Significant Differences In Heart Rate Research Articles

Effects of 2-Hz and 100-Hz Electroacupuncture Stimulation on Respiratory Function and Heart Rate Variability: A Randomized Crossover Study

Background: Bronchial contraction and dilation is thought to be caused by non-adrenergic non-cholinergic nerves. Objective: To investigate the effects of low-frequency (1-5 Hz) and highfrequency (50-100 Hz) electric acupuncture (EA) stimulation on bronchial dilation. Design: Prospective, single-center study Setting: Teikyo Heisei University Subjects: Seventeen healthy male adults Randomization: We randomly assigned subjects to 2-Hz EA and 100-Hz EA groups in a crossover trial. The washout period was 2 weeks. Intervention: Both groups underwent a respiratory function test, followed by a 5-minute rest, followed a 5-minute rest or EA stimulation, followed by a 5min rest. Heart rate variability was measured at rest, followed by another respiratory function test. Acupuncture was delivered near the cervical ganglia at the level of the sixth cervical vertebra on the left side. EA stimuli were set to 2-Hz or 100-Hz, and stimulation intensity was set to a level where no pain was felt. Main outcome measures: Spirometry (forced vital capacity, forced expiratory volume in 1 s, and maximum respiratory flow), autonomic nerve activity (low-frequency component, high-frequency component, and their ratio), and heart rate variability. Results: Heart rate variability analysis showed significant differences in heart rate between the 2-Hz EA and 100-Hz EA groups. The 2-Hz EA group showed a significant increase in HF.Conclusions: 2-Hz EA stimulation resulted in decreased heart rate and increased HF during stimulation. This may be more effective for regulation of the autonomic nerves of the cardiopulmonary system than 100-Hz EA stimulation. Future studies are required to confirm our findings.

Left Atrial Filling Time Index (LAFTI) Evaluated by 2D Speckle Tracking Echocardiography Predicts Poor Cardiac Prognosis in Patients with Heart Failure.

Left atrial (LA) dysfunction is known to be a more sensitive prognostic marker than left ventricular (LV) dysfunction in patients with heart failure (HF). Persistent LA overload increases LA stiffness which impairs LA relaxation. The aim of this study was to investigate whether LA filling time is associated with clinical outcomes in patients with HF. Two-dimensional speckle tracking echocardiography (2DSTE) was performed at discharge, to measure LA and LV strain in 179 HF patients admitted to our hospital. The LA filling time index (LAFTI) was defined as the time from onset of the R wave to the peak LA systolic strain divided by the R-R interval. All patients were prospectively followed with cardiac events including cardiac death and rehospitalization for HF. There were 64 cardiac events during a median follow-up period of 451 days. There were no significant differences in heart rate, severity of HF at discharge, etiology of HF, severity of mitral regurgitation, or LV global longitudinal strain between the cardiac event group and no cardiac event group. Patients with cardiac events had significantly higher levels of brain natriuretic peptide (BNP), ratio of the E wave to e' (E/e'), left atrial volume index (LAVI), and lower LAFTI than those without. Kaplan-Meier analysis showed that patients with lower LAFTI were associated with higher cardiac event rates. Multivariate Cox hazard analysis showed that LAFTI was independently associated with the cardiac events after adjustment for confounding factors. In conclusion, LAFTI is a feasible predictor for cardiac events in patients with HF.

Examination of the acute heart rate and salivary cortisol response to a single bout of walking in urban and green environments: A pilot study

BackgroundRegular physical activity can help prevent noncommunicable diseases, and improve mental health, quality of life, and well-being. ‘Green exercise’ is physical activity performed in natural settings such as parks and open green spaces. It is important to understand whether green exercise can provide additional physiological benefits over and above those of physical activity in urban environments. This pilot study compared the acute effects of a 30-min walk in a green environment to a 30-min walk in urban streets on adults’ heart rate and salivary cortisol. MethodsUsing a 2 × 2 randomised cross-over design, groups of 2–5 adults completed two experimental sessions involving a randomly assigned walk in an urban or a green environment. Heart rate and salivary cortisol were collected at regular intervals before, during, and in the 1.5 h following the walks and were compared within and between participants. Peak height, reactivity, area under the curve with respect to ground (AUCg) and area under the curve with respect to increase (AUCi), were also calculated for heart rate and cortisol and compared between walking conditions. ResultsThe sample included 20 participants (50 % female, mean =24.4 ± 4.0 years). Changes in heart rate (Condition × Time: F[5.8, 103.8]=1.67, p = 0.140) or cortisol (Condition × Time: F[2.6, 49.5]=0.81, p = 0.482) in response to walking were not statistically significantly different between the urban and green walking conditions. There were also no statistically significant differences in heart rate or salivary cortisol for the peak height of the response, reactivity, or AUCi or AUCg between the urban and green walking conditions. ConclusionOur findings suggest that physical exertion is the main driver of the acute physiological response to walking. Notwithstanding psychological benefits reported elsewhere, the acute physiological response to walking was not influenced by the green compared with the urban environment in the current study. Further research is warranted to understand the longer-term effects of regular green exercise.

