Prophylactic use of intravenous tramadol vs intravenous nalbuphine for control of postspinal shivering after knee arthroscopy: a randomized double-blind placebo controlled trial

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A M Fahmy ◽  
I M Esmat ◽  
T Shabana ◽  
M S M Etman
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Knee Arthroscopy ◽  
Controlled Trial ◽  
Saline Group ◽  
Plasma Catecholamine ◽  
University Hospitals ◽  
Double Blind ◽  
Significant Difference ◽  
Plasma Catecholamine Concentrations

Abstract Background Post-anesthetic shivering refers to spontaneous, involuntary, rhythmic, oscillating and tremor-like muscle hyperactivity that increases metabolic heat production up to 600% after general or regional anesthesia. Shivering is not only subjectively unpleasant but is physiologically stressful because it elevates blood pressure, heart rate, oxygen consumption, and plasma catecholamine concentrations. Moreover, shivering may aggravate pain and hinder wound closure by simply stretching surgical incisions. Objective The aim of this work is to compare the efficacy of intravenous tramadol VS nalbuphine for prevention of post spinal shivering during knee arthroscopy. Methods This prospective randomized double blinded study was carried in Ain Shams University hospitals on 90 patients scheduled for knee arthroscopy. Patients were randomized into three groups 30 patients each: Group C: patients received normal saline 0.9%) intravenously. Group T: Patients received Tramadol 0.5 mg/kg intravenously. Group N: Patients received nalbuphine 0.1mg/kg intravenously. All drugs were given immediately after intra thecal injection of the anaesthetic drugs and returning to the supine position. Results The study revealed that the incidence of shivering was less in the tramadol (23.3%) and nalbuphine (26.7%) groups compared to the saline group (56.7%) (P < 0.05) with no significant difference between Nalbuphine and Tramadol groups (p > 0.05). The mean grade of shivering was comparable between the three groups (P > 0.05). Shivering onset was significantly earlier in the saline group (24.1±2.9 min) compared to Nalbuphine (32.3±4.9min) and Tramadol (36.4±4.3min) groups (P < 0.05) with no significant difference between Nalbuphine and Tramadol groups (p > 0.05). There were no significant differences among the three groups as regards hemodynamics (Heart rate and mean blood pressure), respiratory rate, oxygen saturations, body temperature, the incidence of nausea or vomiting (P > 0.05). While sedation grade was significantly highest in Nalbuphine group followed by Tramadol group and least in Saline group (P < 0.001). Conclusion The current study revealed that both tramadol 0.5mg/kg and balbuphine 0.1mg/kg was effective in prevention of post spinal shivering in patients undergoing knee arthroscopy.

scholarly journals Effects of 12-Week Supplementation of a Polyherbal Formulation in Old Adults with Prehypertension/Hypertension: A Randomized, Double-Blind, Placebo-Controlled Trial

2019 ◽  
Vol 2019 ◽  
pp. 1-15 ◽  
Author(s):  
Tian Shen ◽  
Guoqiang Xing ◽  
Jingfen Zhu ◽  
Yong Cai ◽  
Shuxian Zhang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Placebo Group ◽  
Controlled Trial ◽  
Adult Population ◽  
Chest Tightness ◽  
Double Blind ◽  
Old Adults ◽  
Severity Scores ◽  
Rapid Heart Rate

Background. Uncontrolled blood pressure is the leading cause of mortality and disability due to associated cerebral and cardiovascular diseases and kidney failure. More than one-third of the old adult population have hypertension or prehypertension and many of their blood pressure are poorly controlled. Objective. We hypothesized that plant extracts-based antioxidants may benefit those with prehypertension/hypertension. Method. One hundred age- and gender-matched healthy older adults were randomly assigned to receive HyperBalance capsules (n=50) or placebo (n=50) at Tang-Qiao Community Health Service Center, Shanghai. Blood pressure and severity scores of hypertension treatment-related symptoms (dizziness, headache, ringing/buzzing in ears, rapid heart rate, and chest tightness) were evaluated before and after the 12-week intervention. Results. Ninety-eight people completed the study, with 2 dropouts in the placebo group before the end of the study. Forty-one subjects (82%) of the HyperBalance group and 40 subjects (83.3%) of the placebo group had prehypertension (systolic blood pressures (SBP) between 130-139 and diastolic blood pressure (DBP) between 85-89mmHg), and 9 subjects (18%) in the HyperBalance group and 8 subjects (16.7%) in the placebo group had hypertension (≥140/90mmHg) before the intervention. HyperBalance significantly (P<0.01) reduced SBP from 136.18±4.38 to 124.14±3.96 mmHg and reduced DBP from 82.45±2.91 to 80.24±2.41mmHg, respectively, and reversed all 9 hypertension people to normotension or prehypertension state, whereas the placebo moderately reduced SBP from 135.79±4.22 to 132.35±4.656mmHg and reduced DBP from 82.90±3.07 to 82.27±3.01mmHg. All symptom severity scores became significantly lower in the HyperBalance group than in the placebo group after HyperBalance intervention: dizziness (0.82±0.44; vs 2.02±0.64, P<0.01); headache (0.46±0.50; vs 1.81±0.61, P<0.01); ringing/buzzing in ears (0.44±0.50; vs 1.04±0.29, P<0.01); and rapid heart rate and chest tightness (0.30±0.46; vs 0.92±0.28, P<0.01). Conclusion. Polyherbal supplementation such as HyperBalance could benefit old adults with prehypertension/hypertension and improve treatment-related symptoms. Further studies are needed to validate the current findings.

