scholarly journals Hemodynamic response to Sevoflurane and Propofol induction: a comparative study

2015 ◽  
Vol 2 (1) ◽  
pp. 2-7
Author(s):  
Prabhat Rawal ◽  
Uday Bajracharya
Keyword(s):  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Critical Event ◽  
Physical Status ◽  
Hemodynamic Stability ◽  
Elective Surgical Procedures ◽  
Inhalational Anesthetic ◽  
American Society ◽  
American Society Of Anesthesiologists

  Background: Induction of anesthesia is a critical event and hemodynamic stability is an important factor during this period. Propofol is a commonly used intravenous anesthetic and Sevoflurane is a newly introduced inhalational anesthetic in the context of a developing country. This study compared the hemodynamics on induction of anesthesia with Propofol and Sevoflurane.Methods: A total of 108 American Society of Anesthesiologists physical status I patients undergoing elective surgical procedures under general anesthesia were randomized into two groups. Group ‘P’ patients were induced with intravenous 1% Propofol and Group ‘S’ patients were induced with inhalation of 8% Sevoflurane. Mean arterial pressures and heart rates were recorded at baseline, before induction, during induction and at 1, 3 and 5 minutes after induction of anesthesia before endotracheal intubation.Results: The two groups were comparable with respect to demographics and baseline hemodynamic parameters. There was a significant decrease in mean arterial pressure and heart rate from pre-induction values within both groups during and after induction. The reduction in mean arterial pressure was significantly more in Propofol group transiently during induction. The reduction in heart rate was significantly more in Sevoflurane group at 1, 3 and 5 minutes after induction (P < 0.05).Conclusion: Induction of anesthesia with Propofol demonstrated a greater decrease in mean arterial pressure whereas induction with Sevoflurane was associated with greater reduction in heart rate.Journal of Society of Anesthesiologists of Nepal 2015; 2(1): 2-7

scholarly journals EFFECT OF ORAL MOXONIDINE IN THE ATTENUATION OF THE HAEMODYNAMIC RESPONSES SEEN DURING LAPAROSCOPIC SURGERIES

2017 ◽  
Vol 10 (3) ◽  
pp. 409
Author(s):  
Sidharth Sraban Routray ◽  
Ramakanta Mohanty
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Placebo Group ◽  
Stress Response ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Significant Rise ◽  
Hemodynamic Stability ◽  
Blinded Study ◽  
Double Blinded

ABSTRACTObjective: During laparoscopic surgeries, pneumoperitoneum can lead to various pathophysiologic changes in the cardiovascular system resulting inhypertension and tachycardia. Search for ideal drug to prevent this hemodynamic response goes on. The aim of our study was to evaluate the effect oforally administered moxonidine in attenuating the hemodynamic responses that occur during the laparoscopic surgeries.Methods: A total of 50 adult acetylsalicylic acid I and II patients scheduled for elective laparoscopic surgeries were selected for this prospectiverandomized double-blinded study. They were randomly allocated into two groups: moxonidine group (M) and placebo group (P). M group receivedoral moxonidine 0.3 mg at 8 pm on the day before surgery and at 8 am on the day of surgery. P group received a placebo at the same timing as that ofthe M group.Results: Following pneumoperitoneum rise in systolic blood pressure (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and heart rate (HR)was higher in P group in comparison to M group which was statistically significant.Conclusion: Significant rise in HR, SBP, DBP, and mean BP was noted in the P group in comparison to moxonidine group. Moxonidine provided betterperioperative hemodynamic stability in patients undergoing laparoscopic surgeries.Keywords: Moxonidine, Stress response, Laparoscopic.

scholarly journals A randomized comparative study of preloading with Ringers lactate and intravenous Ephedrine for the prevention of hypotension due to propofol during induction of general anesthesia

2016 ◽  
Vol 3 (1) ◽  
pp. 22-27 ◽  
Author(s):  
Manisha Pradhan ◽  
Brahma Dev Jha
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Systolic Blood Pressure ◽  
General Anesthesia ◽  
Diastolic Blood Pressure ◽  
Endotracheal Intubation ◽  
Physical Status ◽  
Volume Loading

