Mean Arterial Pressure Values Research Articles

Delta Inferior Vena Cava Index Correlated with Mean Arterial Pressure (MAP) in Spinal Anesthesia

Background: Spinal anesthesia has become an alternative to general anesthesia. However, spinal anesthesia has the most common side effects including, bradycardia and hypotension. The aim of this study was to determine the relationship between changes in the inferior vena cava index (delta inferior vena cava index) to changes in mean arterial pressure in spinal anesthesia. Methods: This study was an observational pre-post test study in thirty-two patients who received spinal anesthesia. The inferior vena cava index (inferior vena cava collectibility index and caval-aorta index) was measured before and after spinal anesthesia (5 and 10 minutes after onset). Data were analyzed using the Kolmogorov Smirnov test, Shapiro-Wilk test, T-test, and correlation test with α=5% Result: There was a significant difference in mean arterial pressure (MAP), delta inferior vena cava collectibility index (D-IVC-CI), and delta caval-aorta index (D-CAo-I) before and after spinal anesthesia. D-IVC-CI and D-CAo-I are significantly correlated with MAP. The correlation between D-IVC-CI and MAP had R = -0.371 (P <0.05) at 5 minutes post-anesthesia, while D-CAo-I and MAP had R = 0.472 (P <0.05) at 10 minutes post-anesthesia. Conclusion: The delta inferior vena cava index is correlated with the mean arterial pressure (MAP) value in spinal anesthesia.

Comparing Intra-Arterial, Auscultatory, and Oscillometric Measurement Methods for Arterial Blood Pressure.

AIMThis study aimed to compare the measurement results of arterial blood pressure obtained through intra-arterial, auscultatory, and oscillometric methods.METHODThis prospective and descriptive study was conducted with 180 patients hospitalized in the intensive care units of cardiovascular surgery and anesthesia. Arterial blood pressures of the patients in the study were measured with 3 methods, and the mean arterial pressure values obtained by each method were analyzed to find out whether they were different or consistent.RESULTSThe average systolic blood pressure value using the intra-arterial method was found to be 125.47 ± 21.39 mm Hg, and the average of diastolic blood pressure measurement obtained using the oscillometric method was the highest (73.91 ± 10.62 mm Hg). The highest correlation was seen between the arterial BP measurements of the intra-arterial and auscultatory methods (systolic [0.96] and diastolic [0.90]). According to the British and Irish Hypertension Society protocol, a very good agreement between the diastolic blood pressure values and a good agreement between the systolic blood pressure values were obtained.CONCLUSIONThe measurement results obtained through the auscultatory method more consistent with the results obtained through the intra-arterial method compared with those obtained using the oscillometric method.

Causes of arterial hypotension during anesthetic induction with propofol investigated with perfusion index and ClearSightTM in young and elderly patients.

Mechanism underlying the hypotension during anesthetic induction in elderly patients is inferred to differ from that in younger patients due to structural changes in arteries. The aim of the study was to determine if a decrease in cardiac output (CO) or systemic vascular resistance (SVR) is the main mechanism of the hypotension. Fifty-six patients comprising 28 healthy elderly patients aged 75-90 years (group E) and 28 healthy younger patients aged 20-40 years (group Y) were enrolled. General anesthesia was induced with propofol (1.2 mg/kg, group E; 2 mg/kg, group Y), remifentanil (0.15 µg/kg/min, group E; 0.3 µg/kg/min, group Y) and rocuronium. Primary outcome was to compare serial changes in PI of Radical-7TM, SVR, CO and stroke volume variations (SVV) of ClearSightTM (Edwards Lifesciences Corp., Irvine, CA, USA) during the five-minute period from propofol administration until intubation. The degree of increase in PI and reduction in SVR in group Y were significantly greater than those in group E (P<0.01 with repeated measure ANOVA). The degree of reduction in CO and increase in SVV were significantly larger in group E (P<0.01). All values of mean arterial blood pressure measured during the five-minute correlated negatively with PI in group Y (r=0.44, P<0.01) and positively with CO in group E (r=0.4, P<0.01). The main mechanisms of hypotension during anesthetic induction contribute to the decrease in CO in elderly and reduction of SVR in younger. PI only shows the vascular tone of a finger but can be a surrogate for SVR.