Comparison of Fentanyl and Dexmedetomidine in Preventing an Increase in Heart Rate During Intubation Among Patients Undergoing General Anesthesia: A Meta-Analysis.

General anesthesia induction, tracheal intubation, extubation, and laryngoscopy are associated with specific hemodynamic changes. Tracheal intubation and laryngoscopy are related to sympathetic stimulation and lead to hypertension and tachycardia. Recent studies have shown that dexmedetomidine is safe and effective as it does not depress respiratory function. This meta-analysis aims to compare the efficacy of dexmedetomidine and fentanyl in preventing an increase in heart rate (HR) during intubation among patients undergoing general anesthesia. A systematic literature search was done using PubMed, Cochrane Library, and Embase to assess studies comparing the efficacy of dexmedetomidine and fentanyl in preventing an increase in HR during intubation. A meta-analysis was done utilizing a random-effects model, and mean differences of HR were determined between fentanyl and dexmedetomidine at baseline, one minute, five minutes, and 10 minutes of intubation. In this meta-analysis, eight randomized control trials were included, involving 548 patients (274 in the fentanyl group and 274 in the dexmedetomidine group). The findings showed that significant difference of HR was significantly lower in the dexmedetomidine group than the fentanyl group at one minute of intubation (mean difference = -8.46; P-value = 0.003), at five minutes of intubation (mean difference = -7.51; P-value = 0.001), and at 10 minutes of intubation (mean difference = -5.15; P-value = 0.030). In the current meta-analysis, dexmedetomidine was better than fentanyl in preventing tachycardia following endotracheal intubation. HR was significantly lower at one minute, five minutes, and 10 minutes after intubation in the dexmedetomidine group compared to the fentanyl group.

Clinical evaluation of prone position ventilation in the treatment of acute respiratory distress syndrome induced by sepsis.

BACKGROUNDAcute respiratory distress syndrome (ARDS) is an acute, diffuse, inflammatory lung injury. Previous studies have shown prone position ventilation (PPV) to be associated with improvement in oxygenation. However, its role in patients with ARDS caused by sepsis remains unknown. AIMTo analyze the clinical effects of PPV in patients with ARDS caused by sepsis. METHODSOne hundred and two patients with ARDS were identified and divided into a control group (n = 55) and a PPV treatment group (n = 47). Outcomes included oxygenation index, lung compliance (Cst) and platform pressure (Pplat), which were compared between the two groups after ventilation. Other outcomes included heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), left ventricular ejection fraction (LVEF), the length of mechanical ventilation time and intensive care unit (ICU) stay, and levels of C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) after ventilation. Finally, mortality rate was also compared between the two groups. RESULTSOn the first day after ventilation, the oxygenation index and Cst were higher and Pplat level was lower in the PPV group than in the conventional treatment group (P < 0.05). There were no significant differences in oxygenation index, Cst, and Pplat levels between the two groups on the 2nd, 4th, and 7th day after ventilation (P > 0.05). There were no significant differences in HR, MAP, CVP, LVEF, duration of mechanical ventilation and ICU stay, and the levels of CRP, PCT, and IL-6 between the two groups on the first day after ventilation (all P > 0.05). The mortality rates on days 28 and 90 in the PPV and control groups were 12.77% and 29.09%, and 25.53% and 45.45%, respectively (P < 0.05). CONCLUSIONPPV may improve respiratory mechanics indices and may also have mortality benefit in patients with ARDS caused by sepsis. Finally, PPV was not shown to cause any adverse effects on hemodynamics and inflammation indices.

