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

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

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The Effect of Adjunctive use of Dexmedetomidine and Metoral with Thiopental on Hemodynamic Status, Agitation, and Patient Satisfaction in Patients with Mood Disorders after Electroconvulsive Therapy

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.4399 ◽

2020 ◽

Vol 8 (B) ◽

pp. 329-333

Author(s):

Talat Mohammadi ◽

Hamidreza Jamilian ◽

Anita Alaghemand ◽

Alireza Kamali

Keyword(s):

Patient Satisfaction ◽

Oxygen Saturation ◽

Mood Disorders ◽

Electroconvulsive Therapy ◽

Recovery Time ◽

Arterial Oxygen Saturation ◽

The Other ◽

Arterial Oxygen ◽

Hemodynamic Status ◽

The Mean

AIM: The aim of our study was to determine the effect of adjunctive use of dexmedetomidine and metoral with thiopental on hemodynamic status, agitation, patient satisfaction, and duration of seizure in patients with mood disorders in electroconvulsive therapy (ECT). METHODS: This study is a randomized, double-blind, clinical trial. Sixty patients (18–60 years) according to DSM5 criteria had mood disorder and were candidates for ECT. Patients were randomly divided into two groups of 30 each. One group received 5.0 μg/kg dexmedetomidine 10 min before induction of thiopental, and the other group received 5.2 mg intravenous metoprolol immediately before ECT. Patients’ satisfaction, duration of seizure, and arterial oxygen saturation were evaluated. RESULTS: The mean age of both groups was approximately 37 years with the majority of men. No significant difference was found between the two groups in terms of age and sex, blood pressure (BP), heart rate (HR), duration of seizure, and arterial oxygen saturation before ECT. The mean BP and HR in the recovery were lower in the dexmedetomidine group than in the metoral group. Arterial oxygen saturation percentage was not significantly different between the two groups. The recovery time in the dexmedetomidine group was longer than the metoral group (p = 0.001). Post-ECT satisfaction was found to be higher in the dexmedetomidine group than in the metoral group and the mean agitation score was found to be higher in the metoral group. CONCLUSION: Both metoral and dexmedetomidine as adjuvants decrease the hyperdynamic responses of patients after ECT, whereas the effect of dexmedetomidine is more than metoral; on the other hand, neither dexmedetomidine nor metoral has any negative effect on seizure duration, but dexmedetomidine significantly prolonged recovery time as compared to metoral.

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The effect of Bispectral index monitoring during induction of anesthesia on the amount of propofol consumtion in patients candidates for surgery

Journal of Contemporary Medical Sciences ◽

10.22317/jcms.v7i4.1033 ◽

2021 ◽

Vol 7 (4) ◽

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

General Anesthesia ◽

Arterial Blood Pressure ◽

Mean Arterial Blood Pressure ◽

Bispectral Index ◽

Time Points ◽

Arterial Blood ◽

Significant Difference ◽

The Mean

Objectives: This study investigated the effect of Bispectral index (BIS) during induction of anesthesia on the amount of propofol consumed in patient candidates for surgery. Methods: This double-blind clinical trial study was performed on patients undergoing elective surgery under general anesthesia in a hospital. Patients were divided into case and control groups. After being transferred to the operating room, patients were monitored including ECG 3 or 5 leads, non-invasive barometer, and pulse oximetry. Mean arterial blood pressure and heart rate were measured before and after induction, immediately, and 5 minutes after intubation. The dose of propofol was then measured. Data analysis was performed by SPSS software version 20. Results: In the present study, no significant difference was found between the mean age and gender (P> 0.05). The amount of propofol consumed in the case group was significantly lower than the control group (P = 0.039) and the amount of propofol consumed in men and women was not statistically significant (P <0.05). Mean arterial blood pressure before induction was not statistically significant between the two groups (P = 0.83). However, a statistically significant difference was found in the mean arterial blood pressure of the patients during the 4-time points (P = 0.001). There was no statistically significant difference in heart rate between patients before induction (P = 0.48). Statistical analysis of data by ANOVA test did not show a significant interaction between time and group (P = 0.418 and P = 0.74). However, a statistically significant difference was found in patients' heart rate during the 4-time points (F = 7.59 and P = 0.001). Moreover, a significant increase was observed in heart rate after intubation in both groups (P = 0.001). Conclusion: The use of BIS can be effective in reducing the amount of propofol consumed and its side effects. The condition of patients under general anesthesia can be improved by BIS, resulting in the improvement of their subsequent condition.

