Effect of Age on Haemodynamic Response to Tracheal Intubation. A Comparison of Young, Middle-aged and Elderly Patients

The effect of age on the haemodynamic response to tracheal intubation was studied. Ninety ASA 1 or 2 patients were divided into three groups of 30 each based on age; i.e., young (18–25 years), middle-aged (40–50 years) and elderly (65–80 years). The haemodynamic response after tracheal intubation was observed as percentage change in heart rate and blood pressure compared to the baseline. Inter-group comparison was also done at different time points. The greatest percentage change in the systolic arterial pressure after tracheal tube insertion was seen in the elderly group (15%). The increase in systolic arterial pressure was significantly less in the young group compared with the two older groups at one, two, three and four minutes post-intubation. The greatest percentage increase in the diastolic blood pressure compared to the baseline was seen in the middle aged group (24%). The elderly and young patients showed a significant difference in the diastolic blood pressure response only at one minute post-intubation. The heart rate response was greatest in the middle-aged patients (40%) and least in the elderly (16%). These differences may have clinical significance and should be considered in assessing and performing research into the haemodynamic response to intubation.

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A Comparison of Three Fluid-Vasopressor Regimens Used to Prevent Hypotension during Subarachnoid Anaesthesia in the Elderly

Anaesthesia and Intensive Care ◽

10.1177/0310057x9802600504 ◽

1998 ◽

Vol 26 (5) ◽

pp. 497-502 ◽

Cited By ~ 14

Author(s):

J. C. M. Yap ◽

L. A. H. Critchley ◽

S. C. Yu ◽

R. M. Calcroft ◽

J. L. Derrick

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Arterial Pressure ◽

Elderly Patients ◽

Hip Fractures ◽

Normal Saline ◽

Computer Software ◽

Systolic Arterial Pressure ◽

The Elderly ◽

Group A

We aimed to compare the efficacy of fluid preloading with two recently recommended fluid-vasopressor regimens for maintaining blood pressure during subarachnoid anaesthesia in the elderly. Sixty elderly patients requiring surgery for traumatic hip fractures received subarachnoid anaesthesia using 0.05 ml/kg of 0.5% heavy bupivacaine. Hypotension, i.e. systolic arterial pressure <75% of baseline, was prevented or treated by: A—normal saline 16 ml/kg plus intravenous ephedrine boluses (0.1 mg/kg); B—normal saline 8 ml/kg plus intramuscular depot ephedrine (0.5 mg/kg); or C—Haemaccel 8 ml/kg plus metaraminol infusion. Systolic arterial pressure and heart rate were recorded using custom-written computer software (Monitor, version 1.0). Systolic arterial pressure decreased in all groups after five minutes (P<0.001). Decreases were greatest in group A (P<0.05). Heart rate increased by 7% group A and decreased by 9% in group C (P<0.05). During the first hour, hypotension was present for 47%, 25% and 20% of the time in groups A, B and C respectively and overcorrection of systolic arterial pressure occurred in 19% of the time in group C. We conclude that treatment A was inadequate in preventing hypotension. Treatments B and C were more effective but were associated with an increased heart rate and overcorrection of systolic arterial pressure respectively.

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Sex differences in blood pressure responsiveness to spontaneous K-complexes during stage II sleep

Journal of Applied Physiology ◽

10.1152/japplphysiol.00825.2020 ◽

2020 ◽

Author(s):

Ian Mark Greenlund ◽

Carl A. Smoot ◽

Jason R. Carter

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Arterial Pressure ◽

Cardiac Cycle ◽

Pressor Response ◽

Systolic Arterial Pressure ◽

Stage Ii ◽

Men And Women ◽

Blood Pressures ◽

Blood Pressure Responses

K-complexes are a key marker of non-rapid eye movement sleep (NREM), specifically during stages II sleep. Recent evidence suggests the heart rate responses to a K-complexes may differ between men and women. The purpose of this study was to compare beat-to-beat blood pressure responses to K-complexes in men and women. We hypothesized that the pressor response following a spontaneous K-complex would be augmented in men compared to women. Ten men (Age: 23 ± 2 years, BMI: 28 ± 4 kg/m2) and ten women (Age: 23 ± 5 years, BMI: 25 ± 4 kg/m2) were equipped with overnight finger plethysmography and standard 10-lead polysomnography. Hemodynamic responses to a spontaneous K-complex during stable stage II sleep were quantified for 10 consecutive cardiac cycles, and measurements included systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and heart rate. K-complex elicited greater pressor responses in men when blood pressures were expressed as SAP (cardiac cycle × sex: p = 0.007) and DAP (cardiac cycle × sex: p = 0.004). Heart rate trended to be different between men and women (cardiac cycle × sex: p = 0.078). These findings suggest a divergent pressor response between men and women following a spontaneous K-complex during normal stage II sleep. These findings could contribute to sex-specific differences in cardiovascular risk that exist between men and women.

