scholarly journals Effect of Dexmedetomidine on Perioperative Stress Response and Immune Function in Patients With Tumors

2020 ◽  
Vol 19 ◽  
pp. 153303382097754
Author(s):  
Lihong Zheng ◽  
Juan Zhao ◽  
Likun Zheng ◽  
Shuangfeng Jing ◽  
Xiaoting Wang
Keyword(s):  
Heart Rate ◽  
Stress Response ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Immune Function ◽  
Spontaneous Respiration ◽  
General Anesthetics ◽  
Ifn Γ ◽  
Group D ◽  
Perioperative Stress

Objective: This study aims to investigate the effect of dexmedetomidine on perioperative stress response and immune function in patients with tumors. Methods: Sixty patients who underwent selective radical gastrectomy for cancer were randomly divided into 3 groups: remifentanil group (group R), dexmedetomidine group (group D), and sufentanil group (group S). Remifentanil, dexmedetomidine, and sufentanil were used as general anesthetics. Endotracheal intubation and mechanical ventilation were performed after the spontaneous respiration disappeared. Then, the data were recorded, and blood samples were collected at all time points. Results: The heart rate significantly increased ( P < 0.05) at T1 in group S, and both heart rate and mean arterial pressure significantly increased ( P < 0.05) in group R when compared to group D. The heart rate significantly increased ( P < 0.05) at T2 in group S and group R. Furthermore, the heart rate significantly increased ( P < 0.05) at T3 and T4 in group S and group R. Intra-group comparison: The heart rate at T1–T4 and mean arterial pressure at T1–T4 significantly increased ( P < 0.05) in group S, and the heart rate at T1 and T4, and mean arterial pressure at T2–T4 significantly increased ( P < 0.05) in group R when compared to T0. The serum IL-6, IFN-γ, and β-EP significantly increased ( P < 0.05) at T0’ in group S and group R when compared to group D. Blood glucose, and serum IL-10, IFN-γ, and β-EP significantly increased ( P < 0.05), while IL-18 significantly decreased ( P < 0.05) at T1’ in group S and group R. Conclusion: Continuous infusion of dexmedetomidine in combination with the inhalation of sevoflurane is superior to sevoflurane + remifentanil or sufentanil in patients undergoing tumor surgery.

scholarly journals EFFECT OF ORAL MOXONIDINE IN THE ATTENUATION OF THE HAEMODYNAMIC RESPONSES SEEN DURING LAPAROSCOPIC SURGERIES

2017 ◽  
Vol 10 (3) ◽  
pp. 409
Author(s):  
Sidharth Sraban Routray ◽  
Ramakanta Mohanty
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Placebo Group ◽  
Stress Response ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Significant Rise ◽  
Hemodynamic Stability ◽  
Blinded Study ◽  
Double Blinded

ABSTRACTObjective: During laparoscopic surgeries, pneumoperitoneum can lead to various pathophysiologic changes in the cardiovascular system resulting inhypertension and tachycardia. Search for ideal drug to prevent this hemodynamic response goes on. The aim of our study was to evaluate the effect oforally administered moxonidine in attenuating the hemodynamic responses that occur during the laparoscopic surgeries.Methods: A total of 50 adult acetylsalicylic acid I and II patients scheduled for elective laparoscopic surgeries were selected for this prospectiverandomized double-blinded study. They were randomly allocated into two groups: moxonidine group (M) and placebo group (P). M group receivedoral moxonidine 0.3 mg at 8 pm on the day before surgery and at 8 am on the day of surgery. P group received a placebo at the same timing as that ofthe M group.Results: Following pneumoperitoneum rise in systolic blood pressure (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and heart rate (HR)was higher in P group in comparison to M group which was statistically significant.Conclusion: Significant rise in HR, SBP, DBP, and mean BP was noted in the P group in comparison to moxonidine group. Moxonidine provided betterperioperative hemodynamic stability in patients undergoing laparoscopic surgeries.Keywords: Moxonidine, Stress response, Laparoscopic.