Effect of Evening Bromazepam Administration on Blood Pressure and Heart Rate in Mild Hypertensive Patients

Pharmacology ◽  
2019 ◽  
Vol 104 (1-2) ◽  
pp. 1-6
Author(s):  
Alfredo Costa ◽  
Daniele Bosone ◽  
Matteo Cotta Ramusino ◽  
Giulia Perini ◽  
Natascia Ghiotto ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Ambulatory Monitoring ◽  
Night Time ◽  
Double Blind ◽  
Hypertensive Patients ◽  
Treatment Groups ◽  
Significant Difference ◽  
Nocturnal Increase ◽  
Mild Hypertensive

Aim: To assess the effects of chronic evening oral administration of bromazepam alone or in combination with propranolol on ambulatory blood pressure (BP) and heart rate (HR) in mild hypertensive subjects. Methods: Thirty-seven mild hypertensive patients after a 2-week placebo period were randomized to bromazepam 3 mg, propranolol 40 mg, bromazepam 3 mg plus propranolol 40 mg or placebo for 2 weeks according to a double-blind, double dummy, cross-over design. After each treatment period, 24-h BP and HR ambulatory monitoring was performed by using a non-invasive device. Results: Ambulatory monitoring showed that during night-time SBP and DBP values were unaffected by bromazepam as compared to placebo, whereas SBP was significantly reduced by propranolol both when taken alone and in combination with bromazepam. HR nocturnal values were significantly reduced by propranolol, whereas they were significantly increased by bromazepan both when taken alone (+11.5%, p < 0.05 vs. placebo) and in combination with propranolol (+12.8%, p < 0.05 vs. propranolol). No significant difference in day-time values of SBP, DBP and HR was observed among the 4 treatment groups. Conclusions: In mild hypertensive patients, evening consumption of bromazepam for a 2-week period did not affect BP, while it increased nocturnal HR. Such an increase was observed both when bromazepam was taken alone and in combination with propranolol, which suggests that it depends on a bromazepam mediated decrease in vagal tone. Whatever the mechanism, the HR nocturnal increase might be of clinical relevance, due to the role of high HR as cardiovascular risk factor, particularly in already at risk hypertensive subjects.

Pentobarbital effects on plasma catecholamines: temperature, heart rate, and blood pressure

1985 ◽  
Vol 248 (1) ◽  
pp. E95-E100 ◽  
Author(s):  
D. Baum ◽  
J. B. Halter ◽  
G. J. Taborsky ◽  
D. Porte
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Nervous System ◽  
Animal Models ◽  
Sympathetic Nervous System ◽  
Rectal Temperature ◽  
Plasma Catecholamines ◽  
Plasma Catecholamine ◽  
Sympathetic Nervous ◽  
Plasma Catecholamine Concentrations

The effects of intravenous pentobarbital were studied in dogs. Plasma pentobarbital concentrations were inversely related to epinephrine and norepinephrine concentrations. Plasma catecholamines appeared fully suppressed at pentobarbital levels greater than 25-30 micrograms/ml. Furthermore, pentobarbital levels were negatively related to rectal temperature, heart rate, and mean blood pressure. The methods of pentobarbital administration influenced plasma pentobarbital as well as epinephrine and norepinephrine levels, temperature, heart rate, and blood pressure. These observations suggest the possibility that pentobarbital inhibits the sympathetic nervous system, which in turn may affect temperature, heart rate, and blood pressure. Because pentobarbital anesthesia affects plasma catecholamine concentrations, the regimen used in animal models requires consideration when interpreting data potentially influenced by the sympathetic nervous system.

