Significant Hemodynamic Changes Research Articles

Comparative Evaluation of Dexmedetomidine and Clonidine on Propofol Consumption, Haemodynamics and Postoperative Recovery in Laparoscopic Surgeries: A Prospective, Double-Blind, Placebo-Controlled, Randomised Study

Background and Aims: Laparoscopic surgery is associated with significant haemodynamic changes due to pneumoperitoneum formation. Various studies have demonstrated that α2 adrenergic agonists, such as clonidine and dexmedetomidine, prevent the haemodynamic response due to pneumoperitoneum during laparoscopic surgery. Methods: A total of 104 female patients undergoing laparoscopic hysterectomies were divided into three groups at random. Group D patients were administered a loading dose of 1 μg/kg of dexmedetomidine prior to induction over a period of 15 minutes and a maintenance dose of 0.5 μg/kg/h during the surgical procedure. Group CL patients were given a loading dose of 2 μg/kg of clonidine before induction over a period of 15 minutes and a maintenance dose of 1 μg/kg/h during the surgery. Group C received same volume of normal saline over same duration and maintenance infusion throughout the surgery. The primary outcome was the haemodynamic changes at different time interval. The secondary outcome was the response to verbal commands, extubation time and orientation time. Results: There was no significant difference in heart rate and blood pressure values between group D and group CL during whole study period. Whereas in group C, there was a statistically significant increase in heart rate and blood pressure after intubation and during pneumoperitoneum period ( P < 0.05). Extubation time and orientation time were significantly delayed in group D and group CL when compared with group C and D ( P < 0.05). Conclusion: Clonidine or dexmedetomidine effectively attenuates the haemodynamic changes in patients undergoing laparoscopic hysterectomies compared to the control group.

Retrospective clinical study on the efficacy and complications of interventional embolization in the treatment of scalp arteriovenous fistula

IntroductionScalp arteriovenous fistula (AVF) is a rare and intricate vascular anomaly characterized by a direct connection between an artery and a vein, without an intervening capillary system. This anomaly can induce significant local hemodynamic changes and is associated with various complications, such as pain, a pulsatile mass, increasing swelling, and venous hypertension skin ulcerations which may be non-healing. This study aimed to evaluate the efficacy and safety of interventional embolization treatments for scalp AVF at Shandong Provincial Hospital.MethodsThis retrospective clinical analysis assessed 21 patients who underwent interventional embolization between 2018 and 2024. Patients included were those treated in the vascular surgery department at Shandong Provincial Hospital, who had comprehensive medical records and follow-up data. Treatment methods, outcomes, and complications were thoroughly analyzed through patient medical records.ResultsAmong the patients studied, direct puncture was the most prevalent treatment method, employed in 42.86% (9/21) of cases, followed by various combinations of arterial, venous, and direct approaches. Ethanol, used in 85.71% (18/21) of the cases, demonstrated its broad efficacy and application in clinical settings. Immediate imaging post-treatment confirmed a cure rate of 85.71% (18/21). The main postoperative complications included swelling, with some patients also experiencing nodules, scabbing, or hair loss.ConclusionInterventional embolization has proven to be a safe and effective method for managing scalp AVF, significantly minimizing complications. Future research should focus on further optimizing these treatment methods to enhance efficacy and improve patient quality of life.

Identification of left ventricular flow features in healthy and pathological conditions

