Cerebral desaturation events in the beach chair position: correlation of noninvasive blood pressure and estimated temporal mean arterial pressure

Background We examined the effects of different anesthetics on cerebral oxygenation and systemic hemodynamics in patients undergoing surgery in beach chair position (BCP). Jugular venous bulb oxygen saturation (SjvO2) and regional cerebral tissue oxygen saturation (SctO2) were determined while patients were placed from the supine to BCP. Whether SctO2 and SjvO2 are interchangeable in assessing the cerebral oxygenation was also examined. Methods Forty patients undergoing shoulder surgery in BCP were randomly assigned to receive sevoflurane-nitrous oxide (S/N) or propofol-remifentanil (P/R) anesthesia. Four patients taking angiotensin II receptor antagonists were excluded post hoc. Mean arterial pressure and heart rate, as well as SjvO2 and SctO2, were measured before (postinduction baseline in supine position) and after BCP. Results Mean arterial pressure decreased by BCP in both groups. It was, however, significantly higher in S/N (n = 19) than in P/R group (n = 17) at 7 to 8 min after the positioning. SjvO2 also significantly decreased after BCP in both groups, the magnitude of which was lower in S/N than in P/R group (11 ± 10% vs. 23 ± 9%, P = 0.0006). The incidences of SjvO2 <50% and mean arterial pressure less than 50 mmHg were lower in S/N group, but SctO2and the incidence of cerebral desaturation (more than 20% decrease from baseline) did not significantly differ between the groups. SctO2 and SjvO2 were only weakly correlated (β = 0.218, r2 = 0.133). Bland-Altman analysis showed a mean difference of -7.2% with 95% limit of agreement between -38.2% and 23.8%. Conclusions The margin of safety against impaired cerebral oxygenation is greater and SjvO2 is more preserved with S/N than with P/R anesthesia. SctO2 may not be reliable in detecting a low SjvO2 during the surgery in BCP.

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A PROSPECTIVE RANDOMISED STUDY TO ASSESS WHETHER PROPHYLACTIC ATROPINE ADMINISTRATION ATTENUATES THE NEGATIVE HAEMODYNAMIC EFFECTS OF INDUCTION OF ANAESTHESIA WITH PROPOFOL AND FENTANYL

10.36106/gjra/1501207 ◽

2021 ◽

pp. 36-38

Author(s):

S.Dinesh Kumar ◽

S. Kanthammal

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

General Anaesthesia ◽

Haemodynamic Effects ◽

Noninvasive Blood Pressure ◽

Randomised Study ◽

Vasoactive Medication ◽

Increasing Trend

INTRODUCTION: To provide optimal surgical conditions safely and to avoid particular complications, balanced general anaesthesia by administering a combination of propofol and fentanyl as analgesics. This type of balanced anaesthesia often induces unwanted bradycardia and hypotension, raising concerns regarding haemodynamic stability and tissue oxygenation. It is possible that atropine could replace the common clinical practice of administering vasoactive medication such as phenylephrine or norepinephrine to maintain mean arterial pressure (MAP) levels. AIM OF THE STUDY: To study the effect of atropine in suppressing the negative haemodynamic effects of induction agents- propofol and fentanyl in patients receiving general anaesthesia. MATERIALS AND METHODS: This is a prospective randomised interventional study carried out in Department of Anaesthesiology in Kanyakumari Government Medical College from January 2018 to June 2019. Patients were allocated into two groups (25 patients each) by randomization. After preoxygenation Group A: Patient receives Atropine. Patient in Group S: Receives Saline. BMI, Height, weight, Heart rate, Noninvasive blood pressure, Mean arterial pressure were recorded for every minute for 15 minutes. RESULTS: The demographic parameters like age, height, weight and BMI were similar in both groups. Comparing the SBP of both group, at base and 1 minute the difference of SBP was small. After that, the SBP was increasing trend in Atropine subjects and SBP was decreasing trend in saline subjects (P<0.001). Comparing the DBP between the two groups, Base and 1 minutes, the DBP of both groups were not differed signicantly (P>0.05),after that the DBP of Atropine group DBP was increasing trend and the DBP of saline group was decreasing trend (P<0.001). The HR of the both groups were increasing and decreasing accordingly (P<0.001). Comparing the MAP of both groups at base through 15 minutes,MAP of both group at 1minute was not differed signicantly (P>0.05),after that the MAP of Atropine subjects were increasing and Saline subjects were decreasing trend P<0.001). Percentage of fall of parameters (SBP, DBP, HR, and MAP) was more signicant at 5 and 15 mins compared to 10 mins in both th group. This may be due to the intubation response after the 5 minute of induction. All values were signicant with P<0.001. CONCLUSION: Administration of atropine before Propofol and Fentanyl induction during general anaesthesia can signicantly attenuate the fall in Systolic Blood Pressure, Diastolic Blood Pressure, Heart Rate and Mean Arterial Pressure.