The effects of acute yoga practice on heart rate and heart rate variability responses to mental stress

ABSTRACT Yoga has been shown to reduce stress and to provide health benefits for a number of stress-related disorders. However, the effects and mechanism of an acute bout of yoga practice on relieving stress remain unclear. The aim of this study was to examine the effect of a single bout of yoga on heart rate (HR) and heart rate variability (HRV) response to and recovery from mental stress. This study was conducted with a randomised, counterbalanced, crossover design. A total of 44 participants (mean age 24.58 ± 3.84) completed two conditions (yoga and video watching (VW)) in a randomly assigned order. After each condition, participants underwent a Stroop task and mental arithmetic task. HR and HRV, measured via electrocardiogram, were recorded and analyzed at rest, during each condition, and during the stress and recovery periods. HR was significantly lower during the yoga condition as compared to that during the VW condition. There was no significant difference in HRV observed between the conditions. During both mental stress and recovery periods, there was no significant difference in HR or HRV responses between the yoga and VW conditions. These findings suggested that an acute bout of yoga practice was not superior to quiet sitting in reducing HR and HRV reactivity to and recovery from mental stress. Future studies may consider investigating individuals with exaggerated cardiovascular reactivity to further examine the potential reactivity-lowering effect of yoga.

Comparison of hemodynamic changes and fetal outcome between normotensive and preeclamptic parturient undergoing elective cesarean section under spinal anesthesia: A prospective observational cohort study

BackgroundMaternal hypotension is a common problem during spinal anesthesia resulting in adverse maternal and fetal outcomes. According to theoretical knowledge, it is more common in severe preeclamptic parturients undergoing cesarean section with spinal anesthesia. ObjectiveTo compare fetomother outcome in normotensive and severe preeclamptic parturients undergoing elective cesarean section under spinal anesthesia. MethodologyA prospective cohort study was conducted from Novembers to May 30, 2019 on 84 ASA II and III pregnant mothers. After preloading with 500 ml–1000ml crystalloids, a 0.5%isobaric bupivacaine of 10 mg–12.5 mg was administered for spinal anesthesia.Vital signs (SBP, DBP, MAP and HR) were recorded every 3 min till 30 min, every 5 min then after. Neonatal Apgar scores at one and 5 min after birth and intraoperative fluids consumption were recorded. Data distribution was checked by Shapiro walk's test. Chi-square test was used to calculate the incidence of hypotension between groups; both paired and unpaired t-tests were also used to calculate the percent fall in blood pressure and heart rate from baselines of each group and intergroup respectively, and P-value less than 0.05 were considered statistical significance. ResultsThe incidence of hypotension (over a period of 30 min after spinal anesthesia) in the preeclamptic patients (31%) was less than that of the healthy parturients (59.5%). There was no statistically significant difference in heart rate of both groups before and after induction of spinal anesthesia. The 5th minute Apgar score recordings were also comparable between the groups. ConclusionThis study showed that the incidence and magnitude of spinal anesthesia-induced hypotension was less in severely preeclamptic parturient than healthy parturient who underwent elective cesarean delivery under spinal anesthesia and fetal outcome was comparable.

MICROVASCULAR AND METABOLIC EFFECTS OF A BALANCED ELECTROLYTE SOLUTION AND HEPARINIZED AUTOLOGOUS BLOOD IN HEMORRHAGIC SHOCK

Aim: To compare the microvascular and metabolic effects of autologous blood and a balanced electrolyte solution (BES) containing acetate and malate in hemorrhagic shock (HS) in rats. Methods. The experiments were carried out on male Wistar rats (n=21) under general anesthesia. Blood (35% of estimated blood volume) was withdrawn for 5 minutes. After 60 minutes of HS the collected blood was retransfused, followed by the infusion of BES in the volume of 50% of the blood loss (HS+AB group); HS+BES group received BES in a triple volume of blood loss; a sham-hemorrhage control. Heart rate (HR), mean arterial pressure (MAP), skin blood flow (M), gases and acid-base state of arterial blood, post-occlusive reactive hyperemia (PORH) in the rat tail, serum levels of biomarkers S100b and NSE were assessed after 24 hours. After euthanasia, a histological examination of the brain, lungs, heart and kidneys was performed. Results. In HS+AB and HS+BES groups, 24-hour mortality did not differ (one animal in each group). MAP in these groups was moderately reduced compared to sham group. There were no significant differences in HR, M, acid-base state, PORH and levels of S100b and NSE between the groups. Histological examination revealed circulatory disorders of varying severity in groups with hemorrhage, with more pronounced damage to the brain and kidneys in HS+BES group. Conclusion. Both autologous blood and BES containing acetate and malate equally restore MAP, skin microcirculation, and acid-base state 24 hours after HS. However, fluid resuscitation with BES alone is associated with brain and kidney damage.

