scholarly journals Comparison of Atomised Sublingual Dexmedetomidine and Oral Midazolam as Preanaesthetic Medication in Children - A Prospective, Double Blind, Randomised Control Trial

2021 ◽  
Vol 10 (34) ◽  
pp. 2894-2899
Author(s):  
Pooja Bola Rajendra Devendra Kamath ◽  
Ashwin Udupa ◽  
Anitha Nileshwar ◽  
Madhu Rao
Keyword(s):  
Heart Rate ◽  
Repeated Measures ◽  
Demographic Data ◽  
Hospital Setting ◽  
Randomised Control Trial ◽  
Anaesthetic Induction ◽  
Double Blind ◽  
Suitable Alternative ◽  
Oral Midazolam ◽  
Group D

BACKGROUND Pre-operative anxiety is common in children and its relief is an important concern for the anaesthesiologist. Oral midazolam has good sedative and anxiolytic properties. Dexmedetomidine, an alpha-2 agonist, produces sedation like natural sleep, in addition to having analgesic, anxiolytic and anaesthetic-sparing properties, making it a near ideal sedative. Alleviating this anxiety using minimally invasive and painless routes for sedative drugs is of paramount importance. The purpose of this study was to compare the sedation, child-parent separation, and mask acceptance between sublingual atomised dexmedetomidine and oral midazolam, along with the haemodynamic changes associated with these drugs. METHODS This prospective, double-blind, randomised control trial was conducted in a tertiary hospital setting. Using computer-generated randomisation, sixty paediatric patients were divided into one of two groups. Group - D received sublingual dexmedetomidine 1.5 µg/kg using a mucosal atomisation device, and Group - M, oral midazolam 0.5 mg/kg, 45 minutes before anaesthetic induction. Sedation status, child-parent separation, mask acceptance scores, haemodynamics and oxygen saturation were measured at baseline and every 15 minutes till induction. Quantitative data were compared with student’s t-test and repeated measures analysis of variance (ANOVA), and qualitative data using chi-square test. RESULTS Demographic data were comparable between the two groups. Children in Group - D were significantly more sedated (P < 0.0001), with lower heart rate at 30 and 45 minutes (P = 0.003, < 0.0001 respectively) than Group - M. However, mask acceptance score was significantly better (P = 0.007) in Group - M. Child-parent separation score was comparable. CONCLUSIONS Atomised sublingual dexmedetomidine produced significantly greater sedation and low-normal heart rate, but poorer mask acceptance than with oral midazolam. Child-parent separation was comparable. We conclude that sublingual atomised dexmedetomidine 1.5 µg/kg, is not a suitable alternative to oral midazolam 0.5 mg/kg for paediatric premedication. KEY WORDS Anaesthesia, Dexmedetomidine, Midazolam, Anti-Anxiety Agents, Premedication, Paediatric

scholarly journals Dexamethasone Blunts Post-Spinal Hypotension in Geriatric Patients Undergoing Orthopedic Surgery: A Double Blind, Placebo-Controlled Study

2020 ◽  
Author(s):  
Tarek Ashoor ◽  
Noha S. Hussien ◽  
Sherif G. Anis ◽  
Ibrahim M. Esmat
Keyword(s):  
Heart Rate ◽  
Spinal Anesthesia ◽  
Demographic Data ◽  
Volume Overload ◽  
Controlled Study ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Spinal Hypotension ◽  
Group D

Abstract Background. Post-spinal hypotension in elderly is challenging, correction by fluids either colloids or crystalloids or by vasoconstrictors pose the risk of volume overload or compromising cardiac conditions. Dexamethasone is used to treat conditions manifested by decrease of peripheral vascular resistance; we were the first to test the hypothesis of its role in preventing or decreasing the incidence of post-spinal hypotension.Methods. 110 patients aged 60 years or more were recruited in the study, 55 in the Dexamethasone group (D group) were given 8 mg Dexamethasone 2 hours preoperatively, and 55 were given placebo (C group).Variations in blood pressure and heart rate and need of vasoconstrictors and/or atropine following spinal anesthesia (SA) was done. SA was done by subarachnoid injection of 3 ml of hyperbaric bupivacaine.Results. Demographic data and the quality of sensory and motor block were comparable between groups. At 5, 10 minutes; systolic, diastolic and, mean arterial pressures were significantly higher in group D. At 20 minutes readings were non significant between groups. Heart rate changes didn’t show any significance. Need for ephedrine was less in group D, side effects were less in the D group. Conclusion. Dexamethasone may attenuate post-spinal hypotension in elderly, with a favorable response against nausea, vomiting and shivering that associate spinal anesthesia.

