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

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

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

scholarly journals Comparison of hemodynamic responses along with perfusion index to tracheal intubation with Macintosh and McCoy laryngoscopes

2018 ◽  
Vol 6 (5) ◽  
pp. 1673 ◽  
Author(s):  
Vineet K. Choudhary ◽  
Bhawana Rastogi ◽  
V. P. Singh ◽  
Savita Ghalot ◽  
Vijay Dabass ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Tracheal Intubation ◽  
Arterial Pressure ◽  
Macintosh Laryngoscope ◽  
Hemodynamic Response ◽  
Perfusion Index ◽  
Additional Parameter ◽  
Significant Difference

Background: The McCoy Laryngoscope in comparison to macintosh laryngoscope requires less force for performing laryngoscopy and as a result may alter the associated hemodynamic response. Perfusion index (PI) is a noninvasive numerical value of peripheral perfusion obtained from a pulse oximeter.Methods: A randomized prospective single blind comparative clinical study was conducted on 80 patients of ASA physical status I-II aged between 18 years to 58 years of either sex with body mass index (B.M.I) between 20 and 25 undergoing elective surgeries under general anesthesia. 80 patients were divided into 2 groups: Group A (n=40)- Tracheal Intubation with Macintosh Laryngoscope, Group B (n=40)-Tracheal Intubation with McCoy Laryngoscope. Blood Pressure (systolic blood pressure, diastolic blood pressure, and mean arterial pressure) and heart rate (HR), oxygen saturation (SpO2) via pulse oximeter were monitored.Results: The demographic profile showed no significant difference between the groups. Heart rate, systolic, diastolic and mean arterial pressure had highly significant difference in both groups. Perfusion index was statistically significant immediately post laryngoscopy and intubation till 4 mins. Immediately after laryngoscopy and intubation, the correlation between PI and MAP was statistically significant and it was a negative average to good correlation.Conclusions: The McCoy laryngoscope elicits lesser haemodynamic response to laryngoscopy and tracheal intubation as compared to Macintosh laryngoscope in normotensive patients. Perfusion index can also serve as an additional parameter to assess hemodynamic response since it has good negative correlation with the mean arterial pressure.

Comparative Study of Dexmedetomidine and Fentanyl for Attenuation of Hemodynamic Response to Laryngoscopy and Intubation

2019 ◽  
Vol 15 (3) ◽  
pp. 191-196
Author(s):  
Sabin Gauchan ◽  
Chitra Thapa
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Intracranial Pressure ◽  
Myocardial Ischemia ◽  
Arterial Pressure ◽  
Hemodynamic Response ◽  
Raised Intracranial Pressure ◽  
Group D ◽  
Fentanyl Group

Background: Laryngoscopy and intubation cause hypertension and tachycardia which can lead to myocardial ischemia or cerebrovascular hemorrhage in patients with raised intracranial pressure, hypertension. The objective of this study was to compare the efficacy of dexmedetomidine (1 mcg/kg) and fentanyl (2 mcg/kg) in attenuating hemodynamic response to laryngoscopy and intubation. Methods: Sixty patients scheduled for elective surgeries under general anaesthesia were randomly divided into two groups: Group D and Group F. Group D received dexmedetomidine 1 mcg/kg and group F received fentanyl 2 mcg/kg intravenously over 10 min prior to induction of anesthesia. All the drugs and techniques of anesthesia were standardized in patients in both the groups. Heart rate, systolic, diastolic and mean arterial pressure were recorded at following intervals: at baseline, after drug administration (at 2 and 5 min), after induction, and at 1, 2 and 5 min after intubation. Results: Heart rate and blood pressure was found to be significantly lower in dexmedetomidine group as compared to fentanyl group at 1, 2 and 5 min after intubation. Conclusions: Dexmedetomidine 1 mcg/kg is superior to fentanyl 2 mcg/kg for attenuation of hemodynamic response to laryngoscopy and intubation.

scholarly journals A Comparative Study between Two Different Doses of Dexmedetomidine for Attenuation of Hemodynamic Response to Laryngoscopy and Tracheal Intubation.