Association between carotid atherosclerosis and brain activation patterns during the Stroop task in older adults: An fNIRS investigation

There is an increasing body of evidence suggesting that vascular disease could contribute to cognitive decline and overt dementia. Of particular interest is atherosclerosis, as it is not only associated with dementia, but could be a potential mechanism through which cardiovascular disease directly impacts brain health. In this work, we evaluated the differences in functional near infrared spectroscopy (fNIRS)-based measures of brain activation, task performance, and the change in central hemodynamics (mean arterial pressure (MAP) and heart rate (HR)) during a Stroop color-word task in individuals with atherosclerosis, defined as bilateral carotid plaques (n = 33) and healthy age-matched controls (n = 33). In the healthy control group, the left prefrontal cortex (LPFC) was the only region showing evidence of activation when comparing the incongruous with the nominal Stroop test. A smaller extent of brain activation was observed in the Plaque group compared with the healthy controls (1) globally, as measured by oxygenated hemoglobin (p = 0.036) and (2) in the LPFC (p = 0.02) and left sensorimotor cortices (LMC)(p = 0.008) as measured by deoxygenated hemoglobin. There were no significant differences in HR, MAP, or task performance (both in terms of the time required to complete the task and number of errors made) between Plaque and control groups. These results suggest that carotid atherosclerosis is associated with altered functional brain activation patterns despite no evidence of impaired performance of the Stroop task or central hemodynamic changes.

Prone Position in Treatment of Hypoxemia in Patients Who Underwent Type A Aortic Dissection Surgery.

Postoperative hypoxemia is a high-risk complication after acute type A aortic dissection (TAAD) surgery. Prone position (PP) is an effective treatment for acute respiratory failure, which may improve the gas exchange of the injured lung and the patient's survival. PP is reported to improve the respiratory condition after cardiac surgery. However, limited data exist on the effect of PP in patients who underwent acute TAAD surgery. We retrospectively analyzed the clinical outcomes of seven patients with severe hypoxemia who underwent PP after acute TAAD surgery. The results of arterial blood gas, chest X-ray, and survival were collected. Seven patients (3 female, mean age 48.3±11.7 years) were recruited in this study. All patients received total arch replacement and frozen elephant trunk implantation procedure. The PaO2 at day 1 after PP was higher than before PP (126.3±49.3 vs. 77.8±15.5 mmHg). The oxygenation index rose sharply from 83.0 (80.0, 87.0) to 188.3±56.5 at day 3 after PP. There was no significant difference in heart rate between before and after PP procedure. Chest X-ray showed the diffuse shadow was significantly improved after PP. All patients responded well to PP, and all patients were discharged except for one patient, who died perioperatively due to multiple organ failure. PP is a safe and feasible option for severe hypoxemia patients after TAAD surgery.

Low-Intensity Resistance Exercise Combined With Blood Flow Restriction is More Conducive to Regulate Blood Pressure and Autonomic Nervous System in Hypertension Patients-Compared With High-Intensity and Low-Intensity Resistance Exercise.

