Significant Decrease In Heart Rate Research Articles

Eight Weeks of Supervised Pulmonary Rehabilitation Are Effective in Improving Resting Heart Rate and Heart Rate Recovery in Severe COVID-19 Patient Survivors of Mechanical Ventilation.

Background and Objectives: Patients who survive severe COVID-19 require significant pulmonary rehabilitation. Heart rate (HR) has been used as a safety variable in the evaluation of the results of interventions in patients undergoing pulmonary rehabilitation. The aim of this research was to analyse HR during a pulmonary rehabilitation program in post-severe COVID-19 patients who survived mechanical ventilation (MV). The study includes the initial and final evaluations and aerobic training sessions. Materials and Methods: Twenty patients (58 ± 13 years, 11 men) were trained for 8 weeks. A 6-minute walk test (6 MWT) was performed and, subsequently, a supervised and individualised training plan was created. Resting heart rate (RHR), heart rate recovery (HRR), heart rate at minute 6 (HR6 min) and the product of HR6 min and systolic blood pressure (HR6 minxSBP) were measured at 6 MWT. In addition, HR was measured at each training session. Results: After 8 weeks of pulmonary rehabilitation, patients decreased their RHR from 81.95 ± 9.36 to 73.60 ± 9.82 beats/min (p < 0.001) and significantly increased their HRR from 12.45 ± 10.22 to 20.55 ± 7.33 beats/min (p = 0.005). HR6 min presented a significant relationship with walking speed and walked distance after the pulmonary rehabilitation period (r = 0.555, p = 0.011 and r = 0.613, p = 0.011, respectively). HR6 minxSBP presented a significant relationship with walking speed and walked distance after training (r = 0.538, p = 0.014 and r = 0.568, p = 0.008, respectively). In the pulmonary rehabilitation sessions, a significant decrease in HR was observed at minutes 1, 6 and 15 (p < 0.05) between sessions 1 and 6 and at minute 1 between sessions 1 and 12. Conclusions: Eight weeks of individualised and supervised pulmonary rehabilitation were effective in improving RHR and HRR in COVID-19 patients surviving MV. HR is an easily accessible indicator that could help to monitor the evaluation and development of a pulmonary rehabilitation program in COVID-19 patients who survived MV.

Assessment of Intraoperative Hemodynamics and Recovery Characteristics in Pediatric Patients Receiving Buprenorphine and Propofol Anesthesia for Cleft Palate Surgery: A Prospective Observational Study.

Children with cleft palate are usually operated on before 18 months of age. Cleft palate surgery demands stable hemodynamic parameters, a bloodless surgical field, and an awake and pain-free child after surgery. We aimed to study the anesthesia technique using buprenorphine and propofol for cleft palate surgery. The design involves prospective observational study. The study was conducted at a tertiary care hospital. After the Institutional Ethics Committee approval, 42 patients aged 6 months to 12 years undergoing cleft palate surgery were enrolled. Anesthesia induction commenced with sevoflurane or propofol 3 mg.kg-1. After intubation, buprenorphine 3 μg.kg-1 was given, and propofol infusion was started at 2-8 mg.kg-1.h-1. Hemodynamic parameters, awakening time, and surgeon's satisfaction score were noted. After extubation, pain score, emergence agitation (EA) score, sedation score, recovery score, and adverse events were noted. All statistical analyses were performed using the 20.0 version of the Statistical Package for the Social Science (SPSS) software program. Continuous data were summarized as mean and standard deviation, and were analyzed using a two-sided Student's unpaired t-test. Categorical data were represented using frequencies and proportions. The single dose of buprenorphine with propofol infusion started immediately postintubation causes a significant decrease in heart rate after 1 h. This contributed to a favorable operative field, increasing the surgeon's satisfaction score. In the recovery room, patients were essentially pain-free till 2.5 h after surgery, with only one patient requiring rescue analgesia. Furthermore, 90% of patients showed a smooth and calm recovery with no EA. The Steward's recovery score remained high throughout without any complication. In cleft palate surgeries, a single-dose buprenorphine 3 μg.kg-1 and propofol maintenance infusion 2-8 mg.kg-1.h-1 were effective in maintaining hemodynamic parameters and a bloodless surgical field and managing postoperative pain with a good recovery profile.