Abstract Background In the presence of mitral valve diseases or following surgical interventions, the hemodynamics in the left ventricle (LV) are significantly altered [1]. These maladaptive intraventricular hemodynamic alterations can stimulate a cascade of events leading to progressive adverse LV remodeling and eventual heart failure [2]. Qualitative and quantitative evaluation of LV flow features may provide a potential for sensitive risk stratification of clinical cardiac function [3]. Purpose The purpose of this study is to identifying LV flow features using in vitro experiments under both normal and pathological conditions, including mitral regurgitation (MR), mitral valve replacement with bioprosthetic/mechanical valve, and transcatheter mitral valve edge-to-edge repair (TEER). Methods We utilized a biohybrid approach to construct the in vitro experimental platform, where the native mitral valve (including chordae tendineae and papillary muscles) and aortic valve from porcine were combined with a 3D-printed silicon LV (figure 1). To ensure comparability across different conditions, we maintained consistency by utilizing the same native valve and 3D-printed LV. For pathological conditions, we cut the chordae tendineae in A2 zone to induce the severe degenerative MR, and TEER was performed on this prolapsed valve by placing two clips in A2-P2 zone. Then, the anterior leaflet of valve was cut, and a bioprosthetic valve and mechanical valve were sutured to mitral annulus to simulate surgical valve replacement, respectively. Left ventricular flow fields were measured using four-dimensional particle image velocimetry (4D-PIV) technique, with vector interval of 0.9 mm in all the spatial directions and temporal resolution of 10 ms. Results Significant differences in mean flow field were observed among healthy and pathological conditions (figure 2). Firstly, the vortex orientation was clockwise in healthy, MR, bioprosthetic valve replacement, and TEER conditions, which could accompany the redirection of blood flows towards the aortic valve. However, the replacement with a mechanical valve resulted in an alteration in vortex orientation from clockwise to counterclockwise. Secondly, the position of the center of the vortex changed in pathological conditions, with the center of the vortex closest to the apex and the left ventricle outflow tract in the healthy condition. Thirdly, the maximum Reynolds shear stress (RSS), which may be responsible for thrombus formation, significantly increased after TEER procedure and bioprosthetic valve replacement. Conclusions This study demonstrates significant changes in LV hemodynamics across different conditions. The flow features, including vortex orientations, vortex positions and the RSS, may potentially become crucial considerations for the optimization of artificial valves and mitral valve repair devices.Figure 1 Figure 2

Noninvasive optical monitoring of cerebral hemodynamics in a preclinical model of neonatal intraventricular hemorrhage.

Intraventricular hemorrhage (IVH) is a common complication in premature infants and is associated with white matter injury and long-term neurodevelopmental disabilities. Standard diagnostic tools such as cranial ultrasound and MRI are widely used in both preclinical drug development and clinical practice to detect IVH. However, these methods only provide endpoint assessments of blood accumulation and lack real-time information about dynamic changes in ventricular blood flow. This limitation could potentially result in missed opportunities to advance drug candidates that may have protective effects against IVH. In this pilot study, we aimed to develop a noninvasive optical approach using diffuse correlation spectroscopy (DCS) to monitor real-time hemodynamic changes associated with hemorrhagic and sub-hemorrhagic events in a preclinical rabbit model of IVH. DCS measurements were conducted during the experimental induction of IVH, and results were compared with ultrasound and histological analysis to validate findings. Significant changes in hemodynamics were detected in all animals subjected to IVH-inducing procedures, including those that did not show clear positive results on ultrasound. The study revealed progressively elevated coefficients of variation in blood flow, particularly driven by increased oscillations within the 0.05-0.1 Hz frequency band. These hemodynamic changes were more pronounced in animals that developed IVH, as confirmed by ultrasound. Our findings suggest that real-time optical monitoring with DCS can provide critical insights into pathological blood flow changes, offering a more sensitive and informative tool for evaluating potential therapeutics in the context of IVH.

The Effectiveness Of Hyperbaric Bupivacaine Administration On Hemodynamic Changes In Sectio Caesarea Patients

Background: Sectio Caesarea (SC) is a critical surgical intervention used to manage abnormal labor, addressing potential health risks for both mother and infant. Spinal anesthesia, frequently administered using hyperbaric bupivacaine, plays a crucial role in the procedure. Purpose: This study aimed to evaluate the impact of hyperbaric bupivacaine on hemodynamic parameters in SC patients at Kardinah Hospital, Tegal City. Methods: A pre-experimental design with a One-Group Pretest-Posttest approach was employed. The study utilized purposive sampling to include 67 SC patients, aged 18-40 years with a BMI >18.5. Hyperbaric bupivacaine was administered as part of the anesthesia protocol. Hemodynamic parameters, including systolic and diastolic blood pressure, pulse rate, mean arterial pressure (MAP), SpO2, and respiratory rate (RR), were measured before and after administration of the anesthetic. Results: Analysis revealed a statistically significant effect of hyperbaric bupivacaine on systolic and diastolic blood pressure, pulse rate, and MAP (p = 0.00). In contrast, no significant effects were observed on SpO2 (p = 0.34) or RR (p = 0.15). Conclusions: The administration of hyperbaric bupivacaine in SC patients resulted in significant hemodynamic changes, particularly affecting blood pressure, pulse rate, and MAP. However, it did not significantly alter SpO2 or RR. These findings underscore the importance of monitoring hemodynamic parameters during spinal anesthesia to ensure patient safety and optimal management during cesarean sections

Comparing the Effect of Rosemary and Ketamine Gargles on Voice Hoarseness and Sore Throat After Tracheal Intubation