scholarly journals Comparison the Sedation Effect and Satisfaction of Two Combinations, Dexmedetomidine and Fentanyl with Midazolam and Fentanyl, in Patients Undergoing Bronchoscopy

2021 ◽  
Vol 6 (6) ◽  
Author(s):  
Alireza Kamali ◽  
Sepideh Sarkhosh ◽  
Hosein Kazemizadeh
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Oxygen Saturation ◽  
Statistical Tests ◽  
Arterial Oxygen Saturation ◽  
Mean Blood Pressure ◽  
Arterial Oxygen ◽  
P Value ◽  
Double Blind ◽  
Significant Difference

Objectives: The aim of this study was to compare sedative effects of dexmedetomidine and fentanyl with midazolam and fentanyl in patients undergoing bronchoscopy. Methods: This study was a double-blind randomized clinical trial that was performed on 92 patients who referred to Amir al Momenin Hospital in Arak for bronchoscopy and underwent ASA 1 or 2 underlying grading procedure. Patients were randomly divided into two groups of dexmedetomidine and fentanyl (D) midazolam and fentanyl (M). Primary vital signs including hypertension and arterial oxygen saturation were monitored and recorded. Then all patients were injected with 2 μg / kg fentanyl as a painkiller and after 3 minutes 30 μg dexmedetomidine in syringe with code A and midazolam 3 mg in syringe with code B were injected to patients by an anesthesiologist. Then the two groups were compared in terms of pain at injection, conscious relaxation, satisfaction of operation, recovery time, hypotension and arterial oxygen saturation and drug side effects and data were analyzed by using statistical tests. Results: There was no significant difference between the two groups in terms of mean age and sex distribution. According to the results of this study, there was no significant difference between the two groups in mean blood pressure (P-value = 0.6) and mean heart rate (P-value = 0.4) at the time of bronchoscopy, but at 5 and 10 minutes after bronchoscopy there was a significant difference, mean blood pressure and heart rate were significantly lower in dexmedetomidine group. Conclusion: Both dexmedetomidine and midazolam drug groups contributed to the development of stable and sedative hemodynamics and satisfaction in patients undergoing bronchoscopy, however, the dexmedetomidine and fentanyl group showed a significant decrease in blood pressure and heart rate compared to midazolam and fentanyl and a weaker decrease in arterial oxygen saturation, and patients with bronchoscopy were more satisfied in the dexmedetomidine group.

Use of antihypertension agents for the suppression of arterial pulse pressure waveforms in patients with intracranial aneurysms

2006 ◽  
Vol 104 (4) ◽  
pp. 531-536 ◽  
Author(s):  
Carole L. Turner ◽  
Ian B. Wilkinson ◽  
Peter J. Kirkpatrick
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Pulse Pressure ◽  
Intracranial Aneurysms ◽  
Augmentation Index ◽  
Isosorbide Mononitrate ◽  
Double Blind ◽  
Arterial Blood ◽  
Unruptured Intracranial Aneurysms ◽  
Significant Difference

Object Patients with intracranial aneurysms tend toward raised blood pressure and abnormal pulse pressure profiles. The authors have investigated the influence of three antihypertension agents on blood pressure and pulse pressure waveforms in patients with known intracranial aneurysms, with a view to assessing the potential benefits of longterm antihypertension therapy on the progression of unruptured intracranial aneurysms. Methods Nineteen patients with a mean age of 56 years (range 38–76 years) were recruited for this study. All patients had confirmed intracranial aneurysms. A double-blind, randomized, crossover study was performed using perindopril, irbesartan, isosorbide mononitrate, and a placebo. Blood pressure and pulse pressure waveforms were assessed at the end of each 4-week treatment period. Perindopril and irbesartan were well tolerated. For all measured parameters except heart rate (p = 0.03), no significant difference between baseline and placebo was identified. Each drug when compared with placebo reduced peripheral arterial blood pressure. Perindopril significantly decreased mean blood pressure by 10 mm Hg (p = 0.004), irbesartan by 9 mm Hg (p = 0.004), and isosorbide mononitrate by 13 mm Hg (p = 0.005). The administration of each drug effected a significant reduction in the carotid artery augmentation index (AIX) compared with baseline values (perindopril p = 0.01, irbesartan p = 0.0002, and isosorbide mononitrate p = 0.03). There was also a significant difference in the AIX between irbesartan and the placebo (p = 0.05). Compared with the placebo, there was a significant difference in AIX (adjusted for heart rate) following the administration of irbesartan (p = 0.003) and isosorbide mononitrate (p = 0.01), but not with perindopril (p = 0.17). Conclusions Irbesartan appears to be the most effective treatment for the combined suppression of blood pressure and AIX in patients with intracranial aneurysms and has a high degree of patient tolerance.

