Significant Increase In Heart Rate Research Articles

Assessment of systemic hemodynamic changes in medical workers of PCR laboratories when using personal protective equipment

In the conditions of the COVID-19 pandemic, clinical diagnostic laboratories conducting a test for the presence of coronavirus using polymerase chain reaction (PCR), in most cases, work with significant overload. Performing professional duties in these conditions imposes special requirements on medical personnel. First of all, this concerns the parameters of systemic hemodynamics as an objective criterion of health risk.
 The study aims to analyze the state of systemic hemodynamics in medical workers of PCR laboratories when working in the conditions of the COVID–19 pandemic when using personal protective equipment against a biological factor.
 The researchers have conducted the study in the winter period of the year in PCR laboratories for the diagnosis of a new coronavirus infection. The observation group included 33 people aged 32.5±1.44 years and 1–33 months of experience in the PCR laboratory. We have evaluated the key parameters of systemic hemodynamics, heart rate variability and the degree of oxygen saturation in the blood of laboratory staff. The authors have carried out measurements at the beginning and end of the work shift.
 There was a significant increase in heart rate (by 3.7%), minute heart volume (by 5.2%), myocardial oxygen consumption (by 5.6%) at the end of the work shift compared with its beginning. The values of these parameters of systemic hemodynamics remained within the normal range. At the same time, the increase in the values of these indicators indicates a significant strain on self-regulatory mechanisms and the development of fatigue.
 When using personal protective equipment against a biological factor, the tension of the systemic mechanisms of hemodynamic self-regulation in medical workers of PCR laboratories increases. The degree of severity of the tension of these mechanisms significantly depends on the features of the functional state of the cardiovascular system and vegetative status. At the same time, it is necessary to provide a physiological and hygienic justification for the duration of the periods of work of medical workers of PCR laboratories when using various types of personal protective equipment against a biological factor, which justifies the relevance of further research.
 Limitations. The results of this study were obtained on a relatively small sample. Therefore, in order to increase its representativeness, it is necessary to increase the number of participants, which will allow leveling the existing restrictions.
 Ethics. The study was conducted in compliance with the ethical standards set out in the Helsinki Declaration of 1975 with additions of 2008. The study participants signed a form of "Informed Voluntary consent to conduct a study", developed in accordance with the requirements of the local ethics committee of the Federal State Budgetary Educational Institution of the Volga State Medical University of the Ministry of Health of the Russian Federation.

Younger postnatal age is associated with a lower heart rate on Holter monitoring during the first week of life

To evaluate heart rate (HR), the presence of extrasystoles and other Holter findings among healthy newborns, and to collect data for new normal limits for Holter parameters in newborns. For this cross-sectional study, 70 healthy term newborns were recruited to undergo 24-h Holter monitoring. Linear regression analysis was used in HR analyses. The age-specific limits for HRs were calculated using linear regression analysis coefficients and residuals. The mean (SD) age of the infants was 6.4 (1.7) days during the recording. Each consecutive day of age raised the minimum and mean HR by 3.8 beats per minute (bpm) (95% CI: 2.4, 5.2; P < .001) and 4.0 bpm (95% CI: 2.8, 5.2; P < .001), respectively. Age did not correlate with maximum HR. The lowest calculated limit for minimum HR ranged from 56 bpm (aged 3 days) to 78 bpm (aged 9 days). A small number of atrial extrasystoles and ventricular extrasystoles were observed in 54 (77%) and 28 (40%) recordings, respectively. Short supraventricular or ventricular tachycardias were found in 6 newborns (9%).Conclusion: The present study shows an increase of 20 bpm in both the minimum and mean HRs of healthy term newborns between the 3rd and 9th days of life. Daily reference values for HR could be adopted in the interpretation of HR monitoring results in newborns. A small number of extrasystoles are common in healthy newborns, and isolated short tachycardias may be normal in this age group.What is Known:• The current definition of bradycardia in newborns is 80 beats per minute.• This definition does not fit into the modern clinical setting of continuously monitored newborns, where benign bradycardias are commonly observed.What is New:• A linear and clinically significant increase in heart rate was observed in infants between the ages of 3 and 9 days. • It appears as though lower normal limits for heart rate could be applied to the youngest newborns.