Comparative Study of Dexmedetomidine and Fentanyl for Attenuation of Hemodynamic Response to Laryngoscopy and Intubation

2019 ◽  
Vol 15 (3) ◽  
pp. 191-196
Author(s):  
Sabin Gauchan ◽  
Chitra Thapa
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Intracranial Pressure ◽  
Myocardial Ischemia ◽  
Arterial Pressure ◽  
Hemodynamic Response ◽  
Raised Intracranial Pressure ◽  
Group D ◽  
Fentanyl Group

Background: Laryngoscopy and intubation cause hypertension and tachycardia which can lead to myocardial ischemia or cerebrovascular hemorrhage in patients with raised intracranial pressure, hypertension. The objective of this study was to compare the efficacy of dexmedetomidine (1 mcg/kg) and fentanyl (2 mcg/kg) in attenuating hemodynamic response to laryngoscopy and intubation. Methods: Sixty patients scheduled for elective surgeries under general anaesthesia were randomly divided into two groups: Group D and Group F. Group D received dexmedetomidine 1 mcg/kg and group F received fentanyl 2 mcg/kg intravenously over 10 min prior to induction of anesthesia. All the drugs and techniques of anesthesia were standardized in patients in both the groups. Heart rate, systolic, diastolic and mean arterial pressure were recorded at following intervals: at baseline, after drug administration (at 2 and 5 min), after induction, and at 1, 2 and 5 min after intubation. Results: Heart rate and blood pressure was found to be significantly lower in dexmedetomidine group as compared to fentanyl group at 1, 2 and 5 min after intubation. Conclusions: Dexmedetomidine 1 mcg/kg is superior to fentanyl 2 mcg/kg for attenuation of hemodynamic response to laryngoscopy and intubation.

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

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

<p><strong> </strong></p><p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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 &amp; 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.</p><p class="abstract"><strong>Results:</strong> 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.  </p><p class="abstract"><strong>Conclusions:</strong> 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.</p>

scholarly journals Hemodynamic responses to laryngoscopy and intubation using Macintosh, Miller and McCoy blades

2019 ◽  
Vol 9 (4) ◽  
pp. 47-51
Author(s):  
Gopendra Prasad Deo ◽  
Suresh Gautam ◽  
Indra Narayan Shrestha ◽  
Bharati Sharma Regmi ◽  
Subin Shrestha ◽  
...  
Keyword(s):  
Heart Rate ◽  
Stress Response ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
General Anaesthesia ◽  
Endotracheal Intubation ◽  
Haemodynamic Response ◽  
Macintosh Blade ◽  
Essential Components ◽  
Haemodynamic Stress

Background: Direct Laryngoscopy and endotracheal intubation are essential components of administration of general anaesthesia but trigger major stress response, in the form of in­creased catecholamines leading to tachycardia and hypertension. This study is designed to compare the haemodynamic stress response with the Macintosh, McCoy and Miller blades. Methods: This prospective comparative study was conducted in 150 ASA grade I and II pa­tients, undergoing laparoscopic cholecystectomy under general anaesthesia from March 2017, were randomly divided into three groups using Macintosh, McCoy and Miller blade for endotracheal intubation respectively. Results: The groups were also comparable in respect to gender, mean age, ASA grade, Cor­mack and Lehane grade, Laryngoscopic intubation time, baseline heart rate, heart rate before laryngoscopy, baseline mean arterial pressure and Mean Arterial Pressure before laryngos­copy. The mean heart rates at end of 1, 3 and 5 minute were 93.58±13.11, 88.28±11.57 and 83.64±10.94 bpm with Macintosh blade; 93.08±12.09, 94.54±11.87 and 87.50±10.72 bpm with McCoy blades; 108.20±13.94, 95.18±12.75 and 93.22±12.32 bpm with Miller blades. Rise in heart rate as well as mean arterial pressure following intubation was greatest with Miller blade, followed by Macintosh blade and least with McCoy blade and was statistically significant (P< 0.01). Conclusions: Miller blade produced maximum haemodynamic stress response, followed by Macintosh blade and McCoy blade produced the least haemodynamic response, hence the latter is preferable when less haemodynamic response is desired.

scholarly journals Attenuation of hemodynamic response to laryngoscopy and endotracheal intubation with dexmedetomidine: a randomized controlled trial

2016 ◽  
Vol 3 (1) ◽  
pp. 28-31
Author(s):  
Nabin Pokhrel ◽  
Uday Bajra Bajracharya
Keyword(s):  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Endotracheal Intubation ◽  
Controlled Trial ◽  
Hemodynamic Response ◽  
Saline Group ◽  
Controlled Study ◽  
Randomized Controlled ◽  
Group D

