scholarly journals Comparison of Dexmedetomidine, Lidocaine, and Fentanyl in Attenuation Hemodynamic Response of Laryngoscopy and Intubation in Patients Undergoing Cardiac Surgery

2020 ◽  
Vol 2020 ◽  
pp. 1-8 ◽  
Author(s):  
Maziar Mahjoubifard ◽  
Mehdi Heidari ◽  
Maryam Dahmardeh ◽  
Seyed Bashir Mirtajani ◽  
Alireza Jahangirifard
Keyword(s):  
Blood Pressure ◽  
Cardiac Surgery ◽  
Heart Surgery ◽  
Vital Signs ◽  
Chi Square ◽  
Heart Ischemia ◽  
Cerebrovascular Events ◽  
Life Threatening ◽  
And Gender ◽  
Group D

Introduction and Objective. Laryngoscopy and intubation are accompanied by sympathetic responses. These transient responses appear as an increase in blood pressure and heart rate. In patients with cardiovascular problems, the hemodynamic changes may lead to life-threatening risks, such as heart ischemia, acute heart failure, and cerebrovascular events. Materials and Methods. This clinical trial was conducted on 90 patients, aged 30–70 years, who had heart surgery. The participants were categorized into three groups. Group D received 1 µg/kg intravenous dexmedetomidine in 10 minutes, group L received 1.5 mg/kg lidocaine (1%) 90 seconds before intubation, and group F received 2 µg/kg fentanyl. The vital signs (HR, SBP, DBP, and MAP) were measured before intubation and 1st, 3rd, 5th, and 10th minutes after intubation. Data were analyzed with SPSS 19 software (chi-square, one-way ANOVA, or Kruskal–Wallis). Results. The age (P=0.389) and gender distributions of patients were similar in all three groups. Dexmedetomidine significantly attenuated HR in the 3rd (P=0.001), 5th (P=0.001), and 10th (P=0.003) minutes after intervention. It also reduced the systolic blood pressure in the 5th (P=0.024) and 10th (P=0.006) minutes. This reduction was significantly higher in the dexmedetomidine group than that in the two other groups. In addition, dexmedetomidine caused a greater reduction in MAP in the 1st (P=0.048), 5th (P=0.0001), and 10th (P=0.0001) minutes. Discussion. All three medications were effective in controlling HR; however, dexmedetomidine caused bradycardia in the 3rd, 5th, and 10th minutes. Lidocaine resulted in an increase in MAP in the 1st minute after intubation; whereas, dexmedetomidine reduced MAP at the 5th and 10th minutes after intubation. Changes in blood pressure and mean arterial pressure in the fentanyl group was lower than the two other groups. Conclusion. As a result, dexmedetomidine was not suitable for hemodynamic control and led to hypotension and bradycardia; on the other hand, fentanyl was more effective than two other medications in patients undergoing cardiac surgery. This trial is registered with IRCT2017013132320N1.

Clinical response to arginine vasopressin therapy after paediatric cardiac surgery

2012 ◽  
Vol 23 (3) ◽  
pp. 387-393 ◽  
Author(s):  
Christopher W. Mastropietro ◽  
Maria C. Davalos ◽  
Shivaprakash Seshadri ◽  
Henry L. Walters ◽  
Ralph E. Delius
Keyword(s):  
Blood Pressure ◽  
Cardiac Surgery ◽  
Arginine Vasopressin ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
P Value ◽  
Haemodynamic Instability ◽  
Post Operation ◽  
The Mean ◽  
Haemodynamic Improvement

AbstractObjectiveTo describe the haemodynamic response of children who receive arginine vasopressin for haemodynamic instability after cardiac surgery and to identify clinical variables associated with a favourable response.Materials and MethodsWe reviewed patients less than or equal to 6 years undergoing open heart surgery in our institution between January, 2009 and July, 2010 who received arginine vasopressin during the first 7 days post operation. Favourable responders were defined as those in whom blood pressure was increased or maintained and catecholamine score was decreased, or blood pressure was increased by greater than or equal to 10% of baseline and catecholamine score was unchanged at 6 hours following arginine vasopressin initiation.ResultsOf the 34 patients identified, 17 (50%) patients responded favourably to arginine vasopressin. At 6 hours, the mean blood pressure was increased by 32.2% in responders as compared with 4.6% in non-responders, with a p-value less than 0.001. The mean catecholamine score decreased by 30.1% in responders and increased by 7.6% in non-responders, with a p-value less than 0.001. Anthropometric, demographic, and intra-operative variables were similar in both groups, as was maximum dose of arginine vasopressin. The median time after arrival to the intensive care unit at which arginine vasopressin was initiated, however, was later in those who responded, 20 hours as compared with those who did not, 6 hours, with a p-value equal to 0.032.ConclusionsArginine vasopressin therapy led to haemodynamic improvement in only half of the children in this study, and improvement was more likely to occur if arginine vasopressin was initiated after the post-operative night.

