Effect of dexmedetomidine on hemodynamic and recovery responses during tracheal extubation

Endotracheal extubation is associated with cardiovascular and airway responses leading to tachycardia, hypertension, arrhythmias, myocardial ischemia, coughing, agitation, bronchospasm, increased bleeding, raised intracranial and intraocular pressure which may be life threatening especially in vulnerable patients. Dexmedetomidine, a highly selective α2-adrenoreceptor agonist is found to attenuate these effects and provide a smooth extubation. To assess the effect of dexmedetomidine on hemodynamic and ventilatory recovery during tracheal extubation. This comparative study was done in 42 patients who fulfilled the inclusion and exclusion criteria between the age group of 20 to 45 years from both sexes were randomly allocated in to two groups of 21 each. One group received 0.5mg Dexmedetomidine and the other group received 100 ml NS. Both groups were compared for the hemodynamic parameters at different time intervals during the whole procedure and were compared for differences if any. In the study group, parameters like Mean arterial pressure, Systolic Blood Pressure, Diastolic Blood Pressure and Heart Rate were under control than the control group. The extubation quality score between controls and dexmedetomidine group (2.14 vs. 1.24) is statistically significant (P<0.001). 14.28% of study group had cough compared to 52.39% in the control group. Bradycardia and Hypertension were significantly higher in the study population. Justbefore extubation, administration of dexmedetomidine ensures the smooth extubation of the trachea and reduces the cardiovascular responses. It also provides adequate sedation postoperatively.

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Attenuation of haemodynamic responses to endotracheal extubation-diltiazem versus lidocaine

International Journal of Clinical Trials ◽

10.18203/2349-3259.ijct20201714 ◽

2020 ◽

Vol 7 (2) ◽

pp. 77

Author(s):

Shaik Umar Farooq ◽

B. Sandhya Rani ◽

Anand Acharya

Keyword(s):

Blood Pressure ◽

Cardiovascular Responses ◽

Practical Method ◽

Tracheal Extubation ◽

Control Group ◽

Base Line ◽

Group Iii ◽

Group I ◽

Group Ii ◽

Endotracheal Extubation

Background: Endotracheal extubation is one of the frequently performed procedure in the practice of anaesthesia. This study was done to observe the haemodynamic responses during tracheal extubation and to compare the efficacy of IV diltiazem 0.2 mg/kg versus IV lidocaine 1 mg/kg in attenuating the hemodynamic response to tracheal extubation.Methods: 90 patients aged 20 to 60 yrs, belonging to ASA I and II, normotensive were included in the study and they were randomly allocated into 3 groups of 30 each. Group I received normal saline and served as control. Group II received 0.2 mg/kg of IV diltiazem 2 min before extubation. Group III received 1 mg/kg of lidocaine IV 2 min before extubation. At the end of the surgery, heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded served as base line values.Results: After tracheal extubation, all the haemodynamic parameters increase from the basal level in the control group and decreased in the study group. The change in HR, SBP and DBP were significantly less in group II and group III compared to group I. The change in HR, SBP and DBP were significantly less in group II compared to group III.Conclusions: Diltiazem hydrochloride, a calcium channel blocker belongs to the benzothiazepine group given in dose of 0.2 mg/kg IV 2 min before tracheal extubation in ASA grade I and grade II patients is a simple, effective and practical method of blunting cardiovascular responses to tracheal extubation. This suppressive effect of diltiazem was comparable to or even more potent than that of lignocaine 1 mg/kg IV 2 min before tracheal extubation.

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Application of the Measurement of Carotid Intima-Media Thickness for Prediction of the Essential Hypertension in Children

Revista de Chimie ◽

10.37358/rc.18.6.6366 ◽

2018 ◽

Vol 69 (6) ◽

pp. 1550-1553

Author(s):

Rosana Manea ◽

Bianca Elena Popovici ◽

Carmen Daniela Neculoiu ◽

Dan Minea ◽

Alina Calin

Keyword(s):