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Differences in Reflex Control of Arterial Pressure and Renin Release during Head-Up Tilting in the Cat

Clinical Science ◽

10.1042/cs055179s ◽

1978 ◽

Vol 55 (s4) ◽

pp. 179s-181s ◽

Cited By ~ 1

Author(s):

A. Stella ◽

R. A. L. Dampney ◽

R. Golin ◽

A. Zanchetti

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Blood Flow ◽

Arterial Pressure ◽

Renin Release ◽

Haemodynamic Response ◽

First Episode ◽

Haemodynamic Changes ◽

Cervical Vagotomy ◽

Reflex Control

1. Anaesthetized cats were subjected to two 10 min trials of head-up tilting spaced 30 min. Arterial pressure, heart rate, blood flow to an innervated kidney and to the contralateral denervated one, and renin release from both kidneys were measured. 2. The same haemodynamic changes and comparable increases in renin release from innervated kidneys occurred during both episodes of tilting when cats were subjected to sham cervical vagotomy between the two tilting trials. 3. Bilateral cervical vagotomy, performed after the first episode of head-up tilting, did not affect the haemodynamic response to the change in posture, but significantly and markedly reduced the increase in renin release from the innervated kidney. 4. After sino-aortic denervation a marked and sustained arterial hypotension occurred during tilting, and the postural increase in renin release from the innervated kidney was even greater. 5. In no condition, even during the marked fall in blood pressure in sino-aortic denervated cats, did head-up tilting increase renin release from the denervated kidney. 6. It is concluded that maintenance of arterial pressure during tilting is mainly due to sino-aortic reflexes, whereas vagal reflexes are mostly responsible for the postural increase in renin release.

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Comparison of esmolol versus combination of esmolol and fentanyl in preventing cardiovascular stress response to intubation

International Journal of Clinical Trials ◽

10.18203/2349-3259.ijct20170309 ◽

2017 ◽

Vol 4 (1) ◽

pp. 49

Author(s):

Rahul Bhalke ◽

Maroti S. Karale ◽

Umesh Deshmukh

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Stress Response ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Cardiovascular Responses ◽

Intravenous Fentanyl ◽

Group 2 ◽

Post Intubation ◽

Group 1

Background: A number of cardiovascular responses occur during laryngoscopy and intubation which can have serious consequences during anaesthesia.We planned to conduct a study to evaluate effectiveness of intravenous Esmolol and intravenous Fentanyl in attenuating hemodynamic stress response to laryngoscopy and endotracheal intubation.Methods: A prospective, observational, randomized, double blind comparative clinical study, conducted on 60 cases of ASA grade I/II patients undergoing elective abdominal surgery under general anesthesia. The data obtained was divided in the two groups based on drug used 5 min prior to induction, Group 1 (I.V. Esmolol 2 mg/kg) and Group 2 (I.V. Esmolol 2 mg/kg & I.V. Fentanyl 2 µg/kg). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were measured at various time intervals.Results: There was no significant difference in HR, SBP, DBP, MAP after premedication and induction in both the groups. However at intubation, both groups showed an increase in HR, SBP, DBP and MAP but the rise was attenuated in both groups. Increase in HR was more in group 1 as compared to group 2 and it was statistically significant at 01 and 02 minutes post intubation. The increase in SBP was statistically significant at 00, 01 and 02 minutes post intubation. The increase in MAP was statistically significant immediately after induction, at 00, 01, 02, 05 and 10 minutes post intubation. Conclusions: Combination of intravenous Esmolol and intravenous Fentanyl is more effective in attenuating heart rate, systolic, diastolic and mean arterial pressure response to intubation than intravenous Esmolol alone.

