scholarly journals Effects of long periods of pneumoperitoneum combined with the head-up position on heart rate-corrected QT interval during robotic gastrectomy: an observational study

2018 ◽  
Vol 46 (11) ◽  
pp. 4586-4595
Author(s):  
Na Young Kim ◽  
Sun-Joon Bai ◽  
Hyoung-Il Kim ◽  
Jung Hwa Hong ◽  
Hoon Jae Nam ◽  
...  
Keyword(s):  
Heart Rate ◽  
Observational Study ◽  
Close Monitoring ◽  
Qtc Interval ◽  
Robotic Gastrectomy ◽  
Anaesthetic Induction ◽  
Carbon Dioxide Pneumoperitoneum ◽  
Long Duration ◽  
Haemodynamic Changes ◽  
Registration Number

Objective Pneumoperitoneum and the head-up position reportedly stimulate the sympathetic nervous system, potentially increasing the risk of cardiac arrhythmia. We evaluated the effects of a long duration of pneumoperitoneum in the head-up position on the heart rate-corrected QT (QTc) interval during robotic gastrectomy. Methods This prospective observational study involved 28 patients undergoing robotic gastrectomy. The QTc interval was recorded at the following time points: before anaesthetic induction (baseline); 10 minutes after tracheal intubation; 1, 5, 30, 60, and 90 minutes after pneumoperitoneum induction in the head-up position; after pneumoperitoneum desufflation in the supine position; and at the end of surgery. The primary outcome was the QTc interval, which was measured 90 minutes after pneumoperitoneum combined with the head-up position. Results Compared with baseline, the QTc interval was significantly prolonged at 1 and 60 minutes after pneumoperitoneum, peaked at 90 minutes, and was sustained and notably prolonged until the end of surgery. However, no considerable haemodynamic changes developed. Conclusion A long period of carbon dioxide pneumoperitoneum application in a head-up position significantly prolonged the QTc interval during robotic gastrectomy. Therefore, diligent care and close monitoring are required for patients who are susceptible to developing ventricular arrhythmia. Trial Registration: Registered at ClinicalTrials.gov; https://clinicaltrials.gov/ct2/show/NCT02604979 ; Registration number NCT02604979

scholarly journals Fentanyl Pretreatment Modifies Anaesthetic Induction with Etomidate

1988 ◽  
Vol 16 (2) ◽  
pp. 171-176 ◽  
Author(s):  
R. J. Stockham ◽  
T. H. Stanley ◽  
N. L. Pace ◽  
S. Gillmor ◽  
F. Groen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Side Effects ◽  
Linear Regression ◽  
Anaesthetic Induction ◽  
Arterial Blood ◽  
Group I ◽  
Haemodynamic Changes ◽  
Induction Of Anaesthesia ◽  
Fentanyl Group

Haemodynamic changes and side-effects of induction of anaesthesia with etomidate were evaluated in 60 ASA Class I or II patients. The objective was to find an optimal pre-induction dose of fentanyl which eliminated haemodynamic changes and side-effects during induction and intubation without introducing other problems. Patients were randomly assigned to four groups according to the pretreatment dose of fentanyl (Group I= 2 ml normal saline; Group II= 100 μg of fentanyl; Group III= 250μg of fentanyl; Group IV = 500 μg of fentanyl) administered intravenously five minutes prior to induction of anaesthesia with etomidate, 0.3 mg/kg. There was an increasing incidence of apnoea (53, 87, 87 and 100% in Groups I-IV respectively) and a decreasing incidence of myoclonus (60, 33, 13 and 0% in Groups I-IV respectively) and injection pain (53, 13, 7 and 0% in Groups I-IV respectively), P< 0.002 chi-square test for linear trends, with increasing fentanyl dosage. The incidences of postoperative nausea and vomiting were similar in the four groups. There were also significant linear regression relationships (P< 0.01 ANOVA for linear regression) between increasing doses of fentanyl administered before etomidate and the prevention of increases in systolic blood pressure and heart rate during the induction-intubation sequence. The data demonstrate that increasing pre-induction doses of fentanyl are more effective at minimising side-effects and preventing increases in systolic arterial blood pressure and heart rate but also increase the incidence of apnoea during induction. The results suggest that 500 μg of fentanyl is an ideal pretreatment dose in fit patients prior to anaesthetic induction with etomidate.

