scholarly journals INTUBATING CONDITIONS: PROPOFOL WITH MUSCLE RELAXSANT AND PROFOFOL WITHOUT MUSCLE RELAXANT A STUDY IN TERTIARY CARE CENTRE

2020 ◽  
Vol 4 (5) ◽  
Author(s):  
Anita Chikara
Keyword(s):  
Mean Arterial Pressure ◽  
Tracheal Intubation ◽  
Arterial Pressure ◽  
Neuromuscular Blocking ◽  
Induction Agent ◽  
Age Group ◽  
Neuromuscular Blocking Drugs ◽  
Intubating Conditions ◽  
Group I ◽  
Group Ii

Introduction:  Neuromuscular blocking drugs, particularly Succinylcholine, may cause serious side effects, but remain in clinical use to facilitate tracheal intubation due to a lack of suitable alternatives. Recent studies have suggested that propofol provides good intubating conditions without muscle relaxants, due to its relaxing action on upper air way.. A search for better and ideal intravenous induction agent has led to propofol, a 2, 6, di-isopropyl phenol which was developed following a series of investigations. Propofol reduces hypertension and tachycardia during intubation. The changes in blood pressure observed are due to both decrease in cardiac output and decrease in systemic vascular resistance. Increasing the depth of anaesthesia by administering supplementary increments of induction agent, opioids or lignocaine may improve conditions. These techniques also protect against the potentially adverse effects of tracheal intubation namely systemic, intra-cranial and intra-ocular hypertensions and tachycardia. Material and Methods: The study comprised of 100 adult patients of ASA grade I & II of either sex belonging to the age group of 18-60 years, drawn from various surgical specialties and undergoing surgery under general anaesthesia. Thorough pre anesthetic checkup was carried out in all patients and informed consent for surgery and general anesthesia was obtained. Routine investigations were carried out in all patients. 100 patients were randomly divided into two groups of 50 patients each. Results: Youngest patient was of 18 years in group I and 20years in group II. Eldest patient was of 59 years in group I and 60 years in group II. Maximum number of patients were in 20-30 years of age group. The pre induction mean pulse rate (base line) was 101.04±11.78 and 102.36±15.14 in group I and group II respectively. There was slight decrease in pulse rate initially after induction with mean 98.23±13.87 and 97.31±12.60 in group I and group II respectively. The pre induction mean arterial pressure (MAP) (baseline) was 91.47±7.64 and 92.45±9.21in group I and group II respectively. There was slight decrease in arterial pressure initially after induction with mean 80.48±6.29and 83.31±8.41in group I and group II respectively, but the difference was not statistically significant (P>0.05) from the baseline values. There was slight increase in mean arterial pressure just after intubation with mean 93.10±8.47 and 94.58±9.33 in group I and group II respectively, which was not statistically significant (p>0.05). Conclusion: In healthy adults, with normal airway, propofol 2.5mg/kg when used alone as inducing agent without the use of any neuromuscular blocking agents produced acceptable intubating conditions, when compared to propofol, 2.5mg/kg along with succinylcholine. It was also demonstrated that there was no significant cardiovascular changes when intubation was done without relaxant after induction with propofol. Keywords: Neuromuscular blocking drugs, cardiovascular, propofol  

scholarly journals COMPARISON OF INTUBATING CONDITIONS, FOLLOWING PROPOFOL WITH MUSCLE RELAXSANT AND PROFOFOL WITHOUT MUSCLE RELAXANT

2019 ◽  
Vol 3 (10) ◽  
Author(s):  
Dr. Sanjeev Kumar Agrawal ◽  
Dr. Kaushal Kumar Sahu
Keyword(s):  
Body Weight ◽  
Tracheal Intubation ◽  
Neuromuscular Blocking ◽  
Muscle Relaxants ◽  
Induction Agent ◽  
Intubating Conditions ◽  
Group I ◽  
Baseline Values ◽  
Group Ii ◽  
The Difference