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CHARACTERISTICS OF 24-HOUR BLOOD PRESSURE INDICATORS IN PATIENTS WITH HYPERTENSION AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Ulyanovsk Medico-biological Journal ◽

10.34014/2227-1848-2020-1-31-41 ◽

2020 ◽

pp. 31-41

Author(s):

M.A. Bubnova ◽

O.N. Kryuchkova

Keyword(s):

Blood Pressure ◽

Chronic Obstructive Pulmonary Disease ◽

Mean Arterial Pressure ◽

High Risk ◽

Arterial Pressure ◽

Pulmonary Disease ◽

Comparison Group ◽

Cardiovascular Complications ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease

Patients with hypertension (HT) and chronic obstructive pulmonary disease (COPD) have a high risk of cardiovascular complications. Up to now, there is no optimal strategy for combined antihypertensive therapy. Still, the data of 24-hour blood pressure monitoring (BPM) are important while choosing treatment tactics. The aim of the paper is to study the features of indicators in patients with arterial hypertension (AH) and COPD. Materials and methods. 130 patients with HT were included in the study. The main group (n=90) included comorbid patients with HT and COPD, their average age was 61.30±1.01; the comparison group (n=40) consisted of patients with HT, their average age was 59.10±1.53. All patients underwent 24-hour BPM. Results. Comorbid patients revealed an increase in the mean 24-hour and night systolic and mean arterial pressure values as well as a significant increase in the load index of systolic, diastolic and mean arterial pressure. Also, comorbid patients demonstrated higher blood pressure in contrast to the patients of the comparison group. They had increased systolic, diastolic and mean blood pressure variability and a quicker rate of morning blood pressure rise. According to 24-hour blood pressure dynamics, pathological types of the 24-hour blood pressure curve, a higher frequency of the night-peaker profile dominated in patients with COPD if compared to patients with HT. Conclusion. The obtained data indicated a high risk of cardiovascular complications in comorbid patients, early target organ damage and an unfavorable disease prognosis. It means that both further study of hypertension clinical course in such patients and personalization of antihypertensive therapy are relevant. Keywords: hypertension, chronic obstructive pulmonary disease, 24-hour monitoring, blood pressure. Пациенты с артериальной гипертензией (АГ) и хронической обструктивной болезнью легких (ХОБЛ) имеют высокий риск возникновения кардиоваскулярных осложнений. В настоящее время в лечении не определена наиболее оптимальная стратегия комбинированной антигипертензивной терапии. Для выбора тактики терапии важную роль играют показатели суточного мониторирования артериального давления (СМАД). Цель. Изучить особенности показателей СМАД у пациентов с АГ на фоне ХОБЛ. Материалы и методы. В исследование включено 130 пациентов с АГ. В основную группу (n=90) вошли пациенты с АГ и ХОБЛ (средний возраст – 61,30±1,01 года), в группу сравнения (n=40) – больные только АГ (средний возраст – 59,10±1,53 года). Всем пациентам проведено СМАД. Результаты. У пациентов с коморбидностью выявлены следующие особенности суточных показателей артериального давления: увеличение значений среднесуточных и средненочных показателей систолического и среднего артериального давления; существенное повышение индекса нагрузки систолическим, диастолическим и средним артериальным давлением. Также эти больные отличались от пациентов группы сравнения более высокими значениями пульсового давления, имели повышенную вариабельность систолического, диастолического и среднего артериального давления, у них наблюдалось увеличение скорости утреннего подъема артериального давления. Суточная динамика артериального давления у пациентов с ХОБЛ характеризовалась преобладанием патологических типов суточной кривой АД, более высокой частотой профиля night-peaker по сравнению с больными только АГ. Выводы. Выявленные особенности свидетельствуют о высоком риске сердечно-сосудистых осложнений у пациентов с коморбидностью, раннем поражении органов-мишеней и неблагоприятном прогнозе заболевания, что требует дальнейшего изучения особенностей клинического течения АГ у таких больных и индивидуализации антигипертензивной терапии. Ключевые слова: артериальная гипертензия, хроническая обструктивная болезнь легких, суточное мониторирование, артериальное давление.