Background: This study compared the effects of rosemary and ketamine gargling on voice hoarseness and sore throat after tracheal intubation. Methods: This clinical trial was conducted on 116 patients who required general anesthesia and were randomly divided into intervention (30 drops of rosemary extract and 40mg of ketamine) and control (30 mL distilled water) groups using Randomize Allocation software. The measurement methods for obtaining information in the current study included the Visual Analogue Scale (VAS) for pain, GRBAS (Grade of Hoarseness; Roughness, Breathiness, Asthenia, and Strain), the auditory scale for the severity of voice hoarseness, and a questionnaire to evaluate the patient’s level of satisfaction. Then, the data was imported into SPSS V. 25 after data gathering. Results: The results revealed that patients of the three groups did not indicate significant hemodynamic changes, including the parameters systolic blood pressure (P = 0.73), diastolic blood pressure (P = 0.97), SpO2 level (P = 0.6), and heart rate (P = 0.31). However, the sore throat pain intensity of the rosemary group was significantly lower (P = 0.0008). The difference in time of the first pain sensation significantly differed among the three groups (P = 0.011). However, the mean pethidine administration of the control group (P = 0.003) was significantly higher, and the control group's satisfaction level (P = 0.02) was significantly lower. Conclusions: Gargling rosemary solution and ketamine did not affect the voice hoarseness after tracheal intubation, but the rosemary group had lower sore throat pain intensity.

AFTER-CA: Autonomic Function Transformation and Evaluation Following Catheter Ablation in Atrial Fibrillation.

Background: Catheter ablation (CA) is a well-established treatment for atrial fibrillation (AF). However, its effects on autonomic function and underlying mechanisms remain poorly understood. This study investigated autonomic and haemodynamic changes following CA and explored their potential implications for patient outcomes. Methods: Seventy-eight patients with AF underwent CA and were followed up at one, three, and six months. Autonomic function was assessed using a combination of head-up tilt (HUT), handgrip (HG), and deep breathing (DB) manoeuvres along with baroreflex sensitivity (BRS) and baroreflex effectiveness index (BEI) evaluation. Heart rate (HR), blood pressure (BP), and their variability were measured at each time point. Results: Significant autonomic alterations were observed after ablation, particularly at one month, with reductions in parasympathetic tone and baroreflex function. These changes gradually normalised by six months. Both pulmonary vein isolation (PVI) and cryoablation (CryO) had similar effects on autonomic regulation. Improvements in quality of life, measured by the AFEQT scores, were consistent with these physiological changes. Conclusions: CA for AF induces significant time-dependent autonomic and haemodynamic changes with recovery over six months. These findings underscore the need for ongoing monitoring and personalised post-ablation management. Further research is required to explore the mechanisms driving these alterations and their long-term impacts on patient outcomes.

Complete atrioventricular canal in a dog—sounds like a final judgment but is it actually one? A case report

Congenital heart disease (CHD) is an important subset of all cardiovascular diseases in dogs. Among them, there are a number of other less commonly described congenital malformations. One of these is the atrioventricular canal, which involves a defect that has several phenotypes. This report details a case of a complete atrioventricular canal (cAVC) defect. Using Rastelli’s classification scheme, the diagnosis of a type-A cAVC defect was based on two-dimensional, contrast, and color Doppler echocardiography. Despite a severe defect that resulted in the atypical anatomy of the atrioventricular apparatus, as well as significant hemodynamic changes in the heart, the affected dog remained asymptomatic throughout the 48-month follow-up period. Due to its stable clinical condition, the decision was made not to begin pharmacological therapy. As this defect is rare in dogs, there are limited data in the literature on this condition. Therefore, in clinical practice, the management and monitoring of the patient may pose difficulties. Due to such limited data, it can be very difficult to provide a prognosis. For the above reasons, we hope that the following case will contribute valuable information for the monitoring of this kind of CHD.

The Influence of Pulmonary Arterial Hypertension In Pregnancy: A Review.