scholarly journals Time Course and Magnitude of Tolerance to the Ergogenic Effect of Caffeine on the Second Ventilatory Threshold

Life ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 343
Author(s):  
Carlos Ruiz-Moreno ◽  
Beatriz Lara ◽  
Jorge Gutiérrez-Hellín ◽  
Jaime González-García ◽  
Juan Del Coso
Keyword(s):  
Heart Rate ◽  
Aerobic Exercise ◽  
Body Mass ◽  
Repeated Measures ◽  
Time Course ◽  
Ventilatory Threshold ◽  
Statistical Significance ◽  
Ergogenic Effect ◽  
Double Blind ◽  
Main Effects

Pre-exercise caffeine ingestion has been shown to increase the workload at ventilatory threshold, suggesting an ergogenic effect of this stimulant on submaximal aerobic exercise. However, the time course of tolerance to the effect of caffeine on ventilatory threshold is unknown. This study aimed to determine the evolution of tolerance to the ergogenic effect of caffeine on the ventilatory threshold. Methods: Eleven participants (age 32.3 ± 4.9 yrs, height 171 ± 8 cm, body mass 66.6 ± 13.6 kg, VO2max = 48.0 ± 3.8 mL/kg/min) took part in a longitudinal, double-blind, placebo-controlled, randomized, crossover experimental design. Each participant took part in two identical treatments: in one treatment, participants ingested a capsule containing 3 mg of caffeine per kg of body mass per day (mg/kg/day) for twenty consecutive days; in the other treatment, participants ingested a capsule filled with a placebo for the same duration and frequency. During these treatments, participants performed a maximal ramp test on a cycle ergometer three times per week and the second ventilatory threshold (VT2) was assessed by using the ventilatory equivalents for oxygen and carbon dioxide. Results: A two-way ANOVA with repeated measures (substance × time) revealed statistically significant main effects of caffeine (p < 0.01) and time (p = 0.04) on the wattage obtained at VT2, although there was no interaction (p = 0.09). In comparison to the placebo, caffeine increased the workload at VT2 on days 1, 4, 6 and 15 of ingestion (p < 0.05). The size of the ergogenic effect of caffeine over the placebo on the workload at VT2 was progressively reduced with the duration of the treatment. In addition, there were main effects of caffeine (p = 0.03) and time (p = 0.16) on VO2 obtained at VT2, with no interaction (p = 0.49). Specifically, caffeine increased oxygen uptake at VT2 on days 1 and 4 (p < 0.05), with no other caffeine–placebo differences afterwards. For heart rate obtained at VT2, there was a main effect of substance (p < 0.01), while the overall effect of time (p = 0.13) and the interaction (p = 0.22) did not reach statistical significance. Heart rate at VT2 was higher with caffeine than with the placebo on days 1 and 4 (p < 0.05). The size of the effect of caffeine on VO2 and heart at VT2 tended to decline over time. Conclusion: Pre-exercise intake of 3 mg/kg/day of caffeine for twenty days enhanced the wattage obtained at VT2 during cycling ramp tests for ~15 days of ingestion, while there was a progressive attenuation of the size of the ergogenic effect of caffeine on this performance variable. Therefore, habituation to caffeine through daily ingestion may reduce the ergogenic effect of this stimulant on aerobic exercise of submaximal intensity.

scholarly journals Comparison of Dexmedetomidine, midazolam and propofol for sedation of post operative patients on mechanical ventilation- An open label randomised control trial

2021 ◽  
Vol 8 (3) ◽  
pp. 392-395
Author(s):  
Surajit Paul ◽  
Vaskar Majumdar
Keyword(s):  
Heart Rate ◽  
Mechanical Ventilation ◽  
Continuous Infusion ◽  
Maintenance Dose ◽  
Randomised Control Trial ◽  
Time Interval ◽  
Type I ◽  
Loading Dose ◽  
Open Label ◽  
Group D