MO570PULSE PRESSURE: A PREDICTOR OF CARDIOVASCULAR CALCIFICATION AND CARDIOVASCULAR MORTALITY IN HEMODIALYSIS PATIENTS

Abstract Background and Aims The mortality rate is extremely high in chronic kidney disease (CKD), primarily due to the high prevalence of cardiovascular disease (CVD). Increased pulse pressure (PP), defined as the difference between inappropriately elevated systolic blood pressure (SBP) and reduced diastolic blood pressure (DBP) at any value of mean arterial pressure (MAP), is a surrogate measure of increased arterial stiffness of central elastic arteries (aorta and its major branches). CKD-MBD anomalies leading to calcification contribute to increased arterial stiffness and pulse pressure. This study aimed to evaluate the relationship of pulse pressure parameter with valve calcification and abdominal aortic calcification in hemodialysis patients and its impact on cardiovascular mortality. Method We performed a prospective case series study with 3 years follow- up. Plain X-ray images of the lateral lumbar spine from all subjects were studied to obtain images of the lower abdominal aorta using semiquantitative scores as described by Kauppila et al. Cardiac valve calcifications were evaluated by two-dimensional echocardiography with an HDI 5000 Sono CT echocardiographic machine with a 3.3-MHz multiphase array probe in subjects lying in the left decubitus position an according to the recommendations of the European Association of Echocardiography. The patient was evaluated as having vascular calcification if he had the presence of calcification in at least one of the site examined: a mitral valve, aortic valve or abdominal aorta. Results We studied 85 chronic stable hemodialysis patients. Mean age and meantime is therapy was 49.9±12.4 years and 51.5±28.7 months, respectively. Mean pulse pressure was 55.72±14.2 mmHg. Fifty-nine patients (69.4%) were identified with aortic abdominal calcification, and the mean Kauppila score was 4.91 ± 4.05. Sixty patients (70.5%) had at least one valve calcified, while thirty-three patients (38.8%) had both valves calcified. Univariate analysis revealed that every 1 mmHg increase in pulse pressure was associated with increased cardiovascular calcification risk p=0.020. In multivariate analysis, after adjustment for age, gender, diabetes mellitus, cholesterol, and triglyceride serum levels, the association also remained strong, where every increase of 1 mm Hg in pulse pressure was associated with increased risk for cardiovascular calcification (HR 1.02, 95% CI (1.00-1.03), p= 0.038). Besides, pulse pressure was an independent predictor for cardiovascular mortality (HR 1.03, 95% CI (1.02-1.05), p=0.002). Conclusion Pulse pressure may identify hemodialysis patients with subclinical cardiovascular calcification who need further evaluation. Wide pulse pressure is associated with increased cardiovascular mortality.

The circadian rhythm of arterial blood pressure in Alzheimer's disease and vascular dementia.

Hypertension is considered a risk factor for stroke and dementia. Ambulatory blood pressure monitoring (ABPM) is a useful tool in the diagnosis and treatment of hypertension. This study aimed to evaluate blood pressure using ABPM, in 30 Alzheimer's disease (AD) patients and 30 vascular dementia (VaD) patients in comparison with 30 healthy controls. BP was recorded every 15min from 6 AM to 10 PM, and every 30min from 10 PM to 6 AM. Mean systolic (SBP) and diastolic (DBP) blood pressure during daytime, nighttime, diurnal index, pulse pressure, and heart rate were extracted from the ABPM recordings.VaD patients presented higher SBP values compared to AD patients and healthy controls. DBP values in the AD group were the lowest, while VaD patients presented the highest DBP values, including day and nighttime. Mean arterial pressure values were also the highest in the VaD group, while AD patients had similar values with the control group. The VaD patients presented the lowest systolic diurnal index compared to AD patients and controls. The mean pulse pressure and nighttime pulse pressure values were higher in both groups of dementia patients when compared with the control group. Increased SBP, pulse pressure, and alteration in the circadian pattern with the highest incidence of the non-dipper and reverse dipper patterns were found in patients with dementia when compared with the healthy elderly. Also, decreased values of DBP were found in AD patients, especially during the night period.

5. THE ADDITION OF SEHAT, AN ADAPTATION OF DASH DIET, IN ONGOING REGIMENT OF CAPTOPRIL IN A HYPERTENSION PATIENT AT PRIMARY HEALTHCARE SETTING: AN EXPERIMENTAL STUDY