2019 ◽  
Vol 21 (3) ◽  
pp. 178-183
Author(s):  
Chitra Thapa ◽  
S. Gauchan
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Tracheal Intubation ◽  
Arterial Pressure ◽  
Systolic Blood Pressure ◽  
Study Drug ◽  
Hemodynamic Response ◽  
Group A ◽  
Group B

Laryngoscopy and end tracheal intubation are stressful situation for the patients, as these procedures are capable of producing tachycardia, hypertension and arrhythmias. This study was conducted with the objective of arriving at an optimal dose of dexmedetomidine that can attenuate the hemodynamic response to laryngoscopy and intubation with minimal side effects. The current study was conducted in 60 patients, posted for elective surgery under general anesthesia withendotracheal intubation. The patients were divided into two groups: Group A and Group B. Group A received dexmedetomidine 0.5 μg/kg and group B received dexmedetomidine 1 μg/kg intravenously over 10 min prior to induction of anesthesia. The anesthesia technique was standardized in both the groups. Heart rate, systolic, diastolic and mean arterial pressure were monitored and recorded at 5min and 10 min of completion of infusion of study drug, after induction, and at 1 min, 2 min, 5 min after intubation. The baseline heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were statistically similar in both the groups. After the infusion of the study drug the mean heart rate, mean systolic blood pressure, mean diastolic blood pressure, mean arterial pressure at all times were comparable in both the groups. Episodes of hypotension and bradycardia were also statistically similar in both the groups. Attenuation of hemodynamic response to laryngoscopy and intubation by dexmedetomidine is similar with the two doses: 0.5  μg/kg and 1 μg/kg. Both the doses of dexmedetomidine were devoid of any significant adverse effects.

scholarly journals Maternal hemodynamic effect of prophylactic glycopyrrolate after spinal anaesthesia for elective caesarean section

2021 ◽  
Vol 8 (1) ◽  
pp. 44-50
Author(s):  
Roshan Piya ◽  
Anil Shrestha ◽  
Manisha Pradhan ◽  
Shirish Amatya ◽  
Niroj Hirachan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Caesarean Section ◽  
Arterial Pressure ◽  
Spinal Anesthesia ◽  
Elective Caesarean Section ◽  
Hemodynamic Effect ◽  
Group I ◽  
Group Ii

Introduction: Hypotension and bradycardia are the most common complications during spinal anesthesia. Bradycardia decreases cardiac output, resulting in hypotension and even cardiac arrest. Glycopyrronium, an anticholinergic drug increases heart rate and prevents bradycardia during spinal anesthesia by blocking the effects of acetylcholine on the sinoatrial node. The study aims to measure the maternal hemodynamic effect of glycopyrrolate after spinal anesthesia for elective caesarean section. Method: An intervention, comparative study was conducted in Patan Hospital after approval from Ethical Committee. Eighty-two pregnant women scheduled for elective caesarean section were randomly assigned in two groups by sealed envelope method; Group I received glycopyrrolate 0.2mg intravenous,  Group II did not receive glycopyrrolate. The patient’s heart rate, blood pressure, mean arterial pressure, a total dose of ephedrine, the occurrence of nausea, vomiting, and dry mouth were recorded. Independent-T test, chi-square test were used for statistical analysis. Result: Among 82 elective caesarean sections, 41 in each group, Group II (non-glycopyrrolate) reported increased heart rate compared to Group I (glycopyrrolate), but was statistically not significant. The highest recorded diastolic blood pressure was more in Group I compared to Group II and was statistically significant. The highest recorded Mean Arterial Pressure was high in the glycopyrrolate group and was statistically significant. The total dose of ephedrine was lower in the statistically significant glycopyrrolate group. The incidence of dry mouth was more in the glycopyrrolate group and the difference was statistically significant. Conclusion: Glycopyrrolate reduces the incidence of hypotension but not bradycardia and decreases the need for vasopressor.

scholarly journals Comparative Evaluation of Topical Lignocaine Versus Intravenous Lignocaine for Laryngeal Mask Airway Insertion in Wardha, Maharashtra

