scholarly journals Endotracheal Tube and Proseal Laryngeal Mask Airway in Elderly Hypertensive Diabetic Patients Undergoing Routine Laparoscopic Surgical Procedures: A Comparison of Hemodynamic Parameters

2018 ◽  
Vol 36 (4) ◽  
pp. 153-158
Author(s):  
Md Mushfiqur Rahman ◽  
Md Mhbubul Hasan Munir ◽  
Kawsar Sardar ◽  
Abdus Salam Khan ◽  
AKM Nurnobi Chowdhury ◽  
...  
Keyword(s):  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Laryngeal Mask Airway ◽  
Arterial Pressure ◽  
Pressor Response ◽  
Cardiovascular Responses ◽  
Proseal Laryngeal Mask Airway ◽  
Laryngeal Mask ◽  
Diabetic Patients ◽  
Elderly Hypertensive

Background: The effects of ProSeal laryngeal mask airway (PLMA) removal and tracheal extubationon cardiovascular responses were studied in elderly hypertensive diabetic patients in a randomize double-blind study.Methods: A total of 60 elderly controlled diabetic hypertensive American Society of Anesthesiologists II & III patients were randomly allocated to two groups (n-30 of each) for PLMA insertion or endotracheal intubation. A standardized anesthetic sequence was used for induction and maintenance of anesthesia. The two groups were then compared for haemodynamic changes at the time of extubation/PLMA removal.Results: In PLMA group, heart rate increased during PLMA removal but remained elevated for only 3 minutes while mean arterial pressure remained elevated for only 2 minutes.The elevations of heart rate and mean arterial pressure were exaggerated in the extubation group and persisted for more than 5 minutes. No complication was observed in any patient and no difficulty was encountered in insertion of PLMA in any patient.Conclusion: Elderly hypertensive diabetic patients are at risk of exaggerated pressor response at the time of extubation. PLMA removal is associated with fewer hemodynamic changes than tracheal extubation and should be preferred wherever possible.J Bangladesh Coll Phys Surg 2018; 36(4): 153-158

Effects of Mexiletine on the Haemodynamic Responses to Tracheal Intubation

1992 ◽  
Vol 20 (2) ◽  
pp. 121-126
Author(s):  
K Mikawa ◽  
N Maekawa ◽  
R Goto ◽  
H Yaku ◽  
N Saitoh ◽  
...  
Keyword(s):  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Tracheal Intubation ◽  
Arterial Pressure ◽  
Elective Surgery ◽  
Pressor Response ◽  
Cardiovascular Responses ◽  
Saline Group ◽  
Treatment Groups ◽  
Induction Of Anaesthesia

The efficacy of intravenous mexiletine in attenuating the cardiovascular responses to laryngoscopy and tracheal intubation was studied in 30 normotensive patients undergoing elective surgery. The patients were randomly allocated to one of three treatment groups: saline ( n = 10); 2 mg/kg mexiletine ( n = 10); and 3 mg/kg mexiletine ( n = 10). The placebo/mexiletine was administered immediately before induction of anaesthesia using 5 mg/kg thiopentone and tracheal intubation was facilitated with 0.2 mg/kg vecuronium; laryngoscopy lasting 30 s was attempted 2 min after induction of anaesthesia. All groups showed a significant ( P < 0.05) increase in mean arterial pressure and heart rate associated with tracheal intubation. The increase in mean arterial pressure was significantly ( P < 0.05) smaller in patients receiving 3 mg/kg mexiletine compared with those receiving either saline or 2 mg/kg mexiletine. There was no significant attenuation in heart rate in either of the mexiletine treatment groups compared with the saline group. It is concluded that 3 mg/kg mexiletine given intravenously provides a simple and effective method for attenuating the pressor response to laryngoscopy and tracheal intubation.

AN OBSERVATIONAL STUDY TO EVALUATE THE HAEMODYNAMIC CHANGES BETWEEN ENDOTRACHEAL INTUBATION AND LARYNGEAL MASK AIRWAY INSERTION

2021 ◽  
pp. 56-58
Author(s):  
Rahul Kumar ◽  
Anant Prakash ◽  
Chandeshwar Choudhary ◽  
Debarshi Jana
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Laryngeal Mask Airway ◽  
Observational Study ◽  
Arterial Pressure ◽  
Airway Management ◽  
Endotracheal Intubation ◽  
Laryngeal Mask ◽  
Laryngeal Mask Airway Insertion

