Impact of Bilateral St36 and Pc6 Electroacupuncture on the Depth of Sedation in General Anaesthesia

2015 ◽  
Vol 33 (2) ◽  
pp. 103-109 ◽  
Author(s):  
Yiding Chen ◽  
Hongwei Zhang ◽  
Yumin Tang ◽  
Jingjun Shu
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Abdominal Surgery ◽  
Equilibrium State ◽  
General Anaesthesia ◽  
Control Group ◽  
Acupuncture Points ◽  
Time Points ◽  
The Impact ◽  
Narcotrend Index

Objective To investigate the impact of electroacupuncture (EA) at bilateral acupuncture points ST36 and PC6 on the level of sedation in general anaesthesia. Methods 40 patients undergoing abdominal surgery were randomly divided into two groups: EA combined with general anaesthesia (EA group, n=20) and general anaesthesia control group (n=20). The bilateral acupuncture points ST36 and PC6 were selected in both groups. Target-controlled infusion (TCI) of propofol was used for the induction and maintenance of general anaesthesia to reach an equilibrium state of Narcotrend Index (NT index). In the EA group, EA was performed with a Hans EA device. In the control group, general anaesthesia was performed without EA stimulation. In both groups, heart rate (HR), mean blood pressure (MAP) and NT index were recorded at corresponding time points up to 30 min after the end of acupuncture. Results The NT indices of the EA group showed a downward trend after EA stimulation (p=0.01). From 15 min after the start of EA stimulation the NT indices of the EA group were significantly lower than those of the control group (p<0.05). HR and MAP of the two groups showed no significant differences at any time points (p≥0.05). Conclusions EA stimulation at bilateral ST36 and PC6 significantly deepens the sedation level of general anaesthesia in patients with propofol TCI, has little impact on haemodynamics and provides significant delayed sedation effects.

Pharmacoequivalence of Enoxaparin and Contaminated Enoxaparin

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3018-3018
Author(s):  
Jacqueline Kuziej ◽  
Walter Jeske ◽  
Debra Hoppensteadt ◽  
Evangelos Litinas ◽  
Elizabeth McGeehan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Drug Administration ◽  
Jugular Vein ◽  
Ex Vivo ◽  
Subcutaneous Administration ◽  
Saline Control ◽  
Control Group ◽  
Serious Adverse Events ◽  
The Impact