ROLE OF MELATONIN IN ATTENUATION OF HAEMODYNAMIC RESPONSES TO LARYNGOSCOPY AND INTUBATION IN GENERAL ANAESTHESIA

Objective: The aim of the study was to study the effects of melatonin in attenuation of hemodynamic responses such as heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean blood pressure (MBP) to laryngoscopy and intubation (L&amp;I) in general anesthesia. Methods: This was a prospective and observational study conducted in a tertiary care teaching hospital on 120 patients aged 20–45 years belonging to American Society of Anaesthesiologists Grade I, undergoing elective surgery under general anesthesia. Selected patients were allotted into Group A (control group) and Group B (patients who took tablet melatonin 6 mg, 120 min before induction) of 60 patients each. Hemodynamic parameters such as HR, systolic, diastolic, and MBPs were recorded before the administration of drug (baseline), 120 min after administration of study drug (just before induction), immediately after induction, at L&amp;I, just after L&amp;I and at 1, 3, 5, and 10 min thereafter. Results: The gender distribution and mean age of both groups were comparable. Both the groups were also comparable with respect to baseline values of HR, systolic, diastolic, and mean arterial pressure. The control group showed significant increases in HR, SBP, DBP, and mean arterial blood pressure after L&amp;I and this increase persisted for the next 10 min. In the melatonin group, there was no significant increase in HR, systolic, diastolic, or MBP at any point of measurement after L&amp;I. Conclusion: Pre-treatment with 6 mg oral melatonin 120 min before induction of anesthesia is effective for attenuating hemodynamic responses to L&amp;I without significant side effects.

Caloric state modulates locomotion, heart rate and motor neuron responses to acute administration of d-amphetamine in zebrafish larvae

Psychostimulant drugs increase behavioral, cardiac and brain responses in humans and other animals. Acute food deprivation or chronic food restriction potentiates the stimulatory effects of abused drugs and increases the propensity for relapse to drug seeking in drug-experienced animals. The mechanisms by which hunger affects cardiac and behavioral activities are only beginning to be elucidated. Moreover, changes in motor neuron activities at the single neuron level induced by psychostimulants, and their modulation by food restriction, remain unknown. Here we investigated how food deprivation affects responses to d-amphetamine by measuring locomotor activity, cardiac output, and individual motor neuron activity in zebrafish larvae. We used wild-type larval zebrafish to record behavioral and cardiac responses and the larvae of Tg(mnx1:GCaMP5) transgenic zebrafish to record motor neuron responses. Physiological state gated responses to d-amphetamine. That is, d-amphetamine evoked significant increases in motor behavior (swimming distances), heart rate and motor neuron firing frequency in food-deprived but not fed zebrafish larvae. The results extend the finding that signals arising from food deprivation are a key potentiator of the drug responses induced by d-amphetamine to the zebrafish model. The larval zebrafish is an ideal model to further elucidate this interaction and identify key neuronal substrates that may increase vulnerability to drug reinforcement, drug-seeking and relapse.

Responses of signal crayfish Pacifastacus leniusculus to single short-term pulse exposure of pesticides at environmentally relevant concentrations

Although pesticides are often discharged into surface waters in pulses as opposed to a sustained release, the effect of episodic pollution events on freshwater crayfish is largely unknown. We monitored change in heart rate and distance moved to assess the response of signal crayfish Pacifastacus leniusculus to short-term exposure to environmentally relevant concentrations of metazachlor (MTZ), terbuthylazine (TER), and thiacloprid (TCL). Crayfish exposed to 20 µg/L of MTZ exhibited a significant increase in mean heart rate and distance moved. Increased heart rate was detected at 118 ± 74 s post-exposure to MTZ. There were no significant differences in mean heart rate and distance moved in crayfish exposed to 6 µg/L of TCL and 4 µg/L of TER. A significant correlation between heart rate and distance moved was found in all exposed groups. These results suggest that pulse exposure to MTZ impact crayfish physiology and behavior during short-term period. With pulse exposure to TCL and TER, crayfish not exhibiting a locomotor response may continue to be exposed to lower, but potentially harmful, levels of pollutants. Evidence of the impacts of pesticide pulse at environmentally relevant concentrations on crayfish is scarce. Further study is required to determine the ecological effects of such events on freshwater crayfish.

Hemodynamic Effects of Oxytocin and Carbetocin During Elective Cesarean Section in Preeclamptic Patients Under Spinal Anesthesia: A Randomized Double-blind Controlled Study.