scholarly journals Pronounced haemodynamic changes during and after robotic-assisted laparoscopic prostatectomy: a prospective observational study

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e038045
Author(s):  
Michael T Pawlik ◽  
Christopher Prasser ◽  
Florian Zeman ◽  
Marion Harth ◽  
Maximilian Burger ◽  
...  
Keyword(s):  
Heart Rate ◽  
Observational Study ◽  
Supine Position ◽  
Prospective Observational Study ◽  
Volume Index ◽  
Robotic Assisted ◽  
Laparoscopic Prostatectomy ◽  
Haemodynamic Parameters ◽  
Steep Trendelenburg Position ◽  
Haemodynamic Changes

ObjectivesRobotic-assisted laparoscopic prostatectomy (RALP) is typically conducted in steep Trendelenburg position (STP). This study investigated the influence of permanent 45° STP and capnoperitoneum on haemodynamic parameters during and after RALP.DesignProspective observational study.SettingHaemodynamic changes were recorded with transpulmonary thermodilution and pulse contour analysis in men undergoing RALP under standardised anaesthesia.ParticipantsInformed consent was obtained from 51 patients scheduled for elective RALP in a University Medical Centre in Germany.InterventionsHeart rate, mean arterial pressure, central venous pressure (CVP), Cardiac Index (CI), systemic vascular resistance (SVR), Global End-Diastolic Volume Index (GEDI), global ejection fraction (GEF), Cardiac Power Index (CPI) and stroke volume variation (SVV) were recorded at six time points: 20 min after induction of anaesthesia (T1), after insufflation of capnoperitoneum in supine position (T2), after 30 min in STP (T3), when controlling Santorini’s plexus in STP (T4), before awakening in supine position (T5) and after 45 min in the recovery room (T6). Adverse cardiac events were registered intraoperatively and postoperatively.ResultsAll haemodynamic parameters were significantly changed by capnoperitoneum and STP during RALP and partly normalised at T6. CI, GEF and CPI were highest at T6 (CI: 3.9 vs 2.2 L/min/m²; GEF: 26 vs 22%; CPI: 0.80 vs 0.39 W/m²; p<0.001). CVP was highest at T4 (31 vs 7 mm Hg, p<0.001) and GEDI at T6 (819 vs 724 mL/m², p=0.005). Mean SVR initially increased (T2) but had decreased by 24% at T6 (p<0.001). SVV was highest at T5 (12 vs 9%, p<0.001). Two of the patients developed cardiac arrhythmia during RALP and one patient suffered postoperative cardiac ischaemia.ConclusionsRALP led to pronounced perioperative haemodynamic changes. The combination of increased cardiac contractility and heart rate reflects a hyperdynamic situation during and after RALP. Anaesthesiologists should be aware of unnoticed pre-existing heart failure to worsen during STP in patients undergoing RALP.

scholarly journals Effects of esmolol on QTc interval changes during tracheal intubation: a systematic review

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e028111 ◽  
Author(s):  
Venkatesan Thiruvenkatarajan ◽  
Jenn Yuan Lee ◽  
Manesha Sembu ◽  
Richard Watts ◽  
Roelof Markus Van Wijk
Keyword(s):  
Systematic Review ◽  
Tracheal Intubation ◽  
Torsades De Pointes ◽  
Secondary Outcome ◽  
Qtc Interval ◽  
Qtc Prolongation ◽  
Anaesthetic Induction ◽  
Registration Number ◽  
Transmural Dispersion ◽  
Randomised Controlled