Blood Pressure ◽

Essential Hypertension ◽

Carotid Artery ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

Diagnostic Methods ◽

Control Group ◽

Study Group ◽

Media Thickness ◽

Hypertension In Children

Hypertension is a major risk factor for progression of the atherosclerotic process and for developing of degenerative cardiovascular diseases in adulthood. The aim of this study is to evaluate how the measurement of carotid intima - media thickness for prediction of essential hypertension in children can be used.The study group included 81 children and the control group 61 children, all aged between 5 - 17 years and 11 months old, and admitted in Children Hospital Brasov in the period of 2009 � 2014. The study protocol included: BMI, blood pressure and Doppler echography of the common carotid artery for each group. Mean age of the patients from the study group was 13.67 years, 43.20 % girls and 56.80 % boys, while in the control group, the mean age was 14.07 years, 54.10% girls and 45.90 % boys. 70.37% of the children from the study group presented obesity, while in the control group 40.98% were obese. The IMTC study group ranged from 0.52 - 0.69 mm and the limits of the normotensive subjects were 0.32 -0.54 mm. In both groups the obese patients were found to have increased carotid artery intima-media, which means that IMTC was positively correlated with BMI (p=0.000001).It is necessary to identify diagnostic methods easily applicable for children, allowing involvement of the characteristics of the arterial wall in the degenerative pathological processes. Increased intima-media ratio is positively correlated with high values of blood pressure.

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Effect of intravenous oxycodone on the physiologic responses to extubation following general anesthesia

BMC Anesthesiology ◽

10.1186/s12871-021-01350-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Menglu Jiang ◽

Jiawei Ji ◽

Xin Li ◽

Zhenqing Liu

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

General Anesthesia ◽

Control Group ◽

Study Group ◽

Clinical Trial Registry ◽

Blood Oxygen Saturation ◽

Blood Concentrations ◽

Number Of Patients ◽

Blood Hormones

Abstract Background Endotracheal intubation and extubation may cause undesirable hemodynamic changes. Intravenous oxycodone has recently been introduced and used for relieving hemodynamic alterations in response to intubation, but there is insufficient information regarding its application in stabilizing hemodynamics during extubation in the patients emerging from general anesthesia. Methods One hundred patients, who had undergone assorted laparoscopic surgeries under general anesthesia, were randomly assigned to Control group (saline injection, 50 cases) and Study group (intravenous injection of 0.08 mg/kg oxycodone immediately after completion of the surgical procedure, 50 cases). Blood pressure, heart rate, blood oxygen saturation (SpO2) as well as blood concentrations of epinephrine, norepinephrine, and cortisol were recorded or measured immediately before extubation (T0), during extubation (T1), as well as one minute (T2), 5 min (T3), and 10 min after extubation (T4). In addition, coughing and restlessness, time of eye-opening, and duration from completing surgery to extubation as well as Ramsay Sedation Scale were analyzed. Results Blood pressure and heart rate as well as blood concentrations of epinephrine, norepinephrine, and cortisol were significantly higher in the Control group compared with the Study group at the time of extubation as well as 1, 5, and 10 min after extubation (P < 0.05). When the patients emerged from general anesthesia, 70 % of the Control group had cough, which was significantly higher than that of Study group (40 %, P < 0.05). Significantly higher number of patients manifested restlessness in the Control group before (40 %) and after extubation (20 %) compared with that in the Study group (20 and 2 %, respectively, P < 0.05). In addition, patients of Control group had lower Ramsay score at extubation (1.7 ± 0.7) as well as 30 min after extubation (2.4 ± 0.9) compared to that of the patients of Study group (2.2 ± 0.9, and 3.0 ± 0.8, respectively, P = 0.003 and 0.001). Conclusions Intravenous oxycodone attenuated alterations of hemodynamics and blood hormones associated with extubation during emergence from general anesthesia. Trial registration Chinese Clinical Trial Registry: ChiCTR2000040370 (registration date: 11-28-2020) “‘retrospectively registered”.

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Anesthetic Effect of Compound Artevacaine Hydrochloride in Patients Undergoing Oral Implantation

Journal of Clinical and Nursing Research ◽

10.26689/jcnr.v5i4.2373 ◽

2021 ◽

Vol 5 (4) ◽

pp. 220-224

Author(s):