Background: Hypertension still becomes a menacing worldwide problem. Ninety percent of people over 55 years will develop hypertension. DASH (Dietary Approaches to Stop Hypertension) diet proven to have substantial blood pressure (BP)-lowering action. Captopril is one of the first-line hypertension treatments in Indonesia since it was accessible and affordable. We conducted SEHAT (Seleksi Gaya Hidup Anti Hipertensi), a more adapted hypertension intervention program based on the DASH diet. Objective: Here we are going to report the results of adding SEHAT in an ongoing regiment of captopril in a hypertension patient in a primary healthcare setting. Method: : We conducted SEHAT counseling in the monthly “PROLANIS” in Sutojayan Primary Health Care. 14 patients with essential hypertension divided into 2 groups: 7 patients accustomed to SEHAT and received 3 × 25 mg Captopril, while 7 others with only captopril consumption as a control group. We measured the difference value of systolic, diastolic, and Mean Arterial Pressure (MAP) pre and post 4-weeks intervention. Statistical analysis was done using an independent t-test. Result: Based on mmHg measurement, there were a greater reduction of systolic blood pressure (−11.43 vs 1.71; p = 0.259), diastolic blood pressure (−4.29 vs −2.57; p = 0.833), and MAP (−1.14 vs −6.86; p = 0.517) between SEHAT and control group respectively. Conclusion: SEHAT has the potency to become a promising antihypertension program in primary health care. As there was no significant result, further studies need to be carried out with a greater sample to strengthen its efficacy.

Associated factors with umbilical arterial pH after cesarean delivery under spinal anesthesia: a retrospective cohort study

BackgroundMaximum decrease of blood pressure and number of minutes of hypotension were independently associated with umbilical arterial pH. However, the impact of hypotension considering the duration of it on umbilical arterial pH is unknown. MethodsPregnant women aged ≥ 20 years who delivered a baby at full-term via a cesarean delivery under a single-shot spinal anesthesia between January 2017 and March 2019 were included. The main outcome was to predict umbilical arterial pH, based on the value of the time integral of hypotension. Patient demographics, patient comorbidities, and intraoperative data, including the total dose of ephedrine and phenylephrine by fetal delivery and cumulative duration of maternal hypotension, were evaluated. Maternal hypotension was reflected as a decrease in systolic arterial pressure and mean arterial pressure to < 80% of baseline values. The systolic arterial pressure and mean arterial pressure were independently included in a multiple regression analysis along with all other explanatory factors to predict the umbilical arterial pH. ResultsOf the 416 eligible patients, 381 were enrolled. When including the systolic arterial pressure or mean arterial pressure in the model, emergency cases, the total dose of ephedrine, hypertensive disorders of pregnancy, and systolic arterial pressure or mean arterial pressure values were found to be significant predictive factors of umbilical arterial pH. ConclusionOur results suggest that an elevated time integral of maternal hypotension may have a negative impact on umbilical arterial pH. Therefore, to minimize the risk of fetal acidosis, maternal hypotension should be prevented with the consideration of vasopressors selection.

Prediction of preeclampsia throughout gestation with maternal characteristics and biophysical and biochemical markers: a longitudinal study

The current approach to predict preeclampsia combines maternal risk factors and evidence from biophysical markers (mean arterial pressure, Doppler velocimetry of the uterine arteries) and maternal blood proteins (placental growth factor, soluble vascular endothelial growth factor receptor-1, pregnancy-associated plasma protein A). Such models require the transformation of biomarker data into multiples of the mean values by using population- and site-specific models. Previous studies have focused on a narrow window in gestation and have not included the maternal blood concentration of soluble endoglin, an important antiangiogenic factor up-regulated in preeclampsia. This study aimed (1) to develop models for the calculation of multiples of the mean values for mean arterial pressure and biochemical markers; (2) to build and assess the predictive models for preeclampsia based on maternal risk factors, the biophysical (mean arterial pressure) and biochemical (placental growth factor, soluble vascular endothelial growth factor receptor-1, and soluble endoglin) markers collected throughout pregnancy; and (3) to evaluate how prediction accuracy is affected by the presence of chronic hypertension and gestational age. This longitudinal case-cohort study included 1150 pregnant women: women without preeclampsia with (n=49) and without chronic hypertension (n=871) and those who developed preeclampsia (n=166) or superimposed preeclampsia (n=64). Mean arterial pressure and immunoassay-based maternal plasma placental growth factor, soluble vascular endothelial growth factor receptor-1, and soluble endoglin concentrations were available throughout pregnancy (median of 5 observations per patient). A prior-risk model for preeclampsia was established by using Poisson regression based on maternal characteristics and obstetrical history. Next, multiple regression was used to fit biophysical and biochemical marker data as a function of maternal characteristics by using data collected at 8 to 15+6, 16 to 19+6, 20 to 23+6, 24 to 27+6, 28 to 31+6, and 32 to 36+6 week intervals, and observed values were converted into multiples of the mean values. Then, multivariable prediction models for preeclampsia were fit based on the biomarker multiples of the mean data and prior-risk estimates. Separate models were derived for overall, preterm, and term preeclampsia, which were evaluated by receiver operating characteristic curves and sensitivity at fixed false-positive rates. (1) The inclusion of soluble endoglin in prediction models for all preeclampsia, together with the prior-risk estimates, mean arterial pressure, placental growth factor, and soluble vascular endothelial growth factor receptor-1, increased the sensitivity (at a fixed false-positive rate of 10%) for early prediction of superimposed preeclampsia, with the largest increase (from 44% to 54%) noted at 20 to 23+6 weeks (McNemar test, P<.05); (2) combined evidence from prior-risk estimates and biomarkers predicted preterm preeclampsia with a sensitivity (false-positive rate, 10%) of 55%, 48%, 62%, 72%, and 84% at 8 to 15+6, 16 to 19+6, 20 to 23+6, 24 to 27+6, and 28 to 31+6 week intervals, respectively; (3) the sensitivity for term preeclampsia (false-positive rate, 10%) was 36%, 36%, 41%, 43%, 39%, and 51% at 8 to 15+6, 16 to 19+6, 20 to 23+6, 24 to 27+6, 28 to 31+6, and 32 to 36+6 week intervals, respectively; (4) the detection rate for superimposed preeclampsia among women with chronic hypertension was similar to that in women without chronic hypertension, especially earlier in pregnancy, reaching at most 54% at 20 to 23+6 weeks (false-positive rate, 10%); and (5) prediction models performed comparably to the Fetal Medicine Foundation calculators when the same maternal risk factors and biomarkers (mean arterial pressure, placental growth factor, and soluble vascular endothelial growth factor receptor-1 multiples of the mean values) were used as input. We introduced prediction models for preeclampsia throughout pregnancy. These models can be useful to identify women at risk during the first trimester who could benefit from aspirin treatment or later in pregnancy to inform patient management. Relative to prediction performance at 8 to 15+6 weeks, there was a substantial improvement in the detection rate for preterm and term preeclampsia by using data collected after 20 and 32 weeks' gestation, respectively. The inclusion of plasma soluble endoglin improves the early prediction of superimposed preeclampsia, which may be valuable when Doppler velocimetry of the uterine arteries is not available.