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Plasticity in breathing and arterial blood pressure following acute intermittent hypercapnic hypoxia in infant rat pups with a partial loss of 5-HT neurons

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.00241.2015 ◽

2015 ◽

Vol 309 (10) ◽

pp. R1273-R1284 ◽

Cited By ~ 3

Author(s):

Jennifer Magnusson ◽

Kevin J. Cummings

Keyword(s):

Blood Pressure ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Arterial Blood Pressure ◽

Cardiovascular Responses ◽

Partial Loss ◽

Rat Pups ◽

Arterial Blood ◽

Hypercapnic Hypoxia ◽

Long Term Facilitation

The role of serotonin (5-HT) neurons in cardiovascular responses to acute intermittent hypoxia (AIH) has not been studied in the neonatal period. We hypothesized that a partial loss of 5-HT neurons would reduce arterial blood pressure (BP) at rest, increase the fall in BP during hypoxia, and reduce the long-term facilitation of breathing (vLTF) and BP following AIH. We exposed 2-wk-old, 5,7-dihydroxytryptamine-treated and controls to AIH (10% O2; n = 13 control, 14 treated), acute intermittent hypercapnia (5% CO2; n = 12 and 11), or acute intermittent hypercapnic hypoxia (AIHH; 10% O2, 5% CO2; n = 15 and 17). We gave five 5-min challenges of AIH and acute intermittent hypercapnia, and twenty ∼20-s challenges of AIHH to mimic sleep apnea. Systolic BP (sBP), diastolic BP, mean arterial pressure, heart rate (HR), ventilation (V̇e), and metabolic rate (V̇o2) were continuously monitored. 5,7-Dihydroxytryptamine induced an ∼35% loss of 5-HT neurons from the medullary raphe. Compared with controls, pups deficient in 5-HT neurons had reduced resting sBP (∼6 mmHg), mean arterial pressure (∼5 mmHg), and HR (56 beats/min), and experienced a reduced drop in BP during hypoxia. AIHH induced vLTF in both groups, reflected in increased V̇e and V̇e/V̇o2, and decreased arterial Pco2. The sBP of pups deficient in 5-HT neurons, but not controls, was increased 1 h following AIHH. Our data suggest that a relatively small loss of 5-HT neurons compromises resting BP and HR, but has no influence on ventilatory plasticity induced by AIHH. AIHH may be useful for reversing cardiorespiratory defects related to partial 5-HT system dysfunction.

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Investigation of Cerebral Desaturation Events during Shoulder Arthroscopy in the Beach Chair Position

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2012.12.014 ◽

2013 ◽

Vol 22 (4) ◽

pp. e30

Author(s):

Dane H. Salazar ◽

Benjamin W. Sears ◽

Pietro M. Tonino ◽

Guido Marra

Keyword(s):

Shoulder Arthroscopy ◽

Beach Chair Position ◽

Cerebral Desaturation ◽

Beach Chair

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Hypotensive and Regional Haemodynamic Effects of Exercise, Fasted and after Food, in Human Sympathetic Denervation

Clinical Science ◽

10.1042/cs0940049 ◽

1998 ◽

Vol 94 (1) ◽

pp. 49-55 ◽

Cited By ~ 11

Author(s):

Sharmini Puvi-Rajasingham ◽

Gareth D. P. Smith ◽

Adeola Akinola ◽

Christopher J. Mathias

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Superior Mesenteric Artery ◽