Abstract Introduction: Earlier this year, heparin was found to be contaminated with a non-heparin sulfated polymer identified as oversulfated chondroitin sulfate (OSCS). The presence of this contaminant was associated with severe adverse reactions such as hypotension and anaphylaxis, leading to death in some patients. Some batches of a widely used low-molecular heparin, enoxaparin, also contained OSCS. However, the amount of this contaminant was much lower (less than 5%) in the low-molecular weight heparin batches compared to unfractionated heparin where the amount of the contaminant was up to 30%. Owing to the sizeable number of syringes in Europe that contained the low level of OSCS and the absence of any serious adverse events, the European Medicines Equivalence Agency (EMEA) allowed the qualified use of the subcutaneous administration of the contaminated enoxaparin to ensure access to this essential medication. Despite this, no studies on the anti-thrombotic and bleeding effects or basic physiologic parameters have been reported. To address the bioequivalence of enoxaparin and its contaminated version, studies were undertaken in established animal models of bleeding and thrombosis. Materials & Methods: Contaminant-free enoxaparin (CFE) and one of the commercially available contaminated enoxaparin (CCE) batches were compared at an equivalent subcutaneous dosage of 2.5 mg/kg in a jugular vein clamping model of thrombosis (n=6/group). A separate group comprised of saline control animals served as control. Blood pressure and heart rate measurements were made at 90 minutes after drug administration, followed by jugular vein clamping model at 120 minutes after drug administration. After the completion of the jugular vein clamping model, blood samples were collected via cardiac puncture for ex-vivo monitoring of anti-coagulant and anti-protease effects. Results: No differences in the blood pressure and heart rate were observed between the two groups. The anti-thrombotic effects of both the CCE and CFE were measured by jugular vein clamping model. In comparison to the saline treated group (3.5 ± 0.5 clampings), both the CCE and CFE treated animals required a significantly higher number of clampings to induce thrombosis (4.8 ± 0.7 and 5.0 ± 0.6, respectively; p = 0.001 vs. saline; p=0.658 CFE vs. CCE). The ex-vivo analysis of whole blood aPTT revealed a slight elevation in both of the enoxaparin-treated groups in comparison to saline control. (CFE: 36.8 ± 18.6 sec; CCE: 30.5 ± 10.9 sec vs. saline: 26.7 ± 3.9 sec). The anti-Xa effects in plasma were significantly higher with the CFE (84.4 ± 1.5% inhibition) compared to that observed with the CCE (80.5 ± 2.9 % inhibition; p=0.026) while the anti-IIa levels were comparable in the two groups (37.1 ± 22.0 and 30.6 ± 17.9 % inhibition). Ex-vivo analysis of plasma samples from the control group did not reveal any anti-protease or anti-coagulant activity. Discussion: These results demonstrate that small amounts of OSCS (less than 5%) in enoxaparin do not impact its anti-thrombotic effects when administered subcutaneously. Since OSCS exhibits only anti-IIa activity and does not have any anti-Xa effects, the observed anti-Xa activity of the CCE was less than that of CFE. Other plasmatic anti-coagulant and anti-protease activities were not altered by the presence of OSCS. Since OSCS is highly charged it is likely that upon subcutaneous administration it is not absorbed. This observation is supported by the fact that the anti-Xa and IIa ratios of the samples collected after jugular vein clamping are approximately equal. Thus, the anti-thrombotic and pharmacodynamic effects of the two versions of enoxaparin are identical. The impact of repeated administration of contaminated enoxaparins and long-term pharmacodynamic and immunogenic effects need to be further explored.

The Effects of the Medical Pause on Physiological Stress Markers among Health Care Providers: A Pilot Randomized Controlled Trial

2021 ◽  
pp. 019394592110276
Author(s):  
Ebru Cayir ◽  
Tim Cunningham ◽  
Ryne Ackard ◽  
Julie Haizlip ◽  
Jeongok Logan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Health Care ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Health Care Providers ◽  
Physiological Stress ◽  
Intervention Group ◽  
Control Group ◽  
Care Providers ◽  
The Impact

Contemplative practices promote well-being, work engagement and resilience among health care providers. We examined the impact of The Pause, a brief contemplative intervention, on health care providers’ physiological stress response. Participants were randomly assigned to either The Pause or the control group. They participated in a high-fidelity, stressful medical simulation. Following the simulation, intervention group practiced The Pause. Outcome measures were heart rate variability, heart rate, and blood pressure. We adjusted for baseline physiological variables, sociodemographic variables, self-care practices, and perceived stress. Participants in the intervention group had a standard deviation of the normal-to-normal RR intervals (heart rate variability indicator) that was 13.8 (95% CI 4.0, 23.5; p < .01) points higher than those in the control group. There were no significant effects of The Pause on heart rate or blood pressure. The Pause may reduce stress reactivity, increase heart rate variability, and enhance resilience in health care providers.

scholarly journals Nociception-guided versus Standard Care during Remifentanil–Propofol Anesthesia

2019 ◽  
Vol 130 (5) ◽  
pp. 745-755 ◽  
Author(s):  
Fleur S. Meijer ◽  
Chris H. Martini ◽  
Suzanne Broens ◽  
Martijn Boon ◽  
Marieke Niesters ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Relative Risk ◽  
Abdominal Surgery ◽  
Standard Care ◽  
Clinical Care ◽  
Major Abdominal Surgery ◽  
Control Group ◽  
Noxious Stimulation ◽  
Vasoactive Medication