Chengxi Chi ◽

Mengmeng Zhao ◽

Jiajing He ◽

Yanli Wang

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Operation Time ◽

Control Group ◽

Study Group ◽

Research Subjects ◽

Implant Surgery ◽

Anesthetic Effect ◽

Significant Difference ◽

Oral Implant

Objective: To investigate and analyze the anesthetic effect of compound artevacaine hydrochloride in patients undergoing oral implantation. Methods: In this study, 60 patients receiving oral implant surgery in our hospital were selected as the research subjects, and the operation time was from July 2019 to March 2021. Patients were randomly selected and divided into groups for the study. 30 patients receiving lidocaine hydrochloride anesthesia were used as the control group, and 30 patients receiving compound artevacaine hydrochloride anesthesia were used as the research group. The anesthetic effect and safety of the two groups were compared and analyzed. Results: The anesthetic effect of the study group was significantly better than that of the control group (P < 0.05). The blood pressure and heart rate in the study group were significantly lower than those in the control group (P < 0.05). There was no significant difference in blood pressure and heart rate between the two groups before anesthesia (P > 0.05). There was no significant difference in the incidence of ADR between the two groups (P > 0.05). Conclusions: For patients undergoing oral implant surgery, choosing compound artevacaine hydrochloride as anesthetic drug has obvious anesthetic effect and can stabilize patients' life indexes. The anesthetic effect is obvious, and there is no obvious adverse reaction, and the clinical value is obvious.

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Effects of occupational stress on working ability of patients suffering from arterial hypertension

Medicinski pregled ◽

10.2298/mpns1312497m ◽

2013 ◽

Vol 66 (11-12) ◽

pp. 497-501 ◽

Cited By ~ 4

Author(s):

Marijana Matic ◽

Jovana Jovanovic ◽

Jovica Jovanovic ◽

Nada Macvanin

Keyword(s):

Blood Pressure ◽

Arterial Hypertension ◽

Diastolic Blood Pressure ◽

Occupational Stress ◽

Stress Index ◽

Work Place ◽

Control Group ◽

Study Group ◽

Working Ability ◽

Disability Retirement

Introduction. The aim of this research was to quantify the presence of occupational stressors and to analyze their effects on temporary and permanent working ability of workers with arterial hypertension. Material and Methods. The research included 817 workers. The study group consisted of 504 workers with arterial hypertension without other diseases or disorders, whereas the control group was composed of 313 healthy workers. Results. The study group showed a significantly higher level of total occupational stress index as well as of the stress index related to high job demands, conflicts at work place, underload and time limit (p<0.001) compared to the control group. A positive and statistically significant correlation between total occupational stress index and systolic and diastolic blood pressure was found in the study group. The total level of occupational stress over 40 led to a significant increase of systolic and diastolic blood pressure in persons with arterial hypertension. The analysis of temporary working inability determined a statistically significantly higher level of lost workdays per a worker in the study group compared to the controls (p<0.001). The average number of lost workdays per a worker in a year in the study group increased statistically significantly along with the occupational stress index values at their work place (p<0.001). In the study group the number of workers eligible for disability retirement over a period of one year was significantly higher compared to the controls. The number of workers eligible for disability retirement in the exposed group increased statistically significantly along with occupational stress index values at their work place. Conclusion. The results show that occupational stress is a significant factor in the development of arterial hypertension and reduction of work ability of exposed workers.

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Effects of Confounding Factors on Blood Pressure in Hypertensive Patients: A Cross Sectional Study

10.21203/rs.3.rs-283642/v1 ◽

2021 ◽

Author(s):

Emrah Ersoy ◽

Cuneyt Ardic

Keyword(s):

Blood Pressure ◽

Blood Pressure Control ◽

Pressure Control ◽

Control Group ◽

Poor Sleep ◽

Study Group ◽

Confounding Factors ◽

Cross Sectional ◽

Hypertensive Patients ◽

Significant Difference

Abstract Background Blood pressure is influenced by biopsychosocial factors such as physical, environmental, emotional, cognitive and behavioral in hypertensive patients. ObjectiveThe aim of this study is to investigate confounding factors in hypertensive patients who have poor blood pressure control.DesignThis study was designed as a cross-sectional study.ParticipantsOur sample was 407 patients with hypertension in Rize, a Northern city in the Black Sea Region of Turkey. In study group, there were 207 hypertensive patients who had admission to emergency department due to high blood pressure. In control group, there were 200 hypertensive patients visiting family physician,who defined themselves as having regulated blood pressure over the past six months.Main MeasuresPatients completed the questionnaire including sociodemographic data, lifestyle behaviors, health risks and confounding factors via the face-to-face interview method. Key ResultsOf the hypertensive patients, 81.2% (n=168) of the study group and 34.0% (n=68) of the control group had confounding factors. There was a significant difference between the hypertensive patients of study and control group in terms of their confounding factors (p<0.001). When we asked the patients of study group questions to reveal their confounding factors, 21.3% (n=44) stated ‘anger’, 12.6% (n=26) ‘sadness’, 11.1% (n=23) ‘anxiety’, 10.6% (n=22) ‘depressed’, 9.2% (n=19) ‘unhealthy diet’, 7.2% (n=15) ‘fatigue and poor sleep quality’, and 3.9% (n=8) ‘irregular medication’. Mean systolic and diastolic blood pressure were significantly higher in hypertensive patients having confounding factors than those without confounding factors (p=0.001, p=0.001, respectively). Mean systolic blood pressure of hypertensives who stated their confounding factor as ‘anger’ was significantly higher than those the remaining groups (p<0.001).ConclusionsThis study has shown that confounding factors impair blood pressure control in patients with hypertension. Confounding factors should be kept in mind and revealed in case of poor blood pressure control in hypertensive patients.