Cerebrovascular autoregulation and arterial carbon dioxide in patients with acute respiratory distress syndrome: a prospective observational cohort study

BackgroundEarly hypercapnia is common in patients with acute respiratory distress syndrome (ARDS) and is associated with increased mortality. Fluctuations of carbon dioxide have been associated with adverse neurological outcome in patients with severe respiratory failure requiring extracorporeal organ support. The aim of this study was to investigate whether early hypercapnia is associated with impaired cerebrovascular autoregulation during the acute phase of ARDS.MethodsBetween December 2018 and November 2019, patients who fulfilled the Berlin criteria for ARDS, were enrolled. Patients with a history of central nervous system disorders, cerebrovascular disease, chronic hypercapnia, or a life expectancy of less than 24 h were excluded from study participation. During the acute phase of ARDS, cerebrovascular autoregulation was measured over two time periods for at least 60 min. Based on the values of mean arterial blood pressure and near-infrared spectroscopy, a cerebral autoregulation index (COx) was calculated. The time with impaired cerebral autoregulation was calculated for each measurement and was compared between patients with and without early hypercapnia [defined as an arterial partial pressure of carbon dioxide (PaCO2) ≥ 50 mmHg with a corresponding arterial pH < 7.35 within the first 24 h of ARDS diagnosis].ResultsOf 66 patients included, 117 monitoring episodes were available. The mean age of the study population was 58.5 ± 16 years. 10 patients (15.2%) had mild, 28 (42.4%) moderate, and 28 (42.4%) severe ARDS. Nineteen patients (28.8%) required extracorporeal membrane oxygenation. Early hypercapnia was present in 39 patients (59.1%). Multivariable analysis did not show a significant association between early hypercapnia and impaired cerebrovascular autoregulation (B = 0.023 [95% CI − 0.054; 0.100], p = 0.556). Hypocapnia during the monitoring period was significantly associated with impaired cerebrovascular autoregulation [B = 0.155 (95% CI 0.014; 0.296), p = 0.032].ConclusionOur results suggest that moderate permissive hypercapnia during the acute phase of ARDS has no adverse effect on cerebrovascular autoregulation and may be tolerated to a certain extent to achieve low tidal volumes. In contrast, episodes of hypocapnia may compromise cerebral blood flow regulation.Trial registration ClinicalTrials.gov; registration number: NCT03949738; date of registration: May 14, 2019

Levosimendan Ameliorates Post-resuscitation Acute Intestinal Microcirculation Dysfunction Partly Independent of its Effects on Systemic Circulation: A Pilot Study on Cardiac Arrest in a Rat Model