Abstract Editor’s Perspective What We Already Know about This Topic The nociception level index (Medasense Biometrics Ltd., Ramat Gan, Israel), is a reliable measure of moderate to intense noxious stimulation during anesthesia and surgery What This Article Tells Us That Is New In a randomized trial in patients having major abdominal surgery, compared to standard practice, nociception level-guided analgesia resulted in 30% less intraoperative remifentanil consumption Background The multidimensional index of nociception, the nociception level, outperforms blood pressure and heart rate in detection of nociceptive events during anesthesia. We hypothesized that nociception level–guided analgesia reduces opioid consumption and suboptimal anesthesia events such as low blood pressure and use of vasoactive medication. Methods In this single-blinded randomized study, 80 American Society of Anesthesiologists class I–III adult patients of either sex, scheduled for major abdominal procedures under remifentanil/propofol anesthesia by target-controlled infusion, were included. During the procedure nociception level, noninvasive blood pressure, and heart rate were monitored. Patients were randomized to receive standard clinical care or nociception level–guided analgesia. In the nociception level–guided group, remifentanil concentration was reduced when index values were less than 10 or increased when values were above 25 for at least 1 min, in steps of 0.5 to 1.0 ng/ml. Propofol was titrated to bispectral index values between 45 and 55. The primary outcomes of the study were remifentanil and propofol consumption and inadequate anesthesia events. Results Compared with standard care, remifentanil administration was reduced in nociception level–guided patients from (mean ± SD) 0.119 ± 0.033 to 0.086 ± 0.032 μg · kg-1 · min-1 (mean difference, 0.039 μg · kg-1 · min-1; 95% CI, 0.025–0.052 μg · kg-1 · min-1; P &lt; 0.001). Among nociception level–guided patients, 2 of 40 (5%) experienced a hypotensive event (mean arterial pressure values less than 55 mm Hg) versus 11 of 40 (28%) patients in the control group (relative risk, 0.271; 95% CI, 0.08–0.77; P = 0.006). In the nociception level–guided group, 16 of 40 (40%) patients received vasoactive medication versus 25 of 40 (63%) patients in the standard care group (relative risk, 0.64; 95% CI, 0.40–0.99; P = 0.044). Conclusions Nociception level-guided analgesia during major abdominal surgery resulted in 30% less remifentanil consumption.

scholarly journals A randomized controlled study of intravenous esmolol to attenuate the cardiovascular responses to laryngoscopy and endotracheal intubation

2020 ◽  
Vol 8 (3) ◽  
pp. 1103
Author(s):  
Ninad Deepak Chodankar ◽  
Bhagyashree Shivde
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
General Anaesthesia ◽  
Endotracheal Intubation ◽  
Elective Surgery ◽  
Cardiovascular Responses ◽  
Controlled Study ◽  
Control Group ◽  
Significant Difference ◽  
Control Group Group

Background: Objective is to compare the efficacy of intravenous Esmolol to attenuate the cardiovascular responses to laryngoscopy and endotracheal intubation with control group.Methods: Study was done on 60 adults, ASA grade I or II normotensive patients, undergoing elective surgery under general anaesthesia and willing to participate. These patients where be randomly allocated in to either group C (Control) or E (Esmolol). Group ‘C’ Control group. Group ‘E’, patients were given intravenous Esmolol 1.5 mg/kg 2 minutes before start of laryngoscopy. All patients were premedicated, induced and intubated using Thiopentone and Succinyl Choline as per the protocol. Heart Rate (HR), SBP, DBP and MAP were recorded at baseline (taken half an hour prior to anaesthesia), Before sedation, After induction but before intubation, Immediately after endotracheal intubation and Thereafter at 1, 2, 3, 4, 5 and 10 minutes.Results: Heart rate was lower in Group E as compared to Group C, and there was statistically significant difference immediately after intubation till 4 minutes after intubation. While Blood pressure was lower in Group E as compared to Group C, and there was statistically significant difference only immediately after intubation.Conclusions: In Normotensive patients requiring general anaesthesia with laryngoscopy and intubation, authors conclude that intravenous Esmolol 1.5 mg/kg attenuated Heart rate response but fails to satisfactorily prevent rise in blood pressure.

scholarly journals Preoperative regional scalp block versus intraoperative intravenous fentanyl for attenuating intraoperative surgical stress response to supratentorial craniotomy in adult patients under general anaesthesia