Oxytocin and carbetocin are uterotonic medications that are used to decrease postpartum hemorrhage (PPH). However, there are not enough clinical data about the hemodynamic side effects of carbetocin. This study aimed to compare carbetocin and oxytocin hemodynamic effects in preeclamptic patients undergoing elective cesarean section under spinal anesthesia. In this double-blind, randomized controlled trial, intravenous oxytocin or carbetocin was administered to 80 women (40 per group). The hemodynamic effects, such as blood pressure (BP), heart rate (HR), and oxygen (O2) saturation, were measured before the operation and after 1, 5, 10, and 15 minutes of the administration of both drugs. Intragroup and intergroup comparisons were conducted during statistical analysis. Based on the intragroup comparison, there was a significant increase in HR and a reduction in BP from baseline to all intervals after the administration of both interventions. Moreover, based on the intergroup comparison, there was a significantly more increase in HR and a decline in BP and O2 saturation in the oxytocin group than in the carbetocin group. There were three and seven cases that required another dose of carbetocin and oxytocin, respectively. Moreover, one case developed PPH in the carbetocin group; nevertheless, two cases developed PPH in the oxytocin group. The minimal effect of carbetocin on patients' hemodynamics suggests extending the use of this drug instead of oxytocin as a uterotonic drug in patients with preeclampsia, hemorrhagic risk factors, and/or hypertension.

Formaldehyde causes an increase in blood pressure by activating ACE/AT1R axis

Previous studies suggest some link between formaldehyde exposure and harmful cardiovascular effects. But whether exposure to formaldehyde can cause blood pressure to rise, and if so, what the underlying mechanism is, remains unclear. In this study, C57BL/6 male mice were exposed to 0.1, 0.5, 2.5 mg/m3 of gaseous formaldehyde for 4 h daily over a three-week period. The systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP) and heart rate (HR) of the mice were measured by tail-cuff plethysmography, and any histopathological changes in the target organs of hypertension were investigated. The results showed that exposure to formaldehyde did cause a significant increase in blood pressure and heart rate, and resulted in varying degrees of damage to the heart, aortic vessels and kidneys. To explore the underlying mechanism, a specific inhibitor of angiotensin converting enzyme (ACE) was used to block the ACE/AT1R axis. We observed the levels of ACE and angiotensin II type 1 receptor (AT1R), as well as the bradykinin (BK) in cardiac cytoplasm. The data suggest that exposure to formaldehyde induced an increase in the expression of ACE and AT1R, and decreased the levels of BK. Strikingly, treatment with 5 mg/kg/d ACE inhibitor can attenuate the increase in blood pressure and the pathological changes caused by formaldehyde exposure. This result has improved our understanding of whether, and how, formaldehyde exposure affects the development of hypertension.

Physiological changes associated with copper sulfate-induced nausea and retching in felines.

Nausea is a common disease symptom, yet there is no consensus regarding its physiological markers. In contrast, the process of vomiting is well documented as sequential muscular contractions of the diaphragm and abdominal muscles and esophageal shortening. Nausea, like other self-reported perceptions, is difficult to distinguish in preclinical models, but based on human experience emesis is usually preceded by nausea. Here we focused on measuring gastrointestinal and cardiorespiratory changes prior to emesis to provide additional insights into markers for nausea. Felines were instrumented to chronically record heart rate, respiration, and electromyographic (EMG) activity from the stomach and duodenum before and after intragastric delivery of saline or copper sulfate (CuSO4, from 83 to 322mg). CuSO4 is a prototypical emetic test agent that triggers vomiting primarily by action on GI vagal afferent fibers when administered intragastrically. CuSO4 infusion elicited a significant increase in heart rate, decrease in respiratory rate, and a disruption of gastric and intestinal EMG activity several minutes prior to emesis. The change in EMG activity was most consistent in the duodenum. Administration of the same volume of saline did not induce these effects. Increasing the dose of CuSO4 did not alter the physiologic changes induced by the treatment. It is postulated that the intestinal EMG activity was related to the retrograde movement of chyme from the intestine to the stomach demonstrated to occur prior to emesis by other investigators. These findings suggest that monitoring of intestinal EMG activity, perhaps in combination with heart rate, may provide the best indicator of the onset of nausea following treatments and in disease conditions, including GI disease, associated with emesis.

Comparison of Normal Saline and Alkalinized 2% Lignocaine to Reduce Emergence Phenomenon and Post-Intubation Morbidities: A Prospective, Double-Blind, Randomized Study.

