Terms Of Hemodynamic Variables Research Articles

Post-cesarean Delivery Analgesia Using Spinal Anesthesia: Ropivacaine-Fentanyl vs. Ropivacaine-Sufentanil.

To improve the quality of intraoperative and postoperative analgesia during spinal anesthesia, intrathecal opioids are used as adjuvant drugs in combination with local anesthetics. This study aimed to compare the intrathecal injection of ropivacaine-fentanyl with ropivacaine-sufentanil in terms of the duration of analgesia after cesarean section (CS). This randomized, double-blind clinical trial study was conducted on women referred to Imam Khomeini Hospital of Ahvaz City for elective CS in 2021. A total of 51 patients were randomly divided into 2 groups. The first group (n = 25) received ropivacaine (17.5 mg) + fentanyl (25 μg), while the second group (n = 26) received ropivacaine (17.5 mg) + sufentanil (2.5 μg) for spinal anesthesia. Eventually, several parameters were investigated, including the duration of sensory and motor block, duration of analgesia (based on the Visual Analog Scale (VAS)), hemodynamic parameters, and possible complications. The duration of surgery (P = 0.059) and the duration of motor block (P = 0.962) were not significantly different between the 2 groups. The mean duration of analgesia (from the time of entering recovery to reaching VAS = 3) was 203.12 ± 72.93 and 207.46 ± 69.59 minutes in the fentanyl and sufentanil groups, respectively (P = 0.658). Systolic and diastolic blood pressure (SBP/DBP) drops in minute 5 were observed more frequently in the sufentanil group than in the fentanyl group (P = 0.027 and P = 0.002, respectively). At the other time points, however, no significant difference was observed between the 2 groups in terms of hemodynamic variables (P > 0.05). Finally, the frequency of pruritus was higher in the sufentanil group than in the fentanyl group (26.9% vs. 4.0%; P = 0.024). Adding fentanyl or sufentanil to intrathecal ropivacaine provides a similar duration of analgesia. However, fentanyl was associated with better hemodynamic stability and a lower incidence of pruritus.

The Effect of Erector Spinae Plane Block and Combined Deep and Superficial Serratus Anterior Plane Block on Acute Pain After Video-Assisted Thoracoscopic Surgery: A Randomized Controlled Study

The study aimed to compare the analgesic effects of erector spinae plane block (ESPB) and a combination of the deep and superficial serratus anterior plane block (C-SAPB) methods in patients who underwent video-assisted thoracoscopic surgery (VATS). A prospective, randomized study. At a single-center, high-volume, tertiary thoracic surgery center. Adult patients undergoing VATS. Ultrasound-guided ESPB and C-SAPB. Patients were assigned to ESPB (group 1) or C-SAPB (group 2) groups according to the analgesia protocol. All interventions were performed with single-needle insertion. Multimodal analgesia was achieved via paracetamol, dexketoprofen, and intravenous morphine for both study groups. Pain scores were assessed by the visual analog scale (VAS). Morphine consumption, rescue analgesic requirements, and side effects were recorded postoperatively for 24 hours. The primary outcome was determined as VAS scores at rest and coughing. The secondary outcomes of this study were postoperative morphine consumption and the requirement of rescue analgesics. There was no statistically significant difference between the groups in terms of VAS scores (p > 0.05). The groups also were similar in terms of demographic characteristics, side effects, morphine consumption, additional analgesic use, and duration of block procedures (p > 0.05). There also were comparable results in terms of hemodynamic variables (p > 0.05). Patients who underwent VATS receiving ESPB or C-SAPB had similar pain scores, opioid consumption, and side effects during the first postoperative 24 hours. At the same time, the fact that the duration of the block procedure was similar in both groups showed that multisite serratus anterior plane block can be an effective alternative method in analgesic treatment after VATS, considering that it easily can be applied. The authors here think that C-SAPB can be a good alternative to ESPB because the outcomes of both applications are similar, and C-SAPB easily can be seen and applied with ultrasound.

