scholarly journals Treatment of supraventricular tachycardias in patients with non-cardiac surgery by dexmedetomidine during the perioperative period

2020 ◽  
Author(s):  
Yan Xu ◽  
CuiWen Hu ◽  
Xuan Guo ◽  
ZhiHong Hu ◽  
Hui Shi ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cardiac Surgery ◽  
Therapeutic Effect ◽  
Cardiac Disease ◽  
Perioperative Period ◽  
Adult Patients ◽  
Significant Difference ◽  
Supraventricular Tachycardias ◽  
Group D ◽  
Frequency Power

Abstract Background: Supraventricular tachycardias (SVTs) can increase the risk of adverse events in perioperative period. Previous studies have shown that application of dexmedetomidine (DEXm) combined anesthesia during surgery can significantly reduce postoperative cardiovascular and cerebrovascular complications and mortality in patients with cardiac disease. In fact, many anesthetic drugs have cardiac protection effects. However, it is a pity that these findings are not well applied in clinical practice to treat cardiac disease. Therefore, the aim of this study was to explore the therapeutic effect of DEXm on perioperative SVTs in adult patients with non-cardiac surgery. Methods: Forty-two patients with SVTs, aged between 35 and 61 years, were randomly divided into DEXm group (group D) and midazolam group (group M). The patients undergoing elective surgery in two groups were infused intravenously DEXm 0.5-1µg/kg or midazolam 0.06-0.08mg/kg using a micro-pump for 10 minutes, respectively. The the Observer’s Assessment of Alertness/Sedation (OAA/S) score, heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2) and occurrence of SVTs, heart rate variability (HRV) including normalized low frequency power (LFnorm), normalized high frequency power (HFnorm) and the balance ratio of sympathetic to vagal tone (LF/HF) in two groups were recorded at T0 (before the infusion DEXm or midazolam), T1 (5 minutes after the infusion), T2 (at the end of the infusion), T3 (5 minutes after the end of the infusion), and T4 (10 minutes after the end of the infusion). Results: The OAA/S score in two groups at T4 was obviously decreased compared with T0. And the OAA/S score in group M was lower than in group D at T4 (P<0.05). Compared to T0, HR and MAP in two groups were obviously decreased, and HR and MAP in group D were apparently lower than group M from T1 to T4 (P<0.05). Three patients developed mild hypotension in group D. However, none of patients developed clinically significant bradycardia, hypotension, and anoxia. There was no significant difference for SpO2 from T0 to T4 in group D. Compared to T0 or group D, SpO2 in group M obviously decreased at T2 (P<0.05). In addition, SVTs in all patients were terminated until T4 in group D after DEXm infusion. However, only two patients were finally improved in group M. Compared to T0, HFnorm were elevated, and LFnorm and LF/HF were decreased from T1 to T4, furthermore, the changes in HFnorm, LFnorm and LF/HF had statistical significance (P<0.05) in group D. However, there was no significant difference for HFnorm, LFnorm and LF/HF in group M from T0 to T4.Conclusions: Perioperative use of dexmedetomidine had a significant therapeutic effect for supraventricular tachycardias without significant adverse effects in adult patients .Trial Registration: ClinicalTrials.gov Registration Number: NCT04284150 on 26th February 2020

scholarly journals Treatment of Supraventricular Tachycardia in Patients with Non-Cardiac Surgery by Dexmedetomidine During the Perioperative Period. A Randomized Trial

2020 ◽  
Author(s):  
CuiWen Hu ◽  
Yan Xu ◽  
Xuan Guo ◽  
Shengnan Yang ◽  
Qi Zhang ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cardiac Surgery ◽  
Supraventricular Tachycardia ◽  
Therapeutic Effect ◽  
Low Frequency ◽  
Perioperative Period ◽  
Cardiac Autonomic Nervous System ◽  
Midazolam Group ◽  
Low Frequency Power ◽  
Frequency Power

