Caudal bupivacaine - midazolam for post operative analgesia in children

Introduction: While most intravenous induction agents decrease arterial blood pressure, laryngoscopy and endotracheal intubation increase the heart rate and blood pressure. Propofol causes a decrease in systemic blood pressure whereas etomidate has minimal effects on the cardiovascular system. This study aims to evaluate and compare the hemodynamic effects of propofol and etomidate during induction and endotracheal intubation. Methods: 62 ASA I and II patients, 20-60 years of age, scheduled for elective surgery were enrolled in this prospective, randomised and double blind comparative study. Group A received inj. Propofol (2 mg/kg) and group B received inj. Etomidate (0.3 mg/kg), as induction agents. Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial blood pressure were recorded after induction and after intubation at one, three, five and ten minutes and intergroup comparisons were made. Results: After induction the decrease in systolic, diastolic and the mean arterial pressures were more in group A compared to group B (p = 0.003, 0.004 and 0.002). After 1 minute of intubation all haemodynamic parameters increased from the baseline with no significant differences between the two groups (p >0.05). At three minutes the decrease in heart rate, diastolic blood pressure and mean arterial pressure was more in group A than group B with p values of 0.001, 0.002 and 0.05, however systolic blood pressures showed no significant difference (p = 0.144). The decrease in blood pressures showed significant difference between the two groups (p <0.05) at five and ten minutes but the decrease in heart rate remained significant only at five minutes of intubation (p = 0.001). Conclusions: Propofol and etomidate are both effective in preventing the haemodynamic changes due to induction and endotracheal intubation, with etomidate providing more haemodynamic stability.

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The Influence of Physical Activity on Arterial Pressure during Ambulatory Recordings in Man

Clinical Science ◽

10.1042/cs0580115 ◽

1980 ◽

Vol 58 (1) ◽

pp. 115-117 ◽

Cited By ~ 45

Author(s):

D. B. Rowlands ◽

T. J. Stallard ◽

R. D. S. Watson ◽

W. A. Littler

Keyword(s):

Physical Activity ◽

Blood Pressure ◽

Heart Rate ◽

Arterial Pressure ◽

Ambulatory Blood Pressure ◽

Physical Activities ◽

Hypertensive Patients ◽

Arterial Blood ◽

Significant Difference ◽

Hypotensive Therapy

1. Ambulatory blood pressure recordings were made over a 48 h period on six hypertensive patients. The conditions of study were standardized, particularly with regard to physical activity, and during one period of each day the patients were randomly allocated to be active or inactive. 2. Results show that blood pressure was highest during physical activity and lowest during sleep. There was no significant difference between the arterial pressures measured during the same physical activities carried out at the same time each day. However, during the same time on consecutive days when activity was randomized, there was a significant difference between the pressure recordings during physical activity compared with those during inactivity. Heart rate changes showed a similar trend during the randomized period. 3. Physical activity and sleep have a profound effect on continuous arterial blood pressure recordings and these are independent of time alone. These observations should be taken into account when using this ambulatory system to assess hypotensive therapy.

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Effect of Multimodal Anesthesia on the Hemodynamic Profile and Acid-Base Balance in the Early Post-Operative Period in Patients Operated for Lung Tumors

Journal of New Medical Technologies ◽

10.12737/17026 ◽

2015 ◽

Vol 22 (4) ◽

pp. 63-73

Author(s):

