scholarly journals Nalbuphine versus dexmedetomidine for attenuation of haemodynamic response to laryngoscopy and intubation: A randomised double blind comparative study

2021 ◽  
Vol 8 (4) ◽  
pp. 579-585
Author(s):  
Akanksha Rathore ◽  
Sujata Chaudhary ◽  
Mahendra Kumar ◽  
Rashmi Salhotra
Keyword(s):  
Blood Pressure ◽  
Haemodynamic Response ◽  
Time Interval ◽  
Double Blind ◽  
Anaesthesia Practice ◽  
Ethical Committee Approval ◽  
Baseline Values ◽  
Group D ◽  
Written Informed Consent ◽  
Time Point

Laryngoscopy and intubation are noxious stimuli which result in marked sympathetic response. However, literature search did not reveal any study comparing nalbuphine and dexmedetomidine for attenuation of haemodynamic response to laryngoscopy and intubation. After Institutional Ethical Committee approval and written informed consent, 80 ASA I and II patients were randomised in two groups of 40 each. Group N received 0.2 mg/kg of nalbuphine; group D received 1 µg/kg dexmedetomidine over a period of 10 min. Anaesthesia was induced as per standard general anaesthesia practice. Haemodynamic parameters [Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), & Mean Arterial Pressure (MAP)] were recorded at baseline, 0, 1, 3, 5, 10, and 15 min following intubation. Patients were also observed for any side effects of the study drugs.There was a significant decrease (p<0.001) in mean HR in group D compared to group N, after administration of drug and 1 min after intubation. Both group N and group D showed no significant increase in mean HR at any time point compared to baseline values. There was no significant increase in mean SBP at any time interval in both the groups when compared to baseline. There was a significant increase (p<0.001) in mean DBP and MAP at the time of intubation in group N whereas no significant increase in mean DBP, and MAP was observed in group D at any time point. Dexmedetomidine was found to be more effective in attenuating haemodynamic response to laryngoscopy and intubation as compared to nalbuphine.

scholarly journals The effectiveness of intravenous dexmedetomidine on haemodynamic responses during tracheal extubation in patients undergoing craniotomies

2017 ◽  
Vol 5 (8) ◽  
pp. 3626
Author(s):  
Shikha Goyal ◽  
Megha Bandil ◽  
Ram Pratap Bansal
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Diastolic Blood Pressure ◽  
Drug Administration ◽  
Haemodynamic Response ◽  
Control Group ◽  
Skin Closure ◽  
Double Blind ◽  
Group D ◽  
Endotracheal Extubation

Background: Dexmedetomidine an α2 agonist reduces heart rate and blood pressure due to sympatholytic activity. The aim of this study was to evaluate the effect of dexmedetomidine on haemodynamic response during endotracheal extubation in patients undergoing craniotomies for intracranial space occupying lesion (ICSOL).Methods: Sixty patients of ASA grade I and II, age 18-50 years scheduled for craniotomy for nonvascular ICSOL were selected after randomization into 2 groups with 30 patients in each group. Group D and C received an IV infusion of dexmedetomidine 0.5 mg/kg and normal saline 100 ml respectively over 10 min at the time of skin closure in a double-blind manner. Heart rate, systolic and diastolic blood pressure were recorded just before drug administration, 3 and 5 minutes after drug administration, during extubation and at 3, 5, 10 and 15 minutes after extubation. Respiratory rate and oxygen saturation were analyzed at 3, 5, 10 and15 minutes after extubation. Any laryngospasm, bronchospasm, desaturation, respiratory depression, vomiting, hypotension and bradycardia was noted.Results: Heart rate, systolic and diastolic blood pressure increased during emergence time in both groups (p<0.05) but this increase was more significant in control group than group D. SBP and heart rate were significantly lower in group D from 3 minutes after drug administration to 15 minutes after extubation. DBP was lower in group D during extubation till 15 minutes after extubation (p<0.01). No significant differences were observed in the respect of adverse events between the groups.Conclusions: Intravenous dexmedetomidine 0.5 mg/kg before extubation is attenuates haemodynamic response during endotracheal extubation in craniotomies.