Reassessment of the Effect of Transcutaneous Auricular Vagus Nerve Stimulation Using a Novel Burst Paradigm on Cardiac Autonomic Function in Healthy Young Adults

BackgroundTranscutaneous auricular vagus nerve stimulation (taVNS) may modulate cardiac autonomic function. However, the response rate of the traditional tonic paradigm is low, and the results remain inconsistent. A recent pilot study presented a novel burst paradigm to activate the cardiac parasympathetic system, which might offer a new approach to treat cardiac autonomic function. The present study reassessed the effect of burst taVNS on modulating heart rate variability and explored the difference between burst and traditional tonic paradigms. Materials and MethodsForty-two young adults were recruited for this study. Each participant underwent three types of taVNS with sham (30 sec of stimulation), tonic (25 Hz, 500 μsec), and burst (five pulses at 500 Hz every 200 msec) paradigms, respectively, with simultaneous electrocardiogram recording. One-way analysis of variance, multivariate analysis of variance, and linear regression were used for analysis. Multiple testing was performed using Bonferroni correction. ResultsBoth burst and tonic paradigms induced a significant decrease in heart rate, which continued until poststimulation, and increased cardiac parasympathetic activity. Moreover, two parasympathetic system indicators showed significant increase only in burst taVNS. The response rates during burst (35.7%) and tonic (38.1%) stimulations were both higher than that during sham stimulation (11.9%). The response to taVNS showed parameter specificity with few nonresponders to the tonic paradigm responding to the burst paradigm. The overall response rate increased from 38.1% in tonic taVNS to 54.8% in taVNS using both burst and tonic paradigms. For both burst and tonic responders, baseline cardiac parasympathetic activity was found to be significantly negatively correlated with changes during stimulation. ConclusionThe burst parameter could be used as an alternative strategy for regulating cardiac parasympathetic function by taVNS, which has the potential to be used as a complementary paradigm to traditional tonic taVNS for promoting clinical treatment efficacy.

Effect of caudally administered clonidine on sevoflurane induced emergence agitation-A randomized trial.

Background and Aims:Emergence agitation (EA) is an unpleasant problem encountered in children following anesthesia with Sevoflurane. We studied the effectiveness of caudal epidural block (CEB) with ropivacaine 0.2% and clonidine two microgram per kilogram (mcg/kg) on the incidence of EA, with respiratory depression and hemodynamic variables as secondary end points.Material and Methods:Ninety children aged one to eight years undergoing infra umbilical surgeries were randomly allocated into two groups. Group RS: Ropivacaine 0.2% one ml/kg + . Saline one ml and Group RC: Ropivacaine 0.2% one ml/kg + Clonidine two mcg/kg made to one ml. They were then administered general anesthesia with endotracheal intubation followed by CEB using test drugs. Post surgery, EA was evaluated by Modified Richmond Agitation Scale at 15-minute intervals for one hour. The results were then analyzed using mean and standard deviation (SD), Chi square test, and Independent t test.Results:EA was significantly lower in group RC when compared to group RS (P < 0.0001). Group RC had 12 (28.5%) children with EA at 15 minutes compared to 35 (83.3%) children in Group RS. At 30 minutes, it was seen in five (11.3%) and 27 (64.2%) children in group RC and RS, respectively. No significant respiratory depression was noted in both groups. A significant decrease in heart rate was seen in Group RC (P < 0.001) but was not significant clinically. No adverse events were recorded in both the groups.Conclusion:Addition of clonidine (2mcg/kg) to ropivacaine 0.2% offers an advantage over 0.2% ropivacaine alone in decreasing the incidence of sevoflurane induced EA in children undergoing lower abdominal surgery without any adverse effects.

Blockade of alpha2-adrenergic receptors in the caudal raphe region enhances the renal sympathetic nerve activity response to acute intermittent hypercapnia in rats.

The study investigated the role of alpha2-adrenergic receptors of the caudal raphe region in the sympathetic and cardiovascular responses to the acute intermittent hypercapnia (AIHc). Urethane-anesthetized, vagotomized, mechanically ventilated Sprague-Dawley rats (n=38) were exposed to the AIHc protocol (5×3 min, 15 % CO2+50 % O2) in hyperoxic background (50 % O2). alpha2-adrenergic receptor antagonist-yohimbine was applied intravenously (1 mg/kg, n=9) or microinjected into the caudal raphe region (2 mM, n=12) prior to exposure to AIHc. Control groups of animals received saline intravenously (n=7) or into the caudal raphe region (n=10) prior to exposure to AIHc. Renal sympathetic nerve activity (RSNA), mean arterial pressure (MAP) and heart rate (HR) were monitored before exposure to the AIHc protocol (T0), during five hypercapnic episodes (THc1-5) and at 15 min following the end of the last hypercapnic episode (T15). Following intravenous administration of yohimbine, RSNA was significantly greater during THc1-5 and at T15 than in the control group (P<0.05). When yohimbine was microinjected into the caudal raphe region, AIHc elicited greater increases in RSNA during THc1-5 when compared to the controls (THc1: 138.0+/-4.0 % vs. 123.7+/-4.8 %, P=0.032; THc2: 137.1+/-5.0 % vs. 124.1+/-4.5 %, P=0.071; THc3: 143.1+/-6.4 % vs. 122.0±4.8 %, P=0.020; THc4: 146.1+/-6.2 % vs. 120.7+/-5.7 %, P=0.007 and THc5: 143.2+/-7.7 % vs. 119.2+/-7.2 %, P=0.038). During THc1-5, significant decreases in HR from T0 were observed in all groups, while changes in MAP were observed in the group that received yohimbine intravenously. These findings suggest that blockade of the alpha2-adrenegic receptors in the caudal raphe region might have an important role in sympathetic responses to AIHc.