Качур ◽

S. Kachur ◽

Долгих ◽

V. Dolgikh

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Ejection Fraction ◽

Lung Tumors ◽

Acid Base Balance ◽

Acid Base ◽

Arterial Blood ◽

Post Operative Period ◽

Base Balance ◽

Hemodynamic Profile

This work presents the effects of multimodal anesthesia with neuraxial blockade on the basic parameters of central hemodynamics in patients operated for lung tumors, revealed by method of terapolar rheovasography by Kubicek (systolic blood pressure, diastolic, average heart rate, ejection fraction, minute volume of blood circulation, cardiac index, oxygen delivery index, the index of the total peripheral vascular resistance), as well the effects on acid‐base balance of arterial blood in the immediate post‐operative period. The level of antinociceptive protection was assessed by visual analogue scale. Comparison of results of patients operated by means of multimodal anesthesia and the patients, operated in an inhalation intravenous anesthesia with artificial lung ventilation and peri‐operative analgesia by opioid analgesics has revealed that the hemodynamic profile of the first group of patients is characterized by stability of the basic parameters such as blood pressure and heart rate, the lack of a pronounced reduction of the ejection fraction and stroke volume of the heart, despite vasoplegia caused by epidural blockade. The level of partial oxygen tension of arterial blood was decreased in the early postoperative period, but it was in the normal limits and he was statistically significantly higher than in the comparison group that can help reduce the risk of post‐operative complications. Significantly lower level of pain indicates adequate antinociceptive protection of patients.

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Heart Rate and Arterial Pressure Changes during Whole-Body Deep Hypothermia

ISRN Pediatrics ◽

10.1155/2013/140213 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 9

Author(s):

Giacomo Cavallaro ◽

Luca Filippi ◽

Genny Raffaeli ◽

Gloria Cristofori ◽

Federico Schena ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Mild Hypothermia ◽

Clinical Signs ◽

Deep Hypothermia ◽

Whole Body ◽

Arterial Blood ◽

Significant Difference ◽

Pressure Changes ◽

Ischemic Encephalopathy

Whole-body deep hypothermia (DH) could be a new therapeutic strategy for asphyxiated newborn. This retrospective study describes how DH modified the heart rate and arterial blood pressure if compared to mild hypothermia (MH). Fourteen in DH and 17 in MH were cooled within the first six hours of life and for the following 72 hours. Hypothermia criteria were gestational age ≥36 weeks; birth weight ≥1800 g; clinical signs of moderate/severe hypoxic-ischemic encephalopathy. Rewarming was obtained in the following 6–12 hours (0.5°C/h) after cooling. Heart rates were the same between the two groups; there was statistically significant difference at the beginning of hypothermia and during rewarming. Three babies in the DH group and 2 in the MH group showed HR < 80 bpm and QTc > 520 ms. Infant submitted to deep hypothermia had not bradycardia or Qtc elongation before cooling and after rewarming. Blood pressure was significantly lower in DH compared to MH during the cooling, and peculiar was the hypotension during rewarming in DH group. Conclusion. The deeper hypothermia is a safe and feasible, only if it is performed by a well-trained team. DH should only be associated with a clinical trial and prospective randomized trials to validate its use.

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Effect of adding dexmedetomidine or remifentanil to thiopental in patients with mood disorder candidate for electroconvulsive therapy

European Journal of Translational Myology ◽

10.4081/ejtm.0.8877 ◽

2020 ◽

pp. 1-6

Author(s):

Faezeh Heidarbeigi ◽

Hamidreza Jamilian ◽

Anita Alaghemand ◽

Alireza Kamali

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Mood Disorders ◽

Electroconvulsive Therapy ◽

Recovery Time ◽

Arterial Oxygen ◽

Arterial Blood ◽

Significant Difference ◽

The Mean ◽

Remifentanil Group

Electroconvulsive therapy (ECT) is one of the appropriate treatments for many neuropsychiatric patients, especially those with mood disorders. Short-term complications of ECT include agitation and postictal. In this study, we compared the addition of dexmedetomidine or remifentanil to thiopental as the main anaesthetic used in ECT. In this double-blind randomised clinical trial, 90 patients with mood disorders (candidates for ECT) were divided into two groups based on their therapy: dexmedetomidine or remifentanil. In the first group (DG), patients were slowly injected intravenously with 0.5 μg/kg dexmedetomidine before induction of anesthesia. In the second group (GR), 100 μg of remifentanil was slowly injected intravenously.In addition, we collected demographic information such as respiratory rate, heart pulse rate, seizure time, mean of arterial blood pressure, recovery duration and the oxygen arterial saturation recorded after recovery. Data obtained were analysed by use of statistical software, SPSS-23. The mean age of both groups was approximately 37 years with the majority being men. There was no significant difference between the two groups in terms of age and sex, blood pressure, heart rate, duration of seizures and arterial oxygen saturation before ECT. The mean blood pressure and heart rate in the recovery group were lower in the dexmedetomidine group than in the remifentanil group and the hemodynamics in the dexmedetomidine group were more stable. The recovery time in the dexmedetomidine group was longer than that of the remifentanil group (p = 0.001). Both groups had approximately the same satisfaction and the rate of agitation after ECT was the same. Both remifentanil and dexmedetomidine as adjuvants lead to a decrease in patients' post-ECT hyperdynamic responses. In our study, we demonstrated that the effect of dexmedetomidine is greater than remifentanil. On the other hand, neither dexmedetomidine nor remifentanil had a negative effect on seizure duration, but dexmedetomidine significantly prolonged recovery time, when compared to remifentanil.