Background: The ideal method to prevent hypotension due to intravenous propofol for induction of anesthesia is still debatable. The aim of the study was to compare the hemodynamic response of ephedrine and volume loading with ringer lactate in preventing the hypotension caused by propofol as inducing agent in patients scheduled for elective surgeries requiring general anesthesia with endotracheal intubation.Methods: This was prospective randomized study conducted in 40 patients of ASA physical status I, aged 20-50 years, scheduled for elective surgeries requiring general anesthesia with endotracheal intubation. Group I received intravenous ephedrine sulphate (70 mcg/kg) just before induction of anaesthesia, and patients assigned to Group II received preloading with Ringer's lactate (12 ml/kg) over the 10-15 minutes before the administration of propofol. The variables compared were heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure following induction of anesthesia till 10 minutes after intubation of trachea.Results: We found that there were increase in systolic blood pressure, diastolic blood pressure and mean arterial pressure after induction in both the groups but the difference between the groups was not significant. The increase in heart rate was found to be significantly higher in ephedrine group in comparison to volume loading group.Conclusion: Our study showed that both the methods used were equally effective in preventing hypotension induced by propofol in the adult ASA physical status I patients requiring general anesthesia with endotracheal intubation. However, the heart rate was significantly higher in patients receiving ephedrine in comparison to volume loading group.

A Non-inferiority Trial: Safety and Efficacy of Topical 1:1000 versus 1:10 000 Epinephrine in Sino-nasal Surgeries

2020 ◽  
pp. 000348942096282
Author(s):  
Cassie L. Dow ◽  
Anders W. Sideris ◽  
Ravjit Singh ◽  
Mitchell H. Giles ◽  
Catherine Banks ◽  
...  
Keyword(s):  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Nasal Passage ◽  
Hemodynamic Parameters ◽  
Hemodynamic Stability ◽  
Absolute Change ◽  
Significant Difference ◽  
Blood Pressures ◽  
Surgical Conditions

Objective: This study aimed to test the non-inferiority of topical 1:1000 epinephrine compared to topical 1:10 000 with regard to intraoperative hemodynamic stability, and to determine whether it produced superior visibility conditions. Methods: A single-blinded, prospective, cross-over non-inferiority trial was performed. Topical 1:1000 or topical 1:10 000 was placed in 1 nasal passage. Hemodynamic parameters (heart rate, systolic and diastolic blood pressures, and mean arterial pressure) were measured prior to insertion then every minute for 10 minutes. This was repeated in the contralateral nasal passage of the same patient with the alternate concentration. The surgeon graded the visualization of each passage using the Boezaart Scale. The medians of the greatest absolute change in parameters were compared using a Wilcoxon Rank-Signed test and confidence intervals were calculated using a Hodges-Lehman test. The non-inferiority margin was pre-determined at 10 bpm for heart rate and 10 mmHg for blood pressures. A Wilcoxon Rank-Signed test was used to assess superiority in visualization. Results: Thirty-two patients were enrolled and after exclusions, nineteen were assessed (mean age = 35.63 ± 12.49). Differences in means of greatest absolute change between the 2 concentrations were calculated (heart rate = 2.49 ± 1.20; systolic = −1.51 ± 2.16; diastolic = 2.47 ± 1.47; mean arterial pressure = 0.07 ± 1.83). In analyses of medians, 1:1000 was non-inferior to the 1:10 000. There was a significant difference (–0.58 ± 0.84; P = .012) in visualization in favor of topical 1:1000. Conclusion: Topical 1:1000 epinephrine provides no worse intraoperative hemodynamic stability compared to topical 1:10 000 but affords superior visualization and should be used to optimize surgical conditions.