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The Effect of Dipping Tobacco on Pulse Wave Analysis among Adult Males

BioMed Research International ◽

10.1155/2020/7382164 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Areeg E. Elemam ◽

Nisreen D. Omer ◽

Neima M. Ibrahim ◽

Ahmed B. Ali

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Pulse Wave ◽

Pulse Wave Analysis ◽

Control Group ◽

Study Group ◽

Adult Males ◽

Wave Analysis ◽

Increased Risk ◽

Wall Stiffness

Background. The current study investigated the effect of dipping tobacco (DT) use on arterial wall stiffness which is a known marker of increased risk of cardiovascular events. Methods. A case-control study which included 101 adult males was carried out in Al-Shaab Teaching Hospital. Blood pressure and pulse wave analysis parameters were recorded in 51 DT users (study group) before and after 30 minutes of placing tobacco and in 50 nontobacco users (control group). Anthropometric measurements were collected using data collection sheet. Data were entered into a computer and analyzed by using the software Statistical Package for the Social Sciences (SPSS) version 20 (SPSS Inc., Chicago, IL, USA). Results. At baseline measurements, heart rate (HR) was significantly lower in the study group compared to the control group ( 66.15 ± 9.21 vs. 72.87 ± 10.13 beats/min; P value ≤ 0.001). Subendocardial viability ratio (SEVR) was significantly higher in the study group compared to the control group ( 203.44 ± 30.34 vs. 179.11 ± 30.51 % ; P value ≤ 0.001). Acute effects of DT compared to pretobacco dipping showed significant increase in HR ( 72.50 ± 10.89 vs. 66.15 ± 9.21 beats/min; P value ≤ 0.001) and significant decrease in augmentation pressure (AP) (4.30 (2.30-8.00) vs. 3.30 (0.60-6.3) mmHg; P value ≤ 0.001), ejection duration (ED) ( 271.65 ± 19.42 vs. 279.53 ± 20.47 ms ; P value ≤ 0.001), and SEVR ( 187.11 ± 29.81 vs. 203.44 ± 30.34 ; P value ≤ 0.001). Linear regression analysis for AP predictor showed that only HR and AIx@75 affect and predict the values of AP ( Beta ± SE ; − 0.242 ± 0.019 , P value ≤ 0.001; 0.685 ± 0.014 , P value ≤ 0.001). Conclusions. Long-term use of DT was not associated with permanent changes in heart rate and blood pressure. Acute tobacco dipping caused an acute increase in heart rate and oxygen demands of myocardium.

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Evidence for Peripheral Vascular Involvement in Mild Elevation of Blood Pressure in Man

Clinical Science ◽

10.1042/cs051065s ◽

1976 ◽

Vol 51 (s3) ◽

pp. 65s-68s

Author(s):

R. Sivertsson ◽

R. Sannerstedt ◽

Y. Lundgren

Keyword(s):

Blood Pressure ◽

Blood Flow ◽

Cardiac Index ◽

Structural Changes ◽

Vascular Involvement ◽

Control Group ◽

Study Group ◽

Blood Pressure Elevation ◽

Pressure Elevation ◽

Arterial Blood

1. Cardiac output at rest, intra-arterial blood pressure and hand blood flow at maximal vasodilatation were studied in two groups of 18–25-year-old men: forty-four with mild blood pressure elevation were referred from a military enlistment centre, and twenty-nine normotensive volunteers were mainly recruited from the same enlistment centre. 2. The study group was characterized by a significantly higher cardiac index at rest, and a significantly higher blood flow resistance in the hand at maximal vasodilatation than the control group, indicating the presence of structural modifications in the resistance vessels of patients with mild blood pressure elevation. 3. The tendency to increased vascular resistance in the blood vessels of the hand at maximal vasodilatation was more pronounced in patients with a normal cardiac index than in those with a high index. This suggests inclusion in the study group of tense, anxious individuals with an elevated cardiac index but otherwise normal circulation, but does not exclude the possibility that these patients may develop structural changes later on.