Daytime Exposure to Blue Light Alters Cardiovascular Circadian Rhythms, Electrolyte Excretion and Melatonin Production.

Artificial light is characterized by certain features of its impact on the body in terms of its spectral distribution of power, duration of exposure and intensity. Short waves, perceived as blue light, are the strongest synchronizing agent for the circadian system. In the present work, we investigated the features of the circadian rhythms of blood pressure (BP), heart rate (HR), the excretion of electrolytes and the secretion of melatonin in normotensive (Wistar–Kyoto) and hypertensive (SHR) rats under the action of monochromatic blue light in the daytime period. It was found that the exposure of Wistar–Kyoto rats to monochromatic blue light was accompanied by a significant decrease in nighttime and 24 h systolic BP. The most remarkable changes are characteristic of the HR in SHR rats under monochromatic light. A significant decrease in HR in each time period was found, but the predominance of nighttime over daytime values remained in SHR animals. There was also a significant increase in the mesor of the HR in SHR rats. Additionally, the amplitude of diastolic BP and HR, as well as the range of oscillations in HR, were significantly increased compared with the standard light pattern. In contrast to SHR rats, the regulation of the circadian rhythms in Wistar–Kyoto rats was more flexible and presented more changes, which may be aimed at the adaptation of the body to environmental conditions. For Wistar–Kyoto rats, an increase in the level of excreted electrolytes was observed under the action of monochromatic light, but no similar changes were found in SHR rats. For Wistar–Kyoto rats, a significant decrease in the urine concentration of aMT6s in the daytime and nighttime periods is characteristic, which results in the loss of the circadian rhythm. In SHR rats, there was a significant decrease in the nighttime content of aMT6s in the urine, while the daytime concentration, on the contrary, increased. The obtained data demonstrate that prolonged exposure to monochromatic blue light in the daytime period affects the circadian structure of the rhythms of the cardiovascular system, the rhythm of electrolyte excretion and the production of epiphyseal melatonin in wild-type and hypertensive animals. In SHR rats, the rhythms of BP and HR exhibit a more rigid pattern.

Effect of Slow Pranayama on Heart Rate Variability in Pregnant Women with Preeclampsia

Background and Aim: Hypertension is one of the common medical problems encountered in 10% of all pregnancies. Pre-eclampsia (PE), a hypertensive disorder during pregnancy has adverse pregnancy and cardiovascular (CV) outcomes. Though anti-hypertensive drugs are used in the management of pregnancy induced hypertension, termination of pregnancy alone offers complete cure. Hence optimizing the health care for pregnant women is an important step to achieve sustainable development objectives, prevention and treatment of hypertensive disorders. While studies have shown the beneficial effects of yoga on high-risk pregnancies, this randomized control trial investigated the effect of slow pranayamas on heart rate variability and CV risks in pregnant women diagnosed with preeclampsia. Methods: A total of 101 pregnant women who were diagnosed with pre-eclampsia were recruited from Women and Children Hospital, JIPMER and were randomized into yoga and control groups. The yoga group (n=48) received standard anti-hypertensive medication along with slow pranayamas, 2 times a day for 4 weeks between 20-34 weeks of gestation. The control group (n=53) received only standard anti-hypertensive medications during the same period. Heart rate, blood pressure and heart rate variability were assessed before and after 4 weeks. Results: Significant decrease in heart rate and blood pressure was seen in in pranayama group compared to control group. Also, LFnu and LF-HF ratio decreased significantly and HFnu increased significantly in pranayama group compared to control group. Conclusion: Four-week practice of slow pranayamas significantly improved the parasympathetic activity and decreased the sympathetic activity and reduced CV risks in preeclamptic pregnant women.

Quantification of Cardiovascular Regulation Applying Heart Rate Variability Analyses for Different Warm and Moist Chest Compresses in Healthy Subjects.

