was statistically significant decrease in the timing of intubation in R group (84.0 ± 18.50) as compared to C group (96.0 ± 13.29). However, there was no statistically significant difference in the intubation score among the two groups. There was significant decrease in heart rate and mean arterial blood pressure after the induction of anaesthesia as compared to the baseline in both groups; Heart rate and mean arterial blood pressure changes were comparable among the two groups all of the time.&#x0D; Conclusion: Rocuronium for rapid sequence induction in morbidly obese patients is associated with faster onset compared with cisatracurium, with comparable intubation condition and hemodynamic variables. We recommend further studies to be conducted for evaluation of both drugs with different doses.

Cardiovascular response to whole-body cold exposure in humans with different initial autonomic tone

Relevance. Cold exposure increases sympathetic activity and blood pressure. It can also promote intensification of hypertension symptoms and its progress in winter. However, the mechanisms of this phenomenon are poorly understood.Intention: To determine the dynamics of cardiovascular parameters in young people with different initial autonomic regulation of heart rate during experimental general cold exposure.Methodology. 30 healthy male volunteers aged 18–20 years were examined. In accordance with the initial type of autonomic regulation of the heart rate, all subjects were divided into 3 groups as follows: predominance of vagotonia (Group I, n = 9), optimal autonomic regulation – normotonia (Group II, n = 14), predominance of sympathicotonia (Group III, n = 7). The experiment included three stages: rest at a temperature (+20 0C); exposure to cold (–20 0C) for 10 minutes; warming the body (+20 0C). The heart rate variability (HRV) was recorded during each stage of the study using a portable complex “Varicard 2.8” (Russia). At the same time, blood pressure and temperature in the ear canal were recorded.Results and Discussion. Moderate short-term general air cooling causes generally the same type of temporary reactions of central hemodynamics (increase in blood pressure) and indicators of the total HRV power with an increase in parasympathetic activity. Baseline and dynamic values of heart rate and stress index in Group III were significantly higher than in Groups I and II. During body cooling, the stress index in individuals from Group III was 4 times lower, and in individuals from Group I was 1.5 times lower than before cooling. In Group I, baroreflex was less pronounced (slightly decreased heart rate and HRV) along with a significant increase in blood pressure, thus suggesting a high risk of cold-associated vessel injuries. In Groups II and III, a baroreflex was maintained (significant decrease in heart rate and SI) in response to an increase in blood pressure.Conclusion. Apparently, an increase in blood pressure during moderate exposure to cold does not disturb the protective mechanisms of the cardiovascular system in healthy residents of the North with normotonia and predomination of sympathicotonia. At the same time, a week baroreflex in Northerners with vagotonia can be considered at risk for developing cold arterial hypertension.

Pre-emptive analgesic effect of ultrasound-guided quadratus lumborum block versus transversus abdominis plane block in laparoscopic cholecystectomy

Background Transversus abdominis plane (TAP) block creates satisfactory somatic analgesia at T6–L1 with minimal or no visceral blockade, whereas quadratus lumborum block (QLB) provides somatic and visceral analgesia of the whole abdomen. Aim To compare the efficacy of QLB with TAP block in controlling pain after laparoscopic cholecystectomy. Patients and methods A total of 70 patients with American Society of Anesthesiologists I and II, aged 18–50 years, who underwent elective laparoscopic cholecystectomy were allocated into two groups: group I (subcostal TAP block) and group II (lateral QLB). Results Pain scores were lower in group II compared with group I at 4, 6, 8, and 10 h postoperatively. The time of first rescue analgesia was prolonged in group II in comparison with group I. Heart rate and mean arterial pressure showed insignificant differences between the two groups intraoperatively. However, there was a significant decrease in heart rate and mean arterial pressure in group II compared with group I at 4, 6, 8, and 10 h postoperatively. There was no reported local anesthetic toxicity or technique-related complication in the two groups. Conclusion Bilateral ultrasound-guided QLB was more effective than bilateral ultrasound-guided subcostal TAP block in patients undergoing laparoscopic cholecystectomy with prolonged postoperative analgesia and less pethidine consumption.

Oral Gabapentin Pretreatment to Attenuate the Haemodynamic Response to Laryngoscopy and Tracheal Intubation

Introduction: Laryngoscopy and intubation are associated with transient sympathetic responses manifesting as a rise in blood pressure and heart rate. This study was conducted to evaluate the role of oral gabapentin pretreatment in the attenuation of such haemodynamic response. Materials and Methods: Sixty-two patients aged 16 to 60 years weighing 50 to 75 kg undergoing elective surgeries requiring endotracheal intubation were randomized into two groups. group G received 900 mg oral gabapentin and group P received a placebo by mouth two hours before induction of anaesthesia. Patients were induced with propofol, fentanyl, and vecuronium. Laryngoscopy was attempted after four minutes and endotracheal intubation was done. Heart rate, systolic, diastolic, and mean arterial pressure at baseline, before intubation, one, three, five, and ten minutes after intubation were compared between two groups. Patients were observed for any adverse events peri-operatively and post-operatively for the first 24 hours. Results: There was significant attenuation of the rise in blood pressure and heart rate before and after intubation in both groups compared with their corresponding baseline parameters. A significant decrease in heart rate was observed in the gabapentin group only 10 minutes after laryngoscopy and intubation (p=0.022). Conclusions: Oral Gabapentin 900 mg two hours before induction is effective in attenuating the rise in blood pressure and heart rate following laryngoscopy and tracheal intubation, though a statistically significant difference was observed only at 10 minutes after intubation, compared with a placebo group. Besides the significant incidence of pre-induction somnolence, there were no serious perioperative adverse effects.

