Immediate effects of the practise of Sheethali pranayama on heart rate and blood pressure parameters in healthy volunteers

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Rohini P. ◽  
Roopa S. ◽  
Padmavathi R. ◽  
Maheshkumar K.
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Healthy Volunteers ◽  
Sympathetic Activity ◽  
Pressure Pulse ◽  
Control Group ◽  
Normal Breathing ◽  
And Control

Abstract Objectives Sheetali pranayama, a cooling pranayama is best known for its calming and relaxing nature, widely used for many conditions like depression, anxiety and hypertension. The aim of the study was to evaluate the immediate effect of the practice of Sheetali pranayama on heart rate and blood pressure parameters in healthy volunteers. Methods Apparently, 60 healthy volunteers were involved, from both sexes. They were split into pranayama (n=30) and control (n=30) groups at random. Sheetali pranayama was performed for 5 min (5 cycles) in the pranayama group and normal breathing (12–16 breaths/min) was permitted in the control group. Heart rate (HR) and blood pressure (BP) were recorded with RMS polyrite in the supine position after 5 min of rest. Results The HR in the pranayama group significantly decreased (p=0.04). Systolic (SBP) and diastolic blood (DBP) pressure, pulse pressure (PP) and mean arterial pressure (MAP) decreased significantly (p<0.05) relative to control after pranayama practice. Pre-Post inter-group results has also shown that the pranayama group has substantially decreased HR and BP indices. Conclusions Present study shows that the practice of Sheetlai pranayama creates a relaxed state, and parasympathetic activity overrides sympathetic activity in this state. It indicates that in healthy volunteers, pranayama strengthens the resting cardiovascular parameters.

Blunted autonomic response to standing up and head-up tilt in individuals with intellectual disabilities

2021 ◽  
Author(s):  
Thessa Irena Maria Hilgenkamp ◽  
Elizabeth C. Lefferts ◽  
Daniel W. White ◽  
Tracy Baynard ◽  
Bo Fernhall
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Intellectual Disabilities ◽  
Autonomic Response ◽  
Control Group ◽  
Standing Up ◽  
Head Up Tilt ◽  
Individuals With Intellectual Disabilities

Previous research suggests individuals with intellectual disabilities (ID) may experience autonomic dysfunction, however this has not been thoroughly investigated. PURPOSE: To compare the autonomic response to standing up (active orthostasis) and head up tilt (passive orthostasis) in individuals with ID to a control group without ID. METHODS: Eighteen individuals with and 18 individuals without ID were instrumented with an ECG-lead and finger-photoplethysmography for continuous heart rate and blood pressure recordings. The active and passive orthostasis protocol consisted of 10 minutes supine rest, 10 minutes standing, 10 minutes supine recovery, 5 minutes head-up tilt at 70 degrees, followed by 10 minutes supine recovery. The last five minutes of each position was used to calculate hemodynamic and autonomic function (time- and frequency-domain heart rate and blood pressure variability measures and baroreflex sensitivity). RESULTS Individuals with ID had higher heart rate during baseline and recovery (p<0.05), and an attenuated hemodynamic (stroke volume, heart rate) and heart rate variability response to active and passive orthostasis (interaction effect p<0.05) compared to individuals without ID. Mean arterial pressure (MAP) was higher in individuals with ID at all timepoints. CONCLUSION Individuals with ID demonstrated altered hemodynamic and autonomic regulation compared to a sex- and age-matched control group, evidenced by a higher mean arterial pressure and a reduced response in parasympathetic modulation to active and passive orthostasis.

scholarly journals Bombesin-like receptor 3 regulates blood pressure and heart rate via a central sympathetic mechanism

2016 ◽  
Vol 310 (7) ◽  
pp. H891-H898 ◽  
Author(s):  
Dalya M. Lateef ◽  
Cuiying Xiao ◽  
Robert J. Brychta ◽  
André Diedrich ◽  
Jurgen Schnermann ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Resting Heart Rate ◽  
Wild Type ◽  
Adrenergic Agonist ◽  
Free Living ◽  
And Control ◽  
G Protein Coupled