Background: In integrative medicine, complementary healing methods, such as external applications (massages, rhythmic rubs, and compresses), are part of the practice and clinical application and have proven their therapeutic effect in various fields. Objective: Aim of this exploratory, controlled, single-blinded study was to investigate the effects of three different warming chest compresses on cardiovascular regulation by analyzing heart rate variability (HRV) in healthy subjects. Methods: Over a period of 4 weeks, three different warming chest compresses (a hot water compress, a ginger powder compress, and a mustard flour compress) in 30 healthy subjects were analyzed. For all subjects, 48-h long-term electrocardiograms were recorded, and afterward, epochs of 5 min length extracted and analyzed by different linear and nonlinear HRV indices. Results: A moist chest compress did not result in any significant short- and long-term stimulation of the autonomic regulation, except for a short-term significant decrease in heart rate (meanNN, p < 0.05). Warm and moist chest compresses with ginger flour led to significantly increased HRV (sdNN, p < 0.05; symbolic dynamics2, p < 0.05) and its complexity (renyi4 entropy, p < 0.05) and a significant decrease in heart rate (meanNN, p < 0.00036), and thus to a short-term relaxation effect. In contrast, warm and moist chest compresses with mustard flour led to significantly decreased HRV and their complexity (time-, frequency-, and nonlinear dynamics domain, p < 0.00036), which can be interpreted as a stress reaction of the autonomous nervous system. Conclusions: The application of chest compresses led to short-term relaxation effects (ginger) as well as short-term stress effects (mustard) but not to any significant longer-term effect on HRV in healthy subjects.

Influence of anesthesia with isoflurane on myocardial velocities of racing pigeons (Columba livia f. domestica).

Tissue Doppler imaging (TDI) is a new technique to measure the myocardial velocities of the avian heart. Using this technique, the present study investigated the influence of isoflurane anesthesia on the systolic and diastolic longitudinal myocardial velocities in racing pigeons. Racing pigeons (n = 40) were anesthetized with isoflurane with a semi-open anesthesia system with an anesthetic mask and spontaneous breath. The echocardiographic examination was performed during the stage of surgical anesthesia with the failure of the toe pinch and wing twitch reflexes and with deep regular breaths. Echocardiographic measurements were taken in conscious and anesthetized pigeons in the right parasternal longitudinal horizontal heart view. The results demonstrated a significant decrease in heart rate, systolic and diastolic A' wave myocardial velocities. The diastolic E' wave velocities were less influenced by anesthesia and significantly decreased only for some heart wall segments. The systolic myocardial velocities were significantly negatively correlated with the heart rate. Using the TDI curve, the isovolumic contraction (IVC) and relaxation time (IVR) and the time of atrioventricular delay during anesthesia could be determined. There is a significant increase in IVR and atrioventricular delay during anesthesia CONCLUSION AND CLINICAL RELEVANCEN: A higher heart rate in anesthesia should be interpreted as a compensation for reduced heart performance. The results of the present study indicate the necessity for establishing normal heart values in conscious and anesthetized pigeons.

Toward applying a device to reduce motion artifact during imaging: a randomized controlled trial

ABSTRACT Objective One of the most critical problems in different types of medical imaging modalities is unwanted patient movement during imaging procedures, which mainly occurs because of stress, anxiety, and restlessness in patients, resulting in poor image quality and decreased diagnostic accuracy. Methods This prospective, randomized, double-blinded, controlled trial comprised 267 patients who underwent MPI, randomly divided into three groups; Group I: streaming music with a special binaural beat frequency (MBB); Group II: streaming simple music (SM) and Group III: control group. Anxiety level was determined by DASS (Depression Anxiety Stress-Scale) questionnaire and heart rate was monitored. Results Stress and anxiety scores were significantly lower in the MBB group compared with both SM and control group (P˂0.0001). Additionally, a significant decrease in heart rate of patients who were in the MBB group in comparison with the SM (p=0.005) and control group (P=0.018) was observed. The study revealed a significant decrease in motion artifact in the MBB group compared with the SM (P=0.003) and control (P˂0.0001) groups. Conclusions Using the proposed device capable of streaming special binaural beat frequency embedded music can cause a significant reduction in anxiety level, heart rate, and consequently motion artifact. This method can be useful during the imaging procedure due to several reasons. First, this can cause a significant reduction in motion artifacts. Next, anxiety and stress can be reduced significantly due to the application of special binaural beat frequency embedded music during an imaging procedure. Then, a significant reduction in post-imaging stress and anxiety scores was achieved after using it. Finally, binaural beat frequency embedded music leads to imaging repetition avoidance.