Introduction and aimsEsmolol is an ultra-short-acting β1 antagonist that has been shown to attenuate the corrected QT (QTc) interval prolongation associated with laryngoscopy and endotracheal intubation (LTI). Prolongation of the QTc interval can precipitate arrhythmias, the most serious of which is torsades de pointes . The aim of this systematic review was to compare esmolol and placebo on QTc changes occurring during LTI.Materials and methodsPubMed, EMBASE, Cochrane Registry of Clinical Trials and CINAHL databases (up to August 2018) were screened for randomised controlled trials comparing esmolol and placebo on QTc changes during LTI in cardiac and non-cardiac surgeries. The primary outcome was QTc changes during LTI and secondary outcome was related to adverse effects from esmolol such as bradycardia and hypotension.ResultsSeven trials were identified involving 320 patients, 160 patients receiving esmolol or placebo apiece. A shortening of the QTc post-LTI was evident in the esmolol group compared with the placebo in four studies. Compared with the baseline, the QTc was reduced post-LTI in the esmolol group. In the placebo group, the QTc was prolonged compared with the baseline post LTI. Nonetheless, esmolol did not prevent QTc prolongation in the remaining three studies, and much of this was attributed to employing QTc prolonging agents for premedication and anaesthetic induction. No significant adverse events were noted.ConclusionCompared with placebo, esmolol reduced the LTI-induced QTc prolongation when current non-QTc prolonging agents were chosen for tracheal intubation. Future studies should explore whether transmural dispersion (a marker of torsadogenicity) is also affected during LTI by analysing parameters such as the Tp-e interval (interval between the peak to the end of the T-wave) and Tp-e/QTc (rate corrected Tp-e interval).Trial registration numberCRD42018090282.

scholarly journals Exercise Intensity during Olympic-Distance Triathlon in Well-Trained Age-Group Athletes: An Observational Study

Sports ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 18
Author(s):  
Atsushi Aoyagi ◽  
Keisuke Ishikura ◽  
Yoshiharu Nabekura
Keyword(s):  
Heart Rate ◽  
Observational Study ◽  
Exercise Intensity ◽  
Time Range ◽  
Age Group ◽  
Slow Group ◽  
H 41 ◽  
The Mean ◽  
Aerobic And Anaerobic ◽  
Very High

The aim of this study was to examine the exercise intensity during the swimming, cycling, and running legs of nondraft legal, Olympic-distance triathlons in well-trained, age-group triathletes. Seventeen male triathletes completed incremental swimming, cycling, and running tests to exhaustion. Heart rate (HR) and workload corresponding to aerobic and anaerobic thresholds, maximal workloads, and maximal HR (HRmax) in each exercise mode were analyzed. HR and workload were monitored throughout the race. The intensity distributions in three HR zones for each discipline and five workload zones in cycling and running were quantified. The subjects were then assigned to a fast or slow group based on the total race time (range, 2 h 07 min–2 h 41 min). The mean percentages of HRmax in the swimming, cycling, and running legs were 89.8% ± 3.7%, 91.1% ± 4.4%, and 90.7% ± 5.1%, respectively, for all participants. The mean percentage of HRmax and intensity distributions during the swimming and cycling legs were similar between groups. In the running leg, the faster group spent relatively more time above HR at anaerobic threshold (AnT) and between workload at AnT and maximal workload. In conclusion, well-trained male triathletes performed at very high intensity throughout a nondraft legal, Olympic-distance triathlon race, and sustaining higher intensity during running might play a role in the success of these athletes.

scholarly journals What are the barriers to the completion of a home-based rehabilitation programme for patients awaiting surgery for lung cancer: a prospective observational study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e041907
Author(s):  
Heloise Catho ◽  
Sebastien Guigard ◽  
Anne-Claire Toffart ◽  
Gil Frey ◽  
Thibaut Chollier ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Living Alone ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Factors Associated ◽  
Home Based ◽  
Registration Number