Mechanical ventilation is a life-sustaining therapy for the treatment of patients with acute respiratory failure. One of the key factors for good clinical practice in the ICU is to provide adequate sedation. An ideal sedative should provide a rapid onset, a rapid recovery. On this background the present study is designed to evaluate the efficacy and safety of dexmedetomidine, propofol and midazolam for sedating property, hemodynamic effects and analgesic. It is an open label, single blinded randomized control trial. Census sampling is planned for recruitment which will have maximum power and type I error &#60;0.05.This study is carried out in 39 adult patients with Glasgow coma scale score of 9-15, Patients were divided randomly into three groups of 13 each. Group M patients received IV inj. Midazolam loading dose 0.15mg/kg followed by maintenance dose of 0.02-0.1mg/kg/hour. Group P patients received intravenous inj. Propofol loading dose of 1.5mg/kg followed by continuous infusion of 1-6 mg/kg/hr. Group D patients received intravenous inj. Dexmedetomidine loading dose of 1μg/kg followed by maintenance dose of 0.2-0.5 μg/kg/hr of continuous infusion by infusion pump. Desired depth of sedation was assessed by Ramsay Sedation Score. The difference in mean age and ASA status among the three groups are not statistically significant. There is no statistical significance of sex & GCS status of the patients of these three groups. In our study, difference of mean HR at different time interval was not statistically significant. But the fall in Heart Rate is more in Group D and Group M than in Group P. The mean heart rate is less in Group D compared to Group M and Group P after 45 minutes of infusion. We found that difference of mean SBP & DBP at different time interval was not statistically significant. In overall Dexmedetomidine Group showed stable RSS score throughout the time interval (between RSS 2 to 3). One patient in Dexmedetomidine group developed bradycardia. Mean opioid at 24th hour was significantly higher in group M than other group and difference was statistically significant and post sedation delirium was not statistically significant. In this study we found that difference of mean hemodynamic parameters at different time interval in three drugs was not statistically significant. The Heart Rate remain lower in Dexmedetomidine Group compared to Midazolam and Propofol Group after 45 minutes of infusion.

scholarly journals Heart Rate Variability Behavior during Exercise and Short-Term Recovery Following Energy Drink Consumption in Men and Women

Nutrients ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 2372
Author(s):  
Nicolas W. Clark ◽  
Chad H. Herring ◽  
Erica R. Goldstein ◽  
Jeffrey R. Stout ◽  
Adam J. Wells ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Repeated Measures ◽  
Energy Drink ◽  
Short Term ◽  
Double Blind ◽  
Warm Up ◽  
Autonomic Responses ◽  
Energy Drink Consumption ◽  
Graded Exercise

This study examined the cardiac autonomic responses, as measured by heart rate variability (HRV), during cycling exercise and short-term rest after energy drink consumption. Seventeen participants (seven males and 10 females; age: 22.8 ± 3.5 years; BMI: 24.3 ± 3.3 kg/m2) completed this double-blind, placebo-controlled, counterbalanced crossover design study. Participants received an energy drink formula containing 140 mg of caffeine and a placebo in a randomized order before completing a 10-min steady-state warm up (WUP) and a graded exercise test to exhaustion (GXT) followed by a 15-min short-term rest (STR) period. Heartbeat intervals were recorded using a heart rate monitor. Data were divided into WUP, GXT, and STR phases, and HRV parameters were averaged within each phase. Additionally, root mean square of the standard deviation of R–R intervals (RMSSD) during GXT was analyzed to determine the HRV threshold. Separate two-way (sex (male vs. female) x drink (energy drink vs. placebo)) repeated measures ANOVA were utilized. Significant increases in high frequency (HF) and RMSSD were shown during WUP after energy drink consumption, while interactions between drink and sex were observed for HRV threshold parameters (initial RMSSD and rate of RMSSD decline). No significant differences were noted during STR. Energy drink consumption may influence cardiac autonomic responses during low-intensity exercise, and sex-based differences in response to graded exercise to exhaustion may exist.

scholarly journals The Effect of AcuteRhodiola roseaIngestion on Exercise Heart Rate, Substrate Utilisation, Mood State, and Perceptions of Exertion, Arousal, and Pleasure/Displeasure in Active Men

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Michael J. Duncan ◽  
Neil D. Clarke
Keyword(s):  
Heart Rate ◽  
Energy Expenditure ◽  
Repeated Measures ◽  
Mood State ◽  
Cycling Performance ◽  
Exercise Heart Rate ◽  
Double Blind ◽  
Substrate Utilisation ◽  
Repeated Measures Analysis ◽  
Before And After

The aim of this study was to examine the effect of acuteRhodiola rosea(R. rosea) ingestion on substrate utilisation, mood state, RPE, and exercise affect. Ten males (mean age ± S.D. = 26 ± 6 years) completed two 30-minute cycling trials at an intensity of 70% ofV˙O2max⁡following ingestion of either 3 mg·kg−1body mass ofR. roseaor placebo using a double-blind, crossover design. During exercise, heart rate and RPE were recorded. Participants completed measures of mood state and exercise affect before and after exercise. Expired air samples were taken during exercise to determine substrate utilisation. Repeated measures analysis of variance indicated that RPE was significantly lower at 30 minutes into exercise versus placebo (P=0.003). Perceptions of arousal (P=0.05) and pleasure were significantly higher after exercise withR. roseacompared to placebo (P=0.003). Mood state scores for vigor were also higher inR. roseacondition compared to placebo (P=0.008). There were no significant differences in energy expenditure, carbohydrate, or fat oxidation between conditions (P>0.05). Ingestion ofR. roseafavourably influenced RPE and exercise affect without changes in energy expenditure or substrate utilization during 30-minute submaximal cycling performance.