Esmolol response in septic shock patients in relation to vascular waterfall phenomenon measured by critical closure pressure and mean systemic filling pressure: a prospective observational study

BackgroundBedside measurements of critical closure pressure (Pcc) and mean systemic circulation filling pressure (Pmsf) were utilized to evaluate the response to esmolol in septic shock patients, in relation to the vascular waterfall phenomenon and body oxygen supply and demand.MethodsThis prospective observational self-controlled study included patients with septic shock, newly admitted to the intensive care unit, between August 2019 and January 2021. Pcc and Pmsf, along with the heart rate and other hemodynamic indicators were observed and compared before and 1 h after esmolol IV infusion.ResultsAfter 24 h of initial hemodynamic optimization, 56 patients were finally enrolled. After start of esmolol infusion, patients had a significant decrease in cardiac index (CI) (4.0 vs. 3.3 L/min/m2, P < 0.001), a significant increase in stroke index (SI) (34.1 vs. 36.6 mL/m2, P < 0.01), and a significant decrease in heart rate (HR) (116.8 vs. 90.6 beats/min, P < 0.001). After 1 h of treatment with esmolol, patients had a significant increase in Pcc (31.4 vs. 36.7 mmHg, P < 0.01). The difference between Pcc and Pmsf before and after treatment was statistically different (4.0 vs. 10.0 mmHg, P < 0.01). After heart rate control with esmolol, the patients had a significant increase in the body circulation vascular resistance indices (RIs) (15.14 vs. 18.25 mmHg/min/m2/L, P < 0.001). There was an increase in ScvO2 in patients after treatment with esmolol, but the difference was not statistically significant (68.4% vs. 69.8%, P > 0.05), while Pcv-aCO2 was significantly lower (6.3 vs. 4.9 mmHg, P < 0.001) and patients had a significant decrease in blood lactate levels (4.0 vs. 3.6 mmol/L, P < 0.05).ConclusionPatients with septic shock whose heart rate is greater than 95 beats/min after hemodynamic optimization were treated with esmolol, which could effectively control heart rate and reduce CI, as well as improve Pcc and increase the difference between Pcc and Pmsf (known as “vascular waterfall” phenomenon), without affecting MAP, CVP, Pmsf and arteriovenous vascular resistance, and improve the balance of oxygen supply and demand in the body.

Characteristics of the acute myocardial infarction course in patients with type 2 diabetes mellitus before and after reperfusion therapy

Introduction. Scientific research is currently being done to diagnose and manage comorbid conditions in patients. The importance of studying the pathophysiological mechanisms of acute myocardial infarction (AMI) in patients with type 2 diabetes mellitus (DM) has been proven. The purpose of the study: to conduct a retrospective analysis before and after reperfusion therapy by evaluating the features of the AMI course in patients with type 2 DM. Material and methods. The study was conducted from January 10, 2020 to January 12, 2021. In total, 74 STEMI patients with or without type 2 DM, aged 59.42±7.66 years were examined at the Intensive Care Unit of the Government Institution “L. T. Malaya National Therapy Institute of the National Academy of Medical Sciences of Ukraine” and the Kharkiv Railway Clinical Hospital No. 1 of the branch “Center of Healthcare” of Public Joint Stock Company “Ukrainian Railway”. Serum levels of insulin, adropin, irisin, fatty acid binding protein 4 (FABP4) and C1q/TNF-related protein (CTRP3) were detected by enzyme-linked immunosorbent assay. Analysis and processing of the findings obtained after examinations were carried out using the computer program IBM SPPS software, version 27.0 (IBM Inc., USA, 2020). Results and discussion. Before the treatment, patients with AMI and type 2 DM had significantly higher values of end-systolic size (ESS) by 5.56%, left atrium (LA) by 10.53%, left ventricular myocardial mass index (LVMMI) by 6.87% and lower values of systolic blood pressure (SBP) by 11.76%, atherogenic index (AI) by 5.80%, glucose by 25.71%, insulin by 39.92%, irisin by 15.34%, FABP4 by 19.76% compared to the values of these indicators 14 days after medicamentous therapy (p&lt;0.05). Patients with AMI and type 2 DM had significantly higher values of adropin by 46.10%, irisin by 20.11%, CTRP3 by 28.78% and lower values of SBP by 17.65%, diastolic blood pressure by 12.38%, heart rate (HR) by 13.73%, pulse by 10.87%, body mass index by 5.57%, weight by 9.52%, glucose by 26.67%, insulin by 40, 75%, total cholesterol by 10.04%, very low-density lipoproteins by 24.75%, low-density lipoproteins by 8.52%, triglycerides by 27.06%, AI by 10.55%, FABP4 by 37.04% before treatment as compared to the values of these indicators 14 days after percutaneous coronary intervention (PCI) (p&lt;0.05). Comparing the studied indicators between subgroups after medicamentous treatment and PCI, a significant decrease in HR by 8.33%, ESS by 4.11%, LA by 9.52%, LVMMI by 5.53%, FABP4 by 21.53% and an increase in the levels of adropin by 36.99%, irisin by 41.88%, CTRP3 by 30.25%, high-density lipoproteins (HDL) by 10.28% were identified (p&lt;0.05). Conclusions. When compared PCI advantages due to the absence of a tendency to the left heart dilatation over the medicamentous therapy, improvements of energy and adipokine metabolism have been observed amid increased levels of adropin, irisin and CTRP3 and decreased levels of FABP4 in patients with AMI and type 2 DM. It should be noted that there has been a significant improvement in the state of energy and adipokine profiles under the conditions of performing PCI.