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The Effects of Gallamine and a Mixture of Pancuronium and Alcuronium on the Pressor and Plasma Catecholamine Responses to Tracheal Intubation

Anaesthesia and Intensive Care ◽

10.1177/0310057x8401200105 ◽

1984 ◽

Vol 12 (1) ◽

pp. 22-26 ◽

Cited By ~ 1

Author(s):

Mary F. Cummings ◽

W. J. Russell ◽

D. B. Frewin ◽

Wendy A. Miller

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Mean Arterial Pressure ◽

Tracheal Intubation ◽

Arterial Pressure ◽

Plasma Noradrenaline ◽

Plasma Catecholamine ◽

Plasma Adrenaline ◽

Noradrenaline Concentration ◽

Noradrenaline And Adrenaline

Tracheal intubation can be accompanied by significant increases in arterial pressure, heart rate and the plasma levels of noradrenaline and adrenaline. The drugs used at induction can enhance or attenuate these responses. In nine patients who had received gallamine, intubation was associated with a 45% rise in mean arterial pressure, a twofold rise in plasma adrenaline and a 49% rise in plasma noradrenaline concentration. When a mixture of pancuronium and alcuronium (in a ratio of 4:10 by weight) was used in ten patients, blood pressure fell 24% after induction and rose 49% after intubation. A 24% rise in plasma noradrenaline in response to intubation was also observed. Compared with pancuronium alone, the use of the mixture attentuates the rise in blood pressure and noradrenaline concentration associated with intubation but does not abolish them. In addition, the mixture was associated with a significant fall in blood pressure between induction and intubation, whereas this was not found with gallamine.

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Comparison of hemodynamic responses along with perfusion index to tracheal intubation with Macintosh and McCoy laryngoscopes

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20181757 ◽

2018 ◽

Vol 6 (5) ◽

pp. 1673 ◽

Cited By ~ 1

Author(s):

Vineet K. Choudhary ◽

Bhawana Rastogi ◽

V. P. Singh ◽

Savita Ghalot ◽

Vijay Dabass ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Mean Arterial Pressure ◽

Tracheal Intubation ◽

Arterial Pressure ◽

Macintosh Laryngoscope ◽

Hemodynamic Response ◽

Perfusion Index ◽

Additional Parameter ◽

Significant Difference

Background: The McCoy Laryngoscope in comparison to macintosh laryngoscope requires less force for performing laryngoscopy and as a result may alter the associated hemodynamic response. Perfusion index (PI) is a noninvasive numerical value of peripheral perfusion obtained from a pulse oximeter.Methods: A randomized prospective single blind comparative clinical study was conducted on 80 patients of ASA physical status I-II aged between 18 years to 58 years of either sex with body mass index (B.M.I) between 20 and 25 undergoing elective surgeries under general anesthesia. 80 patients were divided into 2 groups: Group A (n=40)- Tracheal Intubation with Macintosh Laryngoscope, Group B (n=40)-Tracheal Intubation with McCoy Laryngoscope. Blood Pressure (systolic blood pressure, diastolic blood pressure, and mean arterial pressure) and heart rate (HR), oxygen saturation (SpO2) via pulse oximeter were monitored.Results: The demographic profile showed no significant difference between the groups. Heart rate, systolic, diastolic and mean arterial pressure had highly significant difference in both groups. Perfusion index was statistically significant immediately post laryngoscopy and intubation till 4 mins. Immediately after laryngoscopy and intubation, the correlation between PI and MAP was statistically significant and it was a negative average to good correlation.Conclusions: The McCoy laryngoscope elicits lesser haemodynamic response to laryngoscopy and tracheal intubation as compared to Macintosh laryngoscope in normotensive patients. Perfusion index can also serve as an additional parameter to assess hemodynamic response since it has good negative correlation with the mean arterial pressure.

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A Comparative Study between Two Different Doses of Dexmedetomidine for Attenuation of Hemodynamic Response to Laryngoscopy and Tracheal Intubation.

Nepal Medical College Journal ◽

10.3126/nmcj.v21i3.26444 ◽

2019 ◽

Vol 21 (3) ◽

pp. 178-183

Author(s):