scholarly journals Investigation on the Sensitivity and Specificity of Lipid Profile in the Second Trimester in the Incidence of Preeclampsia in Women Referring to Beheshti and Al-Zahra Hospitals during the Years of 2016 and 2017

2021 ◽  
Author(s):  
Safoura Rouholamin ◽  
Zahra Allameh ◽  
Erfaneh Kamali
Keyword(s):  
Blood Pressure ◽  
Lipid Profile ◽  
P Value ◽  
Second Trimester ◽  
Normal Blood Pressure ◽  
Chi Square ◽  
Specificity And Sensitivity ◽  
Systemic Disorder ◽  
Life Threatening ◽  
Stress Oxidative

Introduction: Preeclampsia is described as a systemic disorder and leads to a potentially life threatening disease. The evidences show that stress oxidative of lipid profile is effective in the pathogenesis of Preeclampsia. In this study, specificity and sensitivity of lipid profile as a predictive factor in the incidence of preeclampsia was studied. Methods: This study was a cohort study that conducted on pregnant women referring to hospitals from 2016 to 2017. In this study, 244 prim gravid women with normal blood pressure in the weeks of 16-18 were included and a lipid profile test wasrequested. Finally, it was followed the cases for the incidence of preeclampsia till the end of pregnancy. In this study, the SPSS 20 software was utilized. Moreover, the Chi-Square, Covariance and independent t tests was run. Results: During this study, 16 cases developed preeclampsia. In preeclamptic cases it was found considerable changes in lipid profile such as significant increase in LDL and TC, and significant decrease in HDL (P-value < 0.001). Likewise, it was not found considerable changes in TG (P-value=0.21). Furthermore, TC with sensitivity of 68.8 % and specificity of 69.6 %, LDL with sensitivity 75 % and specificity of 75.8 % and HDL with sensitivity of 76.2 % and specificity of 75 % were reported. Conclusion: The findings in our study suggested that cases that developed preeclampsia had disturbed lipid profile and the best predictive factors are HDL, LDL and TC, respectively.

Delayed Development of Malignant Hyperthermia Following Cardiopulmonary Bypass

2017 ◽  
Vol 22 (1) ◽  
pp. 95-99 ◽  
Author(s):  
Stephen Hall Sams ◽  
Stephen Revilla ◽  
David Lawrence Stahl
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Malignant Hyperthermia ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Signs And Symptoms ◽  
Life Threatening ◽  
Cardiac Intensive Care ◽  
High Index Of Suspicion ◽  
Post Cardiac Surgery

Malignant hyperthermia (MH) is a rare but potentially life-threatening disorder encountered during general anesthesia. The use of cardiopulmonary bypass during cardiac surgery can obscure many of the cardinal signs and symptoms of MH. The development of postoperative MH following cardiac surgery is rare, but anesthesiologists and intensivists must maintain a high index of suspicion in order to make a prompt diagnosis. Initiation and tailored maintenance of MH therapy must also consider the complex physiologic changes of patients in the immediate post–cardiac surgery period. In this article, we present a case of the development of postoperative MH in the cardiac intensive care unit after elective open heart surgery with cardiopulmonary bypass.

A Prospective Evaluation of Prehospital Patient Assessment by Direct In-field Observation: Failure of ALS Personnel to Measure Vital Signs

1990 ◽  
Vol 5 (4) ◽  
pp. 325-333 ◽  
Author(s):  
Daniel W. Spaite ◽  
Elizabeth A. Criss ◽  
Terence D. Valenzuela ◽  
Harvey W. Meislin ◽  
Paul Hinsberg
Keyword(s):  
Blood Pressure ◽  
Life Support ◽  
Vital Signs ◽  
Advanced Life Support ◽  
Patient Assessment ◽  
Chi Square ◽  
Measure Blood Pressure ◽  
One Year ◽  
Chi Square Analysis ◽  
Careful Assessment