Addition of dexmedetomidine and nalbuphine as an adjuvant to ketofol for deep sedation during endoscopic retrograde cholangiopancreatography: A prospective, randomized, double-blind study

Background: Deep sedation has evolved as a better choice against general anesthesia in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). This study was aimed to evaluate the efficacy of dexmedetomidine and nalbuphine as an adjuvant to ketofol based deep sedation in ERCP.Methods: One hundred patients undergoing ERCP were randomly assigned to receive either IV dexmedetomidine 1 μg/kg (Group D, n = 50) or I. V nalbuphine 0.1 μg/kg (Group N, n = 50), 10 min before ketofol induction. The primary outcome was the total dose of ketofol used for induction and maintenance of deep sedation throughout the procedure. Hemodynamics and respiratory parameters, recovery characteristics, endoscopist's, and anesthetist satisfaction scores were secondary outcomes. P < 0.05 was considered statistically significant.Results: The dose of ketofol at the time of induction was significantly high in Group N as compared to Group D (P < 0.05). Supplemental dose of ketofol at the time of insertion of endoscope was equivalent in both the groups (P > 0.05) but significantly more number of patients in Group D (n = 19 vs. n = 11, P < 0.05) received supplement for facial pain score >5 compared to patients in Group N, where more patients received supplement for Ramsay Sedation Score <3 (n = 20 vs. n = 11 P < 0.05). Significant decrease in heart rate (HR) and mean arterial pressure from baseline values was found in Group D as compared to Group N (P < 0.001). Group N patients achieved postanesthesia recovery score >12 earlier than Group D (P < 0.001). Anesthetist satisfaction score was more in Group N (P < 0.05).Conclusion: Dexmedetomidine reduces the total consumption of ketofol and provides smooth hemodynamics whereas Nalbuphine provides better analgesia and early recovery with high anesthetist satisfaction for deep sedation in ERCP.

Comparison of high flow oxygen therapy in children with respiratory distress due to bronchiolitis and pneumonia

Background: Respiratory support through high flow nasal cannula (HFNC) therapy has emerged as a new method to provide respiratory support with bronchiolitis. Aim was to study outcome of HFNC therapy in children with bronchiolitis and pneumonia.Methods: The study was a prospective observational study involving children admitted to pediatric intensive care unit with respiratory distress (RD) in the age group of 1 month to 6 years over a period of 3 months (February 2017 till April 2017). Severity was assessed by clinical respiratory score (CRS). Children with RD were initiated with high flow nasal cannula. During treatment various parameters including CRS were documented at baseline and at 15 min and then hourly in a carefully designed performa. The primary outcome was failure of HFNC and need for ventilation.Results: Sixty children were included in the study of which 22 (37%) were in the bronchiolitis group and 38 (63%) were in the pneumonia group. 38 children presented with severe RD and 19 children with moderate RD. There was significant decrease in heart rate (HR) (20%), respiratory rate (RR) (20%) and in CRS within 1 hour of HFNC with a clinical stabilization within 24 hours in 16 cases (27%), 24-48 hours in 35 cases (58%) and &gt;48 hours in 5 (8%) cases. Therapy was successful in 55 (92%), and failed in 5 (8%).Conclusions: HFNC has better outcome in children with RD due to acute bronchiolitis when compared to pneumonia. HFNC can be safely commenced in RD in critically ill child with monitoring.

Effects of Preoperative Anxiety Status on Haemodynamic Changes during and after Tooth Extraction in Middle-aged and Elderly Patients with Hypertension: a Prospective Repeated-Measures Cohort Study.