scholarly journals Intraoperative and Postoperative Analgesia Using Intravenous Opioid, Clonidine and Lignocaine

1994 ◽  
Vol 22 (1) ◽  
pp. 15-21 ◽  
Author(s):  
M. de Kock ◽  
P. Lavandhomme ◽  
J. L. Scholtes
Keyword(s):  
Side Effects ◽  
Postoperative Analgesia ◽  
Randomised Trial ◽  
Skin Incision ◽  
Time Interval ◽  
Colonic Surgery ◽  
Double Blind ◽  
Group A ◽  
Group B ◽  
Group D

The postoperative analgesia afforded after colonic surgery by IV opioid, clonidine and lignocaine given intra- and postoperatively was evaluated. In a double-blind randomised trial, 80 male patients scheduled for colonic resection under general anaesthesia received fentany 15 μg.kg−1 at induction and another 4 μg.kg−1 before skin incision (group A) or fentanyl (same dose) plus clonidine 4 μg.kg−1 in 20 min + 2 μg.kg−1.h−1 (group B, C) or fentanyl plus clonidine (same dosage) plus lignocaine 2 mg.kg−1 before skin incision, repeated before peritoneal incision and retractor placement (group D). In the four groups, intraoperative boluses of fentanyl 2 μg.kg−1 were given in response to the painful stimulation of the procedure. Postoperative pain was managed with PCA delivering 2 mg morphine per request in group A, 1.5 mg morphine in group B, 1.5 mg morphine + 15 μg clonidine in group C and 1.2 mg morphine + 15 μg clonidine + 23 mg lignocaine in group D. Postoperative analgesia was assessed by recording the analgesic demands (met and unmet) and the dose of morphine delivered at 6, 12, 18, 24, 36 hours. Side-effects, pain and sedation analogue scores were also recorded. A nalgesic demands and delivered morphine dose were reduced, at any time interval considered, in groups B, C, D, compared with A (P <0.001). No differences were noted between the groups B, C, D. Pain analogue scores were better in groups B, C, D compared with group A (P <0.001). Sedation and side-effects were not increased in groups B, C, D. Intraoperative clonidine was the major determinant of the reduction in analgesic demands and morphine delivered. Lignocaine, at the dose used, failed to afford any additional benefit.

Hemodynamic and Electrocardiographic Effects of Short-Term Ginkgo Biloba

2003 ◽  
Vol 37 (3) ◽  
pp. 345-349 ◽  
Author(s):  
James S Kalus ◽  
Alexandria A Piotrowski ◽  
Christopher R Fortier ◽  
Xinhcun Liu ◽  
Jeffrey Kluger ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Healthy Volunteers ◽  
Ginkgo Biloba ◽  
Study Drug ◽  
P Wave ◽  
Short Term ◽  
Double Blind ◽  
Electrocardiographic Parameters ◽  
Time Point

OBJECTIVE: To evaluate the immediate and short-term hemodynamic and electrocardiographic effects of Ginkgo biloba (ginkgo). METHODS: Healthy volunteers were randomized to receive ginkgo 120 mg or placebo twice daily for 7 days in this prospective, double blind trial. After at least a 7-day washout period, subjects were crossed over to an additional 7 days of alternate therapy. Blood pressure, heart rate, and 12-lead electrocardiograms were evaluated immediately before (baseline), and at 1, 3, and 5 hours after observed ingestion of study drug on days 1 and 7 of therapy. Electrocardiographic parameters (P wave and QRS complex duration; PR, QT, and QTc intervals) were measured in lead II by a blinded investigator. RESULTS: Ginkgo had no effect on any of the evaluated electrocardiographic parameters at any time point on days 1 or 7. Additionally, no changes in heart rate or systolic and diastolic blood pressure were found between the groups at any time point on any evaluative day. CONCLUSIONS: Commonly used doses of Ginkgo biloba do not have any immediate or short-term effects on blood pressure, heart rate, or electrocardiographic variables in young, healthy volunteers.