Abstract Background: Previous studies have shown that application of dexmedetomidine (Dex) combined anesthesia during surgery can significantly reduce cardiovascular system complications and mortality of patients with cardiac disease during the perioperative period. The aim of this study was to explore the therapeutic effect of Dex on perioperative supraventricular tachycardia (SVT) in adult patients with non-cardiac surgery.Methods: Forty-six patients with SVT undergoing elective non-cardiac surgery were randomly divided into two groups, intravenously infused Dex (Dex group, 1.0 µg/kg) or midazolam (midazolam group, 0.06 mg/kg) for 10 minutes, respectively. The observation indexes containing the treatment efficiency of SVT, heart rate (HR) and and heart rate variability (HRV) including normalized low frequency power (LFnorm), normalized high frequency power (HFnorm) and LFnorm/HFnorm were recorded.Results: Treatment rates of SVT were 21/23 (91.3%) in Dex group vs 2/23 (8.7%) in midazolam group (P<0.001). In Dex group, LFnorm and LFnorm/HFnorm were decreased, and HFnorm were elevated and HR were decreased after twenty-three patients infused Dex (P < 0.05). However, there was no difference for HFnorm, LFnorm and LFnorm/HFnorm in midazolam group (P > 0.05). Conclusion: Perioperative use of dexmedetomidine has a significant therapeutic effect for SVT, and its mechanism is related to adjust cardiac autonomic nervous system and has no obvious connection with sedation.Trial registration: This trial was registered at ClinicalTrials.gov. registry number: NCT04284150 on February 13, 2020.

scholarly journals Transvenous endocardial pacemaker pacing in thoracoscopic cardiac surgery

2021 ◽  
Author(s):  
Xiangnian Li ◽  
wu zhang ◽  
Yu Xia ◽  
Shengjie Liao ◽  
xiao shen zhang
Keyword(s):  
Heart Rate ◽  
Cardiac Surgery ◽  
Heart Surgery ◽  
Median Sternotomy ◽  
Operation Time ◽  
Perioperative Period ◽  
Perioperative Outcomes ◽  
Significant Difference ◽  
Epicardial Pacing ◽  
Endocardial Pacing

Background: Temporary cardiac pacing is frequently required during heart surgery due to life-threatening complications of arrhythmias. The conventional method of epicardial pacing could have risks such as bleeding and myocardial tears. Transvenous endocardial pacing provides another option. The efficiency of transvenous epicardial and endocardial pacing were compared in this study. Methods: We performed a retrospective study and reviewed medical records in patients who received either thoracoscopic cardiac surgery with transvenous endocardial pacing or median sternotomy with transvenous epicardial pacing between June 2019 and January 2021. Patients were assigned into two groups depending on the surgical type and pacing method. Preoperative patient characteristics and perioperative outcomes were collected. The efficiencies of endocardial and epicardial pacing were compared and analyzed in SPSS. Results: A total of 68 patients were included. Thirty-five (51.5%) patients were in the thoracoscopic cardiac surgery group with transvenous endocardial pacing. Thirty-three (48.5%) patients were in the median sternotomy group with transvenous epicardial pacing. Intensive care unit (ICU) time (p = 0.014), in-hospital duration (p = 0.036), operation time (p = 0.005), and the 24-h drainage volume (p < 0.001) showed significant differences between the two groups. There was no significant difference between the pre- and post-operative heart rate and rhythm compared between two groups. Conclusions: Compared with transvenous epicardial pacing, transvenous endocardial pacing showed no significant differences in heart rate and arrhythmia during the perioperative period. Transvenous endocardial pacing was also associated with better operative measurements.

scholarly journals Valsalva maneuver techniques for supraventricular tachycardias: Which and how?

2017 ◽  
Vol 24 (6) ◽  
pp. 298-302
Author(s):  
Salih Ekinci ◽  
Gökçe Akgül ◽  
Eda Arş ◽  
Alp Aydin ◽  
Ekrem Musalar ◽  
...  
Keyword(s):  
Heart Rate ◽  
Repeated Measures ◽  
Valsalva Maneuver ◽  
Study Objective ◽  
T Wave ◽  
Wave Inversion ◽  
Heart Rate Decrease ◽  
Significant Difference ◽  
Supraventricular Tachycardias ◽  
Adult Volunteers

Study objective: While some research has been done on Valsalva maneuvers in treating supraventricular tachycardia, there is no standardized algorithm on which technique has been the most effective for the termination of supraventricular tachycardias. In this study, we compare different Valsalva maneuver techniques in order to determine the exact technique needed for maximal vagal response. Methods: This was a repeated measures clinical study, which enlisted a sample of healthy adult volunteers. Participants performed four different Valsalva maneuver techniques (40 mm Hg—10 s, 40 mm Hg—15 s, 50 mm Hg—10 s, and 50 mm Hg—15 s) while lying in a supine position. The maneuvers were repeated three times. An electrocardiography printout was obtained during each trial, and heart rate differences between pre-maneuver and post-maneuver were measured. Results: Among the 97 volunteers who participated in the study, 7 were excluded because the target Valsalva maneuver pressures were not reached, and 1 volunteer was excluded due to T-wave inversion that developed after Valsalva maneuver. We enrolled 89 participants. There was no significant difference in the heart rate decrease among the four techniques. In addition, there was no difference between the vagal responses in terms of age, gender, and body mass index. Conclusion: This study shows that the four different Valsalva maneuver techniques were not superior to one another in terms of decreased heart rate.