Montelukast Efficacy for Improvement of Adult Acute Phase Mild-Moderate Asthma Attack: A Clinical Trial Study

Background: Asthma, an inflammatory disease of the respiratory tract, is one of the most frequent causes of referral to emergency departments. The aim of this study is to evaluate the efficacy of montelukast as a member of LTRAs for the improvement of pulmonary function and clinical symptoms of patients with asthma. Methods: The study was conducted on 80 patients with acute mild- moderate asthma, divided randomly into two groups of 40 subjects. A double-blind clinical trial was conducted on asthmatic patients who encounter an acute phase asthma attack. The experimental group received two montelukast 5 mg chewable tablets at arrival, accompanied by standard mild-moderate asthma treatment consisting of oxygen and nebulization with albuterol 2.5 mg and ipratropium bromide 0.5 mg in 3 doses for 60 minutes. The control group received standard mild-moderate asthma treatment plus placebo chewable tablets at the beginning without any leukotriene inhibitors. Pulmonary function tests, hemodynamic variables and Borg Dyspnea Scale were evaluated and analyzed at 0, 30, 60, 90 and 150 minutes in both case and control groups. Results: No significant differences were observed between the case and the control group in terms of PEFR and FEV1 measurements during the study at different time points [P > 0.05]. There were no significant differences in terms of hemodynamic variables [blood pressure, pulse and respiration rate, pressure of oxygen in arterial blood] and Borg Dyspnea Scale in both groups as well. Conclusion: The study findings showed that the montelukast administration in mild-moderate acute asthma attack setting had no significant impact on pulmonary function tests and clinical symptoms of the studied patients rather than standard asthma treatment.

Effectiveness Comparison of Dexmedetomidine and Remifentanil for Perioperative Management in Patients Undergoing Endoscopic Sinus Surgery.

For patients undergoing endoscopic sinus surgery, intranasal injection of epinephrine can cause acute increases in heart rate and blood pressure. Among the drugs for reducing hyperdynamic effects, dexmedetomidine and remifentanil are expected to blunt the acute hemodynamic responses after intranasal injection of epinephrine. Our study compared a difference in the 2 drugs in their abilities to blunt the hemodynamic responses in intraoperative period and postoperative profile. In this study, the patients were randomly divided into the dexmedetomidine and remifentanil groups. During the intraoperative period, the hemodynamic values were recorded. The surgical condition was assessed by a single surgeon. During the postoperative period, hemodynamic values, sedation scale score, and pain score were recorded. No significant differences in hemodynamic variables were found between the groups before and after intranasal injection of epinephrine. Comparison of the group mean values before endotracheal intubation revealed that the blood pressure values in the remifentanil group were significantly lower than those in the dexmedetomidine group. At 2 minutes after endotracheal intubation, blood pressure and heart rate values in the remifentanil group were significantly lower than those in the dexmedetomidine group. The sedation score was significantly lower in the dexmedetomidine group on arrival and at 30 minutes after arrival at the postanesthetic care unit (P < .001 and P = .001, respectively). At 30 and 60 minutes after the operation, the pain scores were significantly lower in the dexmedetomidine group (P = .015 and P = .001, respectively). Dexmedetomidine had better postoperative sedative and analgesic effects than remifentanil for patients undergoing endoscopic sinus surgery in this study. Remifentanil and dexmedetomidine attenuated acute hemodynamic responses to be within normal ranges after intranasal injection of epinephrine, and no significant differences in terms of hemodynamic variables. Remifentanil was superior to dexmedetomidine in inducing hypotension during endotracheal intubation.