Bombesin-like receptor 3 (BRS-3) is an orphan G protein-coupled receptor that regulates energy expenditure, food intake, and body weight. We examined the effects of BRS-3 deletion and activation on blood pressure and heart rate. In free-living, telemetered Brs3 null mice the resting heart rate was 10% lower than wild-type controls, while the resting mean arterial pressure was unchanged. During physical activity, the heart rate and blood pressure increased more in Brs3 null mice, reaching a similar heart rate and higher mean arterial pressure than control mice. When sympathetic input was blocked with propranolol, the heart rate of Brs3 null mice was unchanged, while the heart rate in control mice was reduced to the level of the null mice. The intrinsic heart rate, measured after both sympathetic and parasympathetic blockade, was similar in Brs3 null and control mice. Intravenous infusion of the BRS-3 agonist MK-5046 increased mean arterial pressure and heart rate in wild-type but not in Brs3 null mice, and this increase was blocked by pretreatment with clonidine, a sympatholytic, centrally acting α2-adrenergic agonist. In anesthetized mice, hypothalamic infusion of MK-5046 also increased both mean arterial pressure and heart rate. Taken together, these data demonstrate that BRS-3 contributes to resting cardiac sympathetic tone, but is not required for activity-induced increases in heart rate and blood pressure. The data suggest that BRS-3 activation increases heart rate and blood pressure via a central sympathetic mechanism.

scholarly journals Acute effects of Zamzam water on blood pressure and heart rate variability

2020 ◽  
Vol 36 (4) ◽  
Author(s):  
Rabia Latif ◽  
Farrukh Majeed ◽  
Ahmed AlSunni ◽  
Rahmah ALamrie ◽  
Shaykhah Al Naimi
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Sympathetic Activity ◽  
Mineral Water ◽  
Acute Effects ◽  
Drinking Period ◽  
Minute Post

Objective: There is a lack of studies exploring the effects of Zamzam water on human physiology. The present study determined the effects of Zamzam water on blood pressure and heart rate variability (HRV). Methods: This comparative interventional study was conducted at the Department of Physiology, of our university in March 2018. A total number of 97 female subjects drank 500 ml of either Zamzam water or mineral water in one minute. Finometer Pro and PowerLab (ADInstrumentsR) with ECG electrodes through bioamplifier and attached finger pulse transducer were used to collect data at the baseline (for five minutes), during (for one minute) and after the drink (for five minutes). Paired and uunpaired student’s t-test, one-way ANCOVA and one-way repeated measure ANOVA were used for analysis. Blood pressure parameters were followed minute by minute and HRV parameters were compared as a 5-minute of baseline segment to 5-minute post drink segment. Results: Within-the-group comparison exhibited significant increases in blood pressure parameters (systolic, diastolic, pulse and mean arterial pressure), over a 5-minute post-drinking period in both groups. Zamzam water caused a significant increase in SDRR (an indication of overall HRV) and RMSSD (an indication of vagal activity) as compared to baseline. Conclusion: Both drinks cause a significant increase in systolic, diastolic, pulse and mean arterial pressure within five minutes post-drinking period. Zamzam water produce a significant increase in cardiac vagal tone but has no effect on cardiac sympathetic activity. Mineral water has no significant effect on both, cardiac vagal and sympathetic activity. doi: https://doi.org/10.12669/pjms.36.4.1755 How to cite this:Latif R, Majeed F, Al-Sunni A, ALamrie RMK, AlNaimi SN. Acute effects of Zamzam water on blood pressure and heart rate variability. Pak J Med Sci. 2020;36(4):---------. doi: https://doi.org/10.12669/pjms.36.4.1755 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Direct and reflexive effects of nitric oxide synthase inhibition on blood pressure