Pulmonary arterial hypertension (PAH) is a severe condition characterized by increased pulmonary vascular resistance and right ventricular failure. This review examines the intersection of PAH and pregnancy, highlighting the significant physiological, hemodynamic, and hormonal changes that exacerbate PAH during gestation. Pregnancy is contraindicated in PAH patients due to high maternal and fetal morbidity and mortality rates. However, some patients choose to continue their pregnancies, necessitating a comprehensive understanding of the implications and management strategies. Effective management of PAH in pregnant patients involves individualized treatment plans. Prepartum management focuses on optimizing therapy and monitoring hemodynamic status. Prostacyclin analogs and phosphodiesterase inhibitors are commonly used, though their safety profiles require further investigation. Intrapartum management prioritizes preventing right ventricular failure, utilizing therapies such as intravenous epoprostenol, inhaled iloprost, and inhaled nitric oxide. Managing PAH in pregnancy requires careful planning, continuous monitoring, and tailored therapeutic strategies to navigate the complex interplay of physiological changes and mitigate risks. Future research should focus on elucidating the pathophysiology of PAH during pregnancy and developing safer, more effective treatments to improve maternal and fetal outcomes.

SIMBA-A Single-Puncture Approach to Lower Limb Block.

Peripheral nerve blocks provide a safe and reliable alternative in the anesthetic management of femur fractures in elderly subpopulations associated with significant comorbidities. Single-Insertion Multiple Nerve Block Anesthesia (SIMBA) is a technique where a single needle insertion is used to block all four nerves that supply the femur shaft: the femoral nerve, obturator nerve, lateral femoral cutaneous nerve, and sciatic nerve. The authors performed this technique in 11 cardiac compromised geriatric patients with midshaft/distal femur fractures, and the surgery was conducted successfully without any significant hemodynamic change and good postoperative analgesia.

Percutaneous Closure of Type IV Aortopulmonary Window. An Illustrative Case

The aortic-pulmonary window is a rare congenital heart defect characterized by a direct communication between the aorta and pulmonary artery, bypassing the normal route through the heart. This defect can lead to significant hemodynamic changes, including increased pulmonary blood flow and volume overload. Symptoms often manifest in infancy or early childhood and can range from mild to severe, depending on the size of the defect and associated cardiac anomalies. Percutaneous treatment of the aortic-pulmonary window represents a promising advancement in the management of this complex congenital defect. While surgical repair remains a viable option for some cases, percutaneous methods provide a less invasive alternative with favorable outcomes. Continued research and technological improvements are essential for optimizing treatment strategies and improving patient quality of life.

The Effect of Increased Intra-Abdominal Pressure on Hemodynamics in Laparoscopic Cholecystectomy-The Experience of a Single Centre.

Laparoscopic cholecystectomy is characterized by reduced postoperative pain, shorter hospital stays, rapid return to preoperative physical activity, and less psychological impact on the patient. During laparoscopic cholecystectomy, the intra-abdominal insufflation of carbon dioxide with secondary increase in intra-abdominal pressure can cause important hemodynamic consequences, like decreased cardiac output and blood pressure, as well as compensatory increase in heart rate. The purpose of this study is to evaluate changes in cardiovascular parameters during general anesthesia in patients undergoing laparoscopic cholecystectomy. Retrospective data from 342 patients with cholecystectomy for cholelithiasis performed at Railway Hospital Galati, Romania, were reviewed. All patients received the same intraoperative anesthetics. Female patients were 85.7% (n = 293). More than half of the patients, 53.51% (n = 183), were 40-59 years old, and only 16.37% (n = 56) were under 40 years old. Patients with a normal body mass index (BMI) represented 45.6% (n = 156), 33.3% (n = 114) were underweight, and 12% (n = 42) had grade 1 obesity (BMI 25-29.9 kg/m2). The minimum intraoperative blood pressure correlated with patient gender (p 0.015 < 0.005), with men having a higher blood pressure than women (p 0.006 < 0.05), and for BMI, a higher BMI was associated with elevated blood pressure (p 0.025 < 0.05). Older age correlated with an increased maximum intraoperative blood pressure (p < 0.001 < 0.05) and with maximum intraoperative heart rate (p 0.015 < 0.05). Patients undergoing laparoscopic cholecystectomy experienced significant hemodynamic changes with pneumoperitoneum, but this type of surgical intervention was safe for patients regardless of their age.