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A Comparison of the Effects of Dexmedetomidine and Propofol in Controlling the Hemodynamic Responses after Intubation: A Double-Blind, Randomized, Clinical Trial Study

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2018.385 ◽

2018 ◽

Vol 6 (11) ◽

pp. 2045-2050

Author(s):

Alireza Kamali ◽

Mehrdad Taghizadeh ◽

Mohtaram Esfandiar ◽

Amin Shams Akhtari

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Tracheal Intubation ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Endotracheal Intubation ◽

Arterial Oxygen ◽

Arterial Blood ◽

The Mean ◽

Group D

AIM: This study aimed to compare the effects of dexmedetomidine and propofol in controlling the hemodynamic response following intubation of patients’ candidate intubation in the emergency department METHODS: A total of 114 patients were randomly assigned to one of 2 groups to receive one of the following treatments: dexmedetomidine 0.4 µg/kg (Group D, n = 57) and propofol 1–1.5 mg/kg/h (Group P, n = 57). Hemodynamic data such as the systolic blood pressure, diastolic blood pressure, arterial oxygen saturation and heart rate (HR) were recorded from the entrance to operation room to 5, 10 and 15 min after tracheal intubation RESULTS: Compared with group D, group P exhibited increases in mean arterial blood pressure (MAP), and systolic blood pressure significantly at all times and immediately after the endotracheal intubation. Moreover, the mean diastolic blood pressure changes due to tracheal intubation in group P were significantly more than group D immediately after the intubation. Furthermore, the mean heart rate changes immediately and 5 min after tracheal intubation was significantly higher in group P CONCLUSION: Our data suggest that the benefits of dexmedetomidine more than propofol in hemodynamic stability because propofol was associated with more variability in systolic/diastolic blood pressure, HR and MAP after endotracheal intubation.

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Cardiovascular Responses to Tracheal Intubation: A Comparison of Direct Laryngoscopy and Fibreoptic Intubation

Anaesthesia and Intensive Care ◽

10.1177/0310057x8901700110 ◽

1989 ◽

Vol 17 (1) ◽

pp. 44-48 ◽

Cited By ~ 42

Author(s):

S. R. Finfer ◽

S. I. P. MacKenzie ◽

J. M. Saddler ◽

T. G. L. Watkins

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Tracheal Intubation ◽

Oxygen Saturation ◽

Arterial Oxygen Saturation ◽

Macintosh Laryngoscope ◽

Cardiovascular Responses ◽

Arterial Oxygen ◽

Arterial Blood ◽

Significant Difference

The cardiovascular responses to tracheal intubation using a fibreoptic bronchoscope or Macintosh laryngoscope were compared in twenty in-patients and twenty day-stay patients. Within these groups patients were randomly allocated to direct laryngoscopic or fibreoptic bronchoscopic intubation. Arterial blood pressure, heart rate and arterial oxygen saturation were recorded before induction and at one-minute intervals until four minutes after intubation. In both groups both laryngoscopic and bronchoscopic intubation resulted in a significant rise in blood pressure and heart rate. At no stage was there a significant difference in mean blood pressure in either group, or in heart rate in the day-stay patients, between the different methods of intubation. In the in-patients mean heart rate was significantly higher in those patients intubated with the bronchoscope at three and four minutes after intubation. Time taken for intubation was significantly longer in those patients intubated with the bronchoscope. In no patient did the arterial oxygen saturation fall below 98%.

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The Effects of Intravenous Nitroglycerin Bolus Doses in Reducing Hemodynamic Responses to Laryngoscopy and Endotracheal Intubation

BioMed Research International ◽

10.1155/2021/6694150 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Pouran Hajian ◽

