scholarly journals Effect of controlled extracorporeal blood cooling on ultrafiltration-induced blood volume changes during hemodialysis.

1997 ◽  
Vol 8 (6) ◽  
pp. 956-964 ◽  
Author(s):  
D Schneditz ◽  
K Martin ◽  
M Krämer ◽  
T Kenner ◽  
F Skrabal
Keyword(s):  
Heat Flux ◽  
Blood Volume ◽  
Volume Changes ◽  
Hemodynamic Stability ◽  
Fluid Removal ◽  
Arterial Blood ◽  
Group A ◽  
Blood Pressures ◽  
Group B ◽  
Relative Blood Volume

Considerable amounts of heat may be lost or gained through the extracorporeal circuit during hemodialysis and influence the hemodynamic stability of the dialysis patient. The effects of two levels of extracorporeal heat flux (Jtherm in W) on blood pressures and ultrafiltration-induced blood volume changes were studied in eight patients on conventional hemodialysis. Treatments were controlled automatically for mild to medium Jtherm of either -13.4 +/- 3.3 W (group A) or -30.2 +/- 3.7 W (group B) (1 W = 1 J/s = 3.6 kJ/h = 0.239 cal/s = 0.86 kcal/h) and repeated once. Values are given as mean +/- SD. With low blood flows (Qb = 251 +/- 21 ml/min), dialysate temperatures were automatically set at 37.3 +/- 0.3 degrees C (group A) and 35.3 +/- 0.2 degrees C (group B) for the two levels of Jtherm, respectively. Arterial blood temperatures increased by 0.4 +/- 0.4 degree C with mild extracorporeal cooling (group A), whereas arterial blood temperatures slightly decreased by -0.1 +/- 0.4 degree C in the group with medium negative heat flux (group B) (P < 0.01). Blood pressures tended to drop in the warm dialysate group and to remain unchanged in the cool dialysate group (P = NS). Relative blood volume changes calculated from on-line ultrasonic blood measurements were significantly larger with cool (-12.8 +/- 8.3 vol%) than with warm (-7.2 +/- 5.5 vol%, P < 0.05) dialysate, indicating reduced fluid removal from peripheral body compartments during cool hemodialysis ultrafiltration. Despite the larger reduction in intravascular volume, intradialytic hemodynamic stability was maintained with extracorporeal cooling and cool dialysate prescription.

scholarly journals Comparative Study of Propofol and Etomidate on the Haemodynamic Effects During Induction and Endotracheal Intubation

2019 ◽  
Vol 18 (2) ◽  
pp. 7-15
Author(s):  
Mallika Rayamajhi ◽  
Puja Thapa ◽  
Anjan Khadka ◽  
Biswa Ram Amatya ◽  
Udaya Bajracharya
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Comparative Study ◽  
Endotracheal Intubation ◽  
Arterial Blood ◽  
Significant Difference ◽  
Group A ◽  
Blood Pressures ◽  
Group B ◽  
Induction Agents

Introduction: While most intravenous induction agents decrease arterial blood pressure, laryngoscopy and endotracheal intubation increase the heart rate and blood pressure. Propofol causes a decrease in systemic blood pressure whereas etomidate has minimal effects on the cardiovascular system. This study aims to evaluate and compare the hemodynamic effects of propofol and etomidate during induction and endotracheal intubation. Methods: 62 ASA I and II patients, 20-60 years of age, scheduled for elective surgery were enrolled in this prospective, randomised and double blind comparative study. Group A received inj. Propofol (2 mg/kg) and group B received inj. Etomidate (0.3 mg/kg), as induction agents. Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial blood pressure were recorded after induction and after intubation at one, three, five and ten minutes and intergroup comparisons were made. Results: After induction the decrease in systolic, diastolic and the mean arterial pressures were more in group A compared to group B (p = 0.003, 0.004 and 0.002). After 1 minute of intubation all haemodynamic parameters increased from the baseline with no significant differences between the two groups (p >0.05). At three minutes the decrease in heart rate, diastolic blood pressure and mean arterial pressure was more in group A than group B with p values of 0.001, 0.002 and 0.05, however systolic blood pressures showed no significant difference (p = 0.144). The decrease in blood pressures showed significant difference between the two groups (p <0.05) at five and ten minutes but the decrease in heart rate remained significant only at five minutes of intubation (p = 0.001). Conclusions: Propofol and etomidate are both effective in preventing the haemodynamic changes due to induction and endotracheal intubation, with etomidate providing more haemodynamic stability.