Use of Video Laryngoscope during Intubation in Patients with Non Difficult Airway

Endotracheal intubation using laryngoscope which is an important skill required for all anesthesiologist in day to day practice is considered as gold standard for airway management. Various methods can be used for endotracheal intubation of which direct laryngoscopy is most commonly used and video laryngoscopy is an alternative. The success rate of tracheal intubation in cases of difficult airways has increased dramatically with the use of video laryngoscopes and improvements in the degree of glottic exposure. Hence this study aims to evaluate the laryngoscopic view, ease of intubation and haemodynamic changes during intubation using video laryngoscope in patients with non difficult airway. This interventional study was conducted in fifty nine patients of ASA I or II, ≥18 yrs of age with Mallampati grade I or II, mouth opening &gt;3 cms, thyromental distance &gt;6.5 cms of either sex planned for elective surgery under general anesthesia. General anesthesia was induced with similar doses for all the patients and intubated using video laryngoscope. Cormack-Lehane grade, intubation time, number of attempts for intubation and haemodynamic parameters were recorded. In this study, all patients had grade I type of laryngeal view during laryngoscopy and the mean time required for intubation was 18.93±7.08 sec. Out of 59 patients, 58 (98.3%) were intubated in single attempt and there was no significant haemodynamic changes during laryngoscopy with video laryngoscope. Hence, the result of this study concluded that endotracheal intubation using video laryngoscope provides good laryngoscopic view, better intubating condition for the ease of intubation without significant haemodynamic changes, thus considering worth for intubation of non difficult airway.

Isoflurane increases the activity of the vascular matrix metalloproteinase-2 in non-pregnant rats and increases the nitric oxide metabolites in pregnancy.

Surgeries that require general anesthesia occur in 1.5-2% of gestations. Isoflurane is frequently used because of its lower possibility of affecting fetal growth. Therefore, we examined the isoflurane anesthesia-induced effects on maternal hemodynamic and vascular changes. We hypothesized that isoflurane would enhance endothelium-dependent vasodilation as a consequence of increased nitric oxide and decreased metalloproteinases (MMPs). Female rats (n=28) were randomized into 4 groups (7 rats/group): conscious (non-anesthetized) non-pregnant group, non-pregnant anesthetized group, conscious pregnant group, and pregnant anesthetized group. Anesthesia was performed on the 20th pregnancy day, and hemodynamic parameters were monitored. Nitric oxide metabolites, gelatinolytic activity of MMP-2 and MMP-9, and the vascular function were assessed. Isoflurane caused no significant hemodynamic changes in pregnant compared with non-pregnant anesthetized group. Impaired acetylcholine-induced relaxations were observed only in conscious non-pregnant group (by approximately 62%) versus 81% for other groups. Phenylephrine-induced contractions were greater in endothelium-removed aorta segments of both pregnant groups (with or without isoflurane) compared with non-pregnant groups. Higher nitric oxide metabolites were observed in anesthetized pregnant in comparison with the other groups. Reductions in the 75 kDa activity and concomitant increases in 64 kDa MMP-2 isoforms were observed in aortas of pregnant anesthetized (or not) groups compared with conscious non-pregnant group. Isoflurane anesthesia shows stable effects on hemodynamic parameters and normal MMP-2 activation in pregnancy. Furthermore, there were increases in nitric oxide bioavailability, suggesting that isoflurane provides protective actions to the endothelium in pregnancy.

#1819 Cardio-fistular recirculation in patients with chronic heart failure and preserved ejection fraction

Abstract Background and Aims Cardio-fistular recirculation (CFR)—ratio of cardiac output (CO) to AVF volume blood flow (Qa)—is a well-known risk factor for death and cardiovascular adverse events. Currently, there are no clear limits for this index that definitely indicate AVF cardiotoxicity. In most cases, an interval score of &amp;lt;20%, 20-30%, or &amp;gt;30% is used to denote low, medium, and high risk, respectively. Typically, the assessment is performed on the interdialysiс day. HD sessions can cause significant hemodynamic changes, which may be important for patients with chronic heart failure (CFH) and preserved ejection fraction (EF), in whom the risk may be underestimated. The aim of this prospective cohort study is to evaluate changes in heart structure and CFR in patients with СFH and preserved EF before and after an HD session. Method The study included 20 stable adult HD patients who met the inclusion criteria: CHF with preserved EF (50%), NYHA I-II, Qa ≥1 l/min, CFR &amp;lt; 30%, interdialysiс weight gain &amp;lt; 5%, eKt/V &amp;gt; 1.2. Non-inclusion criteria: arrhythmias (except grade I AV block), NYHA III-IV, valvular disease (except mitral regurgitation I-II), intradialytic hypo/hypertension. All patients underwent transthoracic ECHO-CG with tissue Doppler on the third day after the last HD session (Monday/Tuesday), one hour before and 2 hours after the HD session. In addition, we measured AVF volume blood flow—brachial artery Qa. Results Patient Descriptive Statistics: M/F 8/12, mean age 52.2 (SD 11.2, range 41-67) years, HD vintage 49 (11.1, 33-72) months, BMI 28.2 (3.8, 22.9-36.0) kg/m2, interdialysiс weight gain 3.2 (0.8, 1.9-4.7) kg, relative interdialysiс weight gain 4.1% (0.8, 2.9-4.9). A significant trend in ECHO-CG parameters was observed, indicating a decrease in cardiac preload (Table 1). Although there were no significant changes in EF, a pronounced decrease in CO was noted with a relatively stable Qa value. As a result, 5 out of 20 patients had a CFR value of more than 30% after HD, which assigned them to a high-risk group. As shown in Fig. 1, even patients with pre-HD CFR values less than 25% were classified as high-risk. Patients were intentionally examined after a long interdialysiс interval because this HD session is associated with the greatest hemodynamic changes. Some publications suggest that the risk of death after long interdialysic interval is significantly higher than that after short interval. Increase in CFR after HD probably has a synergistic deleterious effect with other risk factors. The severity of this influence is determined by both the maximum achieved CFR values and the rate of CO recovery. Conclusion Some patients have a significant increase in CFR after HD. However, the prognostic value of this phenomenon remains unclear. In patients with significant CHF symptoms and normal or subnormal CFR on an interdialytic day, it is recommended to perform a post-HD examination. This can serve as a “stress test” to reveal any latent hemodynamic disadvantage caused by the AVF cardiotoxic effect.