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Effect of adding dexmedetomidine or remifentanil to thiopental in patients with mood disorder candidate for electroconvulsive therapy

European Journal of Translational Myology ◽

10.4081/ejtm.2020.8877 ◽

2020 ◽

Vol 30 (3) ◽

Author(s):

Faezeh Heidarbeigi ◽

Hamidreza Jamilian ◽

Anita Alaghemand ◽

Alireza Kamali

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Mood Disorders ◽

Electroconvulsive Therapy ◽

Recovery Time ◽

Arterial Oxygen ◽

Arterial Blood ◽

Significant Difference ◽

The Mean ◽

Remifentanil Group

Electroconvulsive therapy (ECT) is one of the appropriate treatments for many neuropsychiatric patients, especially those with mood disorders. Short-term complications of ECT include agitation and postictal. In this study, we compared the addition of dexmedetomidine or remifentanil to thiopental as the main anaesthetic used in ECT. In this double-blind randomised clinical trial, 90 patients with mood disorders (candidates for ECT) were divided into two groups based on their therapy: dexmedetomidine or remifentanil. In the first group (DG), patients were slowly injected intravenously with 0.5 μg/kg dexmedetomidine before induction of anesthesia. In the second group (GR), 100 μg of remifentanil was slowly injected intravenously.In addition, we collected demographic information such as respiratory rate, heart pulse rate, seizure time, mean of arterial blood pressure, recovery duration and the oxygen arterial saturation recorded after recovery. Data obtained were analysed by use of statistical software, SPSS-23. The mean age of both groups was approximately 37 years with the majority being men. There was no significant difference between the two groups in terms of age and sex, blood pressure, heart rate, duration of seizures and arterial oxygen saturation before ECT. The mean blood pressure and heart rate in the recovery group were lower in the dexmedetomidine group than in the remifentanil group and the hemodynamics in the dexmedetomidine group were more stable. The recovery time in the dexmedetomidine group was longer than that of the remifentanil group (p = 0.001). Both groups had approximately the same satisfaction and the rate of agitation after ECT was the same. Both remifentanil and dexmedetomidine as adjuvants lead to a decrease in patients' post-ECT hyperdynamic responses. In our study, we demonstrated that the effect of dexmedetomidine is greater than remifentanil. On the other hand, neither dexmedetomidine nor remifentanil had a negative effect on seizure duration, but dexmedetomidine significantly prolonged recovery time, when compared to remifentanil.

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Use of antihypertension agents for the suppression of arterial pulse pressure waveforms in patients with intracranial aneurysms

Journal of Neurosurgery ◽

10.3171/jns.2006.104.4.531 ◽

2006 ◽

Vol 104 (4) ◽

pp. 531-536 ◽

Cited By ~ 2

Author(s):