Endotracheal intubation for airway management in general anesthesia is associated with post-intubation morbidities due to tracheal mucosa injury caused by endotracheal tube (ETT) cuff. Nitrous oxide (N2O) diffuses into tracheal tube cuffs filled with air. The rate of diffusion of N2O through the membrane is proportional to its concentration gradient. High-volume low-pressure cuffs expand with only a slight increase in pressure until fully inflated. At this point, owing to the inelasticity of the material, the cuff pressure rises rapidly. This increased pressure can damage the tracheal mucosa. This phenomenon can be avoided, if we inflate the cuff with either a liquid or a gas mixture identical to the inspired gas and monitor the cuff pressure and volume at regular intervals. When lignocaine is used to inflate the ETT cuff, it diffuses to the underlying tracheal mucosa. Thus reducing local irritation and inflammation of the airway through its local anesthetic action. Alkalinization of lignocaine increases its rate of diffusion across the ETT cuff. It also reduces the dose of local anesthetic required to achieve the desired result. We sought to determine the benefits of filling the ETT cuff with alkalinized lignocaine 2% over normal saline, to prevent ETT-induced emergence phenomenon and reduce the incidence of post-intubation morbidities like sore throat, hoarseness, and nausea. This prospective, randomized, double-blind, and comparative study was done at a multispecialty hospital. A total of 120 individuals ofAmerican Society of Anesthesiologists (ASA) physical status 1 and 2, posted for surgery under general anesthesia, were randomly selected and divided into two groups: alkalinized 2% lignocaine group (group L) and normal saline group (group S). After induction of general anesthesia, the airway was secured with appropriate-sized ETT. The ETT cuff was inflated with either of the study media. Continuous cuff pressure monitoring was done to keep cuff pressure below 30 centimeters of water (cm of H2O), at all times. At extubation, the response was evaluated in terms of percentage change in heart rate (HR) and blood pressure from baseline, coughing, bucking, and restlessness. All the surgeries lasted more than two hours. Post-operatively, the patients were evaluated for sore throat and hoarseness, at regular intervals of up to 24 hours. ETT cuff pressure was initially less in group S, which rose to a significantly higher level at extubation, compared to group L (p <0.001). At extubation, there was a significant increase in HR and systolic blood pressure (SBP) from baseline, in group S than in group L (p <0.001 and p=0.001, respectively).The incidence of cough and restlessness was less in group L, compared to group S (p<0.001 and p=0.002, respectively). Mean extubation time and emergence time was more in group S than in group L (p<0.001). Post-operatively, the incidence and severity of sore throat were significantly higher in group S than in group L (p<0.001). Meanwhile, the incidence of hoarseness and nausea was comparable in the two groups. Continuous ETT cuff pressure monitoring helps to keep cuff pressure below tracheal mucosa capillary occlusion pressure. Filling the ETT cuff with alkalinized lignocaine further reduces extubation response and post-intubation morbidities.

Epidemiological, clinical and hematobiochemical studies on hemotoxic snakebite in bovines

Snakebite is a conflict between venomous snakes and humans as well as livestock and considered as neglected tropical disease. The present study aimed to investigate the hospital prevalence, clinical and hemato-biochemical aspects of hemotoxic snakebite in bovines. The overall hospital prevalence of hemotoxic snakebite in bovines was found to be 0.93%. Highest prevalence of hemotoxic snakebite in bovines was observed in August month during monsoon season in female bovines with higher cases in buffaloes. The highest occurrence was reported in native Marathwadi buffalo, non-descript and Deoni cattle of &gt; 4 years and 1-4 years age group in forelimbs and hindlimbs during morning and evening hours. Ascending swelling over limbs extending upward and lameness in case of bite on limbs while asymmetrical swelling in case of bite over face, occasional signs of bleeding like melena, hematuria, epistaxis and bleeding from the site of bite were the prominent clinical signs observed in hemotoxic snakebite affected bovines. Highly significant increase in heart rate and respiration rate, while decrease in rumen motility was observed in snakebite affected bovines. Hemato-biochemial analysis showed highly significant increase in leukocyte count, erythrocyte count and PCV, significant increase in granulocyte and monocyte count, highly significant decrease in platelet count while increase in capillary blood clotting time, bilirubin, blood urea nitrogen, creatinine, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and creatine kinase levels compared to healthy bovines.