Comparison between the Hemodynamic Profile with Esmolol versus Morphine as an Adjuvant Agent during Induction of Anesthesia

Background: The induction of general anesthesia is a critical phase in anesthetic practice, often associated with significant hemodynamic changes. These changes can lead to complications due to autonomic adrenergic responses. Esmolol, a beta-1 antagonist, is commonly used to blunt these responses, but its availability is limited in some settings. Morphine, a pure mu receptor antagonist, presents a potential alternative. Objective: This study aimed to compare the efficacy of intravenous esmolol versus intravenous morphine in stabilizing the hemodynamic profile during the induction of general anesthesia. Methods: This randomized controlled trial was conducted at the Department of Anesthesiology, Combined Military Hospital, from January to June 2023. After obtaining ethical approval and trial registration, 220 ASA-II patients aged 25-55 years scheduled for elective surgeries under general anesthesia were enrolled. Patients were randomized into two groups: Group E (n=110) received 1.5 mg/kg intravenous esmolol three minutes before laryngoscopy and intubation, and Group M (n=110) received 0.1 mg/kg intravenous morphine five minutes before laryngoscopy and intubation. Baseline heart rate, systolic and diastolic blood pressure, and oxygen saturation were recorded after pre-oxygenation with 100% oxygen for three minutes. Post-intubation, the same parameters were measured five minutes after intubation. Statistical analysis was performed using SPSS version 25.0, with independent samples T-tests used to compare means. A p-value of ≤0.05 was considered statistically significant. Results: The mean age was 39.41 ± 5.13 years in Group E and 39.97 ± 5.08 years in Group M (p=0.414). Mean weight was 68.14 ± 3.88 kg in Group E and 68.08 ± 3.80 kg in Group M (p=0.916). Pre-induction mean heart rate was 71.75 ± 2.33 bpm in Group E and 71.58 ± 2.35 bpm in Group M (p=0.585). Five minutes post-intubation, mean heart rate was significantly lower in Group E (80.73 ± 2.54 bpm) compared to Group M (87.62 ± 2.83 bpm) (p&lt;0.001). Mean systolic blood pressure post-intubation was 132.88 ± 4.65 mm Hg in Group E and 140.25 ± 2.39 mm Hg in Group M (p&lt;0.001). Mean diastolic blood pressure post-intubation was 77.58 ± 2.35 mm Hg in Group E and 85.33 ± 3.71 mm Hg in Group M (p&lt;0.001). Oxygen saturation remained stable in both groups. Conclusion: Intravenous esmolol is superior to intravenous morphine in blunting the hemodynamic responses to laryngoscopy and intubation, providing a more stable hemodynamic profile during the induction of general anesthesia.