Background: The effect of resistance exercise on the autonomic nervous system of patients with hypertension has not been identified. Objective: To explore a suitable resistance training method for hypertension patients to regulate blood pressure (BP) and autonomic nervous system function. Method: Forty-five hypertension patients aged between 55 and 70 years were randomly equally divided into three groups: the high-intensity resistance exercise (HE) group, the low-intensity resistance exercise combined with blood flow restriction (LE-BFR) group, and the low-intensity resistance exercise (LE) group. All patients performed quadriceps femoris resistance exercise. The exercise intensity of HE, LE-BFR and LE group was 65, 30 and 30% of one repetition maximum (1RM), respectively. The LE-BFR group used pressure cuffs to provide 130% of systolic pressure to the patient’s thighs during resistance exercise. The training program was 20 times/min/set with a 1-min break after each set, and was conducted five sets/day and 3 days/week, lasting for 12 weeks. The heart rate (HR), BP, root-mean-square of difference-value of adjacent RR intervals (RMSSD), low frequency (LF) and high frequency (HF) were evaluated before and after the first training and the last training. Result: Significant differences in HR were observed in both recovery states after the first and last training (p < 0.01). After 12 weeks of training, the recovery speed of HR in the LE-BFR group increased significantly (p < 0.01). The systolic blood pressures in the HE and LE-BFR group were significantly reduced (p < 0.05 and p < 0.01), and the differences among groups were significant (p < 0.01). In the last recovery state, the RMSSD of the LE group was significantly lower than that in the first recovery state (p < 0.01). The LF/HF ratios of the HE and LE groups in the resting and recovery states were increased significantly (all p < 0.01). LF/HF ratios in the LE-BFR group in the resting and recovery state were decreased significantly (both p < 0.01). Conclusion: Compared to HE and LE, LE-BFR could effectively decrease systolic pressure and regulate the autonomic nervous system function in hypertension patients.

A Comparison of Physiological Response to Incremental Testing on Stationary and Dynamic Rowing Ergometers.

The purpose of the current study was to compare responses to graded exercise testing (GXT) on 2 popular commercial rowing ergometers. A cohort of 23 subelite male rowers (age 20 [2]y, height 1.88 [0.06]m, body mass 82.0 [8.8]kg) performed a GXT on both stationary (Concept2 [C2]) and dynamic (RowPerfect3 [RP3]) rowing ergometers. Physiological responses including oxygen consumption (VO2), heart rate (HR), blood lactate concentration (BLa), stroke rate (SR), and minute ventilation (VE) were recorded. BLa data were plotted graphically and anaerobic threshold was identified using the Dmax method. Workload, HR, and VO2 at Dmax were interpolated. Physiological responses at maximal exercise and at Dmax were compared, along with response across a discrete range of submaximal workloads. At maximal exercise, no significant differences in HR, VO2, or BLa were observed (P > .05); however, VEpeak was significantly higher during RP3 tests (T = 2.943, P < .05). No significant differences in HR, VO2, or BLa at Dmax were observed (P > .05). When comparing across submaximal workloads, HR was significantly higher with the RP3 at 2 distinct workloads (210 and 240W; P < .05), while SR was higher during RP3 testing at all workloads (F = 56.7, P < .05). When SR was fixed as a covariate, the effect of ergometer on HR response was not significant. A significant workload by ergometer interaction effect was observed for SR with higher data recorded on the RP3 (F = 3.48, P < .01). Levels of agreement for GXT-derived measures of anaerobic threshold (Dmax) were deemed unacceptable. These results indicate that while some differences in HR and VE response were observed between ergometers, these differences were a result of SR alterations between ergometer type. While no differences in response at Dmax were observed, the poor levels of agreement between ergometers suggests that prescription of GXT-derived threshold for training should ideally be specific to the rowing ergometer upon which the test was performed.

Randomized controlled trial of Tesomet for weight loss in hypothalamic obesity.

Context Hypothalamic injury often leads to rapid, intractable weight gain causing hypothalamic obesity, which is associated with increased risk of cardiovascular and metabolic morbidity and mortality. There are no approved or effective pharmacological treatments for hypothalamic obesity, and conventional lifestyle management remains ineffective.Objective To investigate the safety and efficacy of Tesomet (0.5 mg tesofensine/50 mg metoprolol) in adults with hypothalamic obesity.Methods Twenty-one adults with hypothalamic obesity (16 females) were randomized to Tesomet (0.5 mg/50 mg) or placebo for 24 weeks. Patients also received diet/lifestyle counselling. The primary endpoint was safety; secondary endpoints included measures of body weight, appetite scores, quality of life, and metabolic profile.Results Eighteen patients completed 24 weeks. Consent withdrawal, eligibility, and serious adverse events (SAE) unrelated to treatment resulted in dropouts. One patient experienced a Tesomet-related SAE of exacerbated pre-existing anxiety leading to treatment discontinuation. Tesomet-related adverse events were otherwise mostly mild and included sleep disturbances (Tesomet 50%, placebo 13%), dry mouth (Tesomet 43%, placebo 0%), and headache (Tesomet 36%, placebo 0%). No significant differences in heart rate or blood pressure were observed between groups. Compared to placebo, Tesomet resulted in additional mean (95% CI) weight change of −6.3% ((−11.3; −1.3); P = 0.017), increased the number of patients achieving ≥5% weight loss (Tesomet 8/13, placebo 1/8; P = 0.046), and tended to augment the reduction in waist circumference by 5.7 cm ((−0.1; 11.5); P = 0.054).Conclusion Tesomet was welltolerated, did not affect heart rate or blood pressure, and resulted in significant reductions in body weight compared to placebo in adults with hypothalamic obesity.