Chitra Thapa ◽

S. Gauchan

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Mean Arterial Pressure ◽

Tracheal Intubation ◽

Arterial Pressure ◽

Systolic Blood Pressure ◽

Study Drug ◽

Hemodynamic Response ◽

Group A ◽

Group B

Laryngoscopy and end tracheal intubation are stressful situation for the patients, as these procedures are capable of producing tachycardia, hypertension and arrhythmias. This study was conducted with the objective of arriving at an optimal dose of dexmedetomidine that can attenuate the hemodynamic response to laryngoscopy and intubation with minimal side effects. The current study was conducted in 60 patients, posted for elective surgery under general anesthesia withendotracheal intubation. The patients were divided into two groups: Group A and Group B. Group A received dexmedetomidine 0.5 μg/kg and group B received dexmedetomidine 1 μg/kg intravenously over 10 min prior to induction of anesthesia. The anesthesia technique was standardized in both the groups. Heart rate, systolic, diastolic and mean arterial pressure were monitored and recorded at 5min and 10 min of completion of infusion of study drug, after induction, and at 1 min, 2 min, 5 min after intubation. The baseline heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were statistically similar in both the groups. After the infusion of the study drug the mean heart rate, mean systolic blood pressure, mean diastolic blood pressure, mean arterial pressure at all times were comparable in both the groups. Episodes of hypotension and bradycardia were also statistically similar in both the groups. Attenuation of hemodynamic response to laryngoscopy and intubation by dexmedetomidine is similar with the two doses: 0.5 μg/kg and 1 μg/kg. Both the doses of dexmedetomidine were devoid of any significant adverse effects.

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A STUDY OF HAEMODYNAMIC RESPONSE TO LARYNGOSCOPY AND ENDOTRACHEAL INTUBATION WHEN USING FENTANYL:

10.36106/paripex/7209259 ◽

2019 ◽

pp. 1-2

Author(s):

Brenda Paulson

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Tracheal Intubation ◽

Serum Concentration ◽

Cardiovascular System ◽

Endotracheal Intubation ◽

Tracheal Tube ◽

Direct Laryngoscopy ◽

Haemodynamic Response ◽

Noxious Stimuli

Direct laryngoscopy is used to facilitate tracheal intubation under vision.Direct laryngoscopy and passage of a tracheal tube are noxious stimuli that can provoke adverse responses in the cardiovascular system. They cause intense reflex increase in heart rate,blood pressure and serum concentration of catecholamines.This study makes an effort to find the haemodynamic response to laryngoscope and endotracheal intubation using Fentanyl.

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Use of Gabapentin, Esmolol or Their Combination to Attenuate Haemodynamic Response to Laryngoscopy and Intubation

Kathmandu University Medical Journal ◽

10.3126/kumj.v9i4.6336 ◽

2012 ◽

Vol 9 (4) ◽

pp. 238-243 ◽

Cited By ~ 1

Author(s):

G S Shrestha ◽

M N Marhatta ◽

R Amatya

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Systolic Blood Pressure ◽

Normal Saline ◽

Study Drug ◽

Haemodynamic Response ◽

Rate Pressure Product ◽

Significant Difference

Background Laryngoscopy and intubation increases blood pressure and heart rate. Objective The study aims to investigate the effect and safety of gabapentin, esmolol or their combination on the haemodynamic response to laryngoscopy and intubation. Methods A total of 72 patients undergoing elective surgery were randomly allocated to one of the four groups. First study drug was administered orally as gabapentin 1200mg or placebo. Second study drug was administered intravenously as esmolol 1.5mg/kg or normal saline. Heart rate, rate pressure product, systolic blood pressure and mean arterial pressure were recorded at baseline and at zero, one, three and five minutes after tracheal intubation. Results Baseline values were compared with the values at various time intervals within the same group. In group PE (placebo, esmolol), there was significant decrease in heart rate and rate pressure product at five minutes. In group GN (gabapentin, normal saline), there was significant decrease in systolic blood pressure and mean arterial pressure at five minutes. In group GE (gabapentin, esmolol), there was significant decrease in heart rate at zero, three and five minutes. Systolic blood pressure, mean arterial pressure and rate pressure product was significantly lower at three and five minutes. In group PN (placebo, normal saline), there was significant increase in heart rate at zero, one, three and five minutes; systolic blood pressure at zero and one minutes; mean arterial pressure at zero and one minutes & rate pressure product at zero, one and three minutes. In group GN (gabapentin, normal saline), there was significant increase in heart rate at zero, one and three minutes & rate pressure product at zero, one and three minutes. In group PE (placebo, esmolol), there was significant increase in systolic blood pressure at zero and one minutes & mean arterial pressure at zero and one minutes. However, in group GE (gabapentin, esmolol) none of the variables showed statistically significant increase at any time. Inter-group comparison was made for each time point. At zero minute, there was significant difference in heart rate between groups PN and GE, GN and PE & GN and GE Significant difference was also noted in rate pressure product between PN and GE at zero minute. At one minute there was difference in heart rate between PN and PE, PN and GE, GN and PE & between GN and GE. Significant difference was observed in rate pressure product between PN and PE & between PN and GE at one minute. No significant side effects of the study drugs were observed. ConclusionsCombination of gabapentin and esmolol in this study design is safe and better attenuates both the pressor and tachycardic response to laryngoscopy and intubation, than either agent alone.DOI: http://dx.doi.org/10.3126/kumj.v9i4.6336 Kathmandu Univ Med J 2011;9(4):238-43