Background: Laryngoscopy and endotracheal intubation causes marked increase in heart rate and blood pressure. Even though various agent tried to blunt the hemodynamic response but none of them proved to be an ideal. The aim of the study was to compare dexmedetomidine and placebo in blunting the hemodynamic response to laryngoscopy and endotracheal intubation.Methods: A randomized placebo controlled study with total of 90 patients were included in the study of which 30 patients received dexmedetomidine (Group D) 10 minutes prior to endotracheal intubation and 30 patients received 3 ml Normal Saline (Group C) 10 minutes prior to endotracheal intubation. They were evaluated with change in heart rate and mean arterial pressure at 1, 3 and 5 minutes post laryngoscopy and endotracheal intubation. Any adverse effect of the drug was noted. Results: Age, gender, physical status and weight were comparable between the groups. Heart rate and mean arterial pressure attenuated significantly in dexmedetomidine group (p<0.001 in 1, 3 and 5 minute intervals respectively), whereas placebo failed to attenuate hemodynamic response after laryngoscopy and intubation in any measured interval. No complications were noted. Conclusions: Dexmedetomidine 1 mcg/kg given 10 min prior to endotracheal intubation significantly attenuates heart rate and mean arterial pressure at 1, 3 and 5 minutes compared to placebo.

scholarly journals Efficacy of dexmedetomidine in attenuating hemodynamic and airway responses during extubation: a randomized double-blind study

2020 ◽  
pp. e223
Author(s):  
Kripa Pradhan ◽  
Pradip Raj Vaidya
Keyword(s):  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Drug Administration ◽  
Normal Saline ◽  
Blind Study ◽  
Double Blind Study ◽  
Double Blind ◽  
Airway Responses ◽  
Group D

Background Tracheal extubation causes significant hemodynamic changes and airway irritation. During smooth extubation there is absence of straining, movement, coughing, breath holding, laryngospasm and minimal change in hemodynamic. Purpose of this study was to evaluate the efficacy of dexmedetomidine in attenuating hemodynamic and airway responses during extubation. Methodology Eighty patients receiving general anesthesia were included in this randomized double-blind study. Ten minutes before the end of anesthesia, Group D (Dexmedetomidine group) (n=40) received Inj. Dexmedetomidine 0.5mcg/kg and Group N (Normal Saline group) (n=40) received 10 ml normal saline over 10 mins. Heart rate and mean arterial pressure were recorded prior to the drug administration till 10 mins after extubation. The incidence of cough was monitored during extubation. Any possible side effects of study drugs were recorded.     Results Age, gender, physical status, weight, duration of surgery, baseline heart rate and mean arterial pressure were comparable between the groups. There was statistically significant difference (p < 0.05) in heart rate and mean arterial pressure between the groups after 5 mins of study drug administration and then throughout the study period. Using four point scale for coughing during extubation, 10% of Group D and 50% of Group N had minimal cough, 22.5% of Group N and 2.5% of Group D had moderate cough.    Conclusion Finding suggests that intravenous dexmedetomidine before extubation significantly attenuates hemodynamic and airway responses during extubation.

scholarly journals A Prospective Randomized Study on Intraoperative Haemodynamic and Post-Operative Recovery Characteristics of Sevoflurane and Desflurane in Thyroid Surgeries under General Anaesthesia in Wayanad District

2021 ◽  
Vol 8 (24) ◽  
pp. 2045-2051
Author(s):  
Faias Karukappadath Siddique ◽  
Arun Aravind ◽  
Ashabi Mansoortheen
Keyword(s):  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
General Anaesthesia ◽  
Randomized Study ◽  
Significant Difference ◽  
Ethical Committee Approval ◽  
American Society ◽  
Operative Recovery ◽  
Group D