Effects of lignocaine on pressor response to laryngoscopy and endotracheal intubation during general anaesthesia in rigid suspension laryngoscopy

2014 ◽  
Vol 129 (1) ◽  
pp. 79-85 ◽  
Author(s):  
I S Kocamanoglu ◽  
S Cengel Kurnaz ◽  
A Tur
Keyword(s):  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
General Anaesthesia ◽  
Endotracheal Intubation ◽  
Pressor Response ◽  
Physiological Saline ◽  
American Society ◽  
Rate Ratios ◽  
Suspension Laryngoscopy

AbstractObjective:This study aimed to compare the effects of topical and systemic lignocaine on the circulatory response to direct laryngoscopy performed under general anaesthesia.Methods:Ninety-nine patients over 20 years of age, with a physical status of I–II (classified according to the American Society of Anesthesiologists), were randomly allocated to 3 groups. One group received 5 ml of 0.9 per cent physiological saline intravenously, one group received 1.5 mg/kg lignocaine intravenously, and another group received seven puffs of 10 per cent lignocaine aerosol applied topically to the airway. Mean arterial pressures, heart rates and peripheral oxygen saturations were recorded, and changes in mean arterial pressure and heart rate ratios were calculated.Results:Changes in the ratios of mean arterial pressure and heart rate were greater in the saline physiological group than the other groups at 1 minute after intubation. Changes in the ratios of mean arterial pressure (at the same time point) were greater in the topical lignocaine group than in the intravenous lignocaine group, but this finding was not statistically significant.Conclusion:Lignocaine limited the haemodynamic responses to laryngoscopy and endotracheal intubation during general anaesthesia in rigid suspension laryngoscopy.

Comparative Hemodynamic Depression of Sevoflurane versus Halothane in Infants 

1997 ◽  
Vol 87 (4) ◽  
pp. 795-800 ◽  
Author(s):  
Eric Wodey ◽  
Patrick Pladys ◽  
Catherine Copin ◽  
Marie Madeleine Lucas ◽  
Andre Chaumont ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cardiac Index ◽  
Elective Surgery ◽  
Physical Status ◽  
Inhalation Induction ◽  
Cardiovascular Side Effects ◽  
American Society ◽  
End Tidal ◽  
American Society Of Anesthesiologists ◽  
To Receive

Background The cardiovascular side effects of volatile anesthetics are one of the chief causes of postoperative complications in children, and infants seem to be at the greatest risk for this. This study compared cardiovascular changes at equipotent concentrations of sevoflurane and halothane in infants. Methods Thirty infants classified as American Society of Anesthesiologists physical status I or II who required elective surgery were randomized to receive either halothane or sevoflurane for inhalation induction. Cardiovascular and echocardiographic data were recorded in both groups at baseline and at end-tidal concentrations of 1 and 1.5 minimum alveolar concentration (MAC). Results Sevoflurane did not alter heart rate or cardiac index at all concentrations compared with awake values. Sevoflurane significantly decreased blood pressure and systemic vascular resistance compared with awake values at all concentrations. Shortening fraction and rate-corrected velocity of circumferential fiber shortening decreased at 1.5 but not at 1 MAC. Myocardial contractility assessed by stress-velocity index and stress-shortening index decreased significantly at all concentrations, but did not fall into the abnormal range at any concentration. Halothane caused a greater decrease in heart rate, shortening fraction, stress-shortening index, velocity of circumferential fiber shortening, stress-velocity index, and cardiac index at all concentrations than did sevoflurane. Conclusion Sevoflurane causes a lesser decrease in cardiac output than does halothane in infants.

scholarly journals Dexmedetomidine vs Fentanyl in Attenuating the Sympathetic Surge During Endotracheal Intubation: A Scoping Review

2021 ◽  
Author(s):  
Alexandra Schwieger ◽  
Kaelee Shrewsbury ◽  
Paul Shaver
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Systolic Blood Pressure ◽  
General Anesthesia ◽  
Diastolic Blood Pressure ◽  
Endotracheal Intubation ◽  
Scoping Review ◽  
Hemodynamic Stability