ObjectivesHome-based rehabilitation programmes (H-RPs) could facilitate the implementation of pulmonary rehabilitation prior to resection for non-small cell lung cancer (NSCLC), but their feasibility has not been evaluated. The aim of this study was to identify determinants of non-completion of an H-RP and the factors associated with medical events occurring 30 days after hospital discharge.DesignA prospective observational study.InterventionAll patients with confirmed or suspected NSCLC were enrolled in a four-component H-RP prior to surgery: (i) smoking cessation, (ii) nutritional support, (iii) physiotherapy (at least one session/week) and (iv) home cycle-ergometry (at least three times/week).OutcomesThe H-RP was defined as ‘completed’ if the four components were performed before surgery.ResultsOut of 50 patients included, 42 underwent surgery (80% men; median age: 69 (IQR 25%–75%; 60–74) years; 64% Chronic Obstructive Pulmonary Disease (COPD); 29% type 2 diabetes). Twenty patients (48%) completed 100% of the programme. The median (IQR) duration of the H-RP was 32 (19; 46) days. Multivariate analysis showed polypharmacy (n=24) OR=12.2 (95% CI 2.0 to 74.2), living alone (n=8) (single vs couple) OR=21.5 (95% CI 1.4 to >100) and a long delay before starting the H-RP (n=18) OR=6.24 (95% CI 1.1 to 36.6) were independently associated with a risk of non-completion. In univariate analyses, factors associated with medical events at 30 days were H-RP non-completion, diabetes, polypharmacy, social precariousness and female sex.ConclusionFacing multiple comorbidities, living alone and a long delay before starting the rehabilitation increase the risk of not completing preoperative H-RP.Trial registration numberNCT03530059.

Usefulness of cardiac screening in patients with systemic lupus erythematosus and anti-Ro/SSA antibodies

Lupus ◽  
2021 ◽  
pp. 096120332110279
Author(s):  
Roger Villuendas ◽  
Melania Martínez-Morillo ◽  
Gladys Juncà ◽  
Aina Teniente-Serra ◽  
Carles Diez ◽  
...  
Keyword(s):  
Heart Rate ◽  
Lupus Erythematosus ◽  
Holter Monitoring ◽  
Organ Damage ◽  
Cardiac Conduction ◽  
Systemic Lupus ◽  
Cardiac Screening ◽  
Cardiac Evaluation ◽  
Registration Number ◽  
Clinically Significant

Objectives Recent data suggest that some adult patients with autoimmune rheumatic diseases may develop cardiac conduction and repolarization abnormalities mediated by anti-Ro/SSA antibodies. We aim to investigate the utility of a cardiac screening in patients with systemic lupus erythematous (SLE) and anti-Ro/SSA positivity. Methods SLE patients who consecutively attended a Rheumatology clinic during 1 year where evaluated for the presence and levels of anti-Ro/SSA antibodies, and clinical and biological markers of organ damage and disease activity. All participants underwent a cardiovascular anamnesis and physical examination, ECG, echocardiography, and 24-hour Holter. Results Of the 145 recruited patients, 49 (32%) had anti-Ro/SSA positivity. None had any degree of atrioventricular block in the ECG or Holter monitoring. No significant differences were observed between anti-Ro/SSA–positive vs. negative patients in terms of PR, QRS or QTc intervals. No clinically significant arrhythmias were recorded during Holter monitoring and no differences in average heart rate, heart rate variability, or atrial or ventricular ectopy burden were observed. Finally, no differences were found in echocardiographic measurements. Conclusions In this study of SLE patients, anti-Ro/SSA positivity was not associated with significant alterations in ECG, echocardiography, or 24-hour Holter. These findings do not support ordinary cardiac evaluation in these patients. ( Clinicaltrials.gov registration number: NCT02162992).