Differences In Isotonic Beverages Compared to Mineral Water on Blood Pressure, Heart Rate and Sodium in Students of The Faculty of Nursing Universitas Prima Indonesia Underwriting Circuit Training

Circuit training is a training system that can simultaneously improve the overall fitness of the body, namely the elements of power, endurance, strength, agility, speed, and other components of physical condition. This research is an experimental research Pretest-Posttest Control Group Design. The sample in this study were students of the Faculty of Nursing at Prima Indonesia University. The sample numbered 20 people, divided into 2 groups and none of them withdrew. Data processing using the SPSS program version 23. Research time was Wednesday, 14 August 2019 to Monday, 19 August 2019. The results showed that the participants who were given isotonic fluids experienced a significant decrease in systolic blood pressure (p&lt;0.05) and heart rate (p&lt;0.05) on the first and second days due to body adaptation, while on the third to fifth day the decrease did not occur. significant (p&gt;0.05). There was a significant increase in systolic blood pressure (p&lt;0.05) and heart rate (p&lt;0.05) in participants who were given mineral water. Giving isotonic fluids or minerals does not affect diastolic blood pressure. However, there was an increase in blood sodium levels (p&lt;0.05) in participants who were given isotonic fluids, while in participants who were given mineral water there was a decrease in blood sodium levels (p&lt;0.05).

Comparison between dexmedetomidine and fentanyl on intubating condition to facilitate awake oral fibreoptic intubation under topical anaesthesia – A randomised controlled trial

Background and Aims: Awake fibreoptic intubation (AFOI) is the standard method of airway management in the anticipated difficult airway. While many drugs have been employed for sedation, there is no single drug that can be recommended as the drug of choice. Dexmedetomidine is characterised by effects of sedation, analgesia, amnesia and lack of respiratory depression. Hence, we hypothesised that dexmedetomidine should be suitable for AFOI and compared it to the control drug fentanyl. This study assesses the level of sedation and intubating conditions using dexmedetomidine or fentanyl during awake fibreoptic orotracheal intubation. Methods: Sixty adult patients, American Society of Anaesthesiology class I and II, who required orotracheal intubation during general anaesthesia with the normal airway were randomised to receive dexmedetomidine 0.6 μg/kg (Group A) or fentanyl 1.0 μg/kg (Group B) intravenous infusion for 10 min, after topical anaesthesia to the airway. A total of 60 patients were allocated, 30 patients in each group. The primary objective was to assess the intubating conditions with dexmedetomidine compared to fentanyl. Results: The intubation score for vocal cord movement (1.57 ± 0.68 in Group A vs 1.93 ± 0.75 in Group B) and cough (1.50 ± 0.78 in Group A vs 1.90 ± 0.72 in Group B), endoscopy score (2.17 ± 0.59 in Group A vs 2.47 ± 0.69 in Group B), sedation score (4.73 ± 0.5 in Group A vs 4.47 ± 0.57 in Group B) and patient satisfaction score (1.20 ± 0.41 in Group A vs 1.47 ± 0.68 in Group B) were statistically significant in patients receiving dexmedetomidine. During the procedure, there was a statistically and clinically significant increase in heart rate of 1.5% in Group A versus 22% in Group B, and an increase in mean arterial pressure of 1.95% in Group A versus and 10.27% in the Group B. Conclusion: Dexmedetomidine provided better intubation conditions than fentanyl, with greater haemodynamic stability, better sedation and greater patient satisfaction score compared to fentanyl during awake fibreoptic oral intubation.

Evaluation of Haemodynamic Changes in Patients undergoing Total Knee Arthroplasty under Regional Anaesthesia: A Prospective Observational Study

Introduction: Total Knee Arthroplasty (TKA) is a routinely used procedure for the management of knee osteoarthritis. Various haemodynamic changes can occur during TKA, especially during cementing and tourniquet deflation, which can have a significant impact on the patient’s clinical condition. This study emphasises the importance of close haemodynamic monitoring for the timely detection of potential complications during this procedure. Aim: To evaluate the haemodynamic changes occurring during spinal anaesthesia, bone cementation, and tourniquet deflation using Transthoracic Echocardiography (TTE) along with routine non invasive haemodynamic monitors in patients undergoing TKA. Materials and Methods: The present study was a prospective, observational single-arm study conducted at a tertiary care centre from February 2019 to March 202.Thirty patients of either sex, belonging to American Society of Anaesthesiologists physical status I (aged between 40-70 years) and scheduled for TKA under regional anaesthesia, were enrolled in the study. Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), SpO2 levels, respiratory rate, and End-Tidal CO2 (EtCO2 ) were recorded at various time intervals, including baseline value, after spinal anaesthesia, before cement implantation, after cement implantation, before tourniquet deflation, after tourniquet deflation, and at the end of the surgery. Blood gas analysis and TTE were recorded preoperatively, five minutes after cementation, and five minutes after tourniquet deflation. Data were collected and analysed using Student’s t-test for continuous variables and Chi-square test or Fisher’s exact test for nominal categorical variables. Statistical analysis was performed using the SPSS statistical package (version SPSS 17.0). Results: The mean age, weight, and height of the patients were 54.46±6.78 years, 66.43±5.31 kg, and 152.5±7.71 cm, respectively. The mean HR increased from 82.27±6.11 beats/ minute to 101.43±5.23 and 104.33+4.70 beats/minute after three and six minutes of cementation (p-value=0.001). The mean SBP increased from 121.67 mmHg to 144.13 mmHg and 138.87 mmHg after three and six minutes of cementation (p-value=0.001). The preoperative mean pH was 7.44, which decreased to 7.39 at five minutes after cement implantation and 7.38 after five minutes of tourniquet deflation (p-value=0.001). The preoperative mean PaCO2 value was 44.83 mmHg, which increased to 62.30 mmHg after five minutes of cement implantation and 55.17 mmHg after five minutes of tourniquet deflation (p-value&lt;0.05). Conclusion: There was a significant increase in HR, blood pressure, and PaCO2 , as well as a decrease in pH after bone cement implantation. However, TTE performed at various time points did not suggest any significant changes during TKA. Hence, this study demonstrates that routine haemodynamic monitoring is sufficient, and no additional monitoring like ECHO is required in ASA 1 patients undergoing TKA.