A Prospective Randomized Clinical Study to Assess and Compare the Efficacy of Ultrasound Guided Quadratus Lumborum Block versus Transversus Abdominis Plane Block for Postoperative Analgesia in Patients Undergoing Abdominal Hysterectomy Under General Anaesthesia

Abstract Background and Aims: Multimodal analgesia regimens for optimizing the postoperative pain following abdominal surgeries are a crucial component of enhanced recovery after surgery (ERAS), as it reduces postoperative opioid consumption along with their adverse effects. We compared the analgesic efficacy of ultrasound-guided transmuscular quadratus lumborum block (QLB) versus posterior transversus abdominis plane block (TAPB) with respect to duration of analgesia, modified Defense and Veterans Pain Rating Scale (DVPRS) scores for pain, activity, sleep, stress, and mood, respectively, the total amount of rescue analgesic consumption, hemodynamics parameters and side effects, in patients undergoing total abdominal hysterectomy under general anesthesia. Materials and Methods: In this study, which was prospective, randomized, and double-blind, 60 patients of the American Society of Anesthesiologists Physical Status I and II, aged 18–65 years, undergoing abdominal hysterectomy, were randomized into two groups. Group QLB (n = 30) and Group TAPB (n = 30) received bilateral QLB and TAPB with 40 ml of 0.375% ropivacaine, respectively. The data were compared using standard qualitative and quantitative tests. Results: The duration of pain relief was longer in Group QLB compared to Group TAPB (981.83 ± 138.62 min vs. 637 ± 127.02 min, P &lt; 0.0001). The DVPRS score for pain, activity, sleep, stress, and mood, respectively, were significantly lower in Group QLB (P &lt; 0.05). The total rescue analgesic consumption was significantly lesser in Group QLB (103.33 ± 18.26 mg) compared to Group TAPB (150.00 ± 50.85 mg) (P &lt; 0.0001). No significant hemodynamic changes or side effects were observed (P &gt; 0.05). Conclusion: Bilateral QLB significantly prolonged the duration of analgesia with reduced rescue analgesic requirement compared with bilateral TAPB in patients undergoing total abdominal hysterectomy.

Hyperosmolar Therapy in Elderly Neurosurgical Patients: Comparison of the Effect of Mannitol (20%) and Hypertonic Saline (3%) on Advanced Cardiovascular Parameters Using Transesophageal Echocardiography: A Preliminary Randomized Controlled Trial

Osmotherapeutic agents increase the intravascular volume by withdrawing water from the brain followed by relative hypovolemia due to diuresis leading to significant changes in systemic hemodynamics which might have adverse consequences in the elderly. We studied the effect of mannitol (20%) and hypertonic saline (HTS) (3%) on left ventricular outflow tract velocity time integral (LVOT-VTI) and cardiac output (CO) in elderly patients undergoing supratentorial neurosurgical procedures using transesophageal echocardiography. We recruited 28 patients aged above 65years undergoing supratentorial craniotomy who received equiosmolar solutions of 5.35ml/kg of 3% HTS (group HS, n= 14) or 5ml/kg of 20% mannitol (group M, n= 14). LVOT-VTI was recorded at baseline, 15, 30, 45, 60, and 90minutes postinfusion and CO was derived. We also recorded heart rate, blood pressure, fluid balance, brain relaxation, vasopressor use, complications, and neurological outcome. We found a significant decrease in LVOT-VTI at 45, and 60minutes in group M as compared to group HS [mean (standard deviation), 16.76 (1.81) vs. 20.78 (1.87), P<0.001, 17.4 (2.38) vs. 19.16 (2), P=0.044, respectively]. We also found a corresponding significant fall in CO [3863.16 (845.87) vs. 4745.59 (1209.33) ml/minute, P=0.034] and systolic blood pressure (P=0.039), at 45minutes in group M. Urine output was higher in group M (P<0.001). All other parameters were comparable. HTS appears to be associated with better systemic hemodynamics (LVOT-VTI, CO) while providing equivalent brain relaxation as mannitol in elderly patients. A future larger study is required to confirm our preliminary findings.

Effect of Nonionic Iodinated Contrast Media on Blood Pressure during Contrast-enhanced Computed Tomography of Abdomen Examination: A Cross-sectional Study