2020 ◽  
Vol 11 (4) ◽  
Author(s):  
Ahmed Beniamen Mohamed Hussien ◽  
ZakiTahaSaleh ◽  
Hala Abdel Sadek Al attar ◽  
Yasser Mohamed Nasr
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Stress Response ◽  
General Anaesthesia ◽  
Surgical Stress ◽  
Control Group ◽  
Surgical Stress Response ◽  
Intravenous Fentanyl ◽  
Supratentorial Craniotomy ◽  
Scalp Block

During brain tumour resection a lot of noxious stimuli are released resulting in a significant hemodynamic and stress response, its control is challenging during anaesthesia, and can be evaluated by monitoring blood pressure (BP), heart rate (HR) Attenuating autonomic cardiovascular responses to pain resulting from skull pinning, skin incision, and craniotomy are considered significant benefits of Regional Scalp Block (RSB) in addition to reducing postoperative analgesic requirements. This study aims to evaluate the effect of preoperative regional scalp block (RSB) versus intraoperative intravenous fentanyl for attenuating intraoperative surgical stress response to supratentorial craniotomy in adult patients under general anaesthesia. The study included 30 patients randomly distributed into two equal groups with 15 patients in each, Group A: Preoperative RSB was done after induction of general anaesthesia and before skull pinning, Group C: Control group: patients were given conventional intraoperative analgesia in the form of intravenous fentanyl with no block. This study included patients with Supratentorial brain tumours were admitted to Zagazig University Hospitals. Patients have been gathered over two years duration from march 2018 to march 2020. The results showed that there were highly significant differences between RSB group and control group. Preoperative RSB showed advantages over Standard analgesia in terms of better attenuation of stress response to pain in the form of heart rate and blood pressure intraoperatively, decrease opioid consumption, lower Visual Analogue Score (VAS), Preoperative RSB can be performed easily in a short time with very high success rate allowing better intraoperative control of haemodynamics, less postoperative pain. We recommend using preoperative RSB in supratentorial craniotomy as a gold standard in our hospital to get the advantages mentioned above.

scholarly journals A Psychophysiological Examination of the Mutability of Type D Personality in a Therapeutic Trial

2020 ◽  
pp. 1-13
Author(s):  
Kirsty L. Hodgson ◽  
Debbie A. Clayton ◽  
Michael A. Carmi ◽  
Louise H. Carmi ◽  
Ronald A. Ruden ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Treatment Group ◽  
Type D Personality ◽  
Waiting List ◽  
Control Group ◽  
Therapeutic Trial ◽  
Type D ◽  
T1 And T2 ◽  
The Impact

Abstract. Identifying the associations between health and personality has been a focus for psychophysiological research. Type D personality is associated with predisposition to physical and psychological ill-health. This statistician-blind parallel-group controlled trial (intervention group vs. waiting list control group) examined the impact of Havening Techniques on the Type D constituents of negative affect (NA) and social inhibition (SI). One hundred twenty-five adult (18+ years) participants in the United Kingdom (72 females, 53 males) completed the Type D Scale-14 (DS14) measure of Type D personality at baseline (T1), 24-hours (T2), and at 1-month (T3). Forty participants in the treatment group received additional stress biomarker assessment of heart rate, blood pressure, and salivary cortisol. Type D caseness remained stable in the waiting list participants ( n = 57). In the treatment group ( n = 68); NA, SI, and total scores decreased from T1 to T2 ( p < .001, p < .001, and p < .001, respectively), and from T2 to T3 ( p = .004, p < .001, and p < .001, respectively), significantly transmuting to non-caseness ( p < .001 for T1 to T2; p = .025 for T2 to T3). Between T1 and T2, decreases in cortisol ( p < .001), diastolic blood pressure ( p < .001), and systolic blood pressure ( p < .001) were demonstrated. Heart rate fell nonsignificantly between T1 and T2 ( p = .063), but significantly from T1 to T3 ( p = .048). The findings of this study indicate the potential mutability of the psychophysiological illness-prone characteristics of Type D personality.

scholarly journals Effects of dexmedetomidine on the onset and duration of action in non-depolarizing neuromuscular relaxant rocuronium