2021 ◽  
Vol 10 (28) ◽  
pp. 2078-2082
Author(s):  
Swathi Reddy G. ◽  
Karuna Taksande
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Laryngeal Mask Airway ◽  
Arterial Pressure ◽  
Comparative Evaluation ◽  
Laryngeal Mask ◽  
Laryngeal Mask Airway Insertion ◽  
Hemodynamic Parameters ◽  
Group I

BACKGROUND The purpose of present study was to compare and evaluate both topical lignocaine and intravenous lignocaine for laryngeal mask airway (LMA) insertion prior to propofol. Main objective was to study the conditions for LMA insertion with respect to gagging, coughing, Laryngospasm and No. of attempts for LMA insertion and also study the hemodynamic parameters in both the groups (Heart rate, SBP,DBP, MAP, SpO2) METHODS This study included 60 patients of 30 in each group, ASA I & II day care surgeries were performed in our hospital between 2019 and 2021. Patients were randomized into two groups. Group I received intravenous lignocaine 1.5 mg / kg over 30 seconds and group II received topical lignocaine 40 mg. Conditions of LMA insertion, gagging, laryngospasm, coughing were noted at the time of insertion, ECG, NIBP, SPO2 and ETCO2 were recorded according to scheduled times. RESULTS In conditions of LMA insertion, difference between both the groups was found to be significant, P < 0.05 in groups with first minute rise in heart rate, fall in Systolic blood pressure, diastolic blood pressure, mean arterial pressure was significant. At two minutes and three minutes after the LMA insertion, HR, SBP, DBP, MAP all these parameters changed slightly but these changes were statistically not significant. CONCLUSIONS Prior to Propofol induction, compared to intravenous lignocaine, topical lignocaine 10 % aerosol provided excellent conditions for the insertion of LMA without the use of neuromuscular blockers. KEY WORDS IV Lignocaine, Topical Lignocaine, LMA

scholarly journals Use of Gabapentin, Esmolol or Their Combination to Attenuate Haemodynamic Response to Laryngoscopy and Intubation

2012 ◽  
Vol 9 (4) ◽  
pp. 238-243 ◽  
Author(s):  
G S Shrestha ◽  
M N Marhatta ◽  
R Amatya
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Systolic Blood Pressure ◽  
Normal Saline ◽  
Study Drug ◽  
Haemodynamic Response ◽  
Rate Pressure Product ◽  
Significant Difference

Background Laryngoscopy and intubation increases blood pressure and heart rate. Objective The study aims to investigate the effect and safety of gabapentin, esmolol or their combination on the haemodynamic response to laryngoscopy and intubation. Methods A total of 72 patients undergoing elective surgery were randomly allocated to one of the four groups. First study drug was administered orally as gabapentin 1200mg or placebo. Second study drug was administered intravenously as esmolol 1.5mg/kg or normal saline. Heart rate, rate pressure product, systolic blood pressure and mean arterial pressure were recorded at baseline and at zero, one, three and five minutes after tracheal intubation. Results Baseline values were compared with the values at various time intervals within the same group. In group PE (placebo, esmolol), there was significant decrease in heart rate and rate pressure product at five minutes. In group GN (gabapentin, normal saline), there was significant decrease in systolic blood pressure and mean arterial pressure at five minutes. In group GE (gabapentin, esmolol), there was significant decrease in heart rate at zero, three and five minutes. Systolic blood pressure, mean arterial pressure and rate pressure product was significantly lower at three and five minutes. In group PN (placebo, normal saline), there was significant increase in heart rate at zero, one, three and five minutes; systolic blood pressure at zero and one minutes; mean arterial pressure at zero and one minutes & rate pressure product at zero, one and three minutes. In group GN (gabapentin, normal saline), there was significant increase in heart rate at zero, one and three minutes & rate pressure product at zero, one and three minutes. In group PE (placebo, esmolol), there was significant increase in systolic blood pressure at zero and one minutes & mean arterial pressure at zero and one minutes. However, in group GE (gabapentin, esmolol) none of the variables showed statistically significant increase at any time. Inter-group comparison was made for each time point. At zero minute, there was significant difference in heart rate between groups PN and GE, GN and PE & GN and GE Significant difference was also noted in rate pressure product between PN and GE at zero minute. At one minute there was difference in heart rate between PN and PE, PN and GE, GN and PE & between GN and GE. Significant difference was observed in rate pressure product between PN and PE & between PN and GE at one minute. No significant side effects of the study drugs were observed. ConclusionsCombination of gabapentin and esmolol in this study design is safe and better attenuates both the pressor and tachycardic response to laryngoscopy and intubation, than either agent alone.DOI: http://dx.doi.org/10.3126/kumj.v9i4.6336 Kathmandu Univ Med J 2011;9(4):238-43 