Effects of ingesting a commercial thermogenic product on hemodynamic function and energy expenditure at rest in males and females

2009 ◽  
Vol 34 (6) ◽  
pp. 1073-1078 ◽  
Author(s):  
Colin Wilborn ◽  
Lem Taylor ◽  
Chris Poole ◽  
Brandon Bushey ◽  
Laura Williams ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Energy Expenditure ◽  
Resting Energy Expenditure ◽  
Daily Basis ◽  
Controlled Study ◽  
Double Blind ◽  
Time Points ◽  
Significant Difference ◽  
Baseline Values

The purpose of this study was to examine the effects of a commercially available thermogenic product (TP) on resting energy expenditure (REE) and hemodynamic variables in a randomized, double-blind, placebo (PL)-controlled study. Eight male (age: 23.0 ± 3.70 years, weight: 95.77 ± 16.44 kg, height: 182.4 ± 7.87 cm) and 10 female (age: 23.6 ± 4.81 years, weight: 67.25 ± 5.74 kg, height: 172.42 ± 10.31 cm) physically active individuals participated in this study. Participants reported to the laboratory on a 10-h fast and performed baseline testing on REE, heart rate, and blood pressure. Participants were then randomly assigned to ingest 3 capsules of either an experimental TP or a vitamin E PL. Criterion variables were then measured at 1-, 2-, and 3-h post ingestion. Data were analyzed by 2-factor analysis of variance (ANOVA) using SPSS, version 16.0 (SPSS Inc., Chicago, Ill.). Supplementation of the TP resulted in a significant main effect for time (p = 0.040) and for interaction (p < 0.01) in REE when compared with PL. Post hoc analysis revealed that there was no significant difference (p > 0.05) between groups at baseline, but the TP group was significantly higher (p < 0.01) than the PL group at 1-, 2-, and 3-h post, with peak values being achieved at 2-h post time point. The TP group also experienced an overall increase in REE by 17.3%, 19.6%, and 15.3% at the 1-, 2-, and 3-h time points, respectively, over baseline values. Conversely, the PL group experienced a reduction in REE by 2.5%, 1.8%, and 0.3% at the same time points compared with baseline values. There was no significant change in heart rate, systolic blood pressure, or diastolic blood pressure in either group. Taken on a daily basis, a TP may increase overall energy expenditure. Caloric expenditure significantly increased at all 3 time points in the TP group, whereas the PL group experienced no change in energy expenditure.

scholarly journals Intravascular Administration of Isotonic Saline versus Polymerised Gelatin in the Prevention of Spinal Induced Hypotension: A Randomised Clinical Trial

2021 ◽  
Author(s):  
C Sreekanth ◽  
T Gurumurthy
Keyword(s):  
Blood Pressure ◽  
Repeated Measures ◽  
Isotonic Saline ◽  
Randomised Clinical Trial ◽  
Time Interval ◽  
Transurethral Resection Of Prostate ◽  
Double Blind Study ◽  
Double Blind ◽  
Induced Hypotension ◽  
Subarachnoid Block

Introduction: Hypotension remains one of the most common problems associated with subarachnoid blockade. A number of strategies have been developed for its prevention, of which administration of fluids prior to subarachnoid block holds the importance. Gelatin is a colloidal plasma volume expander obtained from degraded gelatine. It is as effective as albumin solution in the treatment of spinal induced hypotension. Aim: To compare the incidence and frequency of hypotension after subarachnoid block in patients receiving colloid (polymerised gelatin) or crystalloid (0.9% normal saline) as prehydration and compare side-effects of colloid and crystalloid prehydration. Materials and Methods: A total of 60 patients scheduled for elective Transurethral Resection of Prostate (TURP) surgery were selected to participate in this prospective randomised double-blind study for a period of two years from April 2006 to April 2008. Patients were randomly allocated into two groups of 30 patients each. Group H received 500 mL of polymerised gelatine (Haemaccel) solution and group N received 1000 mL of 0.9% normal saline15 minutes prior to subarachnoid block. Intraoperative monitoring includes SBP, DBP, MAP and HR for 30 minutes. Incidence of hypotension and number of mephentermine boluses were noted.Statistical analysis of data was determined with Mann-Whitney U test and analysis of variance for repeated measures (ANOVA). Chi-square test was used to find out possible associations. Result: After spinal anaesthesia mean systolic blood pressure decreased in both the groups and was lower in group N compared to group H (97±18.9 vs 102±9.26 mmHg). There was fall in diastolic blood pressure in both the groups and was maximum at 20th minute in group N and group H (66.37±5.47 vs 64.67±10.30). There was highly significant (p<0.01) fall in mean arterial pressure in group N. The change in the heart rate was highly significant (p<0.01) at different time interval in both the groups. Vasopressor was required in 90% and 60% patients in group N and group H, respectively. No statistical difference in the incidence of nausea and vomiting in both the groups. Conclusion: The present study showed that preloading of fluids either with colloids or crystalloids prior to subarachnoid block reduces the incidence of hypotension but not completely eliminating it, also showed that colloids offset hypovolemia and hypotension more effectively than crystalloids in patients undergoing TURP surgery.