Carole L. Turner ◽

Ian B. Wilkinson ◽

Peter J. Kirkpatrick

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Pulse Pressure ◽

Intracranial Aneurysms ◽

Augmentation Index ◽

Isosorbide Mononitrate ◽

Double Blind ◽

Arterial Blood ◽

Unruptured Intracranial Aneurysms ◽

Significant Difference

Object Patients with intracranial aneurysms tend toward raised blood pressure and abnormal pulse pressure profiles. The authors have investigated the influence of three antihypertension agents on blood pressure and pulse pressure waveforms in patients with known intracranial aneurysms, with a view to assessing the potential benefits of longterm antihypertension therapy on the progression of unruptured intracranial aneurysms. Methods Nineteen patients with a mean age of 56 years (range 38–76 years) were recruited for this study. All patients had confirmed intracranial aneurysms. A double-blind, randomized, crossover study was performed using perindopril, irbesartan, isosorbide mononitrate, and a placebo. Blood pressure and pulse pressure waveforms were assessed at the end of each 4-week treatment period. Perindopril and irbesartan were well tolerated. For all measured parameters except heart rate (p = 0.03), no significant difference between baseline and placebo was identified. Each drug when compared with placebo reduced peripheral arterial blood pressure. Perindopril significantly decreased mean blood pressure by 10 mm Hg (p = 0.004), irbesartan by 9 mm Hg (p = 0.004), and isosorbide mononitrate by 13 mm Hg (p = 0.005). The administration of each drug effected a significant reduction in the carotid artery augmentation index (AIX) compared with baseline values (perindopril p = 0.01, irbesartan p = 0.0002, and isosorbide mononitrate p = 0.03). There was also a significant difference in the AIX between irbesartan and the placebo (p = 0.05). Compared with the placebo, there was a significant difference in AIX (adjusted for heart rate) following the administration of irbesartan (p = 0.003) and isosorbide mononitrate (p = 0.01), but not with perindopril (p = 0.17). Conclusions Irbesartan appears to be the most effective treatment for the combined suppression of blood pressure and AIX in patients with intracranial aneurysms and has a high degree of patient tolerance.

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The effect of alphaxalone–alphadolone, propofol, and pentobarbitone anaesthesia on the β-endorphin and ACTH response to haemorrhage in the pig

Canadian Journal of Physiology and Pharmacology ◽

10.1139/y11-035 ◽

2011 ◽

Vol 89 (7) ◽

pp. 521-526 ◽

Cited By ~ 2

Author(s):

Therese Ruane-O’Hora ◽

W.J. Hall ◽

F. Markos

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Anaesthetic Agent ◽

Adrenocorticotrophic Hormone ◽

Hormone Response ◽

Mechanically Ventilated ◽

Group Iii ◽

Anaesthetic Agents ◽

Group I ◽

Significant Difference

In the literature there appears to be variability in reported levels of certain hormones during haemorrhage, specifically adrenocorticotrophic hormone (ACTH) and β-endorphin. It is possible that this variability may be due to the choice of anaesthetic. Therefore, the effect of 3 common research-only anaesthetic agents (alphaxalone–alphadolone, propofol, and pentobarbitone) on ACTH and β-endorphin levels during haemorrhage was assessed in pigs. Animals were divided into 3 groups: group I received alphaxalone–alphadolone (n = 5), group II received propofol (n = 6), and group III received pentobarbitone (n = 6). Pigs were subjected to a continuous fixed-volume haemorrhage under one of the above anaesthetics while being mechanically ventilated. ACTH and β-endorphin levels increased significantly during haemorrhage under propofol and pentobarbitone anaesthesia but not with alphaxalone–alphadolone. For ACTH there was no significant difference between the groups, whereas for β-endorphin there was a significant difference between the propofol- and pentobarbitone-anaesthetized pigs. The increase in heart rate during haemorrhage was significantly different between the alphaxalone–alphadolone and propofol as well as between the propofol and pentobarbitone groups. The drop in blood pressure was only significantly different between the alphaxalone–alphadolone- and propofol-anaesthetized pigs. These results indicate that the choice of anaesthetic agent can affect the hormone response to haemorrhage and may account for the variable hormone levels reported in the published literature to date.

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Epidural tramadol improves the quality of pain relief during labor

Journal of Chitwan Medical College ◽

10.3126/jcmc.v6i3.16694 ◽

2017 ◽

Vol 6 (3) ◽

pp. 14-19

Author(s):