AbstractWe prospectively evaluated the frequency with which advanced life support (ALS) personnel fail to attempt to measure blood pressure (BP) and/or pulse (P) during prehospital patient assessment. A single in-field observer rode on ALS rescue vehicles from 20 Emergency Medical Services (EMS) agencies throughout Arizona during a one-year study (1/89–12/89). Data were collected from urban, suburban, and rural systems. Statistical evaluation was performed by Chi Square analysis with p <0.05 considered significant.Among 227 patient encounters, BP and/or P measurements were omitted in 84 cases (37.0%). BP and/or P were omitted in 50.0% of children (age <18 years) compared to 26.5% of adults (p=0.023). Among patients who were transported to a hospital, 19.4% had BP omitted compared to 49.1% of those not transported (p=0.00003). Seven of 58 patients in whom TVs were attempted (12.1 %) had BP omitted compared to 54 of 169 patients without IV attempts (32.0%, p=0.0055). Blood Pressure was omitted in 21.9% of patients transported Code 3 and in 24.2% of patients with Glasgow Coma Scale ≤13. Omission of BP occurred more frequently in non-urban agencies (33.9%) than in urban ones (20.0%, p=0.027).In a statewide evaluation of prehospital patient assessment, failure to measure vital signs (VS) occurred on a frequent basis. Our data indicate that a concerning lack of attention to the most basic details of patient assessment is common. It is possible that failure to measure VS might even happen more frequently during routine patient encounters without an observer present. Medical control physicians must emphasize to EMS personnel the paramount importance of careful assessment to ensure optimal patient care.

scholarly journals Obesitas dan hubungannya dengan polimorfisme gena promoter 5-HT2A, tekanan darah, profil lipid, kadar glukosa, dan malondialdehid

2011 ◽  
Vol 8 (2) ◽  
pp. 81
Author(s):  
Pramudji Hastuti ◽  
Nur Anisah ◽  
Johan Iswara Siagian ◽  
Kautsar Prastudia Eko Binuko ◽  
Aidil Adhla
Keyword(s):  
Blood Pressure ◽  
Cross Sectional Study ◽  
Lipid Profiles ◽  
Obese Group ◽  
Sectional Study ◽  
Chi Square ◽  
Cross Sectional ◽  
Significant Difference ◽  
Or Gene ◽  
And Gender

Background: Obesity among adults has risen significantly in the world-cutting across all ages, racial and ethnic groups and gender. The 5-HT 2A receptor is crucially involved in regulation of body weight and the appetite. Disturbances in the distribution and or gene regulation of the postsynaptic 5-HT2A receptor are implicated in the pathophysiology of conditions such as obesity, coronary heart disease, high blood pressure, diabetes, stroke dan some cancers.Objective: To test the association between obesity with polymorphism of promoter -1438G→A 5-HT2A receptors gene, blood pressure, lipid profiles, levels of blood glucose and malondialdehyde (MDA).Method: This cross-sectional study included thirty six unrelated obese young people (BMI ≥ 30) recruited from populations in Yogyakarta and 36 controls with age matched with BMI ≤ 25. Statistical differences between blood pressure, lipid profiles, glucose and MDA levels were assessed by t-test and genotypes by Chi square test.Results: There were no significant difference in blood pressure lipid profile, level of glucose and MDA in obese group compared with control (p>0,05). Allele A and G frequency in obese group 25% and 75% respectively, and controls 22.2% and 77.8% respectively, and no significant difference in all two groups, but G allele had higher risk to obese than A allele.Conclusion: These data indicated G allele was mild risk factor for obesity.

scholarly journals The vertebral Artery Anomalous, Stenosis vs Hypoplasia as the leading cause of Stroke. An anatomical cross-Sectional Study of VA anomalies in Neck three-Dimensional computed Tomography Angiography

2021 ◽  
Vol 10 (1) ◽  
pp. 01-06
Author(s):  
Farzaneh Mohammadi ◽  
Hussein Soleimantabar ◽  
Fatemeh Mohamadi ◽  
Sofia Sabouri
Keyword(s):  
Vertebral Artery ◽  
Three Dimensional ◽  
Neck Region ◽  
Signs And Symptoms ◽  
Cross Sectional Study ◽  
Anomalous Origin ◽  
Chi Square ◽  
Cross Sectional ◽  
Life Threatening ◽  
And Gender