Introduction: Airway management is a crucial skill for the clinical anaesthesiologist. It is an integral part of general anesthesia, allowing ventilation and oxygenation as well as a mode for anesthetic gas delivery. The laryngeal mask airways (LMA) have become popular in airway management as a missing link between facemask and tracheal tube in terms of both anatomical position and degree of invasiveness. Haemodynamic stability is an important aspect to the anaesthesiologist for the benet of the patients especially during intubations, laryngeal mask insertion. Laryngoscopy and endotracheal intubation can cause striking changes in Haemodynamics as result of intense stimulation of sympathetic nervous system. The aim of this study was to evaluate the hemodynamic changes between endotracheal intubation and laryngeal mask airway insertion. Material And Methods: This was a prospective observational study on 46 patients of ASA I-II status divided into 2 groups of 23 each. In the ETT (Endotracheal tube) group endotracheal intubation was done using Macintosh laryngoscope by using portex cuffed endotracheal while in LMA (Laryngeal mask airway) group laryngeal mask airway was inserted according to the standard recommendation. Heart rate, Systolic, Diastolic and Mean arterial pressure and dysrhythmias were monitored. Results: The two groups were comparable in terms of demographic data as there were no signicant differences between the 2 groups in terms of age, sex, duration of surgery, ASA grades and MPC classication. Heart rate (HR), Systolic blood pressure (SBP), Diastolic blood pressure(DBP), Mean arterial pressure (MAP) remains on higher side in ETT group than LMA group which was statistically signicant. P<0.05. Dysrhythmias were noted in 2 patients of ETT group while LMA group did not notice any dysrhythmias. Conclusion: This study demonstrated that there is a haemodynamic response consisting of an increase in Heart rate, SBP, DBP and MAP that comes with ETT insertion as well as with LMA insertion. However, the response caused by ETT insertion is signicantly greater than that caused by LMA insertion.

scholarly journals Hemodynamic Responses during Insertion of Laryngeal Mask Airway versus Conventional Intubation

2021 ◽  
Vol 15 (5) ◽  
pp. 984-987
Author(s):  
Vijai Kumar ◽  
Muhammad Faisal Farooq ◽  
Shakil Malik ◽  
Zamir Ahmed ◽  
Muhammad Nadeem Muneer
Keyword(s):  
Mean Arterial Pressure ◽  
Laryngeal Mask Airway ◽  
Arterial Pressure ◽  
Endotracheal Tube ◽  
Cardiovascular Responses ◽  
Laryngeal Mask ◽  
Hemodynamic Responses ◽  
Haemodynamic Parameters ◽  
Intubating Laryngeal Mask Airway ◽  
Group B

Aim: To determine the hemodynamic response during insertion of laryngeal mask airway versus conventional intubation. Study design: Randomized controlled trial. Place and duration of study: Department of Anaesthesia, Jinnah Postgraduate Medical Centre, Karachi from 9th June 2016 to 10th December 2016. Methodology: One hundred and fifty-eight patients were enrolled, and they were divided in two groups; Group A (laryngeal mask airway) and patients falling in group B (conventional method). Baseline haemodynamic parameters were noted, and all patients were induced with propofol 2mg.kg 1. In group B, succinylcholine 1.5mg.kg-1 was used to facilitate intubation. After induction appropriate size endotracheal tube or laryngeal mask airway were inserted for airway control. For first five minutes after intervention, analgesics and any other stimulation were avoided, in order to prevent any haemodynamic alteration. All airway interventions were done by anaesthesiologist who had more than 5 years post fellowship experience. Mean arterial pressures were recorded. Initial haemodynamic parameters were measured when the patient enter the operating room and then second reading taken just after induction of anaesthesia, third reading recorded one minute and fourth reading 5 minutes after the intervention (i.e., after passing either endotracheal tube or laryngeal mask airway). Results: The average mean arterial pressure during process of intubation of patients in Group laryngeal mask airway group was 105.21±5.90 while in conventional group the average mean arterial pressure was 102.21±4.29 with P-value=0.001. Conclusion: Intubation through intubating laryngeal mask airway is accompanied by minimal cardiovascular responses than those associated with direct laryngoscopic tracheal intubation, so it can be used for patients in whom a marked pressor response would be deleterious. Keywords: Intubating laryngeal mask airway, Conventional laryngoscopy, Hemodynamic responses, Airway morbidity,

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

Naturally occurring hypertension in New World nonhuman primates: potential role of the perifornical hypothalamus