2021 ◽  
Vol 19 ◽  
pp. 205873922110005
Author(s):  
Jiaqi Shan ◽  
Xiaofeng Wang ◽  
Xiaoli Zhang ◽  
Junfeng Zhang
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
General Anesthesia ◽  
Neuromuscular Blockade ◽  
Onset Time ◽  
Control Group ◽  
Monitoring Point ◽  
Obvious Effect ◽  
Duration Of Action ◽  
The Impact

To determine the impact of two varying doses of dexmedetomidine (DEX) on the onset and duration of neuromuscular blockade of rocuronium (ROC) under the condition of sevoflurane anesthesia. Eighty-one patients, American Society of Anesthesiologists Class I–II, were stochastically allocated to control group (group C) and two DEX groups (group D1 and group D2). In group D1 and group D2, DEX (0.5 and 1.0 µg/kg, respectively) was administrated 10 min before induction of general anesthesia. In group C, equivalent saline was infused by the same way. We monitored heart rate (HR), blood pressure, and train-of-four (TOF) values of all subjects in the period of anesthesia. We recorded times to reach TOF value 0 (T0, from injection of ROC to disappearance of all four twitches) as the onset time and TOF value 25% (T25, ratio of fourth twitch to first twitch,) as clinical duration of neuromuscular blockade. A total of 81 patients were randomized, 75 of whom accepted treatment, including group D1 ( n = 25), D2 ( n = 25), and C ( n = 25). T0 time of three groups was found to be similar. The duration of action for ROC in group D2 was 62.76 ± 6.33 min, which was much longer than that in group D1 and group C, which were 42.64 ± 3.92 and 42.56 ± 4.04 min ( p < 0.05), respectively. At T2 (after DEX administration) and T4 time point (10 min after trachea intubation), compared with group C, the changes of heart rate (HR) and blood pressure in DEX groups (group D1 and group D2) show greatly differences. Otherwise, there were no obvious differences among different groups at the other monitoring point-in-time. DEX infusion in general anesthesia has no obvious effect on the onset of ROC, but it is capable of prolonging its clinical effect time, which can provide reference for rational application of DEX and ROC in general anesthesia.

The Effects of a Caffeine Placebo and Experimenter Expectation on Blood Pressure, Heart Rate, Well-Being, and Cognitive Performance

2001 ◽  
Vol 6 (1) ◽  
pp. 15-25 ◽  
Author(s):  
Harald Walach ◽  
Stefan Schmidt ◽  
Yvonne-Michelle Bihr ◽  
Susanne Wiesch
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cognitive Task ◽  
Well Being ◽  
Control Group ◽  
Double Blind ◽  
Main Effect ◽  
The Difference ◽  
Being There ◽  
To Receive

We studied the effect of experimenter expectations and different instructions in a balanced placebo design. 157 subjects were randomized into a 2 × 4 factorial design. Two experimenters were led to expect placebos either to produce physiological effects or not (pro- vs. antiplacebo). All subjects except a control group received a caffeine placebo. They were either made to expect coffee, no coffee, or were in a double-blind condition. Dependent measures were blood pressure, heart rate, well-being, and a cognitive task. There was one main effect on the instruction factor (p = 0.03) with the group “told no caffeine” reporting significantly better well-being. There was one main effect on the experimenter factor with subjects instructed by experimenter “proplacebo” having higher systolic blood pressure (p = 0.008). There was one interaction with subjects instructed by experimenter “proplacebo” to receive coffee doing worse in the cognitive task than the rest. Subjects instructed by experimenter “antiplacebo” were significantly less likely to believe the experimental instruction, and that mostly if they had been instructed to receive coffee. Contrary to the literature we could not show an effect of instruction, but there was an effect of experimenters. It is likely, however, that these experimenter effects were not due to experimental manipulations, but to the difference in personalities.