Cardiac arrest (CA) is recognized as a life-threatening disease; however, the initial resuscitation success rate has increased due to advances in clinical treatment. Levosimendan has shown potential benefits in CA patients. However, its exact function on intestinal and systemic circulation in CA or post-cardiac arrest syndrome (PCAS) remained unclear. This study preliminarily investigated the link between dynamic changes in intestine and systemic hemodynamics post-resuscitation after levosimendan administration. Twenty-five rats were randomized into three groups: sham control group (n = 5), levosimendan group (n = 10), and vehicle group (n = 10). Intestinal microcirculation was observed using a sidestream dark-field imaging device at baseline and each hour of the return of spontaneous circulation (≤6 h). Systemic hemodynamics, serum indicators of cardiac injury, and tissue perfusion/metabolism were measured by echo-cardiography, a biological signal acquisition system, and an enzyme-linked immunosorbent assay, respectively. Myocardial injury and global and intestinal perfusion/metabolism were significantly improved by levosimendan treatment. There was no statistically significant difference in the mean arterial pressure values between the vehicle and levosimendan groups (P > 0.05). The intestinal and systemic circulation measurements showed poor correlation (Pearson r-value of variable combinations in the levosimendan group was much less than 0.75; P < 0.01, levosimendan vs. vehicle group). Levosimendan significantly reduced the cardiac injury and corrected the metabolic status in an experimental rat model of ventricular fibrillation induced CA and cardiopulmonary resuscitation. Levosimendan may ameliorate PCAS-induced intestinal microcirculation dysfunction, partly independent of its effects on macrocirculation.

Abstract P511: Optimal Blood Pressure Targets Following Successful Revascularization With Mechanical Thrombectomy

Background/Objective: Blood pressure parameters for patients undergoing mechanical thrombectomy (MT) are not clearly defined. Prior studies have shown that higher maximum and mean systolic blood pressure (SBP) is associated with adverse outcomes. Our study sought to investigate the relationship of blood pressure on clinical outcomes after successful revascularization and determine optimal thresholds for BP parameters that correlated with a poor functional outcome. Methods: This was a retrospective observational study of 88 consecutive patients who received successful MT at one comprehensive stroke center. Systolic, diastolic, and mean arterial pressure values were recorded for each patient over a 48-hour period, as well as patient age and National Institutes of Health Stroke Scale (NIHSS). Outcome measures included modified Rankin Score (mRS), intracranial hemorrhage (ICH), and mortality at time of discharge and 90 days. Both univariable and multivariable logistic regression analysis was performed to identify associations between the BP covariates and functional outcomes. Results: A higher SBP standard deviation (SD) of &gt;14mmHg (OR=1.150) and wider SBP range &gt;64mmHg (OR=1.037) from the mean in the first 48 hours after successful MT were associated with poor MRS at 90 days. A SBP SD&gt;14 was also associated with mortality at 90 days. A higher age (OR=1.052) and NIHSS (OR=1.096) were also associated with a poor MRS at 90 days. A higher DBP mean (OR=1.045) was associated with a higher rate of hemorrhagic transformation (HT). Conclusions: A higher SBP variability within the first 48 hours after successful MT is associated with a higher likelihood of poor 90-day functional outcome and mortality, and a higher mean DBP is associated with a higher rate of HT.

A Reproducible Intensive Care Unit-Oriented Endotoxin Model in Rats.

Sepsis and septic shock remain the leading cause of death in intensive care units. Despite significant improvements in sepsis management, mortality still ranges between 20 and 30%. Novel treatment approaches in order to reduce sepsis-related multiorgan failure and death are urgently needed. Robust animal models allow for one or multiple treatment approaches as well as for testing their effect on physiological and molecular parameters. In this article, a simple animal model is presented. First, general anesthesia is induced in animals either with the use of volatile or by intraperitoneal anesthesia. After placement of an intravenous catheter (tail vein), tracheostomy, and insertion of an intraarterial catheter (tail artery), mechanical ventilation is started. Baseline values of mean arterial blood pressure, arterial blood oxygen saturation, and heart rate are recorded. The injection of lipopolysaccharides (1 milligram/kilogram body weight) dissolved in phosphate-buffered saline induces a strong and reproducible inflammatory response via the toll-like receptor 4. Fluid corrections as well as the application of norepinephrine are performed based on well-established protocols. The animal model presented in this article is easy to learn and strongly oriented towards clinical sepsis treatment in an intensive care unit with sedation, mechanical ventilation, continuous blood pressure monitoring, and repetitive blood sampling. Also, the model is reliable, allowing for reproducible data with a limited number of animals in accordance with the 3R (reduce, replace, refine) principles of animal research. While animal experiments in sepsis research cannot easily replaced, repetitive measurements allow for a reduction of animals and keeping septic animals anesthetized diminishes suffering.

Do children with solitary or hypofunctioning kidney have the same prevalence for masked hypertension?