scholarly journals Comparative Study of Oral Clonidine Versus Gabapentin as Premedication for Anxiolysis, Sedation and Attenuation of Pressor Response to Laryngoscopy and Tracheal Intubation

2018 ◽  
Vol 9 (2) ◽  
pp. 131-136 ◽  
Author(s):  
Muhammad Sazzad Hossain ◽  
Mohammad Mamunur Rashid ◽  
Syed Ariful Islam ◽  
Md Anisur Rahman Babu ◽  
Devashis Saha ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Controlled Trial ◽  
Hemodynamic Response ◽  
Sedation Score ◽  
Oral Clonidine

Background and Aims: We conducted a prospective, randomized, double-blind and controlled trial to compare the effects of oral clonidine and gabapentin as premedication in obtunding hemodynamic response to laryngoscopy and intubation in normotensive patients undergoing elective surgery. We also compared the preoperative anxiety and sedation status between these two drugs.Materials and Methods: A total of 60 patients of American Society of Anesthesiologists (ASA) physical status I, aged 20 -50 years of either sex enrolled in the study were randomly divided into two groups of 30 each. Group A patients received oral clonidine 200 mcg and Group B patients received oral gabapentin 900 mg, 90 minutes prior to induction of anesthesia. The heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were observed and recorded pre and post endotracheal intubation. Anxiety and sedation score were noted after 60 minutes of oral administration of drug as well as before induction of anesthesia.Results: Both groups were matched for age, sex, weight and intubation time. Anxiety score and sedation score before induction were significantly better in clonidine group as compared with gabapentin group. Also oral clonidine attenuated the increase in heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure better than oral gabapentin (p<0.05).Conclusion: Oral clonidine provided good attenuation of hemodynamic response to laryngoscopy and intubation as compared with oral gabapentin. Also clonidine is better agent as anxiolytic and sedative than gabapentin.Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 131-136

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

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

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

Additive Interactions between Propofol and Ketamine When Used for Anesthesia Induction in Female Patients 

1995 ◽  
Vol 82 (3) ◽  
pp. 641-648 ◽  
Author(s):  
T. W. Hui ◽  
T. G. Short ◽  
W. Hong ◽  
T. Suen ◽  
T. Gin ◽  
...  
Keyword(s):  
Heart Rate ◽  
Arterial Pressure ◽  
Additional Term ◽  
Anesthesia Induction ◽  
Response Curves ◽  
Intravenous Anesthesia ◽  
Verbal Command ◽  
Female Patients ◽  
Loss Of Response ◽  
Significant Difference