scholarly journals To compare the hemodynamic effects of the infusion of both intravenous induction anaesthetic agents Etomidate and Propofol under bispectral index guidance

2021 ◽  
Vol 8 (3) ◽  
pp. 428-435
Author(s):  
Renu Chauhan ◽  
Kavita Lalchandani ◽  
M R Upadhyay
Keyword(s):  
General Anaesthesia ◽  
Infusion Pump ◽  
Tertiary Care ◽  
Induction Agent ◽  
Hemodynamic Stability ◽  
Anaesthetic Agents ◽  
Arterial Blood ◽  
Significant Difference ◽  
Group A ◽  
Group B

Intravenous anaesthetic agents are preferred to induce anaesthesia in day to day practice because of rapid and smoother action with fewer risks. An ideal induction agent for general anaesthesia should have hemodynamic stability, minimal respiratory side effects and rapid clearance. This is a prospective, randomised, single blind, control study of total 60 patients.This study was carried out in Department of Anaesthesiology, at a Tertiary Care Teaching Hospital over a period of 1 year. In this study, a total of 60 patients undergoing elective surgery under general anaesthesia were randomized into two groups comprising of 30 patients in each group using envelop method. Group A- Patients received Inj. Etomidate infusion at the rate of 0.05 mg/kg/min through syringe infusion pump, and Group B – Patients received Inj. Propofol infusion at the rate of 0.5 mg/kg/min through syringe infusion pump.The hemodynamic response during induction of general Anaesthesia using Inj. Etomidate and Inj. Propofol under BIS guidance. There was no statistically significant difference observed in mean time taken for induction in both the groups. Mean consumed dose for Etomidate was 0.18+0.05 mg/kg and for Propofol group was 1.82+0.34 mg/kg. There was statistically significant fall in mean arterial blood pressure observed in Group B compared to Group A during and after induction up to 7 minutes. After that there was no significant difference observed in both the groups.: Propofol resulted in hypotension and bradycardia even with the reduced doses given with BIS- guided protocol. However, Etomidate provides more hemodynamic stability during induction and in post induction period also. So, Etomidate can be a better choice of agent for induction of General Anaesthesia as compared to Propofol.

scholarly journals Effect of dexmedetomidine as a sedative in sub-dural hematoma evacuation surgeries

2020 ◽  
Vol 24 (3) ◽  
Author(s):  
Sunil Baikadi Vasudevarao ◽  
Kurinchi Raja ◽  
Rammoorthi Rao
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Arterial Blood Gas ◽  
Hematoma Evacuation ◽  
Arterial Blood ◽  
Group A ◽  
Blood Pressures ◽  
Sedation Scores ◽  
Group B ◽  
Observation Period

Background & objective: We studied the safety and effectiveness of combination of dexmedetomidine and fentanyl for chronic sub-dural hematoma (CSDH) evacuation. Main objectives of the study was to register the effects on the combination on the cardio-respiratory and analgesic outcome. Methodology: 56 patients with CSDH were divided into two group. Patients of Group A received dexmedetomidine 1 µg/kg over a period of 10 min with fentanyl 1 µg/kg, followed by an infusion of dexmedetomidine 0.3 µg/kg/min. Group B received fentanyl 1 µg/kg and midazolam 0.03 mg/kg IV. Sedation scores, hemodynamic changes and serial arterial blood gas (ABG) measurements were compared between the two groups. Results: Heart rate and diastolic blood pressure were significantly lower in Group A compared to Group B throughout the observation period after premedication. Systolic blood pressure readings was significantly lower in Group A compared to Group B from 10 min onwards till the end. ABG analysis showed that Group A had significantly lower PCO2 levels during and at the end of surgery and significantly higher PO2 at the end of procedure. Conclusion: The use of dexmedetomidine is associated with significantly higher PO2 at the end of the surgical procedure. It results in lower heart rate, systolic and diastolic blood pressures and PCO2 levels during and at the end of the subdural hematoma evacuation, but the fall remains within the physiological range.