Having a low nephronnumber is a well-known risk factor for hypertension. There is an inverse relationship between the filtration surface area and systemic hypertension. A significant percentage of masked hypertension can be detected in children with nephron loss by ambulatory blood pressure monitoring (ABPM). We prospectively investigated ABPM results of children having reduced kidney mass with normal office blood pressures (BPs) and kidney function. Forty-three children with congenital solitary kidney (group 1), 11 children with acquired solitary kidney (group 2), and 76 children with hypofunctioning kidney (group 3) were compared with age, gender, and BMI-matched healthy control group (group 4). The dietary salt intake of 76 patients was evaluated as salt equivalent (g/day). The primary endpoint was change from baseline in mean 24-h ABPM variables and the proportion of patients with masked hypertension when assessed by ABPM. The masked hypertension ratio of all patients was 12.3% when assessed with ABPM. Night hypertension was significantly higher in all patient groups than in the control group (p = 0.01). Diastolic BP loads of groups 1 and 3 were higher than in controls (p = 0.024). Systolic BP loads were higher only in group 1 than in the control group (p = 0.003). The dietary salt equivalent of patients in group 1 correlated positively with 24-h SBP and mean arterial pressure (MAP) values. Patients with excessive dietary salt intake in group 1 had a significantly higher diastolic BP load than those without excessive salt intake in group 1 (p = 0.002). Masked hypertension can be seen in children with a solitary kidney or when one of the kidneys is hypofunctioning. Systolic BP loads are higher in children with congenital solitary kidney, and salt intake correlates with systolic BP profiles especially in those. Our results suggest that being born with a congenital solitary kidney increases predisposition to hypertension and salt sensitivity.

Target value of mean arterial pressure in patients undergoing continuous renal replacement therapy due to acute kidney injury

BackgroundAlthough patients undergoing continuous renal replacement therapy (CRRT) due to acute kidney injury (AKI) frequently have instability in mean arterial pressure (MAP), no consensus exists on the target value of MAP related to high mortality after CRRT.MethodsA total of 2,292 patients who underwent CRRT due to AKI in three referral hospitals were retrospectively reviewed. The MAPs were divided into tertiles, and the 3rd tertile group served as a reference in the analyses. The major outcome was all-cause mortality during the intensive care unit period. The odds ratio (OR) of mortality was calculated using logistic regression after adjustment for multiple covariates. The nonlinear relationship regression model was applied to determine the threshold value of MAP related to increasing mortality.ResultsThe mean value of MAP was 80.7 ± 17.3 mmHg at the time of CRRT initiation. The median intensive care unit stay was 5 days (interquartile range, 2–12 days), and during this time, 1,227 (55.5%) patients died. The 1st tertile group of MAP showed an elevated risk of mortality compared with the 3rd tertile group (adjusted OR, 1.28 [1.03–1.60]; P = 0.029). In the nonlinear regression analysis, the threshold value of MAP was calculated as 82.7 mmHg. Patients with MAP < 82.7 mmHg had a higher mortality rate than those with ≥ 82.7 mmHg (adjusted OR, 1.21 [1.01–1.45]; P = 0.037).ConclusionsLow MAP at CRRT initiation is associated with a high risk of mortality, particularly when it is < 82.7 mmHg. This value may be used for risk classification and as a potential therapeutic target.

Effect of Sufentanil Preemptive Analgesia on Anesthesia Recovery Period of Patients undergoing Thoracoscopic Surgery and Nursing Observation

We aim to investigate the effectiveness of intravenous injection of sufentanil before the induction of general anesthesia in patients undergoing thoracoscopic surgery to control pain in the postoperative recovery period and analyze its impact on the qualified rate of nursing and the occurrence of nursing adverse events. Selected 146 patients who underwent thoracoscopic surgery in our department from February 2018 to May 2020. 73 patients with intraoperative intravenous injection of sufentanil were selected as the experimental group and 73 patients with intraoperative intravenous injection of normal saline were selected as the control group. Compared both groups with visual analogue scales scores and Bruggrmann comfort scale scores at 30 min, 1 h, 2 h and 3 h after operation. At the same time, compared both groups with heart rate, blood oxygen saturation, mean arterial pressure and bispectral index values during the anesthesia recovery period and extubation and after extubation and qualified rate of nursing and its nursing adverse events. The heart rate, mean arterial pressure and bispectral index values of the two groups of patients at the time of extubation and 5 min after extubation were significantly different (p<0.05). Visual analogue scale scores and Bruggrmann comfort scale scores of both groups at 30 min, 1 h, 2 h and 3 h after surgery had significant differences (p<0.05). It had significant differences of both groups in the qualified rate of nursing and its adverse events (p<0.05), which were statistically significant. For patients undergoing thoracoscopic surgery, intravenous injection of sufentanil before general anesthesia can promote better postoperative pain. Sufentanil is considered as a potential auxiliary drug for preemptive analgesia, which is used to manage postoperative pain in short-term surgery and is worthy of clinical promotion.