2008 ◽  
Vol 294 (1) ◽  
pp. H190-H197 ◽  
Author(s):  
Jill M. Wecht ◽  
Joseph P. Weir ◽  
David S. Goldstein ◽  
Annmarie Krothe-Petroff ◽  
Ann M. Spungen ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Blood Pressure ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Nitric Oxide Synthase ◽  
Arterial Pressure ◽  
Pressor Response ◽  
Control Group ◽  
Plasma Norepinephrine ◽  
Oxide Synthase

Direct effects of vasoactive substances on blood pressure can be examined in individuals with tetraplegia due to disruption of descending spinal pathways to sympathetic preganglionic neurons, as cervical lesions interfere with baroreceptor reflex buffering of sympathetic outflow. In this study, we assessed effects of the nitric oxide synthase inhibitor nitro-l-arginine methyl ester (l-NAME) on mean arterial pressure, heart rate, and plasma norepinephrine concentrations in individuals with tetraplegia vs. effects shown in a neurologically intact control group. Seven individuals with tetraplegia and seven age-matched controls received, on separate visits and in the following order, placebo (30 ml normal saline) and 0.5, 1, 2, and 4 mg/kg l-NAME intravenously over 60 min. Supine hemodynamic data were collected, and blood was sampled at the end of each infusion and at 120, 180, and 240 min thereafter. l-NAME increased mean arterial pressure, and the relative increase was greater in the tetraplegia group than in the control group. Heart rate was reduced after l-NAME administration in both groups. l-NAME decreased plasma norepinephrine in the control group but not in the group with tetraplegia. These findings suggest that reflexive sympathoinhibition normally buffers the pressor response to nitric oxide synthase inhibition, an effect that is not evident in individuals with tetraplegia as a result of decentralized sympathetic vasomotor control.

scholarly journals Effectivity of 5% Dextrose-Diluted and Ringer Lactate-Diluted Propofol to Reduce Intravenous Injection Pain in Pediatric Patient

2020 ◽  
Vol 2 (1) ◽  
pp. 33
Author(s):  
Dian Raseka Parna ◽  
Arie Utariani ◽  
Elizeus Hanindito
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Intravenous Injection ◽  
Pediatric Patients ◽  
Injection Pain ◽  
Control Group ◽  
Ringer Lactate ◽  
Group I

Introduction: Propofol has been known as one out of many inductive drugs which, can cause pain during intravenous injection. There has been a high prevalence of injection pain in pediatric patients. The mechanism of injection pain has not been known. Some therapeutic methods have been tested to reduce the pain, with several success rates. Objective: To compare the effectivity of 5% dextrose-diluted propofol and ringer lactate-diluted propofol, with dilution comparison of 1:1, in their role to reduce intravenous injection pain in pediatric patients, from age 2-15 years old during elective surgery in the Integrated Surgical Building Center of Dr. Soetomo General Hospital Surabaya. Method and Material: Forty-five patients PS ASA I-II, which fulfill inclusion criteria, were induced with general anesthesia. Patients had been selected randomly into three groups. Group I (control group) were injected with propofol without dilution. Group II was injected with propofol with a dilution of 5% dextrose, into 5 mg/ml liquid. Group III was injected with propofol with a dilution of ringer lactate, into 5 mg/ml liquid. Result and Discussion: The level of pain was evaluated afterward, with responding to the four-point scale and spontaneous expression. Patients’ blood pressure, mean arterial pressure, heart rate, and oxygen saturation were also examined after injection. Compared to the control group, those in groups with 5% dextrose-diluted and ringer lactate-diluted propofol are not effective in reducing intravenous injection pain, with analytical statistics p=0.503 (p > 0.05). Also, the dilution of propofol has no significant difference to the hemodynamic measurement of patients. Systolic and diastolic blood pressure, and mean arterial pressure were declined after the induction, but statistically insignificant. The heart rate of patients was inclined but also not significant. Conclusion: 5% dextrose-diluted and ringer lactate-diluted propofol with a comparison of 1:1 were not significantly effective in reducing intravenous injection pain in pediatric patients.