Regional blood flow in the brain and spinal cord of hypothermic rats

1989 ◽  
Vol 257 (3) ◽  
pp. H785-H790
Author(s):  
T. Sakamoto ◽  
W. W. Monafo
Keyword(s):  
Spinal Cord ◽  
Blood Flow ◽  
Brain Stem ◽  
Regional Blood Flow ◽  
Experimental Conditions ◽  
Pentobarbital Sodium ◽  
Arterial Blood ◽  
Group A ◽  
Group B ◽  
The Brain

[14C]butanol tissue uptake was used to measure simultaneously regional blood flow in three regions of the brain (cerebral and cerebellar hemispheres and brain stem) and in five levels of the spinal cord in 10 normothermic rats (group A) and in 10 rats in which rectal temperature had been lowered to 27.7 +/- 0.3 degrees C by applying ice to the torso (group B). Pentobarbital sodium anesthesia was used. Mean arterial blood pressure varied minimally between groups as did arterial pH, PO2, and PCO2. In group A, regional spinal cord blood flow (rSCBF) varied from 49.7 +/- 1.6 to 62.6 +/- 2.1 ml.min-1.100 g-1; in brain, regional blood flow (rBBF) averaged 74.4 +/- 2.3 ml.min-1.100 g-1 in the whole brain and was highest in the brain stem. rSCBF in group B was elevated in all levels of the cord by 21-34% (P less than 0.05). rBBF, however, was lowered by 21% in the cerebral hemispheres (P less than 0.001) and by 14% in the brain as a whole (P less than 0.05). The changes in calculated vascular resistance tended to be inversely related to blood flow in all tissues. We conclude that rBBF is depressed in acutely hypothermic pentobarbital sodium-anesthetized rats, as has been noted before, but that rSCBF rises under these experimental conditions. The elevation of rSCBF in hypothermic rats confirms our previous observations.

scholarly journals Monitoring skin blood flow to rapidly identify alterations in tissue perfusion during fluid removal using continuous veno-venous hemofiltration in patients with circulatory shock

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Wasineenart Mongkolpun ◽  
Péter Bakos ◽  
Jean-Louis Vincent ◽  
Jacques Creteur
Keyword(s):  
Blood Flow ◽  
Blood Lactate ◽  
Skin Blood Flow ◽  
Removal Rate ◽  
Lactate Concentration ◽  
Tissue Perfusion ◽  
Fluid Removal ◽  
Hemodynamic Variables ◽  
Group A ◽  
Group B