BACKGROUND Maintaining deep plane of anaesthesia to prevent haemodynamic fluctuation and absolute immobility at the same time ensuring early and smooth recovery to prevent bleeding and assessing vocal cord status are the challenges to the anaesthesiologists in thyroid surgeries. Use of volatile anaesthetics with low solubility and low blood gas partition coefficient are used for their haemodynamic stability and faster emergence from anaesthesia in various surgeries under general anaesthesia. we wanted to compare sevoflurane and desflurane in terms of intraoperative haemodynamics, postoperative emergence and recovery characteristics in thyroid surgeries of less than 2 hours duration. METHODS After getting institutional ethical committee approval, 70 patients belonging to American Society of Anaesthesiologists (ASA), physical status I or II undergoing elective thyroid surgery were randomly assigned to two groups to receive either 6 % Desflurane (group D ) or 2 % Sevoflurane (group S) for maintenance of general anaesthesia along with 33 % oxygen with 67 % nitrous oxide. The intraoperative heart rate, mean arterial pressure were recorded at 5 minute intervals and recovery characteristics including times to extubation, first spontaneous motion, response to painful pinch, recall of name, hand grip and PARS score ≥ 9 were recorded in both groups. RESULTS There was no statistically significant difference (P > 0.05) in mean heart rate and mean arterial pressure between group D and S and remained within 20 % of baseline. The time to achieve a PARS ≥ 9 was earlier in the desflurane group and it was statistically significant. CONCLUSIONS Desflurane and Sevoflurane based anaesthesia provides comparable intraoperative haemodynamics whereas post-operative recovery was quicker in patients who received Desflurane compared to Sevoflurane. KEYWORDS Desflurane, Haemodynamics, Recovery, Sevoflurane

scholarly journals Comparison of Intravenous Lignocaine and Dexmedetomidine for Attenuation of Hemodynamic Stress Response to Laryngoscopy and Endotracheal Intubation

2021 ◽  
Vol 10 (16) ◽  
pp. 1123-1129
Author(s):  
Deepti N. Anandani ◽  
Manisha S. Kapdi ◽  
Ami D. Patel ◽  
Pratik Jain
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Stress Response ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Endotracheal Intubation ◽  
Normal Saline ◽  
Rate Pressure Product

BACKGROUND The purpose of the present study was to evaluate the efficacy of intravenous lignocaine 1.5 mg / kg & intravenous dexmedetomidine 1 mcg / kg for attenuating the haemodynamic response to laryngoscopy & endotracheal intubation in patients undergoing elective surgery under general anaesthesia. METHODS In this prospective randomised, comparative, clinical study, 60 patients were randomly divided into 2 groups, among them 30 patients were given infusion of 1.5 mg / kg IV lignocaine, diluted to 10 ml with normal saline, 3 minutes before intubation & 30 patients were given infusion of dexmedetomidine 1 mcg / kg diluted to 25 ml in normal saline over 10 minutes through infusion pump before induction. The heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, rate pressure product, oxygen saturation were measured at baseline, after study drug intubation at L + 1, L + 3, L + 5, L + 7 & L + 10 (L is onset of laryngoscopy). Statistical analysis was done by using descriptive & inferential statistics using chisquare test, Students paired & unpaired t test to find out the significance of the five variables namely mean heart rate (HR), mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP), mean arterial pressure (MAP) and mean rate pressure product (RPP). RESULTS Dexmedetomidine provided better blunting of stress response during laryngoscopy and intubation without causing clinically significant respiratory depression, bradycardia or hypotension. It is better in achieving a low RPP, which is a good predictor of myocardial oxygen consumption. Dexmedetomidine provides better cardio-protection in patients against pressure response than lignocaine. CONCLUSIONS In these 60 patients, dexmedetomidine (1 mcg / kg) was found to be superior to lignocaine (1.5 mg / kg) for attenuation of pressor response. KEY WORDS Laryngoscopy, Endotracheal Intubation, Dexmedetomidine, Lignocaine, Rate Pressure Product

scholarly journals Preclinical Pharmacology in the Rhesus Monkey of CW 1759-50, a New Ultra-short Acting Nondepolarizing Neuromuscular Blocking Agent, Degraded and Antagonized by L-Cysteine

2018 ◽  
Vol 129 (5) ◽  
pp. 970-988 ◽  
Author(s):  
John J. Savarese ◽  
Hiroshi Sunaga ◽  
Jeff D. McGilvra ◽  
Matthew R. Belmont ◽  
Matthew T. Murrell ◽  
...  
Keyword(s):  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Neuromuscular Blockade ◽  
Blocking Agent ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agent ◽  
Duration Of Action ◽  
Short Acting ◽  
Circulatory Effects