Hemodynamic response to administration of vasopressors among patients with septic shock

Background: Septic shock is characterized by refractory hypotension with a mortality of >50%. Early fluid resuscitation, if failed, vasopressors are recommended to maintain mean arterial pressure (MAP) of 65 mmHg to restore organ perfusion. Noradrenaline (NA) is the vasopressor of choice but can be associated with adrenergic hyposensitivity and adverse effects on prolonged high-dose treatment. Hence, the addition of arginine vasopressin (AVP) to reduce the dose of NA is recommended. In view of the paucity of data in our setup, the present observational study was undertaken. Aims and Objectives: The present study was conducted to analyze the hemodynamic response to vasopressors among patients in septic shock and to compare the same among patients receiving NA alone or NA + AVP. Materials and Methods: All consenting adult patients >18 years with septic shock receiving vasopressors were included in the study. Hemodynamic variables such as systolic and diastolic blood pressure and MAP were noted at baseline, 30 min, 1, 6, 24, and 48 h and the same was compared between patients receiving either NA alone or NA + AVP. Results: The median age was 45 years with male preponderance. At admission, median MAP was 63 mmHg. On administration of vasopressors, target MAP was achieved by 1-h and maintained in both the groups of patients receiving NA or NA + AVP. No significant differences were noted in terms of hemodynamic parameters among patients receiving NA alone or NA + AVP. Conclusion: As per the surviving sepsis guidelines 2018, vasopressor administration was initiated and the target MAP of >65 mmHg was achieved by 1 h, sustained over 48 h. No significant differences were noted among the patients receiving NA alone or NA + AVP in terms of hemodynamic variables.

The safety and efficacy of minimal-flow desflurane anesthesia during prolonged laparoscopic surgery

BackgroundMinimal-flow anesthesia can meet the demands of a modern society that is more sensitive to environmental protection and economic burdens. This study compared the safety and efficacy of minimal-flow desflurane anesthesia with conventional high-flow desflurane anesthesia for prolonged laparoscopic surgery.MethodsForty-six male patients (ASA physical status II or III) undergoing laparoscopic urologic surgery for more than 6 hours were randomly divided into two groups: the high-flow (HF) group and the minimal-flow (MF) group. The HF group was continuously administered a fresh gas flow of 4 L/min. In the MF group, a fresh gas flow of 4 L/min was administered for the first 20 minutes and was thereafter lowered to 0.5 L/min. Inspiratory and expiratory desflurane concentrations, respiratory variables, and hemodynamic variables were continuously monitored during administration of anesthesia. Measurements of carboxyhemoglobin (COHb) concentration and arterial blood gas analysis were performed every 2 hours during anesthesia. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN) and creatinine were measured on the first and second day after the surgery.ResultsDemographic data and duration of anesthesia were not different between the two groups. Significant differences were not observed between the two groups in terms of hemodynamic variables, respiratory variables, and inspiratory and expiratory desflurane concentrations. Inspiratory O2 concentration was maintained lower in the MF group than in the HF group (43-53% vs. 53-59%; P < 0.05). Compared with the HF group, COHb concentrations was higher (P < 0.05), but not increased from the baseline value in the MF group. Serum AST, ALT, BUN, and creatinine were not significantly different between the two groups.ConclusionsIn prolonged laparoscopic surgery, no significant differences were found in safety and efficacy between minimal-flow and high-flow desflurane anesthesia.

Comparing the effectiveness of airway management devices in pre-hospital emergency care: A randomized clinical trial.

Objective:To assess the effectiveness of laryngeal mask airway, endotracheal tube and oropharyngeal airway for airway management in prehospital emergency care.Methods:The study sample of this randomized clinical trial was 54 patients needing pre-hospital airway management. All cases of intubation (ETI); after two failed attempts (37 patients), were randomly assigned to the oropharyngeal airway (OPA), and the laryngeal mask airway (LMA) groups. Patients’ hemodynamic, SaO2 and airway management parameters, were compared in three groups. The study data were analyzed by the Chi-square and one-way ANOVA, Bonferroni post-hoc, using SPSS, v. 18.0.Results:The results demonstrated that before and after the study, there was no significant difference among the study groups in terms of hemodynamic variables (P > 0.05) expect SaO2 (P < 0.001). The results also revealed that in the ETI group (n=17), the number of attempts and the time spent on inserting the airway device was significantly more than other two groups (P < 0.05).Conclusion:Laryngeal mask airway is as effective as oropharyngial airway for pre-hospital airway management by paramedics.