Purpose/Background Direct laryngoscopy and endotracheal intubation after induction of anesthesia can cause a reflex sympathetic surge of catecholamines caused by airway stimulation. This may cause hypertension, tachycardia, and arrhythmias. This reflex can be detrimental in patients with poor cardiac reserve and can be poorly tolerated and lead to adverse events such as myocardial ischemia. Fentanyl, a potent opioid, with a rapid onset and short duration of action is given during induction to block the sympathetic response. With a rise in the opioid crisis and finding ways to change the practice in medicine to use less opioids, dexmedetomidine, an alpha 2 adrenergic agonist, can decrease the release of norepinephrine, has analgesic properties, and can lower the heart rate. Methods In this scoping review, studies published between 2009 and 2021 that compared fentanyl and dexmedetomidine during general anesthesia induction and endotracheal intubation of surgical patients over the age of 18 were included. Full text, peer-reviewed studies in English were included with no limit on country of study. The outcomes included post-operative reviews of decrease in pain medication usage and hemodynamic stability. Studies that were included focused on hemodynamic variables such as systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, and use of opioids post-surgery. Result Of 2,114 results from our search, 10 articles were selected based on multiple eligibility criteria of age greater than 18, patients undergoing endotracheal intubation after induction of general anesthesia, and required either a dose of dexmedetomidine or fentanyl to be given prior to intubation. Dexmedetomidine was shown to effectively attenuate the sympathetic surge during intubation over fentanyl. Dexmedetomidine showed a greater reduction in heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure than fentanyl, causing better hemodynamic stability in patients undergoing elective surgery.Implications for Nursing Practice Findings during this scoping review indicate that dexmedetomidine is a safe and effective alternative to fentanyl during induction of general anesthesia and endotracheal intubation in attenuating the hemodynamic response. It is also a safe choice for opioid-free anesthesia.

scholarly journals Effect of Different Loading Doses of Dexmedetomidine on Controlled Hypotension and the Incidence of Bradycardia During Rhinoplasty: A Clinical Trial

2021 ◽  
Vol 11 (4) ◽  
Author(s):  
Soudabeh Djalali Motlagh ◽  
Faranak Rokhtabnak ◽  
Mohammad Reza Ghodraty ◽  
Mojtaba Maleki Delarestaghi ◽  
Sara Saadat ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Heart Rate ◽  
Hypotensive Effect ◽  
Loading Dose ◽  
Controlled Hypotension ◽  
Physical Status ◽  
Surgical Field ◽  
American Society ◽  
Double Blinded ◽  
American Society Of Anesthesiologists

: Controlled hypotension, with a mean arterial pressure (MAP) of 60 mmHg - 70 mmHg, provides a bloodless and visible surgical field during rhinoplasty. It has been shown that dexmedetomidine, an α2-adrenoreceptor agonist, is a suitable choice in this regard. One of the disadvantages of this drug is the possibility of severe bradycardia during infusion. Therefore, we compared lower intravenous (IV) loading doses to determine whether the hypotensive effect of the drug was preserved and the bradycardia incidence decreased. In this randomized, double-blinded clinical trial, 81 patients aged 18 to 50 years with the American Society of Anesthesiologists physical status (ASA-PS) class I and II, scheduled for rhinoplasty randomly received 1.0, 0.9, and 0.8 µg/kg (named as groups 1.0, 0.9, and 0.8, respectively) of IV dexmedetomidine before the induction of anesthesia followed by infusion (0.3 - 0.7 µg/kg/h) during operation. The patients’ heart rate (HR), MAP, the requirements for nitroglycerin (NTG) and extra fentanyl, as well as the incidence of bradycardia, were recorded. Bleeding and visibility of the surgical field were scored by the surgeon using a 6-point visual scale. MAPs, HRs, and consumption of NTG and extra fentanyl were similar in the studied groups. The surgical field was more visible and bloodless in group 1.0 compared to group 0.8 (P < 0.001); the differences were not significant between groups 1.0 and 0.9 (P = 0.605). The incidence (P = 0.027) and the severity of bradycardia (P = 0.017) were higher in the groups with higher loading doses. We concluded that dexmedetomidine is an acceptable agent to provide controlled hypotension. A loading dose of 0.9 µg/kg, but not 0.8 µg/kg, provides similar surgical field conditions as the dose of 1 µg/kg. Furthermore, despite the decrease in the incidence of bradycardia, the hypotensive effect of the drug is preserved.