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Structure–activity studies were performed to identify a new neuromuscular blocking agent retaining the ultra-short acting characteristics of gantacurium, including degradation and reversal by l-cysteine, but lacking its histaminoid properties in man. CW 1759-50 has emerged from this program. Methods Adduction of CW 1759-50 with l-cysteine was studied by high-performance liquid chromatography and mass spectrometry. Institutional Animal Care and Use Committee–approved comparisons of CW 1759-50 to gantacurium were performed in rhesus monkeys. ED95 for neuromuscular blockade was established. Spontaneous recovery was compared to reversal by l-cysteine in paired studies of boluses or infusions. In addition, changes in mean arterial pressure and heart rate after very large doses of 15 to 60 × ED95 were compared. Results The half-time of adduction of l-cysteine to CW 1759-50 in vitro was 2.3 min. The ED95 of CW 1759-50 was 0.069 ± 0.02 mg/kg; ED95 of gantacurium was 0.081 ± 0.05 mg/kg (P = 0.006). Duration of action (recovery to 95% twitch height after 98 to 99% blockade) was as follows: CW 1759-50, 8.2 ± 1.5 min; and gantacurium, 7.4 ± 1.9 min; (n = 8 and 9, P = 0.355). Administration of l-cysteine (30 mg/kg) shortened recovery (i.e., induced reversal) from CW 1759-50 after boluses or infusions (P always less than 0.0001). Recovery intervals (5 to 95% twitch) ranged from 6.1 to 6.7 min (and did not differ significantly) after boluses of 0.10 to 0.50 mg/kg, as well as control infusions (P = 0.426 by analysis of variance). Dose ratios comparing changes of 30% in mean arterial pressure or heart rate to ED95 for neuromuscular blockade (ED 30% Δ [mean arterial pressure or heart rate]/ED95) were higher for CW 1759-50 than for gantacurium. Conclusions CW 1759-50, similar to gantacurium, is an ultra-short acting neuromuscular blocking agent, antagonized by l-cysteine, in the monkey. The circulatory effects, however, are much reduced in comparison with gantacurium, suggesting a trial in humans.

Hypotensive and Regional Haemodynamic Effects of Exercise, Fasted and after Food, in Human Sympathetic Denervation

1998 ◽  
Vol 94 (1) ◽  
pp. 49-55 ◽  
Author(s):  
Sharmini Puvi-Rajasingham ◽  
Gareth D. P. Smith ◽  
Adeola Akinola ◽  
Christopher J. Mathias
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Superior Mesenteric Artery ◽  
Vascular Resistance ◽  
Mesenteric Artery ◽  
Autonomic Failure ◽  
Sympathetic Denervation ◽  
Stroke Distance

1. In human sympathetic denervation due to primary autonomic failure, food and exercise in combination may produce a cumulative blood pressure lowering effect due to simultaneous splanchnic and skeletal muscle dilatation unopposed by corrective cardiovascular reflexes. We studied 12 patients with autonomic failure during and after 9 min of supine exercise, when fasted and after a liquid meal. Standing blood pressure was also measured before and after exercise. 2. When fasted, blood pressure fell during exercise from 162 ± 7/92 ± 4 to 129 ± 9/70 ± 5 mmHg (mean arterial pressure by 22 ± 5%), P < 0.0005. After the meal, blood pressure fell from 159 ± 8/88 ± 6 to 129 ± 6/70 ± 4 mmHg (mean arterial pressure by 22 ± 3%), P < 0.0001, and further during exercise to 123 ± 6/61 ± 3 mmHg (mean arterial pressure by 9 ± 3%), P < 0.01. The stroke distance—heart rate product, an index of cardiac output, did not change after the meal. During exercise, changes in the stroke distance—heart rate product were greater when fasted. 3. Resting forearm and calf vascular resistance were higher when fasted. Calf vascular resistance fell further after exercise when fasted. Resting superior mesenteric artery vascular resistance was lower when fed; 0.19 ± 0.02 compared with 032 ± 0.06, P < 0.05. After exercise, superior mesenteric artery vascular resistance had risen by 82%, to 0.53 ± 0.12, P < 0.05 (fasted) and by 47%, to 0.29 ± 0.05, P < 0.05 (fed). 4. On standing, absolute levels of blood pressure were higher when fasted [83 ± 7/52 ± 7 compared with 71 ± 2/41 ± 3 (fed), each P < 0.05]. Subjects were more symptomatic on standing post-exercise when fed. 5. In human sympathetic denervation, exercise in the fed state lowered blood pressure further than when fasted and worsened symptoms of postural hypotension.

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