Introduction: A thorough understanding of the vertebral artery (VA) variations and course of the artery and its related branches could significantly enhance the efficacy and safety of interventions involving the neck and spine. Here, we aimed to investigate the incidence of various VA variations in individuals presenting with signs and symptoms of stroke with our neurology team. Material and Method: In this retrospective study we investigate CTA images of patients with signs and symptom of stroke who referred to specialized medical imaging centre. An experienced board-certified radiologist evaluated the CTA images, recording the characteristics of VA, regarding dominance and any possible anomalies. These included anomalous origin, anomalous route, anomalous branching, stenosis, hypoplasia, atresia, thrombosis, and dissection. All data were analyzed using SPSS version24 and Pearson Chi-Square and Fishers test used for anomaly and gender correlation. Results: A total of 125 patients (53.6% females; mean age, 60.7 (11-87)) were included. In the case of VA dominance, 66.4% of cases were co-dominant while 16.0% were right, and 12.8% were left dominant. Overall, males had more VA anomalies than females, 24.8% and 17.6%, respectively (in general, 42.4% of all participants) (p = 0.020). Among patients, 4.0% (n = 5) had an anomalous origin and anomalous branching was reported in 5 patients (4.0%). Among the variations, significant stenosis (18.4%) and hypoplasia (17.6%) were the most prevalent anomalies with the earliest one having the higher rate. While anomalous branching was reported in 5 patients (4.0%). Conclusions: VA variations are relatively common and should be addressed during procedures involving the neck region and would allow surgeons to avoid life threatening injury.

scholarly journals Perspective on Cerebral Autoregulation Monitoring in Neonatal Cardiac Surgery Requiring Cardiopulmonary Bypass

2021 ◽  
Vol 12 ◽  
Author(s):  
Jared M. Spilka ◽  
Conor P. O'Halloran ◽  
Bradley S. Marino ◽  
Kenneth M. Brady
Keyword(s):  
Blood Pressure ◽  
Cardiac Surgery ◽  
Arterial Blood Pressure ◽  
Cerebral Autoregulation ◽  
Postoperative Delirium ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Arterial Blood ◽  
Neonatal Cardiac Surgery ◽  
Neonates And Infants

The autoregulation of cerebral blood flow protects against brain injury from transient fluctuations in arterial blood pressure. Impaired autoregulation may contribute to hypoperfusion injury in neonates and infants. Monitoring cerebral autoregulation in neonatal cardiac surgery as a guide for arterial blood pressure management may reduce neurodevelopmental morbidity. Cerebral autoregulation monitoring has been validated in animal models and in an adult trial autoregulation monitoring during bypass improved postoperative delirium scores. The nuances of pediatric cardiac disease and congenital heart surgery make simply applying adult trial findings to this unique population inappropriate. Therefore, dedicated pediatric clinical trials of cerebral autoregulation monitoring are indicated.

Amiodarone in the Management of Cardiac Arrhythmia Following Open Heart Surgery

2021 ◽  
Vol 14 (1) ◽  
pp. 20-23
Author(s):  
Nazmul Hosain ◽  
Md Rajibul Islam ◽  
Muhammad Abdul Quaium Chowdhury ◽  
Mohammad Fazle Maruf ◽  
Ahsan Uddin Mahmud ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Cardiac Arrhythmia ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Ventricular Rate ◽  
Hemodynamic Stability ◽  
Postoperative Arrhythmia ◽  
Life Threatening ◽  
The Mean

Background: Postoperative cardiac arrhythmias may present as life threatening complications like- cerebrovascular strokes, thrombo-embolic manifestations, inadequate ventricular filling and compromised hemodynamic stability. Amiodarone is an effective drug for various postoperative arrhythmias. Objective of this study is to evaluate the efficacy of Amiodarone in controlling postoperative arrhythmia in our settings at the department of cardiac surgery. Methods: This retrospective observational study involved random selection of 20 patients, who developed potentially life-threatening arrhythmia following cardiac surgical procedures under cardiopulmonary bypass (CPB) at Chittagong Medical College Hospital (CMCH) between January 2018 and December 2020. Amiodarone was used in controlling postoperative cardiac arrhythmia by loading 1000 mg in first 24 hours, followed by 800 mg orally in daily divided doses. Results: Among 20 patients under study, five had valvular replacement, three had ASD closure, one VSD closure, one patient had excision of LA myxoma and in ten patients had undergone CABG. The Mean ± SD of the age of the patients was 50.2 ± 14.7 years. Eleven patients (55%) were female. Atrial fibrillation with rapid ventricular rate occurred in 15 patients, supraventricular tachycardia in two and ventricular tachycardia three patients. Targets were achieved in all 20 of these patients. Among them 13 (65%) reverted to sinus rhythm, in other 7 AF persisted but ventricular rates became below 100/m with hemodynamic stability. The Mean ± SD of the time required for target achievement was 8.9 ± 7.4 hours. There was no perioperative death in these patients. Conclusion: Amiodarone is an effective medication in combating both atrial and ventricular arrhythmia following cardiac surgery employing cardiopulmonary bypass. Cardiovasc j 2021; 14(1): 20-23