To investigate the effects of dental anxiety on fluctuations in blood pressure (BP) and heart rate (HR) during tooth extraction in hypertensive patients under local anaesthesia, and how they are influenced by various confounding variables. This is a prospective repeated-measures cohort study involving 600 patients successively recruited from Peking University School and Hospital of Stomatology, Beijing, China. BP and HR were repeatedly measured at rest (T0), before anaesthesia (T1), during tooth extraction (T2) and after tooth extraction (T3). Anxiety status was measured prior to local anaesthesia using a modified dental anxiety scale (MDAS). Three groups were assigned: mild anxiety (Corah DAS score of 4 to 8), moderate anxiety (score of 9 to 12) and severe anxiety (score of 13 to 20). We used a generalised linear mixed model (GLMM) to analyse the effects of dental anxiety on fluctuations in BP and HR. Interaction analysis was used to further explore the correlationship between these interactive factors. The mean anxiety scale score was 9.63 ± 2.88. Severe preoperative anxiety (score of 14 to 20) was associated with significantly increased HR during administration of anaesthesia. Patients with severe anxiety also displayed a significantly greater increase in HR during anaesthetic administration (P < 0.001). When analysing the joint effects of different anxiety statuses over time, blood pressure was significantly elevated in all patients with moderate and severe anxiety during tooth extraction at T2 (β = 1.25, 95% CI 0.24 to 2.27). We also observed a significant decrease in HR in the moderate anxiety group at T3 (β = -1.51, 95% CI -2.38 to -0.63) and a significant increase in HR in the severe anxiety group at T1, T2 and T3 (β = 2.52, 95% CI 1.12 to 3.93; β = 3.84, 95% CI 2.30 to 5.38; β = 4.57, 95% CI 3.03 to 6.11, respectively). This study indicates that the effects of dental anxiety on BP and HR in middle-aged and elderly patients with hypertension during local anaesthesia and tooth extraction were influenced by various confounding variables.

The effect of sensory stimulation on apnea of prematurity

ObjectivesThe study aims to assess the effect of sensory stimulation on apnoea among premature newborns. MethodsThirty preterm newborns that were diagnosed with apnoea of prematurity, had a gestational age between 32 and 34 weeks, had low birth weight, and were appropriate for gestational age from 1200 to 2000 g were included in this prospective randomized study. Subjects were divided into two equivalent groups: a control group that received the standard care including nasal oxygen (one litre per minute) and caffeine citrate, and a study group that received the same care plus sensory stimulation (tactile, proprioceptive, and kinaesthetic). Participants’ heart rate, oxygen saturation, and apnoea frequency were measured by the neonatal intensive care unit team using a pulse-oximeter. The sensory stimulation sessions were 10 min, 3 times per day, totalling 30 min over a 7 day period. ResultsThere was a significant decrease in heart rate within both groups after receiving treatment from before treatment (p < 0.05), with no significant differences between the two groups. Furthermore, there was no significant difference in oxygen saturation within the groups after treatment compared with the levels before treatment, with no significant differences between the two groups (p > 0.05). Before treatment, there was a non-significant difference in the apnoea rate between both groups (p = 0.464), whereas there was a significant decrease in the apnoea rate of the study group after treatment compared with the control group (p = 0.031). ConclusionSensory stimulation applied with standard respiratory care can decrease the frequency of apnoea of prematurity.

Heart rate variability before and after 14 weeks of training in Thoroughbred horses and Standardbred trotters with different training experience.

Changes in heart rate and heart rate variabilty (HRV) were investigated in untrained (UT; starting their first racing season) and detrained (DT; with 1-3 years of race experience) racehorses before and after 14-week conventional training. HRV was measured at rest over 1 h between 9:00 and 10:00 AM on the usual rest day of the horses. The smallest worthwhile change (SWC) rate was calculated for all HRV parameters. UT horses had significantly higher heart rate compared to DT (P<0.001). There were no gender- or training-related differences in heart rate. The root-mean-square of successive differences (rMSSD) in the consecutive inter-beat-intervals obtained after the 14-week training period was lower compared to pre-training rMSSD (P<0.001). The rMSSD was not influenced by breed, age or gender. In DT horses, there was a significant decrease in the high frequency (HF) component of HRV (P≤0.05) as the result of the 14-week training. These results may reflect saturation of high-frequency oscillations of inter-beat intervals rather than the reduction in parasympathetic influence on the heart. The HF did not differ significantly between the two measurements in UT horses; however, 16.6% of the animals showed a decrease in HF below SWC (P≤0.05). This supports the likelihood of parasympathetic saturation. Although no significant decrease in heart rate was found for the post-training, 30.0% of DT and 58.3% of UT horses still showed a decrease in heart rate below the SWC. Also by individual examination, it was also visible that despite significant post-training decrease in rMSSD, 1 (4.6%) DT and 2 (6.7%) UT horses reached SWC increase in rMMSD. In the case of these horses, the possibility of maladaptation should be considered. The present results indicate that similar to as found in human athletes, cardiac ANS status of racehorses also changes during the physiological adaptation to training. To explore more precise links between HRV and training effectiveness in horses, a more frequent recording would be necessary. Detailed analysis of HRV parameters based on SWC will be able to highlight the importance of fitness evaluation at individual level.