scholarly journals Clinical efficacy of Esmolol, Lignocaine and Diltiazem as premedicant for attenuation of hemodynamic responses of laryngoscopy and endotracheal intubation- a comparative evaluation

2017 ◽  
Vol 5 (10) ◽  
pp. 4443 ◽  
Author(s):  
Chitrangna Gupta ◽  
Bhawana Rastogi ◽  
Salony Agarwal ◽  
V. P. Singh ◽  
Vineet K. Choudhary ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Endotracheal Intubation ◽  
Saline Group ◽  
Rate Pressure Product ◽  
Control Group ◽  
Double Blind ◽  
Maximum Increase ◽  
Group D ◽  
Better Than

Background: Direct laryngoscopy and endotracheal intubation after induction of anesthesia is almost always associated with hemodynamic stress response. The aim of this study was to compare esmolol, lignocaine and diltiazem for suppression of laryngoscopy and intubation response.Methods: This randomized prospective double-blind control study was performed on 120 patients of either sex, aged between 18 and 58 years of ASA physical status I and II with Mallampatti grade I and II, undergoing elective surgeries under general anesthesia with endotracheal intubation. Patients were randomized in four groups, Group N (normal saline), Group E (esmolol) 1.5mg/kg I.V, Group D (diltiazem) 0.2mg/kg I.V, and Group L (lignocaine) 1.5mg/kg I.V with 30 patients in each group. Hemodynamic parameters were recorded during the basal period, preinduction, during intubation and at specified intervals.Results: There was significant increase in systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rate in the control group (Group N) in association with tracheal intubation. The heart rate was significantly lower in Group E (Esmolol group), followed by Group D (Diltiazem group) and Group L (Lignocaine group). Rate pressure product was significantly lower in group E as compared to other groups, followed by group D and group L. Maximum increase in rate pressure product (RPP) just after laryngoscopy and intubation was ±74.29% in group N, ±16.11% in group E, 25.38% in group D and 38.77%in group L.Conclusions: Esmolol was better than diltiazem and they both were better than lignocaine for preventing the hemodynamic response after laryngoscopy and intubation.

Caffeine and Placebo Expectation

2007 ◽  
Vol 21 (2) ◽  
pp. 91-99 ◽  
Author(s):  
Yunfeng Sun ◽  
Yinling Zhang ◽  
Ning He ◽  
Xufeng Liu ◽  
Danmin Miao
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Sleep Deprivation ◽  
Cognitive Performance ◽  
Cognitive Functions ◽  
Cardiovascular Regulation ◽  
Double Blind ◽  
Positive Effects ◽  
Pressure Tests ◽  
Healthy Males