scholarly journals Determinants of Blood Pressure among Youth in Ajman, UAE

1970 ◽  
Vol 1 (1) ◽  
pp. 17-21 ◽  
Author(s):  
Jayadevan Sreedharan ◽  
Elsheba Mathew ◽  
Jayakumary Muttappallymyalil ◽  
Shatha Al Sharbatii ◽  
Rizwana B Shaikh ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Body Mass Index ◽  
Body Mass ◽  
Cross Sectional Study ◽  
Chi Square ◽  
Crude Odds Ratio ◽  
Cross Sectional ◽  
The Mean ◽  
And Gender ◽  
Medical University

BackgroundYouth is a vulnerable group for developing almost all life-style related diseases. The present cross-sectional study was conducted to assess the determinants of blood pressure among entry year students in a medical university in Ajman, United Arab Emirates.Materials and Methods  One hundred and ten students from Gulf Medical University, Ajman, UAE participated in the study. A pretested structured questionnaire was used for data collection. Predictive Analytic Software 17 was used for data analysis. Chi-square test, Univariate and multivariate logistic regression were used.ResultsVariables such as tobacco use, duration of sleep, Body Mass Index and gender were considered to assess the association with blood pressure. The mean age of the students was 19 years with a SD of 1.9 years. The mean systolic and diastolic blood pressure was 113.5 (SD 12.0) and 73.7 (SD 11.2) respectively with mean BMI of 24.9 (SD 5.7). A statistically significant association was observed between gender and blood pressure (p<0.05). The crude Odds Ratio (OR) observed for sleep duration and blood pressure was found statistically significant (p<0.05), but the adjusted OR was not statistically significant. Of the participants who sleep for more than 6 hours, majority (70%) have normal blood pressure. Nearly half of the participants who slept for less than 6 hours have pre-hypertension and/ or hypertension. There was statistically significant (p<0.005) association between Body Mass Index (BMI) and blood pressure (BP). The mean BMI among those with normal BP was 23.25 kg/m2 with a SD of 4.6 and those with pre-hypertension and/ or hypertension was 27.6 kg/m2 with a SD of 6.5.ConclusionGender and BMI are the significant factors associated with Blood pressure. The findings may be used to create strategies to impart awareness of the dangers of increased blood pressure among obese and non obese students.Key Words: Body Mass Index; Blood Pressure; UAEDOI: 10.3126/nje.v1i1.4107Nepal Journal of Epidemiology 2010;1 (1):17-21

scholarly journals Nutritional status of elderly participants of the Hiperdia system: socio-demographic characteristics and blood pressure

Rev Rene ◽  
2015 ◽  
Vol 16 (5) ◽  
pp. 746
Author(s):  
Raquel Cristina Luis Mincoff ◽  
Rose Mari Bennemann ◽  
Mayra Costa Martins
Keyword(s):  
Blood Pressure ◽  
Nutritional Status ◽  
Secondary Data ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Demographic Characteristics ◽  
The Body ◽  
Chi Square ◽  
Cross Sectional ◽  
And Gender

Objective: to analyze the socio-demographic characteristics and stages of blood pressure associated to the nutritional status of elderly hypertensive patients included in the System of Registration and Monitoring of Hypertensive and Diabetic patient sin a Basic Health Unit. Methods: cross-sectional study with primary and secondary data collection. The nutritional status was evaluated through the body mass index and analyzed, according to socio-demographic characteristics and stages of blood pressure. To analyze the data, the chi-square test was used. Results: 250 elderly (63.6% women) were evaluated. Statistically significant association was observed between nutritional status and gender (p = 0.008), age group (p = 0.05) andstage of hypertension: optimal, normal and hypertension 1. Conclusion: the elderly assisted by the service require constant nutritional and blood pressure re-evaluation provided by the health team. 

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