Introduction:  After induction of anaesthesia, tracheal intubation is usually facilitated by the use of muscle relaxants. Neuromuscular blocking drugs, particularly Succinylcholine, may cause serious side effects, but remain in clinical use to facilitate tracheal intubation due to a lack of suitable alternatives. Recent studies have suggested that propofol provides good intubating conditions without muscle relaxants, due to its relaxing action on upper air way. A search for better and ideal intravenous induction agent has led to propofol, a 2, 6, di-isopropyl phenol which was developed following a series of investigations. Propofol reduces hypertension and tachycardia during intubation. The changes in blood pressure observed are due to both decrease in cardiac output and decrease in systemic vascular resistance. Increasing the depth of anaesthesia by administering supplementary increments of induction agent, opioids or lignocaine may improve conditions. These techniques also protect against the potentially adverse effects of tracheal intubation namely systemic, intra-cranial and intra-ocular hypertensions and tachycardia. Material and Methods: 50 patients were randomly divided into two groups of 25 patients each. Group I: 2.5 mg/kg body weight of propofol injected slowly over 20 seconds. Group II: 2.5 mg/kg body weight of propofol injected slowly over 20 seconds. After loss of eye lash reflex, induction time was noted with stop watch and then injection succinylcholine 2mg/kg body weight was injected. Patients were monitored throughout the operation E.C.G. using cardiac monitor on lead II, PaO2 with Pulse Oxymeter. Pulse and blood pressure were recorded. Results: Youngest patient was of 20 years in group I and 22 years in group II. Eldest patient was of 56 years in group I and 60 years in group II. Maximum number of patients were in 20-30 years of age 15 (60%) in group I and 11 (44%) in group II. Excellent intubating conditions were seen in 15 (60%) patients of group I and 25 (100%) patients of group II. The pre induction mean pulse rate (base line) was 103.04±13.08 and 104.56±17.14 in group I and group II respectively. There was slight decrease in pulse rate initially after induction with mean 99.92±13.87 and 98.32±14.60 in group I and group II respectively, but the difference was not statistically significant from the baseline values. (p>0.05). There was slight decrease in arterial pressure initially after induction with mean 80.88 ±6.59 and 85.31±8.71 in group I and group II respectively, but the difference was not statistically significant (P>0.05) from the baseline values. There was slight increase in mean arterial pressure just after intubation with mean 94.10 ±8.07 and 95.58±9.46 in group I and group II respectively, which was not statistically significant (p>0.05). These changes in M.A.P. values return to baseline values 5 minutes after intubation. Conclusion: Propofol 2.5mg/kg when used alone as inducing agent without the aid of any neuromuscular blocking agents produced acceptable intubating conditions, when compared to propofol, 2.5mg/kg along with succinylcholine. It was shown that there were no significant cardiovascular changes when intubation was done without relaxant after induction with propofol.

Renal Denervation Prevents Sodium Retention and Hypertension in Salt-Sensitive Rabbits with Genetic Baroreflex Impairment

1996 ◽  
Vol 90 (4) ◽  
pp. 287-293 ◽  
Author(s):  
Marta Weinstock ◽  
Elena Gorodetsky ◽  
Ronald Kalman
Keyword(s):  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Plasma Renin Activity ◽  
Renal Denervation ◽  
Plasma Renin ◽  
High Salt ◽  
Renin Activity ◽  
Group I ◽  
Group Ii

1. Rabbits with a genetic impairment in baroreflex control of heart rate become hypertensive on a high salt diet. The present study determined the effect of bilateral renal denervation on blood pressure and sodium balance after salt loading (four times normal intake; 28–36 mEq NaCl/day) in normotensive rabbits with high (Group I) and low (Group II) baroreflex sensitivity, respectively. 2. Eight rabbits in each group were denervated or sham-denervated 1 week before commencement of the high salt diet. Before operation, the two groups differed only in the gain of their cardiac baroreflex (Group I, −6.4 ± 0.4 beats min−1 mmHg−1; Group II, −3.2 ± 0.15 beats min−1 mmHg−1). 3. In Group I sham-denervated rabbits, mean arterial pressure remained unchanged, and plasma renin activity and heart rate fell significantly in response to the high salt. In Group II sham-denervated rabbits, mean arterial pressure increased by 10.6 ± 1.2 mmHg, and heart rate and plasma renin activity remained unchanged. Their cumulative Na+ retention and weight gain was more than twice that of Group I sham-denervated rabbits. 4. Renal denervation decreased plasma renin activity in both groups to <1 pmol Ang I h−1 ml−1, lowered cumulative Na+ retention from 102 ± 4 to 35 ± 5 mEq (P<0.01) and completely prevented the increase in mean arterial pressure in response to high salt in Group II. 5. The results suggest that Group II rabbits retain salt and fluid in response to their diet because of an abnormality in their control of renal nerve activity, possibly via vagal afferents. This results in blood pressure elevation because of an inability to lower peripheral resistance and heart rate in response to the increase in cardiac output. 6. Since they display several of the characteristics of salt-sensitive hypertensive humans, i.e. salt retention, normal plasma renin activity, but abnormal regulation of plasma renin activity and blood flow in response to salt loading, Group II are an appropriate model of human salt-induced hypertension.