scholarly journals Hemodynamic response in laparoscopic cholecystectomy after magnesium sulphate versus clonidine administration

2018 ◽  
Vol 6 (10) ◽  
pp. 3239
Author(s):  
Vijaya P. Borkar Patil ◽  
Mayuri Ganeshrao Tambakhe ◽  
Sunil Shankarrao Lawhale ◽  
Jayshree J. Upadhye
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Magnesium Sulfate ◽  
Magnesium Sulphate ◽  
Hemodynamic Response ◽  
Double Blind Study ◽  
Double Blind ◽  
Vasopressin Release ◽  
Significant Difference ◽  
The Mean

Background: Magnesium and clonidine both inhibit catecholamine and vasopressin release. They also attenuate hemodynamic response to pneumoperitoneum.Methods: This randomized double-blind study was designed to assess which agent attenuates hemodynamic stress response to pneumoperitoneum better in 70 patients undergoing laparoscopic cholecystectomy.Results: After the administration of drug, heart rate in group M was mean 84.29 while in group C was mean 79.89. Thus, there was more fall in Heart rate in C group. After intubation, heart rate at 1min, 3 min, 5 min was 101.20, 96.69, 93.94 respectively in group M and in C group was 96.37, 85.83, 86.17 respectively with p values (0.12, 0.001, 0.008). After giving drug, there was fall in blood pressure in both groups but in C group, there was significant fall in systolic blood pressure. There was no significant difference in the mean diastolic BP in both the groups immediately at intubation (76.17±10.74 for group M and 78.86±10.48 for group C with p>0.05) as also at 3 min (63.29±8.76 for M group and 65.14±11.705 for clonidine with p>0.05) and 5 min (63.03±7.909 for magnesium sulphate and 67.69±13.588 for clonidine with p>0.05) following intubation. Thus, the rise in mean diastolic BP was statistically similar in both Group M and Group C. There was no significant difference in the mean for MAP in both the groups immediately at intubation (88.86±12.76 for magnesium sulphate and 91.74±11.59 for clonidine) as also at 3 min (73.17±10.019 for M and 75.80±12.849 for C group. But at 5 min (71.71±9.11 for magnesium sulphate and 77.66±13.715 for clonidine) following intubation with p<0.05 which is significant.Conclusions: Administration of magnesium sulfate or clonidine attenuates hemodynamic response to pneumoperitoneum. Although magnesium sulfate produces hemodynamic stability comparable to clonidine, clonidine blunts the hemodynamic response to pneumoperitoneum more effectively.

Dexmedetomidine Does Not Alter the Sweating Threshold, But Comparably and Linearly Decreases the Vasoconstriction and Shivering Thresholds 

1997 ◽  
Vol 87 (4) ◽  
pp. 835-841 ◽  
Author(s):  
Pekka Talke ◽  
Farzin Tayefeh ◽  
Daniel I. Sessler ◽  
Renee Jeffrey ◽  
Mojtaba Noursalehi ◽  
...  
Keyword(s):  
Heart Rate ◽  
Study Drug ◽  
Hospital Environment ◽  
Plasma Catecholamine ◽  
Double Blind ◽  
Arterial Blood ◽  
Blood Pressures ◽  
Plasma Catecholamine Concentrations ◽  
Sweating Threshold ◽  
Dose Dependent