Comparative efficacy of ivabradine and beta-blockers in the treatment of tachycardia in patients after COVID-19

Aim. To assess the changes of heart rate (HR), exercise tolerance and quality of life in patients after coronavirus disease 2019 (COVID-19) during treatment with ivabradine monotherapy or in combination with beta-blockers (BB) compared with BB monotherapy.Material and methods. This randomized comparative study included 90 patients discharged from a university hospital after an acute COVID-19. The main group (n=60) received, in addition to standard therapy, ivabradine monotherapy or in combination with BB, while the control one (n=30) — standard therapy in combination with BB. The follow-up period lasted 24 weeks. Statistical processing was performed using the STATISTICA 8.0 program. The level of statistical significance was p&lt;0,05.Results. There was a significant decrease in heart rate, an increase in physical activity, as well as an improvement in the quality of life in both groups. In the ivabradine group, significantly lower heart rates (71,2±4,1 vs 73,9±5,1 bpm (p=0,015)), significantly higher increase in physical activity (80 (60; 135) vs 65 m (40; 100) (p=0,017)) and quality of life (35 (27; 45) vs 30 (26; 36) points (p=0,03)) was revealed.Conclusion. It has been shown that ivabradine and beta-blockers can be used in post-COVID-19 tachycardia. Ivabradine monotherapy or in combination with beta-blockers causes a more pronounced decrease in heart rate compared to beta-blocker monotherapy, accompanied by a significant improvement in exercise tolerance and quality of life in this category of patients.

Effect of an Active Video Game Intervention Combined With Multicomponent Exercise for Cardiorespiratory Fitness in Children With Overweight and Obesity: Randomized Controlled Trial.

BackgroundChildhood overweight and obesity have become major global health problems and are negatively related with the cardiorespiratory fitness (CRF) level in school children and adolescents. Exercise, specifically multicomponent training, is effective for CRF improvement, but the main challenge is to ensure adherence to exercise in children with overweight and obesity. Therefore, new ways of exercising that are more attractive and motivational for this population are needed and playing or training with active video games (AVGs) has been proposed as an effective alternative because they require full-body movement and therefore increase energy expenditure.ObjectiveThe main aim of this study was to investigate the effects of an AVG intervention combined with multicomponent training on CRF at maximal and submaximal intensities in children with overweight or obesity.MethodsWe recruited 28 children (13 girls and 15 boys) aged 9 to 11 years with overweight or obesity from medical centers and divided them into 2 groups, an intervention group (n=20) that participated in a 5-month supervised AVG exercise program combined with multicomponent exercise, and a control group (n=8) that continued daily activities without modification. A maximal stress test to measure CRF using a walking-graded protocol with respiratory gas exchange was performed by the participants.ResultsThe AVG group showed a significant decrease in heart rate and oxygen uptake for the same intensities in the submaximal stages of the maximal treadmill test, as well as a lower oxygen uptake percentage according to the individual maximal oxygen uptake, whereas the control group did not show overall changes. No change in the peak oxygen uptake (VO2peak) was found.ConclusionsA 5-month AVG intervention combined with multicomponent exercise had positive effects on CRF at submaximal intensity, showing a lower heart rate and oxygen uptake at the same intensities and displaying a lower oxygen uptake percentage according to the individual (VO2peak). Greater benefits were found in children with the highest fat percentage.Trial RegistrationClinicalTrials.gov NCT04418713; https://clinicaltrials.gov/show/NCT04418713

Comparing the Effectiveness of Metoclopramide, Low Dose of Propofol, Ondansetron, and Magnesium Sulfate on Propofol Injection Pain: A Double-Blind Clinical Trial

Objectives: Despite a variety of strategies, propofol injection pain (PIP) is still one of the most distressing adverse effects of the drug. This study aimed to compare the effectiveness of metoclopramide, low dose of propofol, magnesium sulfate, and ondansetron in the prevention of PIP. Materials and Methods: This double-blind clinical trial was conducted at Al-Zahra hospital an academic and referral center affiliated with Guilan University of Medical Sciences, Rasht, Iran. A total of 120 eligible women candidates for elective gynecologic surgeries were divided into four equal groups of magnesium sulfate (30 mg/kg), ondansetron (4 mg), metoclopramide (10 mg), and propofol (15 mg). The primary outcome of this study was to decrease the pain severity of propofol injection. Results: The participants’ demographic characteristics, including age, American Society of Anesthesiologists classification, and body mass index, had no significant differences between the four groups. A significant decrease in heart rate and mean arterial pressure were observed in four groups; however, the difference was insignificant. The mean pain intensity in the magnesium sulfate group was 1.57 ± 0.9, ondansetron 1.37 ± 0.89, metoclopramide 0.95 ± 0.93, and in propofol group was 1.25 ± 1.1 (P=0.036). Conclusions: Metoclopramide could appropriately alleviate PIP. Considering some additional advantages, including antiemetic properties, preventing esophageal reflux, and less risk of postoperative ileus, this drug could be a safe and acceptable choice.