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

scholarly journals A Pharmacokinetic and Pharmacodynamic Study of Oral Dexmedetomidine

2020 ◽  
Vol 133 (6) ◽  
pp. 1223-1233 ◽  
Author(s):  
Shubham Chamadia ◽  
Juan C. Pedemonte ◽  
Lauren E. Hobbs ◽  
Hao Deng ◽  
Sarah Nguyen ◽  
...  
Keyword(s):  
Heart Rate ◽  
Plasma Concentration ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Plasma Concentrations ◽  
Oral Dosage ◽  
Primary Study ◽  
Hemodynamic Stability ◽  
Mixed Effect ◽  
First Order

Background Dexmedetomidine is only approved for use in humans as an intravenous medication. An oral formulation may broaden the use and benefits of dexmedetomidine to numerous care settings. The authors hypothesized that oral dexmedetomidine (300 mcg to 700 mcg) would result in plasma concentrations consistent with sedation while maintaining hemodynamic stability. Methods The authors performed a single-site, open-label, phase I dose-escalation study of a solid oral dosage formulation of dexmedetomidine in healthy volunteers (n = 5, 300 mcg; followed by n = 5, 500 mcg; followed by n = 5, 700 mcg). The primary study outcome was hemodynamic stability defined as lack of hypertension, hypotension, or bradycardia. The authors assessed this outcome by analyzing raw hemodynamic data. Plasma dexmedetomidine concentrations were determined by liquid chromatograph–tandem mass spectrometry. Nonlinear mixed effect models were used for pharmacokinetic and pharmacodynamic analyses. Results Oral dexmedetomidine was associated with plasma concentration–dependent decreases in heart rate and mean arterial pressure. All but one subject in the 500-mcg group met our criteria for hemodynamic stability. The plasma concentration profile was adequately described by a 2-compartment, weight allometric, first-order absorption, first-order elimination pharmacokinetic model. The standardized estimated parameters for an individual of 70 kg was V1 = 35.6 [95% CI, 23.8 to 52.8] l; V2 = 54.7 [34.2 to 81.7] l; CL = 0.56 [0.49 to 0.64] l/min; and F = 7.2 [4.7 to 14.4]%. Linear models with effect sites adequately described the decreases in mean arterial pressure and heart rate associated with oral dexmedetomidine administration. However, only the 700-mcg group reached plasma concentrations that have previously been associated with sedation (&gt;0.2 ng/ml). Conclusions Oral administration of dexmedetomidine in doses between 300 and 700 mcg was associated with decreases in heart rate and mean arterial pressure. Despite low oral absorption, the 700-mcg dose scheme reached clinically relevant concentrations for possible use as a sleep-enhancing medication. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Inhalational Anesthetic Technique in Microlaryngeal Surgery: A Comparison between Sevoflurane-Remifentanil and Sevoflurane-Alfentanil Anesthesia

2003 ◽  
Vol 112 (4) ◽  
pp. 373-378 ◽  
Author(s):  
Ageliki K. Pandazi ◽  
Antonios A. Louizos ◽  
John M. Stivaktakis ◽  
Dimitrios J. Davilis ◽  
Loucas G. Georgiou
Keyword(s):  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Side Effects ◽  
Arterial Pressure ◽  
Anesthetic Technique ◽  
Before And After ◽  
Inhalational Anesthetic ◽  
The Mean ◽  
Microlaryngeal Surgery ◽  
Cardiovascular Stability

We studied the effects of sevoflurane, remifentanil hydrochloride, and alfentanil anesthesia in terms of the hemodynamic responses and emergence characteristics of patients scheduled for elective microlaryngeal surgery. Sixty patients (ASA I to III) were randomly allocated into 2 groups: group S-R (sevoflurane-remifentanil) and group S-A (sevoflurane-alfentanil; 1:20 and 1:4 ratios of remifentanil to alfentanil for induction and maintenance of anesthesia, respectively; doses not strictly equipotent). The mean arterial pressure and heart rate were measured before and after induction of anesthesia, 1 and 3 minutes after endotracheal intubation, at the insertion of the operating laryngoscope, and every 3 minutes during surgery. The emergence times and side effects during the first 30 minutes after surgery were also recorded. The mean arterial pressure values at the insertion of the operating laryngoscope and throughout the procedure were significantly greater (p < .05) in group S-A than in group S-R. The emergence times and postoperative side effects did not differ, except for the greater pain score (p < .05) in group S-R. In conclusion, sevoflurane with remifentanil seems to maintain cardiovascular stability during microlaryngeal surgery more effectively than sevoflurane with alfentanil. Both anesthetic regimens seem to provide rapid and uneventful emergence.

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