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Comparative pharmacodynamics of intranasal and enteral administration of captopril for uncomplicated hypertensive crises

Current issues in pharmacy and medicine science and practice ◽

10.14739/2409-2932.2021.1.226857 ◽

2021 ◽

Vol 14 (1) ◽

pp. 103-108

Author(s):

I. L. Kechyn ◽

V. V. Hladyshev ◽

I. О. Pukhalska

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Arterial Pressure ◽

Arterial Hypertension ◽

Dosage Form ◽

Systolic Arterial Pressure ◽

Controlled Study ◽

Diastolic Arterial Pressure ◽

Intranasal Application ◽

Hypertensive Crises

Uncomplicated hypertensive crises without acute or progressive damage to the target organs pose a potential threat to the patient’s life and require rapid reduction of arterial pressure within hours or days in an outpatient setting. The existing protocol for the treatment of this pathology is not entirely perfect, as it does not offer the primary physician a clear and unambiguous description of the use of effective and complementary drugs. The use in these cases of nasal transport of antihypertensive active pharmaceutical ingredients in appropriate dosage forms makes it possible to ensure their rapid delivery to the bloodstream and perivascular structures of the brain. Based on previous experience, and taking into account biopharmaceutical research on pharmacodynamics and pharmacokinetics of captopril innovative captopril dosage form has been developed and put into practice for trasmucosal administration as 2.5 % intranasal gel with controlled releasing of captopril substance in Zaporizhzhia State Medical University. The aim of the research was to study the pharmacodynamics of captopril gel in patients with arterial hypertension with uncomplicated hypertensive crises. Materials and methods. 58 outpatients with stage 2 arterial hypertension with uncomplicated cardiac crises were surveyed, an experienced group had 30 patients aged from 38 to 69 years (average age 52.60 ± 5.03 years) with average duration of disease 11.50 ± 2.72 years, obtained the intranasal application into two nasal routes 0.5 ml 2.5 % captopril gel with a dose syringe. Comparison group had 28 patients with stage 2 arterial hypertension with uncomplicated cardiac crises aged from 37 to 65 years with duration of arterial hypertension 10.8 ± 2.63 years, obtained peroral captopril in equivalent dose. Captopril tablets 0.025 g were used as a reference drug. In the course of treatment, the indicators of office blood pressure and heart rate in the crisis state were determined after 60, 120 and 240 minutes after the use of captopril. Because of asymmetric distribution, the non-parametric method – the Wilcoxon signed-rank test – was used. Results. There has been a significant reduction in systolic and diastolic arterial pressure one hour after the gel’s intranasal application by 19.9 % and 23.8 % respectively, whereas, after the use of captopril in tablets, there is only a tendency to decrease systolic and diastolic pressures by 8.8 % and 11.6 % respectively. Two hours after the use of the gel, systolic and diastolic blood pressure decreased by 23.5 % and 23.5 % respectively, reaching the level recommended by the leading cardiologists of Ukraine. After oral administration of the captopril tablets, systolic arterial pressure decreased by 13 %, diastolic arterial pressure, and heart rate showed only a downward trend. Four hours after the use of the captopril gel, there was a gradual increase in systolic arterial pressure, and the level of diastolic arterial pressure remained almost the same. After application of captopril gel, the heart rate in the treatment dynamics remained unchanged, with a trend of acceleration in the first time of treatment, and decreased by 4 hours by 12.4 %. Conclusions. A randomized, controlled study of nasal captopril pharmacodynamics in the form of 2.5 % hydrophilic gel compared to its tableted dosage form in patients with arterial hypertension with uncomplicated hypertensive crises was carried out. It has been established that the nasal dosage form of captopril provides for the reduction of the arterial pressure to the level recommended in the case of uncomplicated hypertensive crises for 4 hours more efficiently than the oral agent. Captopril nasal gel has been shown to have good tolerance and there are practically no side effects from its use.

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