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Attenuation of extubation responses: Comparison of prior treatment with verapamil and dexmedetomidine

Journal of Neuroanaesthesiology and Critical Care ◽

10.4103/2348-0548.173234 ◽

2016 ◽

Vol 03 (01) ◽

pp. 033-039 ◽

Cited By ~ 3

Author(s):

Tuhin Mistry ◽

Shobha Purohit ◽

Gunjan Arora ◽

Nitesh Gill ◽

Jaya Sharma

Keyword(s):

Blood Pressure ◽

Stress Response ◽

Tracheal Extubation ◽

Group V ◽

Airway Response ◽

Significant Attenuation ◽

American Society ◽

Airway Responses ◽

Group D

Abstract Background: Tracheal extubation is almost always associated with stress response, airway response, and arrhythmias. There are many ways to attenuate this stress response. We have compared verapamil and dexmedetomidine on attenuation of these responses. Materials and Methods: Thirty patients (American Society of Anaesthesiologists Grade I, II) scheduled for spinal surgeries under general anaesthesia were randomly divided into two groups. At the end of surgery, after return of spontaneous efforts (bispectral index >80), in “Group V” verapamil 0.1 mg/kg and in “Group D” dexmedetomidine 0.3 mcg/kg were administered as bolus intravenously over one minute. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded just before (T0) and 2 min after intravenous administration of study medications (TM), just after oral suction (TS), immediately after extubation (TE) and 1, 3, 5 and 10 min postextubation (E1, E3, E5, E10). Duration of emergence and extubation, quality of extubation, Richmond Agitation Sedation Scale (RASS) score and time to reach modified Aldrete score ≥9 were compared. Results: HR, SBP, DBP, MAP were higher in Group V than Group D, but statistically insignificant (P > 0.05). Extubation quality scores was 1 for 20%, 2 for 60% and 3 for 20% patients in Group V, whereas 1 in 80%, 2 in 20% in Group D. There was occurrence of bradycardia within 2 min of administration of drug in one patient in Group D. RASS score was in the range of -1 to +1 in >90% patient in Group V, whereas -3 to -1 in 80% cases in Group D. Conclusion: Single dose of dexmedetomidine (0.3 mcg/kg) given before extubation produced significant attenuation of circulatory and airway responses during extubation as compared to verapamil (0.1 mg/kg).

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Endocan Concentration in Patients With Primary Hypertension

Angiology ◽

10.1177/0003319717736158 ◽

2017 ◽

Vol 69 (6) ◽

pp. 483-489 ◽

Cited By ~ 8

Author(s):

Dominika Musialowska ◽

Edyta Zbroch ◽

Ewa Koc-Zorawska ◽

Piotr Musialowski ◽

Jolanta Malyszko

Keyword(s):

Blood Pressure ◽

Body Mass Index ◽

Cell Adhesion ◽

Endothelial Dysfunction ◽

Healthy Volunteers ◽

Leukocyte Count ◽

Pressure Control ◽

Primary Hypertension ◽

Control Group ◽

Study Group

Inflammation and endothelial dysfunction may play an important role in the multifactorial pathogenesis of hypertension. Endocan is also thought to play a role in cell adhesion and inflammatory disorders. The aim of the study was to compare endocan concentrations in patients with primary hypertension and healthy volunteers. There were 104 patients with hypertension (study group) and 21 healthy volunteers (control group). The correlation between endocan, catecholamines, and blood pressure control in patients with primary hypertension and the control group was analyzed. The median endocan concentration in the study group (2.03 ng/mL) was significantly higher than in the control group (1.09 ng/mL, P = .0001). Endocan concentration was correlated positively with renalase ( r = .2, P = .047) and norepinephrine ( r = .25, P = .02). Negative correlation was observed between endocan and body mass index ( r = −.25, P = .016) and leukocyte count ( r = −.36, P = .0004). The present study reports higher plasma endocan concentration in patients with treated, well-controlled primary hypertension compared with healthy volunteers. The higher endocan concentration in the study group may reflect endothelial dysfunction in this population.

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