Abstract. Caffeine placebo expectation seems to improve vigilance and cognitive performance. This study investigated the effect of caffeine and placebo expectation on vigilance and cognitive performance during 28 h sleep deprivation. Ten healthy males volunteered to take part in the double-blind, cross-over study, which required participants to complete five treatment periods of 28 h separated by 1-week wash-out intervals. The treatments were no substance (Control); caffeine 200 mg at 00:00 (C200); placebo 200 mg at 00:00 (P200); twice caffeine 200 mg at 00:00 and 04:00 (C200-C200); caffeine 200 mg at 00:00 and placebo 200 mg at 04:00 (C200-P200). Participants were told that all capsules were caffeine and given information about the effects of caffeine to increase expectation. Vigilance was assessed by a three-letter cancellation test, cognitive functions by the continuous addition test and Stroop test, and cardiovascular regulation by heart rate and blood pressure. Tests were performed bihourly from 00:00 to 10:00 of the second day. Results indicated that C200-P200 and C200-C200 were more alert (p < .05) than Control and P200. Their cognitive functions were higher (p < .05) than Control and P200. Also, C200-P200 scored higher than C200 in the letter cancellation task (p < .05). No test showed any significant differences between C200-P200 and C200-C200. The results demonstrated that the combination of caffeine 200 mg and placebo 200 mg expectation exerted prolonged positive effects on vigilance and cognitive performance.

Reduction in Pain Sensitivity from Pharmacological Elevation of Blood Pressure in Persons with Chronically Low Blood Pressure

2009 ◽  
Vol 23 (3) ◽  
pp. 104-112 ◽  
Author(s):  
Stefan Duschek ◽  
Heike Heiss ◽  
Boriana Buechner ◽  
Rainer Schandry
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Pain Sensitivity ◽  
Pain Threshold ◽  
Pain Perception ◽  
Drug Effects ◽  
Pressure Effects ◽  
Double Blind ◽  
Low Blood Pressure ◽  
Present Trial

Recent studies have revealed evidence for increased pain sensitivity in individuals with chronically low blood pressure. The present trial explored whether pain sensitivity can be reduced by pharmacological elevation of blood pressure. Effects of the sympathomimetic midodrine on threshold and tolerance to heat pain were examined in 52 hypotensive persons (mean blood pressure 96/61 mmHg) based on a randomized, placebo-controlled, double-blind design. Heat stimuli were applied to the forearm via a contact thermode. Confounding of drug effects on pain perception with changes in skin temperature, temperature sensitivity, and mood were statistically controlled for. Compared to placebo, higher pain threshold and tolerance, increased blood pressure, as well as reduced heart rate were observed under the sympathomimetic condition. Increases in systolic blood pressure between points of measurement correlated positively with increases in pain threshold and tolerance, and decreases in heart rate were associated with increases in pain threshold. The findings underline the causal role of hypotension in the augmented pain sensitivity related to this condition. Pain reduction as a function of heart rate decrease suggests involvement of a baroreceptor-related mechanism in the pain attrition. The increased proneness of persons with chronic hypotension toward clinical pain is discussed.

The Effects of a Caffeine Placebo and Experimenter Expectation on Blood Pressure, Heart Rate, Well-Being, and Cognitive Performance

2001 ◽  
Vol 6 (1) ◽  
pp. 15-25 ◽  
Author(s):  
Harald Walach ◽  
Stefan Schmidt ◽  
Yvonne-Michelle Bihr ◽  
Susanne Wiesch
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cognitive Task ◽  
Well Being ◽  
Control Group ◽  
Double Blind ◽  
Main Effect ◽  
The Difference ◽  
Being There ◽  
To Receive

We studied the effect of experimenter expectations and different instructions in a balanced placebo design. 157 subjects were randomized into a 2 × 4 factorial design. Two experimenters were led to expect placebos either to produce physiological effects or not (pro- vs. antiplacebo). All subjects except a control group received a caffeine placebo. They were either made to expect coffee, no coffee, or were in a double-blind condition. Dependent measures were blood pressure, heart rate, well-being, and a cognitive task. There was one main effect on the instruction factor (p = 0.03) with the group “told no caffeine” reporting significantly better well-being. There was one main effect on the experimenter factor with subjects instructed by experimenter “proplacebo” having higher systolic blood pressure (p = 0.008). There was one interaction with subjects instructed by experimenter “proplacebo” to receive coffee doing worse in the cognitive task than the rest. Subjects instructed by experimenter “antiplacebo” were significantly less likely to believe the experimental instruction, and that mostly if they had been instructed to receive coffee. Contrary to the literature we could not show an effect of instruction, but there was an effect of experimenters. It is likely, however, that these experimenter effects were not due to experimental manipulations, but to the difference in personalities.

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