Physiological response of dairy goats in tropical climates: A study in Tadukan Raga Village, Deli Serdang Regency, North Sumatra

The physiological response can be an indicator of livestock health status related to the environment. Therefore, the purpose of this study was to determine the physiological response of dairy goats kept in Deli Serdang Regency. A total of 93 PE goats were used and their physiological responses were assessed by measuring rectal temperature, heart, and respiration rate at different ages, body weights, and pregnancy statuses. Subsequently, statistical analysis of the data obtained was carried out with T-Test using SPSS version 21.0. The results indicated that there was no significant difference (P>0.05) in goat rectal temperature (39.0, 39.0, 38.9, and 39.0, respectively). Similarly, heart and respiration rates at various ages did not show a significant difference (P>0.05). The body weights (20-29, 30-39, and 40-50kg) did not show significant differences in heart rate (P>0.05) at 72, 69.6, and 73.2 beats/minute. The physiological response of rectal temperature and respiration rate also did not show any difference (P>0.05). There was no significant difference in the respiratory rate of pregnant and non­pregnant goats (p>0.05), which were 42.9 and 42.9 breaths/minute, respectively. It was concluded that dairy goats in Tandukan Raga Village, Deli Serdang Regency did not show different physiological responses such as rectal temperature, heart and respiration rate despite differences in age, weight, and pregnancy status.

Acute Changes in Heart Rate Variability to Glucose and Fructose Supplementation in Healthy Individuals: A Double-Blind Randomized Crossover Placebo-Controlled Trial.

Simple SummaryIn this study, we investigated the cardio-autonomic stress responses to the ingestion of liquid glucose, fructose, a combination thereof and a placebo in healthy individuals at rest. The cardio-autonomic response was more pronounced in all groups with carbohydrates compared to placebo indicating an increased cardio-autonomic stress response resulting in a reduced heart-rate variability. When investigating different levels of blood glucose, the findings showed a significant decline in heart-rate variability with increasing blood glucose levels. This was also seen with severely low levels of blood glucose. The speed of how quick blood glucose increased and decreased also impacted the cardio-autonomic response which further deteriorated heart-rate variability. These findings indicate that healthy human’s autonomic system responds quickly to changes in their blood glucose.Background: It is unknown how different types of carbohydrates alter the cardio-autonomic system in healthy individuals. Therefore, the aim of this study was to investigate how heart-rate variability changes to single dose ingestion of glucose, fructose, glucose and fructose, and an artificial sweetener (sucralose). Methods: In a double-blind randomized crossover placebo-controlled setting, 15 participants received all study-specific substances in liquid form. During each 2-h visit, venous blood glucose was measured in a 5-min interval while heart-rate variability was measured continuously via Holter-electrocardiograph. Results: Ingestion of different types of carbohydrates and sucralose showed significant differences for heart rate (p < 0.001), SDNN (p < 0.008), RMSSD (p < 0.001), pNN50 (p < 0.001) and blood pressure (p < 0.001). Different glucose levels significantly altered parameters of heart-rate variability and blood pressure (all p < 0.001), while the rate of change in blood glucose led to changes in heart rate variability, but not in heart rate (p = 0.25) or blood pressure (p = 0.99). Conclusions: Ingestion of different types of carbohydrates lead to reductions in heart-rate variability compared to a placebo. Blood glucose values above or below 70–90 mg/dL decreased heart rate variability while this was also seen for rapid glucose changes, yet not as pronounced. Healthy individuals should be conscious about carbohydrate intake while maintaining blood glucose levels between 70–90 mg/dL.