Comparison of Effects of Extubation in Prone and Supine Positions in Patients Operated for Lumbar Disc Herniation.

To observe the effects of prone position extubation on respiratory side effects and hemodynamic parameters in patients who underwent lumbar spinal surgery. This prospective observational study included 60 patients extubated in either the prone (n=30) or supine (n=30) positions. Heart rate, noninvasive arterial blood pressure, peripheral oxygen saturation, train of four values, and bispectral index values were measured and recorded in all patients during operation and at the time of anesthetic agent discontinuation, before and after extubation. The Aldrete recovery score was recorded together with the severity of cough during emergence and recovery. Sore throat visual analog scale (VAS) score was recorded at the first and sixth hours after extubation. Incidents such as nausea, vomiting, respiratory failure, uncontrolled airway, and decreased saturation were also recorded. The number and severity of cough (p < 0.05) and sore throat VAS (p < 0.001) were lower in the prone group. Postextubation breath holding was more frequent in the supine group (p < 0.001). Aldrete recovery scores were higher in the prone group (p < 0.05). Heart rate and mean arterial pressure values were not significantly different in the prone group during the emergence and recovery period as compared with the supine group (p > 0.05). Extubation in the prone position after lumbar spinal surgery provides more comfortable emergence and recovery periods with less alteration of respiratory status and a better recovery profile.

Evaluation of Cardiopulmonary, Blood Gases and Clinical Effects of Dexmedetomidine-Ketamine and Midazolam-Ketamine Anesthesia in New Zealand White Rabbits

This study aimed to investigate the effects of dexmedetomidine-ketamine and midazolam-ketamine combinations on cardiopulmonary and clinical parameters in New Zealand white rabbits. The DXK group (n=8) received dexmedetomidine (50 µg/kg) and ketamine (20 mg/kg), and the MDK group (n=8) received midazolam (0.6 mg/kg) and ketamine (20 mg/kg) in the same syringe through the intramuscular (IM) route. Before anaesthesia and for 120 minutes, reflexes, haemodynamic values and blood gas changes were monitored. It was determined that anaesthesia was induced within a shorter time and lasted longer in DXK. The difference between the groups in terms of the time of loss of the pedal reflex (2.0 min in DXK, 7.5 min in MDK) was statistically significant (p&lt;0.05). It was observed that, in both groups, the heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR) and oxy-haemoglobin saturation (SpO2) values decreased, and the end-tidal CO2 (EtCO2) values increased, but these changes were greater in DXK. With regard to arterial blood gasses, a reduction in pH and pO2 and an increase in pCO2 were also more noticeable in DXK. Consequently, at the doses applied, dexmedetomidine-ketamine caused more noticeable changes in the haemodynamic values and blood gasses in comparison to midazolam-ketamine. High-dose dexmedetomidine (50 µg/kg) and low-dose ketamine (20 mg/kg) achieved induction in a shorter time but led to a significant reduction in RR. It was concluded that the combination of midazolam (0.6 mg/kg) and ketamine (20 mg/kg) could be regarded as appropriate for the anaesthesia of New Zealand white rabbits.

The effects of sevoflurane anesthesia on hemodynamics and cerebral artery diameters in endovascular treatment of intracranial aneurysm: A pilot study.

Cerebral autoregulation is a steady-state of cerebral blood flow despite major changes in arterial blood pressure. Inhalation anesthetics are cerebral vasodilators. In <1 MAC values, the net effect is a moderate decrease in cerebral blood flow and maintenance of responsiveness to carbon dioxide. This study aims to investigate the effects of steady-state sevoflurane anesthesia on hemodynamic and cerebral artery diameter measurements in patients undergoing flow diverter device placement under general anesthesia. Forty-six patients aged 18-70 years who underwent flow diverter devices under general anesthesia were included in this study. Routine monitoring was performed on the patients. Mean arterial pressure (MAP) values were recorded. Internal carotid artery, middle cerebral artery and anterior cerebral artery diameter measurements were made from digital subtraction angiography (DSA) images of patients with anterior aneurysms. Baseline artery, right posterior cerebral artery and left posterior cerebral artery diameter measurements were made from DSA images of patients with posterior aneurysms. These measurements were recorded as preoperative measurements. The same measurements were made from the DSA images performed before the Flow diverter device placement procedure performed under steady-state sevoflurane anesthesia for the same patients. These measurements were recorded as peroperative measurements. The average age of the patients was 56.6±15.1. The MAP of the patients before induction was 76.28±5.13 mmHg, MAP after induction was 64.36±3.23 mmHg, and MAP during sevoflurane anesthesia was 68.26±4.30 mmHg, there was a statistically significant difference. There was a statistically significant difference between the preoperative and perioperative values of anterior cerebral artery diameters. There was a strong relationship between the MAP change percentage and the ICA diameter change percentage (p<0.001, p=-0.785) and a moderate relationship between the MCA diameter change percentage (p=0.033, p=-0.338). In patients undergoing flow diverter devices, <1 MAC sevoflurane has a hemodynamic effect and creates significant vasodilation in the cerebral artery diameters.