The Predictive Role of Biochemical Plasma Factors in Patients with Severe Traumatic Brain Injuries

2019 ◽  
Vol 70 (5) ◽  
pp. 1754-1757
Author(s):  
Marius Toma Papacocea ◽  
Ioana Anca Badarau ◽  
Mugurel Radoi ◽  
Ioana Raluca Papacocea
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Blood Cell ◽  
Brain Injuries ◽  
Hematological Parameters ◽  
Group Versus ◽  
Public Health Problem ◽  
Traumatic Brain Injuries ◽  
High Rate ◽  
Control Group

Traumatic brain injuries (TBI) represent a high impact public health problem due to a high rate of death , long term disability and occurrence especially in young adults. Despite several promising animal studies, several parameters were proposed as biological markers and were assessed for this aim. Our study proposes the study of the early biochemical changes in association to hematological parameters for severe TBI patients prognosis. 43 patients with acute TBI were included in study based on clinical, laboratory and imagistic findings. The severity of the TBI was established by Glasgow Coma Scale GCS 3-8. In all patients were evaluated hematologic parameters (Red blood cell count - RBC, Hematocrit, blood Hemoglobin, White blood cell - WBC, Platelet count and biochemical parameters (glucose, urea, creatinine, electrolytes). Outcome was expressed as Glasgow Outcome Scale (GOS), between 1-5. Values were compared to control group -15 cases. Significant early differences in body temperature, heart rate, and systolic blood pressure were observed in TBI group versus control (p[0.05). After correlation, laboratory findings significantly associated to severe outcome - GOS = 1, 2 - (p[0.05) were plasma Na decrease and significant glucose increase. An early increase of temperature and decrease of Na may predict a severe outcome in patients with acute TBI; association with shifts in heart rate and blood pressure, imposes aggressive treatment measures.

scholarly journals Effect of intravenous oxycodone on the physiologic responses to extubation following general anesthesia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Menglu Jiang ◽  
Jiawei Ji ◽  
Xin Li ◽  
Zhenqing Liu
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
General Anesthesia ◽  
Control Group ◽  
Study Group ◽  
Clinical Trial Registry ◽  
Blood Oxygen Saturation ◽  
Blood Concentrations ◽  
Number Of Patients ◽  
Blood Hormones

Abstract Background Endotracheal intubation and extubation may cause undesirable hemodynamic changes. Intravenous oxycodone has recently been introduced and used for relieving hemodynamic alterations in response to intubation, but there is insufficient information regarding its application in stabilizing hemodynamics during extubation in the patients emerging from general anesthesia. Methods One hundred patients, who had undergone assorted laparoscopic surgeries under general anesthesia, were randomly assigned to Control group (saline injection, 50 cases) and Study group (intravenous injection of 0.08 mg/kg oxycodone immediately after completion of the surgical procedure, 50 cases). Blood pressure, heart rate, blood oxygen saturation (SpO2) as well as blood concentrations of epinephrine, norepinephrine, and cortisol were recorded or measured immediately before extubation (T0), during extubation (T1), as well as one minute (T2), 5 min (T3), and 10 min after extubation (T4). In addition, coughing and restlessness, time of eye-opening, and duration from completing surgery to extubation as well as Ramsay Sedation Scale were analyzed. Results Blood pressure and heart rate as well as blood concentrations of epinephrine, norepinephrine, and cortisol were significantly higher in the Control group compared with the Study group at the time of extubation as well as 1, 5, and 10 min after extubation (P < 0.05). When the patients emerged from general anesthesia, 70 % of the Control group had cough, which was significantly higher than that of Study group (40 %, P < 0.05). Significantly higher number of patients manifested restlessness in the Control group before (40 %) and after extubation (20 %) compared with that in the Study group (20 and 2 %, respectively, P < 0.05). In addition, patients of Control group had lower Ramsay score at extubation (1.7 ± 0.7) as well as 30 min after extubation (2.4 ± 0.9) compared to that of the patients of Study group (2.2 ± 0.9, and 3.0 ± 0.8, respectively, P = 0.003 and 0.001). Conclusions Intravenous oxycodone attenuated alterations of hemodynamics and blood hormones associated with extubation during emergence from general anesthesia. Trial registration Chinese Clinical Trial Registry: ChiCTR2000040370 (registration date: 11-28-2020) “‘retrospectively registered”.

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