Background Clonidine decreases the vasoconstriction and shivering thresholds. It thus seems likely that the alpha2 agonist dexmedetomidine will also impair control of body temperature. Accordingly, the authors evaluated the dose-dependent effects of dexmedetomidine on the sweating, vasoconstriction, and shivering thresholds. They also measured the effects of dexmedetomidine on heart rate, blood pressures, and plasma catecholamine concentrations. Methods Nine male volunteers participated in this randomized, double-blind, cross-over protocol. The study drug was administered by computer-controlled infusion, targeting plasma dexmedetomidine concentrations of 0.0, 0.3, and 0.6 ng/ml. Each day, skin and core temperatures were increased to provoke sweating and then subsequently reduced to elicit vasoconstriction and shivering. Core-temperature thresholds were computed using established linear cutaneous contributions to control of sweating, vasoconstriction, and shivering. The dose-dependent effects of dexmedetomidine on thermoregulatory response thresholds were then determined using linear regression. Heart rate, arterial blood pressures, and plasma catecholamine concentrations were determined at baseline and at each threshold. Results Neither dexmedetomidine concentration increased the sweating threshold from control values. In contrast, dexmedetomidine administration reduced the vasoconstriction threshold by 1.61 +/- 0.80 degrees C x ng(-1) x ml (mean +/- SD) and the shivering threshold by 2.40 +/- 0.90 degrees C x ng(-1) x ml. Hemodynamic responses and catecholamine concentrations were reduced from baseline values, but they did not differ at the two tested dexmedetomidine doses. Conclusions Dexmedetomidine markedly increased the range of temperatures not triggering thermoregulatory defenses. The drug is thus likely to promote hypothermia in a typical hospital environment; it is also likely to prove an effective treatment for shivering.

Autonomic Regulation during Rest and Mental Load in Gilles de la Tourette Syndrome

1998 ◽  
Vol 83 (2) ◽  
pp. 515-529 ◽  
Author(s):  
J. H. M. Tulen ◽  
B. J. M. van de Wetering ◽  
F. Boomsma
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Tourette Syndrome ◽  
Color Word ◽  
Plasma Catecholamines ◽  
Baseline Period ◽  
Plasma Catecholamine ◽  
Cardiovascular Activity ◽  
Mental Load ◽  
Plasma Catecholamine Concentrations

Cardiovascular and catecholaminergic activity during mental load were studied in patients with Tourette syndrome. Patients and controls performed the Color Word Test, preceded by a baseline period, with continuous measurements of heart rate and blood pressure. Blood samples for assay of plasma catecholamine concentrations were obtained before and during the test. The patients showed higher heart rate and blood pressure during baseline than controls, but no differences regarding plasma catecholamines. The tics corresponded with transient increases in heart rate and blood pressure. Spectral analysis of cardiovascular variability during mental load gave only limited evidence of increased sympathetic activity and no alterations in parasympathetic activity in the patients. Therefore, our findings indicate enhanced cardiovascular activity in the patients but not during mental load. The effects of tics on the cardiovascular parameters illustrate the functional complexity of the autonomic nervous system in Tourette syndrome.

Phase I Safety Assessment of Intrathecal Injection of an American Formulation of Adenosine in Humans

2002 ◽  
Vol 96 (1) ◽  
pp. 24-28 ◽  
Author(s):  
James C. Eisenach ◽  
David D. Hood ◽  
Regina Curry
Keyword(s):  
Carbon Dioxide ◽  
Blood Pressure ◽  
Heart Rate ◽  
Phase I ◽  
Controlled Trial ◽  
Intrathecal Injection ◽  
Open Label ◽  
Double Blind ◽  
End Tidal Carbon Dioxide ◽  
End Tidal

Background Preclinical studies of intrathecal adenosine suggest it may be effective in the treatment of acute and chronic pain in humans. A phase I safety trial of the intrathecal injection of a mannitol-containing formulation of adenosine in Sweden showed a considerable incidence of backache. We performed a phase I safety trial of intrathecal injection of the American formulation of adenosine, which lacks mannitol. Methods Following US Food and Drug Administration and institutional review board approval and written informed consent, 65 volunteers were studied in two trials: an open-label, dose-escalating trial with intrathecal adenosine doses of 0.25-2.0 mg (25 subjects) and a double-blind, placebo-controlled trial of adenosine, 2 mg (40 subjects). Blood pressure, heart rate, end-tidal carbon dioxide, and sensory, motor, and reflex neurologic functions were systematically examined for 24 h after injection, and volunteers were contacted by telephone at times up to 6 months after injection. Results Intrathecal adenosine did not affect blood pressure, heart rate, end-tidal carbon dioxide, or neurologic function. Headache was reported by 10 and back pain was reported by 8 of 30 subjects exposed to adenosine in the second double-blind trial, whereas none of these symptoms was reported by the 10 saline-treated subjects. Conclusion These data support further investigation of intrathecal adenosine for analgesia in humans and suggest that this agent does not produce a high incidence of severe side effects.

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