Abstract Background Continuous veno-venous hemofiltration (CVVH) can be used to reduce fluid overload and tissue edema, but excessive fluid removal may impair tissue perfusion. Skin blood flow (SBF) alters rapidly in shock, so its measurement may be useful to help monitor tissue perfusion. Methods In a prospective, observational study in a 35-bed department of intensive care, all patients with shock who required fluid removal with CVVH were considered for inclusion. SBF was measured on the index finger using skin laser Doppler (Periflux 5000, Perimed, Järfälla, Sweden) for 3 min at baseline (before starting fluid removal, T0), and 1, 3 and 6 h after starting fluid removal. The same fluid removal rate was maintained throughout the study period. Patients were grouped according to absence (Group A) or presence (Group B) of altered tissue perfusion, defined as a 10% increase in blood lactate from T0 to T6 with the T6 lactate ≥ 1.5 mmol/l. Receiver operating characteristic curves were constructed and areas under the curve (AUROC) calculated to identify variables predictive of altered tissue perfusion. Data are reported as medians [25th–75th percentiles]. Results We studied 42 patients (31 septic shock, 11 cardiogenic shock); median SOFA score at inclusion was 9 [8–12]. At T0, there were no significant differences in hemodynamic variables, norepinephrine dose, lactate concentration, ScvO2 or ultrafiltration rate between groups A and B. Cardiac index and MAP did not change over time, but SBF decreased in both groups (p < 0.05) throughout the study period. The baseline SBF was lower (58[35–118] vs 119[57–178] perfusion units [PU], p = 0.03) and the decrease in SBF from T0 to T1 (ΔSBF%) higher (53[39–63] vs 21[12–24]%, p = 0.01) in group B than in group A. Baseline SBF and ΔSBF% predicted altered tissue perfusion with AUROCs of 0.83 and 0.96, respectively, with cut-offs for SBF of ≤ 57 PU (sensitivity 78%, specificity 87%) and ∆SBF% of ≥ 45% (sensitivity 92%, specificity 99%). Conclusion Baseline SBF and its early reduction after initiation of fluid removal using CVVH can predict worsened tissue perfusion, reflected by an increase in blood lactate levels.

Relationship between portal venous and hepatic arterial blood flows: spectrum of response

1990 ◽  
Vol 259 (6) ◽  
pp. G1010-G1018 ◽  
Author(s):  
T. Kawasaki ◽  
F. J. Carmichael ◽  
V. Saldivia ◽  
L. Roldan ◽  
H. Orrego
Keyword(s):  
Blood Flow ◽  
Arterial Blood Flow ◽  
Portal Vein Ligation ◽  
Artery Ligation ◽  
Blood Flows ◽  
Arterial Blood ◽  
Group A ◽  
Group B ◽  
The Relationship ◽  
Group D

The relationship between portal tributary blood flow (PBF) and hepatic arterial blood flow (HAF) was studied in awake, unrestrained rats with the radiolabeled microsphere technique. Six distinct patterns of response emerged. In group A (PBF+, HAF 0), ethanol, acetate, glucagon, prostacyclin, and a mixed diet increased PBF without a change in HAF; in group B (PBF+, HAF+), adenosine and histamine increased both PBF and HAF; in group C (PBF 0, HAF+), isoflurane and triiodothyronine did not change PBF but increased HAF; and in group D (PBF-, HAF+), halothane and vasopressin decreased PBF and increased HAF. Acute partial portal vein ligation decreased PBF (56%) and increased HAF (436%). Hypoxia (7.5% O2) decreased PBF (28%) and increased HAF (110%). In group E (PBF+, HAF-), acute hepatic artery ligation increased PBF (35%) and reduced HAF (74%), while in group F (PBF-, HAF-), thyroidectomy reduced PBF and HAF (36 and 47%, respectively). All blood flow responses were accompanied by the expected changes in both portal tributary and hepatic arterial vascular resistances. The data suggest that the portal and hepatic arterial vascular territories have regulatory mechanisms that allow for independent changes.

Minidose Bupivacaine–Fentanyl Spinal Anesthesia for Surgical Repair of Hip Fracture in the Aged

2000 ◽  
Vol 92 (1) ◽  
pp. 6-6 ◽  
Author(s):  
Bruce Ben-David ◽  
Roman Frankel ◽  
Tatianna Arzumonov ◽  
Yuri Marchevsky ◽  
Gershon Volpin
Keyword(s):  
Blood Pressure ◽  
Hip Fracture ◽  
Spinal Anesthesia ◽  
Surgical Repair ◽  
Systolic Pressure ◽  
The Elderly ◽  
Vasopressor Support ◽  
Group A ◽  
Blood Pressures ◽  
Group B