scholarly journals Effect of Mechanical Ventilation During Cardiopulmonary Bypass On End-Expiratory Lung Volume in The Perioperative Period of Cardiac Surgery

2021 ◽  
Author(s):  
Lea Trancart ◽  
Nathalie Rey ◽  
Vincent Scherrer ◽  
Véronique Wurtz ◽  
Fabrice Bauer ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Lung Volume ◽  
Perioperative Period ◽  
Tertiary Teaching ◽  
Significant Difference ◽  
Residual Capacity ◽  
Tertiary Teaching Hospital ◽  
The Impact

Abstract Background Many studies explored the impact of ventilation during cardiopulmonary bypass period. However, its effect on Functional residual capacity or End Expiratory Lung Volume (EELV) has not been specifically studied. Our objective was to compare the effect of two ventilation strategies during cardiopulmonary bypass (CPB) on EELV. Methods observational monocenter study in a tertiary teaching hospital. Adult patients undergoing on-pump cardiac surgery by sternotomy were included and ventilated on the GE Carescape R860® ventilator. Maintenance of ventilation during CPB was left to the discretion of the medical team, with division between "ventilated" and "non-ventilated" groups afterwards. Iterative per and postoperative measurements of EELV were carried out by nitrogen washin-washout technique. Results 40 patients were included, 20 in each group. EELV was not significantly different between the ventilated versus non-ventilated groups at the end of surgery (1796±586ml vs. 1844±524ml; p=1). No significant difference between the two groups was observed on oxygenation, duration of mechanical ventilation, need postoperative respiratory support, occurrence of pneumopathy and radiographic atelectasis. Conclusion Maintaining mechanical ventilation during CPB does not seem to allow a better preservation of EELV in our population.

Cardiac autonomic responses to volume overload in normal subjects and in patients with dilated cardiomyopathy

1999 ◽  
Vol 277 (4) ◽  
pp. H1361-H1368 ◽  
Author(s):  
L. Spinelli ◽  
M. Petretta ◽  
F. Marciano ◽  
G. Testa ◽  
M. A. E. Rao ◽  
...  
Keyword(s):  
Heart Rate ◽  
Dilated Cardiomyopathy ◽  
Repeated Measures ◽  
Volume Expansion ◽  
Normal Subjects ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Significant Difference ◽  
Frequency Power

This study evaluated the effects of acute isotonic volume expansion on heart rate variability (HRV) in 10 patients with dilated cardiomyopathy (DCM) and in 10 age- and sex-matched normal volunteers. Echocardiographic left ventricular volumes and HRV measurements by continuous Holter recording were assessed at baseline, at 60 and 120 min during intravenous saline load (0.9% NaCl, 0.25 ml ⋅ kg−1 ⋅ min−1), and 60 min after infusion was terminated. Data analysis was performed by repeated-measures ANOVA. After volume expansion, left ventricular ejection fraction increased ( F = 9.8; P < 0.001) in normal subjects and decreased ( F = 8.7; P < 0.001) in DCM patients. During volume expansion a significant difference was also detectable between the two groups in root-mean-square successive difference ( F = 25.2; P < 0.001), percentage of differences between successive normal R-R intervals >50 ms ( F = 97.6; P < 0.001), high-frequency power ( F = 50.1; P < 0.001), and low-frequency power ( F = 41.6; P < 0.001), all of which reflect parasympathetic modulation of heart rate; in fact, these measurements increased in normal subjects and decreased in DCM patients. In normal subjects, the increase in HRV measurements during volume expansion suggests a parasympathetic activation, mediated by stimulation of cardiopulmonary and arterial mechanoreceptors. On the contrary, in DCM patients the parasympathetic withdrawal, already detectable at baseline, increases during volume expansion.

scholarly journals Heart Rate Variability following Cardiac Surgery Fails to Predict Short-Term Cardiovascular Instability