Hemodynamic Tolerance of Virtual Reality Intradialysis Exercise Performed during the Last 30 Minutes versus the Beginning of the Hemodialysis Session.

Background: Exercise improves the physical function of people suffering from chronic kidney disease on hemodialysis (HD). Virtual reality is a new type of intradialysis exercise that has a positive impact on physical function. Intradialysis exercise is recommended during the first 2 h, but its safety in the last part of the dialysis session is unknown. Methods: This was a pilot sub-study of a clinical trial. Several hemodynamic control variables were recorded, including blood pressure, heart rate, and intradialytic hypotensive events. These variables were recorded during three different HD sessions, one HD session at rest, another HD session with exercise during the first two hours, and one HD session with exercise during the last 30 min of dialysis. The intradialysis virtual reality exercise was performed for a maximum of 30 min. Results: During exercise sessions, there was a significant increase in heart rate (6.65 (4.92, 8.39) bpm; p < 0.001) and systolic blood pressure (6.25 (0.04,12.47) mmHg; p < 0.05). There was no difference in hemodynamic control between the sessions with exercise during the first two hours and the sessions with exercise during the last 30 min. There was no association between intra-dialytic hypotensive events at rest (five events) or exercise at any point (two vs. one event(s), respectively). Conclusion: performing exercise with virtual reality at the end of a hemodialysis session is not associated with hemodynamic instability.

Hemodynamic impact of early mobilization in critical patients receiving vasoactive drugs: A prospective cohort study.

Vasoactive drugs are one of the most common patient-related barriers to early mobilization. Little is known about the hemodynamic effects of early mobilization on patients receiving vasoactive drugs. This study aims to observe and describe the impact of mobilization on the vital signs of critical patients receiving vasoactive drugs as well as the occurrence of adverse events. This is a cohort study performed in an Intensive Care Unit with patients receiving vasoactive drugs. All patients, either mobilized or non-mobilized, had their clinical data such as vital signs [heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and oxygen saturation], type and dosage of the vasoactive drug, and respiratory support collected at rest. For mobilized patients, the vital signs were also collected after mobilization, and so was the highest level of mobility achieved and the occurrence of adverse events. The criteria involved in the decision of mobilizing the patients were registered. 53 patients were included in this study and 222 physiotherapy sessions were monitored. In most of the sessions (n = 150, 67.6%), patients were mobilized despite the use of vasoactive drugs. There was a statistically significant increase in heart rate and respiratory rate after mobilization when compared to rest (p<0.05). Only two (1.3%) out of 150 mobilizations presented an adverse event. Most of the time, non-mobilizations were justified by the existence of a clinical contraindication (n = 61, 84.7%). The alterations observed in the vital signs of mobilized patients may have reflected physiological adjustments of patients' cardiovascular and respiratory systems to the increase in physical demand imposed by the early mobilization. The adverse events were rare, not serious, and reversed through actions such as a minimal increase of the vasoactive drug dosage.

Cardiovascular and Adverse Effects of Glucagon for the Management of Suspected Beta Blocker Toxicity: a Case Series.