Background Spinal anesthesia for surgical repair of hip fracture in the elderly is associated with a high incidence of hypotension. The synergism between intrathecal opioids and local anesthetics may make it possible to achieve reliable spinal anesthesia with minimal hypotension using a minidose of local anesthetic. Methods Twenty patients aged &gt; or = 70 yr undergoing surgical repair of hip fracture were randomized into two groups of 10 patients each. Group A received a spinal anesthetic of bupivacaine 4 mg plus fentanyl 20 microg, and group B received 10 mg bupivacaine. Hypotension was defined as a systolic pressure of &lt; 90 mmHg or a 25% decrease in mean arterial pressure from baseline. Hypotension was treated with intravenous ephedrine boluses 5-10 mg up to a maximum 50 mg, and thereafter by phenylephrine boluses of 100-200 microg. Results All patients had satisfactory anesthesia. One of 10 patients in group A required ephedrine, a single dose of 5 mg. Nine of 10 patients in group B required vasopressor support of blood pressure. Group B patients required an average of 35 mg ephedrine, and two patients required phenylephrine. The lowest recorded systolic, diastolic, and mean blood pressures as fractions of the baseline pressures were, respectively, 81%, 84%, and 85% versus 64%, 69%, and 64% for group A versus group B. Conclusions A "minidose" of 4 mg bupivacaine in combination with 20 microg fentanyl provides spinal anesthesia for surgical repair of hip fracture in the elderly. The minidose combination caused dramatically less hypotension than 10 mg bupivacaine and nearly eliminated the need for vasopressor support of blood pressure.

Comparative Study Between Dexmedetomidine and Fentanyl as Sedatives in Awake Fiberoptic Intubation in Cervical Spine Surgeries

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Waleed Mohamed Abd El Mageed ◽  
Ahmad Kamal Mohamed Ali ◽  
Eeman Aboubakr ElSiddik Ahmed Bayoumi ◽  
Haitham Sabry Mahmoud Omar
Keyword(s):  
Cervical Spine ◽  
Sedation Score ◽  
Fiberoptic Intubation ◽  
Intubation Time ◽  
Hemodynamic Stability ◽  
Double Blind ◽  
Hemodynamic Variables ◽  
Group A ◽  
Group B ◽  
Awake Fiberoptic Intubation

Abstract Background Various drugs are used for providing favorable intubation conditions during awake fiberoptic intubation (AFOI). However, most of them have various side effects. Aim The aim of this study was to compare the effects of dexmedetomedine and fentanyl as regards sedative effects, hemodynamic stability, intubation time and intubation attempts success during awake fiberoptic intubation. Material and Methods A randomized double-blind prospective study was conducted on a total of 40 patients scheduled for elective cervical spine surgeries who were randomly allocated into two equal groups (n 20): (group A) patients received a bolus dose of dexmedetomidine of 1 mcg/kg over 10 min followed by a continuous infusion of dexmedetomidine at 0.5 mcg/kg/h. and fentanyl group (group B) received dose of 1 μg/kg over 10 min followed by 0.5 μg/kg/hr. Sedation score (Ramsy sedation score), hemodynamic variables, oxygen saturation, intubation time and intubation attempts were noted and compared between the two groups. Results Ramsy Sedation Score was significantly favorable (P &lt; 0.001) in group A in comparison to group B, moreover better hemodynamic stability during intubation (P &lt; 0.05) and less intubation attempts were observed in group A in comparison to group B. Conclusion The results of our study showed that dexmedetomidine provides optimum sedation without compromising airway or hemodynamic stability and with favorable intubation time and less intubation attempts during AFOI in comparison to fentanyl.

scholarly journals Incidence of post-operative cardiac complications in cardiac patients undergoing urological procedures

2015 ◽  
Vol 1 (2) ◽  
pp. 80
Author(s):  
Mastan Saheb Shaik ◽  
Venkata Rama Rao M ◽  
Sailaja K
Keyword(s):  
General Anaesthesia ◽  
Regional Anaesthesia ◽  
Cardiac Complications ◽  
Anesthetic Techniques ◽  
Ecg Changes ◽  
Arterial Blood ◽  
Group A ◽  
Urological Procedures ◽  
The Mean ◽  
Group B