2007 ◽  
Vol 292 (2) ◽  
pp. R937-R945 ◽  
Author(s):  
Orville A. Smith ◽  
Cliff A. Astley
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
New World ◽  
Critical Role ◽  
Cardiovascular Responses ◽  
Routine Laboratory ◽  
New World Primates ◽  
Naturally Occurring

Hypertension is a prominent underlying factor in the genesis of cardiovascular-related morbidity and mortality. A major impediment to the investigation into the causes of the disease is the paucity of naturally occurring animal models of the disease. There is evidence that some species of New World primates spontaneously become hypertensive. We used chronically implanted pressure transducers to assess normally occurring blood pressure and heart rate levels at rest and during routine laboratory procedures in a group of one of these New World primates ( Aotus sp.). Resting mean arterial pressure ranged from 72 to 130 mmHg. Three animals were judged to have resting mean arterial pressure levels in the hypertensive range (≥110 mmHg). In all of the animals, pressor responses to routine laboratory events were exaggerated (average highest mean pressure during 1 min from any session was 97–196 mmHg). Subsequently, the region of the perifornical/lateral hypothalamus known to produce elevated blood pressure and heart rate responses to electrical stimulation was removed, and the blood pressure responses to the laboratory routines were significantly decreased and, in some cases, eliminated. Control lesions in nearby tissue had no effect on these responses. This region may play a critical role in initiating or exacerbating cardiovascular responses that contribute to the development of essential hypertension.

Neuronal and cardiovascular responses to ANF microinjected into the solitary nucleus

1989 ◽  
Vol 256 (2) ◽  
pp. R577-R582 ◽  
Author(s):  
R. Ermirio ◽  
P. Ruggeri ◽  
C. E. Cogo ◽  
C. Molinari ◽  
F. R. Calaresu
Keyword(s):  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Unit Activity ◽  
Atrial Natriuretic Factor ◽  
Single Unit ◽  
Cardiovascular Responses ◽  
Firing Frequency ◽  
Neuronal Firing ◽  
Single Unit Activity

The effect on single-unit activity, arterial pressure, and heart rate of a microinjection of atrial natriuretic factor (ANF) into 78 histologically verified sites in the nucleus tractus solitarii (NTS) was investigated in rats. Injections of 50 nl of 10(-7) M ANF excited 34 neurons (44%), mainly localized at the level of the obex, inhibited 15 (19%), and had no effect on the remaining 29 (37%). The increase in firing frequency of the 34 excited neurons was always followed by a decline in mean arterial pressure [MAP, -10.6 +/- 1.8 (SE) mmHg; P less than 0.01] and heart rate [HR, -9.6 +/- 3.1 (SE) beats/min; P less than 0.05]. When injections of ANF caused either no effect or inhibition of single-unit activity, no changes in either MAP or HR were observed. Single units excited by injections of ANF were also excited by activation of arterial baroreceptors and inhibited by baroreceptor unloading. Control injections of an inactive peptide analogue of ANF or of vehicle never produced any effects on neuronal firing frequency or on MAP and HR. Similar results were obtained from animals paralyzed and artificially ventilated. These results support the hypothesis that ANF plays a role in the chemical transmission of baroreceptor information within the NTS.

Maternal responses to long-term hypoxemia in sheep

1989 ◽  
Vol 256 (6) ◽  
pp. R1340-R1347 ◽  
Author(s):  
T. Kitanaka ◽  
R. D. Gilbert ◽  
L. D. Longo
Keyword(s):  
Heart Rate ◽  
Blood Flow ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Blood Volume ◽  
Cardiovascular Responses ◽  
Uterine Blood Flow ◽  
O2 Uptake ◽  
Arterial Po2

To determine the maternal cardiovascular responses to long-term hypoxemia, we studied three groups of animals: 1) pregnant ewes (n = 20) at 110-115 days gestation subjected to hypoxia for up to 28 days; 2) pregnant ewes (n = 4) that served as normoxic controls; and 3) nonpregnant ewes (n = 6) subjected to hypoxemia for up to 28 days. We measured mean arterial pressure, heart rate, uterine blood flow, and uterine vascular resistance continuously for 1 h/day while the ewe was exposed to an inspired O2 fraction of 12-13% for at least 17 days. Arterial PO2, O2 saturation, hemoglobin, arteriovenous O2 difference, and uterine O2 uptake were measured daily while blood volume and erythropoietin concentration were measured weekly. In the pregnant hypoxic group arterial PO2 decreased from a control value of 101.5 +/- 5.1 to 59.2 +/- 5.1 Torr within a few minutes, where it remained throughout the study. The hemoglobin concentration increased from 8.9 +/- 0.5 to 10.0 +/- 0.5 g/dl within 24 h where it remained, whereas erythropoietin concentration increased from 16.6 +/- 2.1 to 39.1 +/- 7.8 mU/ml at 24 h but then returned to near-control levels. Arterial glucose concentration, mean arterial pressure, and cardiac output decreased slightly but insignificantly. In contrast, body weight, heart rate, blood volume, uterine blood flow, uterine O2 flow, uteroplacental O2 uptake, and the concentrations of catecholamines and cortisol remained relatively constant. Thus both pregnant and nonpregnant sheep experience relatively minor cardiovascular and hematologic responses in response to long-term hypoxemia of moderate severity.