Although glucagon use in beta blocker toxicity has been recommended for many years, evidence for its safety and efficacy in humans is limited. This study aims to determine the magnitude of effect of glucagon on heart rate (HR) and systolic blood pressure (SBP) in patients with suspected beta blocker toxicity and describe potential adverse effects of the medication. We conducted a retrospective, multi-center case series of patients greater than 12years of age who received glucagon for suspected beta blocker toxicity. The primary outcome was the mean difference in HR from immediately pre- to 20-minutes post-glucagon administration. Secondary outcomes included the median difference in SBP, and occurrence of nausea, vomiting, and hyperglycemia. A total of 107 patients met inclusion criteria accounting for 144 glucagon orders. The mean difference in HR from pre- to post-glucagon administration was 4bpm ± 10.6 (95% CI [2.25-5.76], p < 0.001). The median difference (IQR) in SBP was 4.5 (- 6 to 16) mmHg (p = 0.004). Similar increases were observed when patients receiving concomitant vasopressors were excluded. A total of nine glucagon administrations (6.3%) were associated with nausea and 14 (9.7%) with vomiting; however, 52 doses (36.1%) were administered concomitantly with antiemetic medications. Fifteen administrations (10.4%) were associated with hyperglycemia. Glucagon administration was associated with a statistically significant increase in HR, but a small absolute difference of uncertain clinical significance. A similar observation was noted for SBP. Few patients experienced adverse events.

Novel protocol to establish the myocardial infarction model in rats using a combination of medetomidine-midazolam-butorphanol (MMB) and atipamezole.

Myocardial infarction (MI) is one of the most common cardiac problems causing deaths in humans. Previously validated anesthetic agents used in MI model establishment are currently controversial with severe restrictions because of ethical concerns. The combination between medetomidine, midazolam, and butorphanol (MMB) is commonly used in different animal models. The possibility of MMB combination to establish the MI model in rats did not study yet which is difficult because of severe respiratory depression and delayed recovery post-surgery, resulting in significant deaths. Atipamezole is used to counter the cardiopulmonary suppressive effect of MMB. The aim of the present study is to establish MI model in rats using a novel anesthetic combination between MMB and Atipamezole. Twenty-five Sprague Dawley (SD) rats were included. Rats were prepared for induction of the Myocardial infarction (MI) model through thoracotomy. Anesthesia was initially induced with a mixture of MMB (0.3/5.0/5.0 mg/kg/SC), respectively. After endotracheal intubation, rats were maintained with isoflurane 1% which gradually reduced after chest closing. MI was induced through the left anterior descending (LAD) artery ligation technique. Atipamezole was administered after finishing all surgical procedures at a dose rate of 1.0 mg/kg/SC. Cardiac function parameters were evaluated using ECG (before and after atipamezole administration) and transthoracic echocardiography (before and 1 month after MI induction) to confirm the successful model. The induction time, operation time, and recovery time were calculated. The success rate of the MI model was also calculated. MI was successfully established with the mentioned anesthetic protocol through the LAD ligation technique and confirmed through changes in ECG and echocardiographic parameters after MI. ECG data was improved after atipamezole administration through a significant increase in heart rate (HR), PR Interval, QRS Interval, and QT correction (QTc) and a significant reduction in RR Interval. Atipamezole enables rats to recover voluntary respiratory movement (VRM), wakefulness, movement, and posture within a very short time after administration. Echocardiographic ally, MI rats showed a significant decrease in the left ventricular wall thickness, EF, FS, and increased left ventricular diastolic and systolic internal diameter. In addition, induction time (3.440 ± 1.044), operation time (29.40 ± 3.663), partial recovery time (10.84 ± 3.313), and complete recovery time (12.36 ± 4.847) were relatively short. Moreover, the success rate of the anesthetic protocol was 100%, and all rats were maintained for 1 month after surgery with a survival rate of 88%. Our protocol produced a more easy anesthetic effect and time-saving procedures with a highly successful rate in MI rats. Subcutaneous injection of Atipamezole efficiently counters the cardiopulmonary side effect of MMB which is necessary for rapid recovery and subsequently enhancing the survival rate during the creation of the MI model in rats.