Pediyatrik Kalp Cerrahisi Anestezisinde Remifentanil ve Fentanilin İntraoperatif Hemodinamik Etkilerinin Karşılaştırılması

Objective: The aim of this prospective observational study was to compare the hemodynamic effects of remifentanil and fentanyl, which are used as intraoperative analgesics in pediatric cardiac surgery. Methods: Patients were divided into two groups as those who received continuous intravenous remifentanil infusion (Group R) or intermittent intravenous fentanyl for intraoperative analgesia (Group F). These groups were compared in terms of hemodynamic characteristics and intraoperative complications. Results: The most common congenital cardiac pathology observed in the patients included in the study was ventricular septal defects (32%). Intraoperative complications occurred in 21 (40%) patients, and ventricular fibrillation was the most common complication (n=6; 11.5%). When the patients in both groups were compared in terms of intraoperative hemodynamic indicators, the mean arterial pressure values of the patients in Group R after sternotomy were significantly lower than those of the patients in Group F (p=0.034). No statistically significant difference was found between the two groups in terms of other hemodynamic indicators. When the two groups were compared in terms of intraoperative complications, the difference was not statistically significant although the number of patients with complications was higher in Group F (p=0.1). Conclusion: As a result of this study, it was found that remifentanil was as effective as fentanyl in maintaining intraoperative hemodynamic stability in patients undergoing pediatric cardiac surgery.

Comparative analysis of the effect of steroid therapy and blood pressure maintenance on the mid-term outcomes of spinal cord injury

Objective. To analyze the dynamics of neurological symptoms and the structure of complications when using methylprednisolone and the method of maintaining target values of mean arterial pressure during surgical treatment of patients in the acute period of spinal cord injury (SCI). Material and Methods. The study included 110 patients in the acute period of SCI with compression of spinal cord segments who were admitted to the clinic from January 2012 to March 2018 and underwent decompression and stabilization surgery within the first 2–3 hours after admission. In order to improve the blood supply to the damaged segments of the spinal cord and to prevent multiple organ failure, the main direction of intensive care in two groups of patients was to maintain the target blood pressure at the level of 85–90 mm Hg during the first 7–10 days. The MPD group included 43 patients who received methylprednisolone as a neuroprotector at a dose of 30 mg/kg bolus within the first hour after admission, followed by infusion at a dose of 5.4 mg/kg/h for 23 hours; and the MAP group included 67 patients who did not receive methylprednisolone. Non-invasive monitoring of central hemodynamic parameters was carried out on the basis of impedance cardiography data. The objective status of patients and data of X-ray diagnostics at the time of preoperative examination and during instrumental studies, as well as in 3–14 day intervals and in the mid-term (up to 4–6 months) postoperative period were analyzed. Results. In the MPD group, 22 patients had ASIA type A neurological deficit, and an increase in ASIA grade was observed only in 4 (18 %) of them. There were 18 patients with incomplete injury in this group, and 9 of them (50 %) had a positive trend. In the MAP group, 38 patients had ASIA type A, out of them 11 (29 %) improved, and 28 patients had ASIA type B, C or D, out of them 17 (61 %) showed positive dynamics of neurological symptoms. No statistically significant differences were found. In the MPD group, complications such as nosocomial pneumonia and acute endobronchitis were observed three times more often, pulmonary embolism and decubital soft tissue ulcers – four times more often, and sepsis, acute respiratory distress syndrome and surgical site infection – two times more often. There were statistically significant differences in the incidence of nosocomial pneumonia and acute endobronchitis between MPD and MAP groups (p = 0.004 and p = 0.002, respectively.) Conclusion. Maintaining mean arterial pressure at 85–90 mm Hg during the first 7–10 days after admission to the hospital allowed achieving a greater number of cases of improvement in the neurological status of patients, in contrast to the use of methylprednisolone. The use of methylprednisolone in patients with acute SCI increased the risk of nosocomial pneumonia or acute endobronchitis by 2.91 times (p = 0.003).