Background Propofol and ketamine may be paired for anesthesia induction and for total intravenous anesthesia. The nature of any sedative interactions occurring between propofol and ketamine are unknown. The combination when used for anesthesia induction in female patients was studied. Methods Quantal dose-response curves were determined in 180 female patients to whom the drugs were administered individually and in combination. Two minutes after administering the drugs, two endpoints were assessed. First, loss of response to verbal command (hypnosis) and then, in those who failed to respond to this endpoint, loss of response to a 5-s transcutaneous tetanus (anesthesia). Interactions were analyzed by fitting the data to a mathematical model in which response was analyzed in terms of the doses of the two drugs and an additional term included to describe nonadditive interactions. The incidences of apnea, arterial pressure, and heart rate changes during the first 5 min were recorded. Results At the hypnotic endpoint, the ED50s were 1.10 mg/kg propofol (95% CIs 0.93-1.27), 0.39 mg/kg ketamine (95% CIs 0.27-0.46), and the combination of 0.63 mg/kg propofol and 0.21 mg/kg ketamine (95% CIs 0.53/0.18-0.73/0.24). At the anesthetic endpoint, the ED50s were 1.85 mg/kg propofol (95% CIs 1.58-2.36) 0.66 mg/kg ketamine (95% CIs 0.58-0.77), and the combination of 1.05 mg/kg propofol and 0.35 mg/kg ketamine (95% CIs 0.88/0.29-1.27/0.42). The effects were additive at both endpoints; there was no evidence of an interaction. The ED50s for apnea were 1.61 mg/kg propofol (95% CIs 1.39-1.94), greater than 0.85 mg/kg ketamine and for the combination 1.50 mg/kg propofol and 0.50 mg/kg ketamine (95% CIs 1.15/0.38-3.09/1.03). The addition of ketamine did not significantly alter the ED50 for apnea of propofol. There was a significant difference in the arterial pressures among the three groups (P &lt; 0.001). Using the combination, the cardiostimulant effects of ketamine balanced the cardiodepressant effects of propofol. There was no change in arterial pressure or heart rate after the noxious stimulus. Conclusions When using the combination, doses were additive at hypnotic and anesthetic endpoints. Ketamine had no influence on the incidence of apnea after propofol, and the net hemodynamic effects were minimal.

Hypotensive and Regional Haemodynamic Effects of Exercise, Fasted and after Food, in Human Sympathetic Denervation

1998 ◽  
Vol 94 (1) ◽  
pp. 49-55 ◽  
Author(s):  
Sharmini Puvi-Rajasingham ◽  
Gareth D. P. Smith ◽  
Adeola Akinola ◽  
Christopher J. Mathias
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Superior Mesenteric Artery ◽  
Vascular Resistance ◽  
Mesenteric Artery ◽  
Autonomic Failure ◽  
Sympathetic Denervation ◽  
Stroke Distance

1. In human sympathetic denervation due to primary autonomic failure, food and exercise in combination may produce a cumulative blood pressure lowering effect due to simultaneous splanchnic and skeletal muscle dilatation unopposed by corrective cardiovascular reflexes. We studied 12 patients with autonomic failure during and after 9 min of supine exercise, when fasted and after a liquid meal. Standing blood pressure was also measured before and after exercise. 2. When fasted, blood pressure fell during exercise from 162 ± 7/92 ± 4 to 129 ± 9/70 ± 5 mmHg (mean arterial pressure by 22 ± 5%), P < 0.0005. After the meal, blood pressure fell from 159 ± 8/88 ± 6 to 129 ± 6/70 ± 4 mmHg (mean arterial pressure by 22 ± 3%), P < 0.0001, and further during exercise to 123 ± 6/61 ± 3 mmHg (mean arterial pressure by 9 ± 3%), P < 0.01. The stroke distance—heart rate product, an index of cardiac output, did not change after the meal. During exercise, changes in the stroke distance—heart rate product were greater when fasted. 3. Resting forearm and calf vascular resistance were higher when fasted. Calf vascular resistance fell further after exercise when fasted. Resting superior mesenteric artery vascular resistance was lower when fed; 0.19 ± 0.02 compared with 032 ± 0.06, P < 0.05. After exercise, superior mesenteric artery vascular resistance had risen by 82%, to 0.53 ± 0.12, P < 0.05 (fasted) and by 47%, to 0.29 ± 0.05, P < 0.05 (fed). 4. On standing, absolute levels of blood pressure were higher when fasted [83 ± 7/52 ± 7 compared with 71 ± 2/41 ± 3 (fed), each P < 0.05]. Subjects were more symptomatic on standing post-exercise when fed. 5. In human sympathetic denervation, exercise in the fed state lowered blood pressure further than when fasted and worsened symptoms of postural hypotension.

Sign in / Sign up

Export Citation Format

Share Document