scholarly journals Effect of ephedrine on rapid intubation and haemodynamics using propofol and rocuronium: A randomized controlled trial

2014 ◽  
Vol 22 (1) ◽  
pp. 16-20
Author(s):  
SM Abdul Alim ◽  
Md Mozaffer Hossain ◽  
UH Shahera Khatun
Keyword(s):  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Tracheal Intubation ◽  
Arterial Pressure ◽  
Controlled Trial ◽  
Tissue Perfusion ◽  
P Value ◽  
Baseline Heart Rate ◽  
Base Line ◽  
Intubating Conditions

Ephedrine is a suitable drug to increase the cardiac output and tissue perfusion, in adequate dose, resulting in faster delivery of drug to muscles. This study was designed to compare the effect of pretreatment with ephedrine 75,100, 150 ?g/kg and saline on intubating conditions and haemodynamics during rapid tracheal intubation using propofol and rocuronium. The aim of this study was to evaluate the effects of different doses of ephedrine, given before induction, on intubating conditions and haemodynamics during rapid tracheal intubation. One hundred and twenty adult patients randomized into one of the four groups- I, II, III and IV were received iv ephedrine 75, 100, 150?g/kg and saline 0.9% (5ml) respectively, one minutes before administering propofol 2.5 mg/kg and rocuronium 0.6 mg/kg. Patients’ mean arterial pressure, heart rate, were recorded before induction (base line), just before intubation, and 1, 3, and 5 minutes after tracheal intubation. Data were analysed between the groups and within the groups using ANOVA test and X2-test. A p-value of <0.05 were considered as significant. Patients characteristics, baseline heart rate, and mean arterial pressure were comparable between the groups. Iutubating conditions were significantly better in group II (p=0.002). Pulse rate at different times were statistically significant (p<0.001) except base line and just before intubation. The mean difference of average mean blood pressure at different times were statistically significant (p<0.05) except baseline. In conclusion, pre-treatment with ephedrine 100 ?gm/kg improved the intubating conditions during rapid tracheal intubation using propofol and rocuronium. DOI: http://dx.doi.org/10.3329/jbsa.v22i1.18096 Journal of BSA, 2009; 22(1): 16-20

scholarly journals Comparison of Safety and Efficacy of Intubating Conditions between Rocuronium and Suxamethonium

2020 ◽  
Vol 7 (44) ◽  
pp. 2562-2566
Author(s):  
Vudayagiri Ravi Sankar ◽  
Atturi Jeevan Babu ◽  
Mallam Suchitra
Keyword(s):  
Tracheal Intubation ◽  
Duration Of Action ◽  
Safety And Efficacy ◽  
Intubating Conditions ◽  
Group I ◽  
Group Ii

BACKGROUND We wanted to compare the safety and efficacy of rocuronium and suxamethonium with regard to tracheal intubation. METHODS 100 patients were divided at random into two categories of 50 subjects each. The first group was the suxamethonium (10 mg / Kg) group, and the second group was the rocuronium group (0 6 mg / Kg). Intubating conditions, time of intubation, duration of action, and complications if any, were assessed. RESULTS Clinically appropriate (excellent, good) intubating conditions were found in 100 % of patients in both categories. But, the time taken to intubate in group II (rocuronium) was significantly longer with a mean of 92.86 seconds than for group I (suxamethonium) with a mean of 63.04 seconds. The duration of action was longer for rocuronium with a mean of 24.30 minutes compared to suxamethonium with a mean of 72.60 minutes. No significant complications were observed in either group at the time intubation. CONCLUSIONS Rocuronium also creates clinically appropriate intubating conditions in 100 % of patients and rocuronium can be used as an alternative to suxamethonium where suxamethonium is contraindicated or is problematic. KEYWORDS Suxamethonium Rocuronium, Intubation

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 DEXMEDETOMIDINE VERSUS ORAL PREGABALIN TO ATTENUATE HEMODYNAMIC RESPONSE TO LARYNGOSCOPY AND OROTRACHEAL INTUBATION: A COMPARATIVE STUDY

2017 ◽  
Vol 10 (5) ◽  
pp. 258
Author(s):  
Soumya Samal
Keyword(s):  
Mean Arterial Pressure ◽  
Tracheal Intubation ◽  
Arterial Pressure ◽  
Direct Laryngoscopy ◽  
Pressor Response ◽  
Hemodynamic Response ◽  
Orotracheal Intubation ◽  
Age Group ◽  
Physical Status ◽  
Group D