scholarly journals Dexamethasone blunts postspinal hypotension in geriatric patients undergoing orthopedic surgery: a double blind, placebo-controlled study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tarek M. Ashoor ◽  
Noha S. Hussien ◽  
Sherif G. Anis ◽  
Ibrahim M. Esmat
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Elderly Patients ◽  
Spinal Anesthesia ◽  
Demographic Data ◽  
Volume Overload ◽  
Controlled Study ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Link Type

Abstract Background Post-spinal anesthesia (PSA) hypotension in elderly patients is challenging. Correction of PSA hypotension by fluids either colloids or crystalloids or by vasoconstrictors pose the risk of volume overload or compromising cardiac conditions. Dexamethasone is used to treat conditions manifested by decrease of peripheral vascular resistance. The research team was the first to test the hypothesis of its role in preventing or decreasing the incidence of PSA hypotension. Methods One hundred ten patients, aged 60 years or more were recruited to receive a single preoperative dose of dexamethasone 8 mg IVI in 100 ml normal saline (D group) (55 patients) 2 h preoperatively, and 55 patients were given placebo (C group) in a randomized, double-blind trial. Variations in blood pressure and heart rate in addition to the needs of ephedrine and/or atropine following spinal anesthesia (SA) were recorded. SA was achieved using subarachnoid injection of 3 ml hyperbaric bupivacaine 0.5%. Results Demographic data and the quality of sensory and motor block were comparable between groups. At 5th, 10th minutes post SA; systolic, diastolic and mean arterial pressures were statistically significant higher in D group. At 20th minutes post SA; the obtained blood pressure readings and heart rate changes didn’t show any statistically significance between groups. The need for ephedrine and side effects were statistically significant lower in D group than C group. Conclusion Post-spinal anesthesia hypotension, nausea, vomiting and shivering in elderly patients were less common after receiving a single preoperative dose of dexamethasone 8 mg IVI than control. Registration number ClinicalTrials.gov Identifier: NCT 03664037, Registered 17 September 2018 - Retrospectively registered, http://www.ClinicalTrial.gov

scholarly journals To evaluate the effects of dexmedetomidine on intraocular pressure and haemodynamic changes in response to laryngoscopy and tracheal intubation

2014 ◽  
Vol 01 (03) ◽  
pp. 178-182 ◽  
Author(s):  
Shobha Purohit ◽  
Amit Kulshreshtha ◽  
Keyword(s):  
Intraocular Pressure ◽  
Pressor Response ◽  
Demographic Data ◽  
Randomised Control Trial ◽  
Intracranial Tumour ◽  
Adrenoceptor Agonist ◽  
Haemodynamic Changes ◽  
The Difference ◽  
Bispectral Index Monitor ◽  
Group D

Abstract Background: The most important prerequisites for neurosurgeries are brain relaxation, need of stable haemodynamics with less fluctuation in intracranial pressure and speedy recovery from anaesthesia. Endotracheal intubation is the major stressful stimuli that can elicit a marked pressor response. Various drugs have been used to attenuate these reflexes. Dexmedetomidine, a highly selective alpha 2-adrenoceptor agonist, have neuroprotective, cardioprotective, and sedative effects so it is potentially useful during neuroanaesthesia. This is a prospective randomised control trial carried out to see whether administration of Dexmedetomidine prior to intubation can attenuate the various haemodynamic responses, intraocular pressure (IOP) and the requirement of induction dose of propofol in control and study group. Materials and Methods: Fifty patients (ASA grade 1, 2) scheduled for intracranial tumour surgeries were divided into two groups (25 each). Group D received Dexmedetomidine 0.8 μg/kg i.v. over 10 mins and group C received 20 ml saline. Anaesthesia induced with Propofol, dose adjusted using bispectral index monitor. The groups were compared with IOP, Heart rate (HR), Mean arterial pressure (MAP), and dose of Propofol required for induction. Results: Groups were well matched for their demographic data and pre-operative. IOP in both the eyes decreases significantly after premedication and remained below baseline even after 10th min of intubation in group D while in Group C; it increased significantly after intubation and remained above baseline. The difference between groups was also statistically significant. HR and MAP decreased significantly in patients of group D compared to group C ( P< 0.05). Patients were more haemodynamicaly stable at all time points after premedication in group D ( P< 0.05). Propofol requirements for induction was lesser in group D (P < 0.05). Bradycardia and hypotension incidences were higher in group D. Conclusion: Dexmedetomidine premedication decreases the sympathoadrenal effect on IOP and haemodynamic parameters during laryngoscopy/intubation and decreases the requirement of propofol for induction of general anaesthesia.