Anesthesiologic management of elective endovascular stenting of coronary artery

Introduction. Ischemic heart disease is the most common cause of death in the Russian Federation and in the world. One of the main methods of surgical treatment is endovascular stenting of the coronary arteries. Despite the minimally invasive method, there is a need to ensure sedation of the patient during the intervention. The main type of anesthetic aid for this procedure is monitored sedation.The aim of the study was to conduct a comparative analysis of the two most frequently used regimens of monitored sedation for elective endovascular interventions in world practice.Materials and methods. From January to July 2021, a prospective cohort study was conducted that included 70 patients. A comparison was made between the sedation group using phenazepam (n = 38) with the analgosedation group (n = 32) — a combination of sibazone and fentanyl. The comparison was made by the level of sedation (RASS scale), the severity of anginal pain at the stage of stenting of the coronary arteries according to the VAS; vital indicators of patients (sBP, dBP, avgBP, HR, SpO2).Results. The use of a monitored sedation regimen (sibazone + fentanyl) leads to deeper sedation according to the RASS and a more significant decrease in heart rate in patients at the stage of coronary artery stenting compared with the use of benzodiazepine (phenazepam) alone. Despite this, the incidence of anginal pain during the intervention did not differ statistically significantly between the comparison groups.Discussion. In this work, we compared two approaches to anesthetic protection when performing planned endovascular stenting of coronary arteries, which are most often used in foreign and domestic interventional practice.Conclusions. The use of analgosedation (sibazone + fentanyl) for elective endovascular stenting of coronary arteries has no significant advantages over sedation with benzodiazepines (phenozepam) for these types of interventions. It becomes obvious that it is necessary to continue the search for more effective and safer schemes of anesthetic management during planned endovascular stenting of coronary arteries.

Liriodendrin, ameliorates hypertension by calcium channel blockade and enhancing enos expression in wistar rats

Introduction: Hypertension is found to be the prime cause ofdeath worldwide in spite of a number of available treatmentswhich suggests that there is a need of discovering new leadmolecules that would be more effective to treat cardiovasculardisease (CVD). Liriodendrin, the lignan phytoconstituent possessespotential pharmacological effects. Literature survey suggeststhat liriodendrin could be effective in mitigating hypertensionconsidering its structural similarity with reported cardiovascularprotective drugs. Hence liriodendrin is investigated to reveal itsmechanism of actions to support its antihypertensive property.Methods: Hypertension was induced in male wistar rats withDOCA salt. Hypertensive rats were treated with liriodendrin for4 weeks. Blood pressure, heart rate, body weight, lipid profile,serum nitrite levels, vascular reactivity to various catecholamines,in-vitro calcium channel blocking assays, antioxidantassay, determination of aortic calcium level, endothelial function,expression of eNOS analysis were studied.Result: Liriodendrin was found safe orally up to 2000 mg/kg. Itshowed a significant decrease in heart rate, blood pressure andmean arterial pressure. In-vitro study on the isolated rat aorta revealedthe calcium channel blocking potential of liriodendrin. Vascularreactivity to various catecholamines was normalized. Vascularendothelium was significantly protected by the enhancedrelease of nitric oxide and eNOS expression by the western blottechnique. Oxidative stress was also significantly reduced.Conclusion: Liriodendrin was found to be beneficial in hypertensionas it produced vasorelaxation by blocking calciumchannels, enhancing nitric oxide release, and reducing oxidativestress. Thus, liriodendrin may be useful to relieve hypertensionand cardiovascular complications.

THE EFFECT OF A TRAUMATIC BRAIN INJURY ON CHANGES IN THE HEART RATE OF RATS SUBJECT TO VARIOUS MODES OF MOTOR ACTIVITY

For the first time, studies have been conducted to study the reaction of animal heart rate to various modes of motor activity after a traumatic brain injury. It was revealed that on the first day after modeling an open head injury in rats of all age groups, a pronounced increase in heart rate was observed. In this case, the smallest heart rate response to brain injury is observed in animals of immature age. It was found that the implementation of systematic dynamic exercises by animals of mature and preschool age after modeling a craniocerebral injury contributes to a significant decrease in heart rate. A more pronounced formation of training bradycardia is observed in immature animals. It was revealed that limiting motor activity and performing isometric exercises after a traumatic brain injury maintain heart rate at an increased level in all age groups of animals and significantly inhibits the natural, age-related decrease in heart rate in immature animals.