INTRODUCTION: The airway instrumentation of direct laryngoscopy and tracheal intubation are powerful noxious stimuli that should be attenuated by appropriate premedication, smooth induction and rapid intubation. The present study compared the  efficacy intravenous dexmedetomidine and oral pregabalin premedication for attenuation of haemodynamic pressor response to laryngoscopy and intubation.METHODS: A total of 60 patients of age group 20-50 years scheduled for elective surgeries under general anaesthesia with ASA physical status I and II were divided into two groups each of 30. Group D received intravenous dexmedetomidine 1mcg/kg over 10 minutes  before induction and group P received  oral pregabalin 150 mg one hour prior to intubation. Parameters observed were heartrate and mean arterial pressure at baseline, after induction, immediately after intubation and then 5, 10, 15 and 30 minutes thereafter.RESULTS: Attenuation of heartrate in group dexmedetomidine (78.12 ± 10.0 / min)  immediately after intubation was statistically significant than group pregabalin (89.76 ± 10.45 / min). Mean arterial pressure significantly (p < 0.05) decreased after intubation with dexmedetomidine. As compared to oral pregabalin, attenuation of  heartrate and mean arterial pressure was statistically significant till 30 minutes after intubation with intravenous dexmedetomidine. CONCLUSION: Intravenous dexmedetomidine 1µg/kg is more effective than oral pregabalin 150 mg in attenuating hemodynamic response to laryngoscopy and orotracheal intubation.KEYWORDS: Hemodynamic pressor response, Laryngoscopy, Intubation, Intravenous dexmedetomidine, Oral pregabalin.

scholarly journals Preclinical Pharmacology in the Rhesus Monkey of CW 1759-50, a New Ultra-short Acting Nondepolarizing Neuromuscular Blocking Agent, Degraded and Antagonized by L-Cysteine

2018 ◽  
Vol 129 (5) ◽  
pp. 970-988 ◽  
Author(s):  
John J. Savarese ◽  
Hiroshi Sunaga ◽  
Jeff D. McGilvra ◽  
Matthew R. Belmont ◽  
Matthew T. Murrell ◽  
...  
Keyword(s):  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Neuromuscular Blockade ◽  
Blocking Agent ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agent ◽  
Duration Of Action ◽  
Short Acting ◽  
Circulatory Effects

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Structure–activity studies were performed to identify a new neuromuscular blocking agent retaining the ultra-short acting characteristics of gantacurium, including degradation and reversal by l-cysteine, but lacking its histaminoid properties in man. CW 1759-50 has emerged from this program. Methods Adduction of CW 1759-50 with l-cysteine was studied by high-performance liquid chromatography and mass spectrometry. Institutional Animal Care and Use Committee–approved comparisons of CW 1759-50 to gantacurium were performed in rhesus monkeys. ED95 for neuromuscular blockade was established. Spontaneous recovery was compared to reversal by l-cysteine in paired studies of boluses or infusions. In addition, changes in mean arterial pressure and heart rate after very large doses of 15 to 60 × ED95 were compared. Results The half-time of adduction of l-cysteine to CW 1759-50 in vitro was 2.3 min. The ED95 of CW 1759-50 was 0.069 ± 0.02 mg/kg; ED95 of gantacurium was 0.081 ± 0.05 mg/kg (P = 0.006). Duration of action (recovery to 95% twitch height after 98 to 99% blockade) was as follows: CW 1759-50, 8.2 ± 1.5 min; and gantacurium, 7.4 ± 1.9 min; (n = 8 and 9, P = 0.355). Administration of l-cysteine (30 mg/kg) shortened recovery (i.e., induced reversal) from CW 1759-50 after boluses or infusions (P always less than 0.0001). Recovery intervals (5 to 95% twitch) ranged from 6.1 to 6.7 min (and did not differ significantly) after boluses of 0.10 to 0.50 mg/kg, as well as control infusions (P = 0.426 by analysis of variance). Dose ratios comparing changes of 30% in mean arterial pressure or heart rate to ED95 for neuromuscular blockade (ED 30% Δ [mean arterial pressure or heart rate]/ED95) were higher for CW 1759-50 than for gantacurium. Conclusions CW 1759-50, similar to gantacurium, is an ultra-short acting neuromuscular blocking agent, antagonized by l-cysteine, in the monkey. The circulatory effects, however, are much reduced in comparison with gantacurium, suggesting a trial in humans.