Context: There are limited studies indicating the incideance of post operative morbidity and mortality in high risk patients. Urological procedures constitute a major portion of geriatric surgeries where a cardiac obligation is almost inevitable and selected for this study purpose.Aims: To compare the incidence of post operative cardiovascular complications during regional and general anesthetic techniques in patients with known cardiac risk undergoing urological surgeriesSettings and Design: Prospective randomized double blind study.Methods and Material: 40 patients aged above 50 years posted for elective urological surgeries were enrolled in the study after obtaining approval from hospital ethics committee and written informed consent from the patients. Patients were divided into two groups A& B. Group A (n=20) received general and group B (n=20) received regional anaesthesia (spinal/ Epidural). All the patients received standard premedication and their basal vitals( BP, HR, ECG pattern) were recorded. The same parameters were monitored in the post operative period at regular intervals.Statistical analysis used: Student T test is used to test the significance of stastical difference in the variables between the two groups.Results: The mean heart rate and the mean arterial blood pressure were increased (P<0.01) in the general anaesthesia group. Group A showed 10% incidence of ECG changes and group B showed 35% incidence of ECG changes. But the changes in the hemodynamics were not significant.Conclusions: There is no difference between regional anaesthesia and general anaesthesia regarding the post operative outcome after urological procedures with respective hemodynamic changes.

scholarly journals Impact of General Anesthesia Guided by State Entropy (SE) and Response Entropy (RE) on Perioperative Stability in Elective Laparoscopic Cholecystectomy Patients—A Prospective Observational Randomized Monocentric Study

Entropy ◽  
2020 ◽  
Vol 22 (3) ◽  
pp. 356 ◽  
Author(s):  
Anca Raluca Dinu ◽  
Alexandru Florin Rogobete ◽  
Sonia Elena Popovici ◽  
Ovidiu Horea Bedreag ◽  
Marius Papurica ◽  
...  
Keyword(s):  
Study Groups ◽  
Depth Of Anesthesia ◽  
Hemodynamic Stability ◽  
State Entropy ◽  
Multimodal Monitoring ◽  
Response Entropy ◽  
Group A ◽  
Group B ◽  
The Individual ◽  
The Impact

Laparoscopic cholecystectomy is one of the most frequently performed interventions in general surgery departments. Some of the most important aims in achieving perioperative stability in these patients is diminishing the impact of general anesthesia on the hemodynamic stability and the optimization of anesthetic drug doses based on the individual clinical profile of each patient. The objective of this study is the evaluation of the impact, as monitored through entropy (both state entropy (SE) and response entropy (RE)), that the depth of anesthesia has on the hemodynamic stability, as well as the doses of volatile anesthetic. A prospective, observational, randomized, and monocentric study was carried out between January and December 2019 in the Clinic of Anesthesia and Intensive Care of the “Pius Brînzeu” Emergency County Hospital in Timișoara, Romania. The patients included in the study were divided in two study groups: patients in Group A (target group) received multimodal monitoring, which included monitoring of standard parameters and of entropy (SE and RE); while the patients in Group B (control group) only received standard monitoring. The anesthetic dose in group A was optimized to achieve a target entropy of 40–60. A total of 68 patients met the inclusion criteria and were allocated to one of the two study groups: group A (N = 43) or group B (N = 25). There were no statistically significant differences identified between the two groups for both demographical and clinical characteristics (p > 0.05). Statistically significant differences were identified for the number of hypotensive episodes (p = 0.011, 95% CI: [0.1851, 0.7042]) and for the number of episodes of bradycardia (p < 0.0001, 95% CI: [0.3296, 0.7923]). Moreover, there was a significant difference in the Sevoflurane consumption between the two study groups (p = 0.0498, 95% CI: [−0.3942, 0.9047]). The implementation of the multimodal monitoring protocol, including the standard parameters and the measurement of entropy for determining the depth of anesthesia (SE and RE) led to a considerable improvement in perioperative hemodynamic stability. Furthermore, optimizing the doses of anesthetic drugs based on the individual clinical profile of each patient led to a considerable decrease in drug consumption, as well as to a lower incidence of hemodynamic side-effects.

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