scholarly journals Cardiac Parasympathetic Withdrawal and Sympathetic Activity: Effect of Heat Exposure on Heart Rate Variability

2021 ◽  
Vol 18 (11) ◽  
pp. 5934
Author(s):  
Oriol Abellán-Aynés ◽  
Pedro Manonelles ◽  
Fernando Alacid
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Environmental Conditions ◽  
Sympathetic Activity ◽  
Heat Exposure ◽  
Repeated Measurements ◽  
Control Group ◽  
Poincaré Plot ◽  
Activity Effect ◽  
And Control

(1) Background: Research on heart rate variability has increased in recent years and the temperature has not been controlled in some studies assessing repeated measurements. This study aimed to analyze how heart rate variability may change based on environmental temperature during measurement depending on parasympathetic and sympathetic activity variations. (2) Methods: A total of 22 volunteers participated in this study divided into an experimental (n = 12) and control group (n = 10). Each participant was assessed randomly under two different environmental conditions for the experimental group (19 °C and 35 °C) and two identical environmental conditions for the control group (19 °C). During the procedure, heart rate variability measurements were carried out for 10 min. (3) Results: Significantly changes were observed for time and frequency domains as well as Poincaré plot variables after heat exposure (p < 0.05). These findings were not observed in the control group, whose conditions between measurements did not change. (4) Conclusions: The reduction of heart rate variability due to exposure to hot conditions appears to be produced mostly by a parasympathetic withdrawal rather than a sympathetic activation. Therefore, if consecutive measurements have to be carried out, these should always be done under the same temperature conditions.

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.

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.

scholarly journals Cardiovascular response and backward, upward, right push maneuver during laryngoscopy: comparison between CMAC® video laryngoscopy and conventional Macintosh

2017 ◽  
Vol 26 (2) ◽  
pp. 116-21
Author(s):  
Arif H.M. Marsaban ◽  
Aldy Heriwardito ◽  
I G.N.A.D. Yundha
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Cardiovascular Response ◽  
Intervention Group ◽  
Control Group ◽  
Nociceptive Stimulation ◽  
Cardiovascular Parameters ◽  
Pain Stimulation ◽  
Frequent Response

Background: Increased blood pressure and heart rate are the most frequent response to laryngoscopy which sometimes causes serious complications. Laryngoscopy technique and tools modification lessen the nociceptive stimulation, thus preventing hemodynamic response. BURP maneuver is used to lower Cormack-Lehane level, but it can cause additional pain stimulation during laryngoscopy. The aim of this study was to compare the cardiovascular response and the need of BURP maneuver during laryngoscopy between CMAC® and conventional Macintosh.Methods: A randomized, single blinded, control trial was performed to 139 subjects who underwent general anesthesia with endotracheal tube. Subjects were randomised into a control group (conventional Macintosh) and an intervention group (CMAC®). The cardiovascular parameters (systolic, dyastolic, mean arterial pressure, and heart rate) were measured prior to induction (T1). Midazolam 0.05 mg/kg and Fentanyl 2 micrograms/kg were given 2 minutes before the induction. Moreover, they were given propofol 1 mg/kg followed by propofol infusion of 10 mg/kg/hour and Atracurium 0.8–1 mg/kg. After TOF-0 cardiovascular parameters (T2) were remeasured, it was proceeded to laryngoscopy. When Cormack-Lehane 1–2 was reached (with or without BURP maneuver), cardiovascular parameters were measured again (T3).Results: Unpaired T-test showed that cardiovascular response during laryngoscopy were significantly lower in the intervention group compared to the control group (p<0.05). The need of BURP maneuver was significantly lower in the CMAC® group compared to the Convensional Macintosh group (13.9% vs 40.3%; p<0.05).Conclusion: Cardiovascular response and BURP maneuver during laryngoscopy with CMAC® were significantly lower compared to conventional Macintosh.