Shabnaz Sharifi ◽

Mahshid Nikooseresht ◽

Abbas Moradi

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Endotracheal Intubation ◽

Arterial Blood Pressure ◽

Study Groups ◽

Intravenous Nitroglycerin ◽

Hemodynamic Responses ◽

Arterial Blood ◽

Significant Difference ◽

The Mean

Background. Hemodynamic responses to laryngoscopy and endotracheal intubation are transient in most patients. However, in some patients with a history of heart disease, systemic hypertension, or cerebrovascular disease, these may lead to dangerous complications. This study is aimed at determining the effectiveness of intravenous nitroglycerin bolus doses in reducing hemodynamic responses to laryngoscopy and endotracheal intubation. Material and Method. In this double-blind randomized controlled trial, 78 patients aged 18 to 65 years were randomly divided into three groups: 1 μg/kg dose of nitroglycerin (first group), 2 μg/kg dose of nitroglycerin (second group), and normal saline or placebo (third group). 26 samples were allocated for each group. Patients’ hemodynamic responses to laryngoscopy and endotracheal intubation were measured at different times. Data were analyzed using SPSS V 16. Results. Patients in the three study groups were similar in terms of age, sex, and weight. There was no significant difference between the mean saturation of peripheral oxygen (SPO2) and the mean heart rate between the three groups before endotracheal intubation and 1 to 10 minutes after intubation ( P > 0.05 ). The difference of mean arterial blood pressure between study groups was only significant in the first and fifth minutes after intubation. Mean systolic and diastolic blood pressure in the first, third, and fifth minutes after intubation was significantly lower in the intervention groups than the control group ( P < 0.05 ). However, no significant difference was observed between the intervention groups. The frequency of systolic blood pressure decrease was significantly different in the first and fifth minutes after intubation in the three study groups ( P < 0.05 ). Conclusion. Bolus doses of 1 and 2 μg/kg nitroglycerin in noncardiac elective surgery prevents the increase of mean systolic, diastolic, and arterial blood pressure but has no significant effect on heart rate after intubation.

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Caudal bupivacaine - midazolam for post operative analgesia in children

Journal of the Bangladesh Society of Anaesthesiologists ◽

10.3329/jbsa.v23i1.18152 ◽

2014 ◽

Vol 23 (1) ◽

pp. 8-13

Author(s):

Idris Ali ◽

Amirul Islam ◽

Golam Morshed ◽

Nurul Islam ◽

Ashia Ali ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Anaesthetic Agent ◽

Caudal Block ◽

Arterial Blood ◽

Post Operative Period ◽

Caudal Analgesia ◽

Significant Difference ◽

Group B

Background: Adjuvant used with local anaesthetic agent in caudal is more effective for post operative analgesia in children . Aim and objective: To find out the duration and quality of caudal analgesia in children undergoing genitourinary surgery by combination of bupivacaine and midazolam. Methods: A total number of sixty patients ASA grade I&II were selected randomly as per inclusion & exclusion criteria in two groups. Thirty in each group. In group A, caudal block was given by bupivacainemidazolam mixture and in group B, caudal block was given by bupivacaine in lateral decubitus position, just after completion of surgery before reversed from GA. In post operative period arterial blood pressure, heart rate, and duration of analgesia were recorded. Results: There was no significant difference between the groups of blood pressure, heart rate, and pain score up to 30 min but after one hour of post operative period pain scores were significant(p<0.05). Conclusion: Midazolam improves the duration and quality of analgesic effect of bupivacaine. DOI: http://dx.doi.org/10.3329/jbsa.v23i1.18152 Journal of BSA, 2010; 23(1): 8-13

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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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Reduced parasympathetic control of heart rate in obese dogs

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1995.269.2.h629 ◽

1995 ◽

Vol 269 (2) ◽

pp. H629-H637 ◽

Cited By ~ 21

Author(s):

B. N. Van Vliet ◽

J. E. Hall ◽

H. L. Mizelle ◽

J. P. Montani ◽

M. J. Smith

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Rate Control ◽

Saturated Fat ◽

Pressure Control ◽

Resting Heart Rate ◽

Arterial Blood ◽

Parasympathetic Control ◽

The Mean ◽

Affect Heart Rate

We investigated why resting heart rate is elevated in dogs fed a high saturated fat diet for 12.7 +/- 1.8 wk. Obese dogs exhibited elevated body weight (59%), blood pressure (14%), and heart rate (25%). Differences in resting heart rate (control, 58 +/- 5 beats/min; obese, 83 +/- 7 beats/min) were abolished after hexamethonium, indicating an autonomic mechanism. Hexamethonium also reduced blood pressure in obese (20 +/- 4 mmHg) but not control (9 +/- 6 mmHg) animals. Propranolol did not affect heart rate in either group, excluding a beta-adrenergic mechanism. Subsequent administration of atropine increased heart rate more in control than in obese dogs (110 +/- 9 vs. 57 +/- 11 beats/min). The sensitivity of the cardiac limb of the baroreflex (Oxford method) was reduced by 46% in the obese group, confirming impairment of the parasympathetic control of heart rate. The standard deviation of blood pressure measurements was normal when expressed as a percentage of the mean arterial blood pressure (control, 11.2 +/- 0.4%; obese, 11.2 +/- 0.5%). Our results indicate that the development of obesity in dogs fed a high saturated fat diet is accompanied by an attenuated resting and reflex parasympathetic control of heart rate.

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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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