Functional state of the cardiovascular system in women during pregnancy

The article presents the results of studying the effect of pregnancy on the functional state of the cardiovascular system in women. Their evaluation indicates that during pregnancy there is a significant increase in heart rate, arterial blood pressure, systolic blood volume (SBV), minute blood volume (MBV), circulatory efficiency ratio (CER), a significant decrease in the total peripheral vascular resistance (TPVR), a significant fluctuation in both directions in the pulse pressure (PP), the average dynamic arterial pressure (ADAP) and the endurance factor (EF) in women. By the end of pregnancy, the heart rate increased to 89.1 beats per minute (P &lt; 0.001), systolic blood pressure increased to 151.5 mm Hg (P &lt; 0.001), diastolic pressure up to 92.7 (P &lt; 0.001), while in reference group women the values thereof were recorded to be 71.2 beats per minute, 121.6 and 81.3 mm Hg, respectively. The mean values of PP and ADAP in the second trimester decreased to 36.5 (P &lt; 0.02) and 87.9 (P &lt; 0.01) mm Hg, respectively, and in the third trimester they increased to 58.8 (P &lt; 0.001) and 117.4 (P &lt; 0.001), while in the non-pregnant women they were reported to be 40.3 and 97.9, accordingly. SBV reached its maximum value of 61.1 ml (P &lt; 0.02), in the middle period of pregnancy, and MBV reached 5.4 l/min (P &lt; 0.001), and CER was recorded to be 5250 at the end of pregnancy, while the in women of the reference group they were reported to be 57.9 ml, 4.1 l/min and 2875, respectively. The mean value of TPVR in the second trimester decreased to 1332 (P &lt; 0.001) dyn·s·cm-5, and EF increased to 23.0 (P &lt; 0.001), while in reference women they were recorded to be 1832 and 17.7, respectively.

여성노인의 걷기 운동 시 보행 속도별 운동 강도와 에너지 소비량에 관한 비교·분석

The purpose of this study was to compare and analyze the differences in heart rate, exercise intensity (%HRR, RPE), and energy consumption(Kcal/min) according to walking speed. Walking is an aerobic physical activity that has less impact on skeletal muscles and joints compared to sports, such as running or mountaineering. Twelve older females aged over 65 and living in J city, G-do, that could walk 800 m at 120 steps, 140 steps, and 160 steps per minute, participated in this study. The exercise intensity was increased every minute. The number of steps was measured using the metronome beat, the subjective exercise intensity is measured using the RPE, and the energy consumption (Kcal/min) is measured using the regression equation using the heart rate.BRThe results show that the average heart rate was significantly higher(p.01) at 140 steps was 117.4±13.0 compared to 120 steps was 103.2±10.2 bpm/min, Additionally, the average heart rate was significantly higher(p.01) for the 160 steps was 136.7±17.7 than 140 steps was 117.4±13.0. The average exercise intensity per minute was significantly higher(p.01) at 140 steps was 52..8±14.8 %HRR than at, at 120 steps was 37.8±12.0 %HRR. Likewise, average exercise intensity per minute was significantly higher(p.01) at 160 steps was 73.0±19.4 %HRR than at, at 140 steps was 52.8±14.8 %HRR. For the RPE exercise intensity was significantly higher(p.01) according to the number of steps, i.e. 14.1±1.4 at 160 steps, 10.8±1.5 at 140 steps, and 8.7±1.2 at 120 steps. For the energy consumption, there were significant differences(p.01) between the averages according to the step speed, 5.2±1.3 Kcal/min at 160 steps, 3.7±1.0 Kcal/min at 140 steps, and 2.6±0.8 Kcal/min at 120 steps.BRIn conclusion, as expected there were statistically significant increases in heart rate, exercise intensity(Heart rate and RPE), and energy consumption as the walking speed increased.BRIn this study, 12 elderly women 65 years of age or older were limited to the subjects. However, in future studies, it is necessary to study more specific changes in exercise intensity and energy consumption through studies of all age groups and genders.

Left Ventricular Diastolic Response to Isometric Handgrip Exercise in Physically Active and Sedentary Individuals.

This study aims to investigate the diastolic left ventricular (LV) response to isometric handgrip exercise among healthy middle-aged men with high physical activity levels, versus matched sedentary individuals. Two groups of 10 men aged 41-51 years were studied. Men in the first group had high weekly self-reported physical activity levels (&gt;3000 METs × min/week). In comparison, men in the second group reported low physical activity levels (&lt;300 METs × min/week). An isometric handgrip exercise (IHE) stress echocardiography test was performed in all of them. Both groups showed a similar and statistically significant increase in heart rate, systolic, diastolic, and mean arterial pressure following IHE. The group of active men under study did not show a statistically significant change in the ratio of early diastolic mitral valve inflow velocity to early diastolic lateral wall tissue velocity (E/e' ratio) in response to IHE. Conversely, the inactive participants' E/e' ratio was higher at peak activity in the isometric handgrip exercise. Apparently, healthy middle-aged men with high levels of physical activity seem to have an improved lusitropic cardiac function compared to men with low levels of physical activity, as observed by the different diastolic LV responses induced by isometric handgrip exercise.