I N Shrestha ◽

G P Deo ◽

S K Shrestha ◽

S Neupane ◽

B S Regmi

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Side Effects ◽

Pain Relief ◽

Total Dose ◽

Analgesic Efficacy ◽

Time Intervals ◽

Group A ◽

Group B

To study the analgesic efficacy and side effects of Tramadol for painless labor in combination with Bupivacaine. Randomized, controlled, double blind, open prospective study conducted at Department of Obstetrics and Gynaecology, Chitwan Medical College from July 1st 2015 to June 30th 2016. 100 patients of ASA Grade I and II, aged between 20-35 years willing for epidural analgesia for labor pain were included in the study. They were divided into two groups: Group A- Control group and Group B- Study group. Subjects of Group A received 10 ml of 0.25% Bupivacaine and that of Group B received 10ml of 0.25% Bupivacaine with 1mg/kg body weight of tramadol. Analgesic efficacy was assessed by Visual Analogue Scale (VAS) and other vital parameters (Blood Pressure, Heart Rate and Respiratory Rate) before the administration of the drug and at different time intervals of 0, 5 min, 10 min, 15 min, 30 min, 45 min, 60 min and every hourly up to maximum of 5 hrs. Neonatal out comes were assessed by the use of APGAR scores and the side effects of the drugs in two groups were also evaluated. Total number of patients was 100, of ASA Grade I and II, aged between 20-35 years. The mean age of patients in Group A was 23.54 ± 3.74 years and 24.22 ± 3.64 years in Group B. Mode of delivery was spontaneous vaginal in 42 patients (84%) in group A and 45 patients (90%) in group B. Instrumental vaginal delivery was done in 1 patient (2%) of group A and none of group B. Cesarean section was done in 7 patients (14%) of group A and 5 patients (10%) of group B. There was no significant difference in heart rate, blood pressure and respiratory rate at various time intervals. Pain score of Group B was significantly less at 60th min and had lower values than Group A at various time intervals. Time for first top up was significantly delayed and the total dose of bupivacaine was significantly lower in Group B patients but the incidence of nausea and vomiting was significantly high among Group B patients. At one minute majority of the babies of group A had mean APGAR score 6.98 ± 0.55 versus 7.18 ± 0.60 in group B. At 5 minute, Group A had mean score of 8.02 ± 0.47 versus 8.22 ± 0.58 in Group B. There were no significant differences in 2 groups. In both the groups there was no significant effect on duration of second stage of labor and it wasn’t prolonged in any of the patients. Epidural anesthesia with bupivacaine and tramadol provided better pain relief and reduced the total dose of bupivacaine in majority of the patients with no adverse effects on mother and fetus. As tramadol is cheap, safe and effective, it can be considered as a better option to improve quality of pain relief during labor.

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Role of antihypertensives drugs on proteinuria in patients with chronic kidney disease and hypertension

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20174388 ◽

2017 ◽

Vol 6 (10) ◽

pp. 2522

Author(s):

Ritu Bala ◽

Harminder Singh ◽

. Rupali ◽

Kuhu Verma

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Heart Rate ◽

P Value ◽

Biochemical Tests ◽

Mortality And Morbidity ◽

Significant Difference ◽

Group A ◽

Group B

Background: Hypertension is the most prevalent cardiovascular disease and the relevant data suggest that the burden, risk factors and co-morbidities associated with the essential hypertension is increasing with every passing day. It is one of the major chronic diseases resulting in high mortality and morbidity in today’s world. Aim: The aim of the study was to compare effects of cilnidipine and amlodipine on the blood pressure (BP), heart rate and proteinuria among patients of hypertension with chronic kidney disease.Methods: 100 patients were included in this study. Patients were randomly assigned into two groups Group A and Group B (50 each). Group A: Patients received Cilnidipine (5-10mg/day). Group B: Patients received amlodipine (5-10mg/day).Results: No significant difference in SBP, DBP, MBP and proteinuria while comparing both the groups of patients taking cilnidipine and amlodipine at baseline i.e. 0 to 12 week, 12 to 24 weeks and 0 to 24 weeks. Cilnidipine caused decrease in HR 0 to 12 week (p value 0.001), 12 to 24 weeks (p value 0.001) and 0 to 24 weeks (p value 0.0001). Amlodipine had increased heart rate from baseline to 12 weeks (p value 0.0001), 12 to 24 weeks (p value 0.051) and 0 to 24 weeks (p value 0.001). No significant difference was seen in any biochemical readings.Conclusions: There was a significant change in all the parameters including BP, heart rate, proteinuria and other biochemical tests when they compared within the group but no significant difference while comparing both the groups.

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