scholarly journals Perbedaan Respon Hemodinamik dengan Penambahan Blok Scalp Levobupivakain pada Operasi Kraniotomi

2020 ◽  
Vol 9 (1) ◽  
pp. 8-15
Author(s):  
Arya Justisia Sani ◽  
Ardhana Tri Arianto ◽  
Muhammad Husni Thamrin
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Hemodynamic Response ◽  
Anesthesia Induction ◽  
Group I ◽  
Significant Difference ◽  
Scalp Block ◽  
One Way Anova

Latar Belakang dan Tujuan: Peningkatan respon hemodinamik yang disebabkan oleh nyeri dapat menyebabkan peningkatan aliran darah otak dan tekanan intrakranial. Blok scalp pada kraniotomi menumpulkan respon hemodinamik karena rangsangan nyeri serta mengurangi penambahan analgesi lain. Penelitian ini bertujuan untuk mengetahui efektifitas blok scalp sebagai analgetik pada kraniotomi.Subjek dan Metode: Penelitian ini menggunakan uji klinik acak tersamar ganda pada 36 pasien dengan status fisik ASA 1–3 dilakukan operasi kraniotomi eksisi dan memenuhi kriteria inklusi. Sampel dibagi menjadi kelompok I (dengan blok scalp) dan kelompok II (tanpa blok scalp). Blok dilakukan sesaat setelah induksi anestesi. Digunakan levobupivakain 0,375% sebanyak 3 ml tiap insersi, pada masing-masing saraf. Tekanan darah, tekanan arteri rata-rata, detak jantung sebelum intubasi dan setelah intubasi, pemasangan pin, insisi kulit dan insisi duramater serta total kebutuhan fentanyl tambahan dicatat. Data yang diperoleh dianalisis dengan program komputer SPSS versi 17 lalu diuji menggunakan uji Kruskal-Wallis atau One-way ANOVA. Batas kemaknaan yang diambil adalah p < 0,05.Hasil: Selama kraniotomi, detak jantung, tekanan darah, tekanan arteri rata-rata secara signifikan lebih tinggi pada pasien tanpa blok scalp terutama pada saat pemasangan pin. Hasil uji statistik menunjukkan perbedaan signifikan, penambahan fentanyl pada pasien dengan blok scalp lebih sedikit dibandingkan tanpa blok scalp, p=0,000 (p<0,05).Simpulan: Blok scalp levobupivakain efektif dalam menurunkan respon hemodinamik terutama pada saat pemasangan pin. Pasien kraniotomi dengan blok scalp membutuhkan penambahan fentanyl lebih sedikit. Differences on Hemodynamic Response with Levobupivacaine Scalp Block in Craniotomy SurgeryAbstractBackground and Objective: Increased hemodynamic response caused by pain can lead to increased cerebral blood flow and intracranial pressure. Scalp block in craniotomy blunts hemodynamic response due to pain and reduce other analgesics addition. This study aims to determine effectiveness of scalp blocks as analgesic in craniotomy.Subject and Method: This study used a double-blind randomized clinical trial in 36 patients with physical status ASA 1-3 who underwent craniotomy and met inclusion criteria. Samples were divided into group I (with scalp block) and group II (without scalp block). Scalp Block was performed right after anesthesia induction. Using levobupivacaine 0.375% 3 ml for each insertion. Blood pressure, mean arterial pressure, heart rate before and after intubation, during pin placement, skin incision and duramater incision and total need for additional fentanyl were recorded. SPSS version 17 was used and data were analysed using Kruskal-Wallis or One-way ANOVA. Statistical significance was accepted at p < 0.05.Result: During craniotomy, heart rate, blood pressure, mean arterial pressure were significantly higher in patients without scalp block especially during pin placement. Statistical test showed significant difference, additional fentanyl in patients with scalp blocks was lesser, p = 0.000 (p <0.05). Conclusion: Levobupivacaine scalp block was effective to blunt hemodynamic response especially during pin placement. Scalp block also decreased additional fentanyl in craniotomy.

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