Intracranial Lesions Presenting as Bony Swellings of Scalp – An Observational Study of 13 Cases at King George Hospital, Visakhapatnam, A Tertiary Care Government Hospital

2021 ◽  
Vol 8 (31) ◽  
pp. 2822-2829
Author(s):  
Yarlagadda Srinivas Rao ◽  
Manda Venkata Vijayasekhar ◽  
Patirla Prahalad ◽  
Kadali Satyavaraprasad ◽  
Atla Bhagyalakshmi ◽  
...  
Keyword(s):  
Observational Study ◽  
Tertiary Care ◽  
Neurological Deficits ◽  
Intracranial Tumours ◽  
Medical College ◽  
Long Duration ◽  
Intracranial Lesions ◽  
Histological Characteristics ◽  
Malignant Lesions ◽  
King George Hospital

BACKGROUND The purpose of this study was to evaluate the intracranial lesions eroding the calvarium and presenting as bony swellings of the scalp. This kind of presentation is usually rare. This is because intracranial tumours usually manifest early with focal neurological deficits, seizures or features of raised intracranial pressure. Only a few patients, in whom the intracranial lesions, despite being present for a long duration, do not have neurological manifestations but erode the overlying bone and may present as bony swellings of the scalp. We studied the clinical presentation of such lesions, analysed their radiological and histological characteristics. METHODS This is an observational study from October 2018 to September 2020. A total of thirteen cases were studied in the Department of Neurosurgery, Andhra Medical College, Visakhapatnam, Andhra Pradesh. After clinical examination, an appropriate diagnostic workup was done, and all the cases were taken up for surgery. The clinical behaviour and histopathological features of the lesions were analysed. RESULTS In our study of thirteen cases, the most common cause of an intracranial lesion presenting as bony scalp swelling is meningioma which comprised almost 53.8 %, the second most common lesion is secondaries. Others included fibrous dysplasia and malignant small blue round cell tumour. CONCLUSIONS Intracranial lesions eroding the bone and presenting as scalp swellings are rare. In our study, the spectrum of these scalp swellings has ranged from benign lesions like meningioma to malignant lesions like secondary deposits. KEYWORDS Bony Scalp Lesions, Intracranial Tumours with Bony Erosion, Dumbbell Brain Tumours

Reduced heart rate variability during sleep in long-duration spaceflight

2013 ◽  
Vol 305 (2) ◽  
pp. R164-R170 ◽  
Author(s):  
D. Xu ◽  
J. K. Shoemaker ◽  
A. P. Blaber ◽  
P. Arbeille ◽  
K. Fraser ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Substantial Reduction ◽  
Space Station ◽  
Power Spectral Analysis ◽  
Power Spectral ◽  
Long Duration ◽  
Fractal Properties ◽  
Wide Range ◽  
Simultaneous Movement

Limited data are available to describe the regulation of heart rate (HR) during sleep in spaceflight. Sleep provides a stable supine baseline during preflight Earth recordings for comparison of heart rate variability (HRV) over a wide range of frequencies using both linear, complexity, and fractal indicators. The current study investigated the effect of long-duration spaceflight on HR and HRV during sleep in seven astronauts aboard the International Space Station up to 6 mo. Measurements included electrocardiographic waveforms from Holter monitors and simultaneous movement records from accelerometers before, during, and after the flights. HR was unchanged inflight and elevated postflight [59.6 ± 8.9 beats per minute (bpm) compared with preflight 53.3 ± 7.3 bpm; P < 0.01]. Compared with preflight data, HRV indicators from both time domain and power spectral analysis methods were diminished inflight from ultralow to high frequencies and partially recovered to preflight levels after landing. During inflight and at postflight, complexity and fractal properties of HR were not different from preflight properties. Slow fluctuations (<0.04 Hz) in HR presented moderate correlations with movements during sleep, partially accounting for the reduction in HRV. In summary, substantial reduction in HRV was observed with linear, but not with complexity and fractal, methods of analysis. These results suggest that periodic elements that influence regulation of HR through reflex mechanisms are altered during sleep in spaceflight but that underlying system complexity and fractal dynamics were not altered.

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