ABSTRACT Introduction: Computed tomography (CT) scan has high sensitivity and specificity for numerous conditions. The images produced by a CT scanner can be enhanced using iodinated contrast media. Significant hemodynamic changes are seen with rapid intravenous contrast media injection. The average acceptable blood pressure (BP) value is 120/80 mmHg. Many studies have related hypertensive crises with high-osmolar contrast media, whereas its relation with low-osmolar contrast media is still unclear. This study aims to evaluate the effect of nonionic iodinated contrast media on BP during contrast-enhanced CT (CECT) of the abdomen. Materials and Methods: A cross-sectional study was conducted from April 2022 to August 2023. A total of 146 subjects (73 males and 73 females were included in the study). Statistical analysis of data was done using SPSS 23.0. A comparison of systolic BP and diastolic BP across the three periods was done using repeated measures of ANOVA. A between-group comparison was performed by unpaired t-test. The level of significance was set as 5%. All subjects underwent a CECT abdomen, including a plain, arterial, and venous phase. A bolus of 80 mL of Ultravist was administered. BP was measured before the contrast injection (baseline value), between the arterial and venous phases, and 3 min after the contrast injection. Results: Injection of nonionic contrast media caused a decrease in BP among subjects. The mean systolic BP readings before contrast injection in males and females were 127.5 ± 8 mmHg and 122.8 ± 8.4 mmHg, respectively. The mean diastolic BP before contrast injection was 79.2 ± 6.4 and 76 ± 6.4 mmHg among males and females, respectively. For systolic, these values decreased to 123 ± 10.3 mmHg in males and in females to 115 ± 14.6 mmHg when measured between arterial and venous phases. Similarly, for diastolic BP, the mean values recorded between the arterial-venous phase reduced to 76.7 ± 9.3 mmHg and 72.3 ± 10 mmHg, respectively. The BP readings, however, increased near baseline value when measured 3 min after the injection. The mean systolic BP measured 126.1 ± 8.5 mmHg and 124.9 ± 11.8 mmHg for males and females at 3 min after injection. Similarly, the mean diastolic BP values taken after 3 min of contrast injection were 78.3 ± 6.5 mmHg and 76.2 ± 7 mmHg in males and females, respectively, P &lt; 0.001. BP in both male and female groups was affected similarly. Conclusion: Bolus administration of 80 mL of Ultravist reduced BP. This reduction was short-term and got back to normal within a few minutes. The contrast media similarly affected both genders. The BP changes had no clinical significance.

Experience of Morphologic Left Ventricle Training in Congenitally Corrected Transposition of the Great Arteries in Children: Evaluation of the Operation Results

The aim. To evaluate the efficacy of morphologic left ventricle (mLV) training through pulmonary artery banding (PAB) in pediatric patients with congenitally corrected transposition of the great arteries.&#x0D; Materials and methods. From 2003 to 2023, 12 patients underwent PAB for mLV training at the Ukrainian Children`s Cardiac Center. The mean age of the patients was 30.3 ± 25.1 months, the mean weight was 11.6 ± 5.2 kg. Hemodynamic parameters were assessed to determine the size of the band applied to the pulmonary artery (PA) trunk during the operation. Intraoperative transesophageal echocardiography was performed in 6 patients. Transthoracic echocardiography (TTE) was performed in the early postoperative period. In the remote period, all the patients underwent TTE and X-ray angiography.&#x0D; Results. During PAB, the mLV pressure averaged 58 ± 12.6% (from 40% to 80%) of the systemic arterial pressure. PAB dilatation was required for one patient in the early postoperative period (postoperative day 2) because of significant hemodynamic changes. In the early postoperative period, the maximum gradient across PA measured by TTE averaged 39.3 ± 10.0 mm Hg (from 25 to 60 mm Hg). There was no hospital mortality.&#x0D; The follow-up period averaged 47.2 ± 26.0 months (8 to 113 months). In the long-term observation period, 2 patients (16.6%) died, one 8 months and the other 5 years after the operation. The double switch operation was performed in 6 patients, on average, 48.2 ± 6.9 months after PAB. According to angiography, the mLV pressure before the double switch operation was 90.2 ± 11.6% of that in the systemic right ventricle. The end-diastolic pressure in the mLV averaged 14 ± 4.1 mm Hg. The peak pressure gradient across the PA measured by echo was 81.3 ± 28.8 mm Hg. The mLV mass index averaged 62.9 ± 8.8 g/m2, the mLV ejection fraction averaged 61.2 ± 2.9%. Overall radiographic and echocardiographic data in these patients indicated that mLV is trained and capable of performing the role of a systemic ventricle after anatomical correction.&#x0D; Conclusions. PA banding as a method of mLV training can be used in patients with congenitally corrected transposition of the great arteries with intact ventricular septum, restrictive ventricular septal defects and severe tricuspid regurgitation.&#x0D; To evaluate the effectiveness of PAB for mLV training, a multimodal diagnostic approach is used, including non-invasive and invasive methods such as TTE, transesophageal echocardiography, and cardiac catheterization. The optimal age for PAB in patients of this group for the purpose of training the LV was on average 2-2.5 years.