Vascular Resistance ◽

Mesenteric Artery ◽

Autonomic Failure ◽

Sympathetic Denervation ◽

Stroke Distance

1. In human sympathetic denervation due to primary autonomic failure, food and exercise in combination may produce a cumulative blood pressure lowering effect due to simultaneous splanchnic and skeletal muscle dilatation unopposed by corrective cardiovascular reflexes. We studied 12 patients with autonomic failure during and after 9 min of supine exercise, when fasted and after a liquid meal. Standing blood pressure was also measured before and after exercise. 2. When fasted, blood pressure fell during exercise from 162 ± 7/92 ± 4 to 129 ± 9/70 ± 5 mmHg (mean arterial pressure by 22 ± 5%), P < 0.0005. After the meal, blood pressure fell from 159 ± 8/88 ± 6 to 129 ± 6/70 ± 4 mmHg (mean arterial pressure by 22 ± 3%), P < 0.0001, and further during exercise to 123 ± 6/61 ± 3 mmHg (mean arterial pressure by 9 ± 3%), P < 0.01. The stroke distance—heart rate product, an index of cardiac output, did not change after the meal. During exercise, changes in the stroke distance—heart rate product were greater when fasted. 3. Resting forearm and calf vascular resistance were higher when fasted. Calf vascular resistance fell further after exercise when fasted. Resting superior mesenteric artery vascular resistance was lower when fed; 0.19 ± 0.02 compared with 032 ± 0.06, P < 0.05. After exercise, superior mesenteric artery vascular resistance had risen by 82%, to 0.53 ± 0.12, P < 0.05 (fasted) and by 47%, to 0.29 ± 0.05, P < 0.05 (fed). 4. On standing, absolute levels of blood pressure were higher when fasted [83 ± 7/52 ± 7 compared with 71 ± 2/41 ± 3 (fed), each P < 0.05]. Subjects were more symptomatic on standing post-exercise when fed. 5. In human sympathetic denervation, exercise in the fed state lowered blood pressure further than when fasted and worsened symptoms of postural hypotension.

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Increased vascular resistance in paralyzed legs after spinal cord injury is reversible by training

Journal of Applied Physiology ◽

10.1152/japplphysiol.00897.2001 ◽

2002 ◽

Vol 93 (6) ◽

pp. 1966-1972 ◽

Cited By ~ 64

Author(s):

Maria T. E. Hopman ◽

Jan T. Groothuis ◽

Marcel Flendrie ◽

Karin H. L. Gerrits ◽

Sibrand Houtman

Keyword(s):

Blood Pressure ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Blood Flow ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Vascular Resistance ◽

Arterial Blood Flow ◽

Arterial Blood ◽

Cord Injury

The purpose of the present study was to determine the effect of a spinal cord injury (SCI) on resting vascular resistance in paralyzed legs in humans. To accomplish this goal, we measured blood pressure and resting flow above and below the lesion (by using venous occlusion plethysmography) in 11 patients with SCI and in 10 healthy controls (C). Relative vascular resistance was calculated as mean arterial pressure in millimeters of mercury divided by the arterial blood flow in milliliters per minute per 100 milliliters of tissue. Arterial blood flow in the sympathetically deprived and paralyzed legs of SCI was significantly lower than leg blood flow in C. Because mean arterial pressure showed no differences between both groups, leg vascular resistance in SCI was significantly higher than in C. Within the SCI group, arterial blood flow was significantly higher and vascular resistance significantly lower in the arms than in the legs. To distinguish between the effect of loss of central neural control vs. deconditioning, a group of nine SCI patients was trained for 6 wk and showed a 30% increase in leg blood flow with unchanged blood pressure levels, indicating a marked reduction in vascular resistance. In conclusion, vascular resistance is increased in the paralyzed legs of individuals with SCI and is reversible by training.

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EFFECT OF ORAL MOXONIDINE IN THE ATTENUATION OF THE HAEMODYNAMIC RESPONSES SEEN DURING LAPAROSCOPIC SURGERIES

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2017.v10i3.16383 ◽

2017 ◽

Vol 10 (3) ◽

pp. 409

Author(s):

Sidharth Sraban Routray ◽

Ramakanta Mohanty

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Placebo Group ◽

Stress Response ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Significant Rise ◽

Hemodynamic Stability ◽

Blinded Study ◽

Double Blinded

ABSTRACTObjective: During laparoscopic surgeries, pneumoperitoneum can lead to various pathophysiologic changes in the cardiovascular system resulting inhypertension and tachycardia. Search for ideal drug to prevent this hemodynamic response goes on. The aim of our study was to evaluate the effect oforally administered moxonidine in attenuating the hemodynamic responses that occur during the laparoscopic surgeries.Methods: A total of 50 adult acetylsalicylic acid I and II patients scheduled for elective laparoscopic surgeries were selected for this prospectiverandomized double-blinded study. They were randomly allocated into two groups: moxonidine group (M) and placebo group (P). M group receivedoral moxonidine 0.3 mg at 8 pm on the day before surgery and at 8 am on the day of surgery. P group received a placebo at the same timing as that ofthe M group.Results: Following pneumoperitoneum rise in systolic blood pressure (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and heart rate (HR)was higher in P group in comparison to M group which was statistically significant.Conclusion: Significant rise in HR, SBP, DBP, and mean BP was noted in the P group in comparison to moxonidine group. Moxonidine provided betterperioperative hemodynamic stability in patients undergoing laparoscopic surgeries.Keywords: Moxonidine, Stress response, Laparoscopic.

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