1997 ◽  
Vol 25 (6) ◽  
pp. 621-622 ◽  
Author(s):  
G. J. McHugh ◽  
J. W. Sleigh ◽  
H. Bo ◽  
J. D. Henderson
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Cardiac Surgery ◽  
Spectral Power ◽  
Short Term ◽  
Cardiovascular Instability ◽  
Significant Difference ◽  
Straight Leg Raising ◽  
Patient Arrival ◽  
Variability Data

The heart rate variability of 40 patients has been examined by spectral analysis following cardiac surgery. The heart rate variability was measured upon patient arrival in ICU in both a resting supine position, and following passive straight-leg raising. After 12 hours in ICU, the patients were classified as having been cardiovascularly stable or unstable according to a specially devised inventory. Their heart rale variability data was then examined to seek any predictor of instability. Passive straight-leg raising induced a decrease in spectral power across all of the component frequency bands. The LF/HF ratio rose with passive straight-leg raising, but failed to reach significance. None of these changes were sustained. There was no significant difference in heart rate variability patterns between the stable and unstable groups, and so no predictor was identified. Initial clinical assessment was also studied, and it too provided no reliable prediction of short-term cardiovascular instability.

scholarly journals Does dexmedetomidine reduce the risk of acute kidney injury after cardiac surgery: a meta-analysis of randomized controlled trials

2021 ◽  
Author(s):  
Chunxiao Zhao ◽  
Shuo Liu ◽  
Huiquan Zhang ◽  
Mengqi Gao
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Randomized Controlled Trials ◽  
Postoperative Mortality ◽  
Kidney Injury ◽  
Adult Patients ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Postoperative Aki

OBJECTIVE: Acute kidney injury (AKI) is a common complication after cardiac surgery, and there is no pharmacologic prophylaxis of AKI. Some animal and clinical studies showed the renoprotection effect of dexmedetomidine (DEX) on AKI, but data from other trials came to the opposite conclusion following cardiac surgery. METHODS: We searched databases including EMBASE, PubMed, and Cochrane CENTRAL for randomized controlled trials (RCTs) focused on DEX for AKI in adult patients after cardiac surgery. The primary outcome was incidence of AKI. Secondary outcomes were mechanical ventilation (MV) duration, intensive care unit (ICU) length of stay (LOS), hospital LOS and mortality. RESULTS: Fifteen trials enrolling 2907 study patients were collected in the meta-analyses. Compared with controls, DEX reduced the incidence of postoperative AKI [odds ratio (OR), 0.66; 95%confidence interval (CI), 0.48-0.91; P=0.01], and there was no significant difference between groups in postoperative mortality (OR, 0.63; 95%CI, 0.32-1.26; P=0.19), MV duration [weighted mean difference(WMD), -0.44; 95%CI, -1.50-0.63; P=0.42], ICU LOS (WMD, -1.19; 95%CI, -2.89-0.51; P=0.17) and hospital LOS (WMD, -0.31; 95%CI, -0.76-0.15; P=0.19). CONCLUSIONS: Perioperative DEX use reduced the incidence of postoperative AKI in adult patients undergoing cardiac surgery. No significant decrease existed in mortality, MV duration, ICU LOS and hospital LOS owing to the DEX administration.

scholarly journals Bronchial blocker versus double-lumen endobronchial tube in minimally invasive cardiac surgery

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Chuncheng Zhang ◽  
Jing Yue ◽  
Mingyue Li ◽  
Wei Jiang ◽  
Yu Pan ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cardiac Surgery ◽  
Airway Pressure ◽  
Peak Pressure ◽  
Mean Airway Pressure ◽  
Postoperative Sore Throat ◽  
Short Term ◽  
Double Lumen ◽  
Group B ◽  
Group D

Abstract Background To compare the therapeutic value of a bronchial blocker (BB) with a double-lumen tube (DLT) in minimally invasive cardiac surgery (MICS). Methods Sixty patients who underwent MICS were randomized to use either a DLT (Group D, n = 30) or a BB (Group B, n = 29; one failed was omitted). The following data were collected: time of intubation and tube localization; incidence of tube displacement; postoperative sore throat and hoarseness; time of cardiopulmonary bypass; maintenance time for SpO2 < 90% (PaCO2 < 60 mmHg); mean arterial pressure and heart rate; SpO2, PaO2, PaCO2, EtCO2, mean airway pressure, and airway peak pressure; surgeons’ satisfaction with anesthesia; and short-term complications. Results The times of intubation and tube localization were significantly longer in Group B than in Group D (P < 0.05). Patients in Group B exhibited significantly lower incidence of tube displacement, postoperative sore throat, and hoarseness when compared with patients in Group D (P < 0.05). Mean arterial pressure and heart rate were significantly lower in Group B than in Group D after tracheal intubation (P < 0.05). The mean airway pressure and airway peak pressure were significantly lower in Group B than in Group D after one-lung ventilation (P < 0.05). SpO2 and PaO2 in Group B were significantly higher than in group D after cardiopulmonary bypass (P < 0.05). No short-term postoperative complications were observed in patients of Groups B and D during 3 month follow-up. Conclusion BB can be a potential alternative to the conventional DLT for lung isolation in MICS. Trial registration: ChiCTR1900024250, July 2, 2019.