scholarly journals Yohimbine-Induced Reactivity of Heart Rate Variability in Unmedicated Depressed Patients With and Without Adverse Childhood Experience

2021 ◽  
Vol 12 ◽  
Author(s):  
Christian Eric Deuter ◽  
Christian Otte ◽  
Katja Wingenfeld ◽  
Linn Kristina Kuehl
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Repeated Measures ◽  
Stressful Life Events ◽  
Developmental Stress ◽  
Double Blind ◽  
Childhood Experiences ◽  
Repeated Measures Design ◽  
Adverse Childhood ◽  
Before And After

Stressful life events play a role in the pathogenesis of major depressive disorder (MDD) and many patients with MDD were exposed to developmental stress due to adverse childhood experiences (ACE). Furthermore, dysregulation of the autonomic nervous system and higher incidence of cardiovascular disease are found in MDD. In MDD, and independently in individuals with ACE, abnormalities in heart rate variability (HRV) have been reported. While these are often confounded, we systematically investigated them with a study which included MDD patients with/without ACE as well as healthy individuals with/without ACE. With this study, we investigated the influence of noradrenergic stimulation on HRV reactivity in unmedicated participants in a randomized, double-blind, repeated measures design. Our sample consisted of men and women with MDD and ACE (n = 25), MDD without ACE (n = 24), healthy participants with ACE (n = 27), and without ACE (n = 48). Participants received a 10 mg single dose of the alpha-2 antagonist yohimbine that increases noradrenergic activity or placebo on 2 separate days, with ECG recordings before and after drug administration at defined intervals. We found lower basal HRV in MDD and ACE: patients with MDD had reduced RMSSD whereas participants with ACE had lower LF-HRV. Contrary to our hypothesis, there was no effect of yohimbine. With this study, we were able to replicate previous findings on HRV differences in MDD and ACE. From the null effect of yohimbine, we conclude that the yohimbine-induced sympathetic activation is not a significant driver of HRV in MDD and ACE.

scholarly journals Dexamethasone blunts postspinal hypotension in geriatric patients undergoing orthopedic surgery: a double blind, placebo-controlled study

2021 ◽  
Author(s):  
Tarek Ashoor ◽  
Noha S. Hussien ◽  
Sherif G. Anis ◽  
Ibrahim M. Esmat
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Elderly Patients ◽  
Spinal Anesthesia ◽  
Demographic Data ◽  
Volume Overload ◽  
Controlled Study ◽  
Hyperbaric Bupivacaine ◽  
Double Blind

Abstract Background: Post-spinal anesthesia (PSA) hypotension in elderly patients is challenging. Correction of PSA hypotension by fluids either colloids or crystalloids or by vasoconstrictors pose the risk of volume overload or compromising cardiac conditions. Dexamethasone is used to treat conditions manifested by decrease of peripheral vascular resistance. The research team was the first to test the hypothesis of its role in preventing or decreasing the incidence of PSA hypotension.Methods: 110 patients, aged 60 years or more were recruited to receive a single preoperative dose of dexamethasone 8 mg IVI in 100 ml normal saline (D group) (55 patients) 2 hours preoperatively, and 55 patients were given placebo (C group) in a randomized, double-blind trial. Variations in blood pressure and heart rate in addition to the needs of ephedrine and/or atropine following spinal anesthesia (SA) were recorded. SA was achieved using subarachnoid injection of 3 ml hyperbaric bupivacaine 0.5%.Results: Demographic data and the quality of sensory and motor block were comparable between groups. At 5th, 10th minutes post SA; systolic, diastolic and mean arterial pressures were statistically significant higher in D group. At 20th minutes post SA; the obtained blood pressure readings and heart rate changes didn’t show any statistically significance between groups. The need for ephedrine and side effects were statistically significant lower in D group than C group. Conclusion: Post-spinal anesthesia hypotension, nausea, vomiting and shivering in elderly patients were less common after receiving a single preoperative dose of dexamethasone 8 mg IVI than control.

Sign in / Sign up

Export Citation Format

Share Document