Effect of indomethacin on the pressor responses to sustained isometric contraction in humans

1993 ◽  
Vol 75 (1) ◽  
pp. 273-278 ◽  
Author(s):  
K. P. Davy ◽  
W. G. Herbert ◽  
J. H. Williams
Keyword(s):  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Pressor Response ◽  
Voluntary Contraction ◽  
Plasma Norepinephrine ◽  
Isometric Handgrip ◽  
Double Blind ◽  
Muscle Ischemia ◽  
Stimulation Of

The purpose of this study was to test the hypothesis that prostaglandins participate in metaboreceptor stimulation of the pressor response to sustained isometric handgrip contraction in humans. To accomplish this, mean arterial pressure, heart rate (n = 10), and plasma norepinephrine levels (n = 8) were measured in healthy male subjects during sustained isometric handgrip at 40% of maximal voluntary contraction force to exhaustion and during a period of postcontraction muscle ischemia. The subjects were given a double-blind and counterbalanced administration of placebo or a single 100-mg dose of indomethacin. A period of 1 wk was allowed for systemic clearance of the drug. Mean arterial pressure increased 25 +/- 5 vs. 22 +/- 4 mmHg during the final minute of isometric handgrip contraction and 26 +/- 2 vs. 21 +/- 5 during the last minute of postcontraction muscle ischemia in the placebo vs. the indomethacin trial (P > 0.05), respectively. Heart rate was increased 21 +/- 4 vs. 17 +/- 3 beats/min during the final minute of isometric handgrip contraction in the placebo vs. the indomethacin trial (P > 0.05), respectively, and returned to control values during postcontraction muscle ischemia. Plasma norepinephrine levels increased 343 +/- 89 vs. 289 +/- 89 pg/ml after isometric handgrip contraction and 675 +/- 132 vs. 632 +/- 132 pg/ml after postcontraction muscle ischemia (P > 0.05) in the placebo vs. the indomethacin trial, respectively. These results suggest that prostaglandin inhibition does not significantly modulate muscle contraction-induced stimulation of mean arterial pressure, heart rate, or plasma norepinephrine levels.

Spinal action of neurokinins in the rat: effects on mean arterial pressure, heart rate, and vascular permeability

1987 ◽  
Vol 65 (11) ◽  
pp. 2182-2187 ◽  
Author(s):  
Harout Hasséssian ◽  
Réjean Couture ◽  
Line Jacques
Keyword(s):  
Spinal Cord ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Vascular Permeability ◽  
Cardiovascular Responses ◽  
Intrathecal Administration ◽  
Water Soluble ◽  
Neurokinin A ◽  
Anaesthetized Rats

In urethane-anaesthetized rats, the intrathecal administration of 6.5 nmol of substance P (SP), neurokinin A (NKA), or neurokinin B (NKB) at the T8–T10 level of the spinal cord enhances mean arterial pressure and heart rate. However, in the pentobarbital-anaesthetized rat, while NKB produces no effect on mean arterial pressure, NKA produces a biphasic change and SP, a depressor response. All three neurokinins elicit a tachycardia. The following rank order of potency SP ≥ NKA > NKB is observed in relation to these cardiovascular responses when either one of the two anaesthetics is used. The low cardiovascular activity of NKB cannot be attributed to its hydrophobicity, as the water soluble analogue of NKB, [Arg0] NKB, elicits a response as weak as the native peptide. In pentobarbital-anaesthetized rats, the intrathecal administration of 6.5 nmol of SP, also enhances plasma protein extravasation in cutaneous tissues of the back, the hind paws, and the ears. In this response NKA and NKB are either inactive (skin of hind paws) or less potent than SP (ears and dorsal skin). These findings agree with the hypothesis that in the rat spinal cord, the neurokinin receptor producing changes in mean arterial pressure, heart rate, and vascular permeability is of the NK-1 subtype.

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