Efficacy and safety of endotracheal instillation of iloprost for persistent pulmonary hypertension of the newborn.

To determine the efficacy and safety of endotracheal instillation of iloprost as a rescue therapy for persistent pulmonary hypertension of the newborn. Neonates diagnosed with persistent pulmonary hypertension who were unresponsive to standard treatment protocol applied for persistent pulmonary hypertension in our unit, and who were being followed up with mechanical ventilation, were included in the study. Iloprost was instilled endotracheally as a rescue treatment. Systolic pulmonary artery pressure, oxygen saturation index, mean airway pressure, fraction of inspired oxygen, preductal and postductal venous oxygen saturation, heart rate, and blood pressure were recorded before and after 30 minutes of endotracheal iloprost instillation. Adverse events after endotracheal iloprost were recorded. Twenty neonates were included. The median gestational age and birth weight were found to be 37 (30.5-38) weeks and 2975 (2125-3437.5) grams, respectively. When compared to the period before endotracheal iloprost instillation, systolic pulmonary artery pressure, oxygen saturation index, mean airway pressure, and fraction of inspired oxygen values significantly decreased (p < 0.001, p < 0.001, p = 0.021, p = 0.001, respectively), whereas preductal and postductal oxygen saturation values significantly increased 30 minutes after the endotracheal iloprost instillation (p = 0.002, p < 0.001, respectively). There were no significant differences in heart rate and blood pressure values before and after the iloprost administration. No adverse events were observed. Endotracheal instillation of iloprost was found to be an effective and safe therapy for persistent pulmonary hypertension unresponsive to conventional treatment.

Evaluation of Two Doses of Intrathecal Clonidine on Analgesia and Haemodynamic Profile in Elderly Patients Undergoing Endoscopic Bladder SurgeriesA Randomised Clinical Trial

Introduction: Endoscopic bladder surgeries like Transurethral Resection Of Prostrate (TURP) and Transurethral Resection Of Bladder Tumour (TURBT) are performed preferably under spinal anaesthesia, using local anaesthetic like bupivacaine along with an adjuvant. Of these adjuvants used, clonidine is gaining popularity because of its safety and various advantages associated with its use. However its effect on haemodynamics, effect on block characteristics and analgesia in elderly patients has not been studied extensively. Aim: To evaluate the analgesic efficacy and safety of clonidine 30 µg and 50 µg, in elderly patients undergoing endoscopic bladder surgeries. Materials and Methods: It was a double blinded randomized control trial, conducted in Department of Anaesthesia, University College of Medical Sciences, Delhi, India, from September 2008 to October 2011. Sixty American Society of Anaesthesiology (ASA) grade I and II patients, of age 50-80 years, undergoing endoscopic bladder surgeries, were randomly allocated into three groups of 20 each. Group C received 12.5 mg of 0.5 % heavy bupivacaine (2.5 mL) without clonidine, while group A and group B received 30 µg and 50 µg, respectively of clonidine. Intraoperative non invasive and invasive haemodynamic monitoring was done. The duration of analgesia (the time from the intrathecal injection to Visual Analog Scale (VAS) score greater than 0 and Bromage Scale 3), quality of anaesthesia and haemodynamic were compared between the three groups. Analysis of variance (ANOVA) for repeated measures was used for analysing the collected data. Tukey’s Honest Significant Difference (HSD) test was applied as post hoc test whenever applicable. Results: The mean duration of complete analgesia was 3.32±1.80 hours in group A, 6.30±1.45 hours in group B, and 2.22±0.92 hours in group C. The duration of complete analgesia was significantly longer in group A and B, when compared to group C. The mean duration of effective analgesia was 6.05±0.88 hours in group A, 8.65±1.75 hours in group B, and 4.68±1.77 hours in group C. The duration of effective analgesia was significantly longer in group A and B, as compared to group C. Following intrathecal injection, there was no significant difference in heart rate, Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP), cardiac output, stroke volume, systemic vascular resistance in between groups. There were no significant side effects in any of the groups. Conclusion: Intrathecal clonidine in a dose of 30 µg and 50 µg provides faster onset, better quality and prolonged duration of block with stable haemodynamic and minimal side effects in patients undergoing endoscopic bladder surgeries.