The Effect of Heart Rate Variability on Exercise Training Post-Cardiac Surgery

2013 ◽  
Vol 440 ◽  
pp. 140-144
Author(s):  
Shu Cheng Lin ◽  
Ho Cheng Chen ◽  
Shu Wang Lin ◽  
Wei Chin Hong ◽  
Wei Lun Huang ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Cardiac Surgery ◽  
Exercise Training ◽  
Artery Bypass ◽  
Analysis Of Covariance ◽  
Surgery Patient ◽  
Significant Difference ◽  
Training Post ◽  
Post Cardiac Surgery

Purpose: the purpose of this study was to investigate heart rate variability on exercise training post-cardiac surgery. Method: the data collection was from the Chia-yi Christian Hospital Cardiac Surgery implementation of beating heart coronary artery bypass surgery and valve replacement patients. There were a total of 10 patients included in this study. Cardiac patients after discharge from hospital were the participation of exercise training groups (n=5), and no receiving cardiopulmonary physical therapy of patients was the home-based group (n=5). Statistics: Data analysis was conducted using the SPSS statistical software for Windows 20.0. Analysis of covariance (ANCOVA) was used as the statistical method at a significance level (α) of .05. Through statistical analysis and comparison, the results were obtained as below: In HRV time domain portion, SDNN, CV%, results were significant difference. In frequency domain portion, indices such as LF and VHF, results were significant difference. Conclusion: According to the experimental results, the heart rate variability on exercise training better than patients did not participate in sports training after cardiac surgery patient.

scholarly journals A Prospective Randomized Study on Intraoperative Haemodynamic and Post-Operative Recovery Characteristics of Sevoflurane and Desflurane in Thyroid Surgeries under General Anaesthesia in Wayanad District

2021 ◽  
Vol 8 (24) ◽  
pp. 2045-2051
Author(s):  
Faias Karukappadath Siddique ◽  
Arun Aravind ◽  
Ashabi Mansoortheen
Keyword(s):  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
General Anaesthesia ◽  
Randomized Study ◽  
Significant Difference ◽  
Ethical Committee Approval ◽  
American Society ◽  
Operative Recovery ◽  
Group D

BACKGROUND Maintaining deep plane of anaesthesia to prevent haemodynamic fluctuation and absolute immobility at the same time ensuring early and smooth recovery to prevent bleeding and assessing vocal cord status are the challenges to the anaesthesiologists in thyroid surgeries. Use of volatile anaesthetics with low solubility and low blood gas partition coefficient are used for their haemodynamic stability and faster emergence from anaesthesia in various surgeries under general anaesthesia. we wanted to compare sevoflurane and desflurane in terms of intraoperative haemodynamics, postoperative emergence and recovery characteristics in thyroid surgeries of less than 2 hours duration. METHODS After getting institutional ethical committee approval, 70 patients belonging to American Society of Anaesthesiologists (ASA), physical status I or II undergoing elective thyroid surgery were randomly assigned to two groups to receive either 6 % Desflurane (group D ) or 2 % Sevoflurane (group S) for maintenance of general anaesthesia along with 33 % oxygen with 67 % nitrous oxide. The intraoperative heart rate, mean arterial pressure were recorded at 5 minute intervals and recovery characteristics including times to extubation, first spontaneous motion, response to painful pinch, recall of name, hand grip and PARS score ≥ 9 were recorded in both groups. RESULTS There was no statistically significant difference (P > 0.05) in mean heart rate and mean arterial pressure between group D and S and remained within 20 % of baseline. The time to achieve a PARS ≥ 9 was earlier in the desflurane group and it was statistically significant. CONCLUSIONS Desflurane and Sevoflurane based anaesthesia provides comparable intraoperative haemodynamics whereas post-operative recovery was quicker in patients who received Desflurane compared to Sevoflurane. KEYWORDS Desflurane, Haemodynamics, Recovery, Sevoflurane

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