Preclinical Pharmacology of CW002

2016 ◽  
Vol 125 (4) ◽  
pp. 732-743 ◽  
Author(s):  
Hiroshi Sunaga ◽  
John J. Savarese ◽  
Jeff D. McGilvra ◽  
Paul M. Heerdt ◽  
Matthew R. Belmont ◽  
...  
Keyword(s):  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Blocking Agent ◽  
Neuromuscular Blocking ◽  
Safety And Efficacy ◽  
Circulatory Effects ◽  
Autonomic Changes ◽  
Train Of Four

Abstract Background CW002, a novel nondepolarizing neuromuscular blocking agent of intermediate duration, is degraded in vitro by l-cysteine; CW002-induced neuromuscular blockade (NMB) is antagonized in vivo by exogenous l-cysteine.1 Further, Institutional Animal Care and Use Committee–approved studies of safety and efficacy in eight anesthetized monkeys and six cats are described. Methods Mean arterial pressure, heart rate, twitch, and train-of-four were recorded; estimated dose producing 95% twitch inhibition (ED95) for NMB and twitch recovery intervals from 5 to 95% of baseline were derived. Antagonism of 99 to 100% block in monkeys by l-cysteine (50 mg/kg) was tested after bolus doses of approximately 3.75 to 20 × ED95 and after infusions. Vagal and sympathetic autonomic responses were recorded in cats. Dose ratios for [circulatory (ED20) or autonomic (ED50) changes/ED95 (NMB)] were calculated. Results ED95s of CW002 in monkeys and cats were 0.040 and 0.035 mg/kg; l-cysteine readily antagonized block in monkeys: 5 to 95% twitch recovery intervals were shortened to 1.8 to 3.6 min after 3.75 to 10 × ED95 or infusions versus 11.5 to 13.5 min during spontaneous recovery. ED for 20% decrease of mean arterial pressure (n = 27) was 1.06 mg/kg in monkeys; ED for 20% increase of HR (n = 27) was 2.16 mg/kg. ED50s for vagal and sympathetic inhibition in cats were 0.59 and &gt;&gt;0.80 mg/kg (n = 14 and 15). Dose ratios for [circulatory or autonomic changes/ED95 (NMB)] were all more than 15 × ED95. Conclusions The data further verify the neuromuscular blocking properties of CW002, including rapid reversal by l-cysteine of 100% NMB under several circumstances. A notable lack of autonomic or circulatory effects provided added proof of safety and efficacy.

scholarly journals Correlation between Calcium Phosphorus Product and Mean Arterial Pressure among Hemodialysis Patients with End Stage Renal Disease

2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Muhammad Nadeem ◽  
Mansoor Abbas Qaisar ◽  
Ali Hassan Al Hakami ◽  
Fateh Sher Chattah ◽  
Muhammad Muzammil ◽  
...  
Keyword(s):  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Hemodialysis Patients ◽  
Age Group ◽  
Calcium Phosphorus ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage

Background: The mean arterial pressure serves as an expression of blood pressure in patients on chronic hemodialysis. Serum calcium phosphorus product is considered as a risk factor of vascular calcification that is associated with hypertension in the patients of end stage renal disease. The literature regarding this relationship is inconsistent therefore this study is designed to determine the correlation between calcium phosphorus product and mean arterial pressure among hemodialysis patients with end stage renal disease. Methods: A total of 110 patients of end stage renal disease on hemodialysis for at least one year, 20 to 60 years of age were included. Patients with primary or tertiary hyperparathyroidism, peripheral vascular disease, malignancy, hypertension secondary to any cause other than kidney disease were excluded. Mean arterial pressure was calculated according to the standard protocol in lying position. Blood samples for estimation of serum calcium and phosphorous were taken and was sent immediately to the laboratory for serum analysis. Results: Mean age was 44.17 ± 10.94 years. Mean calcium phosphorous product was 46.71 ± 7.36 mg/dl and mean arterial pressure was 103.61 ± 12.77 mmHg. The values of Pearson correlation co-efficient (r) were 0.863 for age group 20 to 40 years and 0.589 for age group 41 to 60 years. This strong positive correlation means that high calcium phosphorous product goes with high mean arterial pressure (and vice versa) for both the age groups. Conclusion: A strong positive relationship exists between the mean arterial pressure and calcium phosphorous product and is independent of patients’ age.

Sign in / Sign up

Export Citation Format

Share Document