Influence of intraoperative lignocaine infusion on analgesia, stress response, and recovery profile in laparoscopic cholecystectomy: A randomized control study

INTRODUCTION: Laparoscopic cholecystectomies are performed as daycare procedures. Postoperative pain associated with it may need multimodal opioid-free approaches to fast track the recovery. Intraoperative intravenous lignocaine infusion was employed in this study to observe it effect on analgesia, hemodynamic stress response, and recovery profile in patients undergoing laparoscopic cholecystectomies.METHODOLOGY AND RESULTS: This was a randomized placebo-controlled study with enrollment of 64 participants. The “L” group received preservative-free intravenous lignocaine 2% at 1.5 mg/kg bolus followed by continuous infusion at a rate of 1.5 mg/kg/h till skin closure. The “C” group received equal amounts of normal saline. No significant statistical difference was observed between the two groups with time to first analgesic, total analgesic consumption, and visual analog scale scores. No significant difference was seen with sedation, time to achieve modified Aldrete score, and time to return of bowel activity. Only significant difference in heart rate was observed in lignocaine group after intubation with no effects on mean arterial pressure.CONCLUSION: Lignocaine infusion did not prove any added benefits in terms of postoperative analgesia, opioid requirements, and functional recovery after laparoscopic cholecystectomy. Hemodynamic stress response were better maintained in lignocaine group. Bolus dose of lignocaine may prove beneficial and equipotent as fentanyl.

Application of topical betaxolol for curing superficial infantile hemangioma: A pilot study.

Beta-blockers have gradually become an attractive option for the treatment of infantile hemangiomas. Topical application is more preferred over oral administration since their potential systemic adverse effects. The aim of this study is to investigate the effect of betaxolol in treating superficial infantile hemangioma. 74 infants admitted to the First Affiliated Hospital of Xinjiang Medical University from 2018 to 2019 were observed and recorded. The changeable indicators such as color, size, tension and thickness were monthly recorded and evaluated according to visual analog scales. Multi-factor analysis of variance with repeated measurements and Kruskal-Wallis H nonparametric test were performed to compare the clinical effectiveness across different groups. After six months of treatment, 33.78% (25/74) got excellent results, 55.41% (41/74) had good response, 8.11% (6/74) had moderate response and 2.70% (2/74) had poor response respectively. Neither local discomforts nor systemic complications had been found. There was no significant difference in gender and location of occurrence among groups (P > 0.05), while the effect of topical application of betaxolol was optimum in the children aged 0-3 months (P = 0.002). None of three age groups had statistically significant discrepancy of heart rate and blood pressure after accepting treatment (one month, P = 0.618; four months, P = 0.138; six months, P = 0.757). Our study showed that topical administration of betaxolol was effective and well-tolerated for superficial infantile hemangiomas, particularly in the early proliferative stage. However, its safety and efficacy need continuous studies to be confirmed.

Closure of defects in a geometric figure pattern associated with tumescent anesthesia with lidocaine in rabbits (Oryctolagus cuniculus)

Abstract The use of tumescent anesthesia with lidocaine can provide better intra- and postoperative analgesia that would benefit extensive reconstructive surgery. However, lidocaine can interfere with the healing process. Therefore, this study aimed to assess the local interference of the healing of induced and closed skin defects in a geometric pattern associated with the use of tumescent anesthesia with lidocaine in rabbits. Furthermore, we assessed its influence on cardiorespiratory parameters and postoperative analgesia. This study included 27 rabbits divided into three groups: GC (without the use of tumescence), GS (use of tumescence with 0.9% NaCl solution), and GL (use of tumescent anesthesia with lidocaine). There was no statistically significant intergroup difference in any stage of the wound healing process on macroscopic evaluations, in the angiogenesis process, or in the process of collagenization and fibroblast deposition. There were significant differences in heart rate (lower in GL), respiratory rate (higher in GC), mean arterial pressure (higher in GL), and expired concentration of isoflurane (lower in GL). There was no significant intergroup difference in the von Frey filament test or the visual analog scale score used to evaluate postoperative analgesia. We concluded that tumescent anesthesia with lidocaine does not impair postoperative tissue repair. Its use features benefits such as reducing the volume of inhaled anesthetic, maintaining the anesthesia plan, stable heart and respiratory rates, and lower hypotension during the surgical procedure.