scholarly journals Comparison of dexmedetomidine and lignocaine on attenuation of airway and pressor responses during tracheal extubation

2014 ◽  
Vol 01 (01) ◽  
pp. 050-055 ◽  
Author(s):  
Vivek Sharma ◽  
Hemanshu Prabhakar ◽  
Girija Rath ◽  
Parmod Bithal
Keyword(s):  
Heart Rate ◽  
General Anaesthesia ◽  
Spinal Surgery ◽  
Pressor Response ◽  
Tracheal Extubation ◽  
Rescue Analgesia ◽  
Study Materials ◽  
Pressor Responses ◽  
Airway Response ◽  
Group D

Abstract Background: Haemodynamic stability and rapid emergence after general anaesthesia used in spinal surgery is a common practice, the goal of which is to permit early neurological motor and sensory examination. Extubation is almost always associated with hypertension, increased airway response and arrhythmias. We have compared the effects of the α-2 agonist Dexmedetomidine and Lignocaine given at the end of the procedure on attenuation of airway and pressor responses following tracheal extubation. This study is a randomised, placebo-controlled, double-blinded study. Materials and Methods: Sixty ASA I-III patients, aged 18-70 years, scheduled to undergo spinal surgery at the level of thoracic, lumbar or sacral region were randomly divided into three groups. Balanced general anaesthesia comprising standard procedures and drugs were used for monitoring, induction and maintenance. At the last skin suture, inhalation anaesthetic was discontinued. After turning the patient supine and return of spontaneous efforts, in Group D Dexmedetomidine 0.5 μg/kg, in Group L Lignocaine 1.5 mg/kg and in Group P normal saline (10 ml) were administered as bolus intravenously over 60 seconds. Systolic, diastolic and mean arterial pressures and heart rate were recorded before intravenous administration and also every minute for 3 minutes, at 5, 10 and 15 minutes post-extubation. Duration of emergence and extubation were noted and attenuation of airway response and quality of extubation was evaluated on cough grading. Results: Mean arterial pressures and heart rate were higher in Group L and Group P than in Group D but not statistically significant. The duration of emergence, extubation and recovery were comparable in all the groups (P > 0.05). Extubation Quality Scores was 1 in 80%, 2 in 20% in Group D; in Group L, the quality scores were 1 for 55%, 2 for 45% and I Group P 1 for 35%, 2 for 45% and 3 for 20% of the patients. The requirement of rescue analgesia was also less and after prolonged time in Group D than in Group L and Group P (P < 0.05). None of the patients in all three groups showed respiratory depression, allergic reactions, nausea, vomiting or shivering. There was occurrence of hypertension for the initial 3 minutes of administration of drug in 10 (50%) of patients in Group D (Dexmedetomidine) group. Conclusion: Without interfering in emergence and extubation times, attenuation of pressor response is comparable between Dexmedetomidine 0.5 μg/kg and Lignocaine 1.5 mg/kg but airway response is much better controlled allowing a smooth easy extubation providing a more comfortable recovery and early neurological examination following spinal surgeries.

Neurocirculatory consequences of abrupt change in sleep state in humans

1996 ◽  
Vol 80 (5) ◽  
pp. 1627-1636 ◽  
Author(s):  
B. J. Morgan ◽  
D. C. Crabtree ◽  
D. S. Puleo ◽  
M. S. Badr ◽  
F. Toiber ◽  
...  
Keyword(s):  
Heart Rate ◽  
Arterial Pressure ◽  
Pressor Response ◽  
Muscle Sympathetic Nerve Activity ◽  
Intrathoracic Pressure ◽  
Nrem Sleep ◽  
Auditory Stimuli ◽  
Sleep State ◽  
Healthy Humans ◽  
Pressor Responses

The arterial pressure elevations that accompany sleep apneas may be caused by chemoreflex stimulation, negative intrathoracic pressure, and/or arousal. To assess the neurocirculatory effects of arousal alone, we applied graded auditory stimuli during non-rapid-eye-movement (NREM) sleep in eight healthy humans. We measured muscle sympathetic nerve activity (intraneural microelectrodes), electroencephalogram (EEG; C4/A1 and O1/A2), arterial pressure (photoelectric plethysmography), heart rate (electrocardiogram), and stroke volume (impedance cardiography). Auditory stimuli caused abrupt increases in systolic and diastolic pressures (21 +/- 2 and 15 +/- 1 mmHg) and heart rate (11 +/- 2 beats/min). Cardiac output decreased (-10%). Stimuli that produced EEG evidence of arousal evoked one to two large bursts of sympathetic activity (316 +/- 46% of baseline amplitude). Stimuli that did not alter EEG frequency produced smaller but consistent pressor responses even though no sympathetic activation was observed. We conclude that arousal from NREM sleep evokes a pressor response caused by increased peripheral vascular resistance. Increased sympathetic outflow to skeletal muscle may contribute to, but is not required for, this vasoconstriction. The neurocirculatory effects of arousal may augment those caused by asphyxia during episodes of sleep-disordered breathing.

Baroreflex buffering of pressor response to vasopressin is mediated by V1, not V2, receptors in conscious rats

1993 ◽  
Vol 264 (2) ◽  
pp. R345-R349
Author(s):  
K. Shimizu ◽  
J. Schwartz ◽  
B. P. McGrath
Keyword(s):  
Heart Rate ◽  
Receptor Agonist ◽  
Pressor Response ◽  
Conscious Rat ◽  
Conscious Rats ◽  
Pressor Responses ◽  
Autonomic Blockade ◽  
V2 Receptor ◽  
Intact Rats

Arginine vasopressin (AVP) enhances reflex buffering of its own pressor response, thus attenuating its vasoconstrictor potential in vivo. To investigate the extent to which this effect of AVP is mediated by V1 or V2 receptors, mean arterial pressure (MAP) and heart rate (HR) changes were examined in response to graded injections of AVP or [Phe2,Orn8]oxytocin, a potent, selective V1-receptor agonist, in the absence and presence of infusion of [Val4,D-Arg8]VP, a selective V2-receptor agonist. Responses were compared in intact and autonomically blocked conscious rats. During autonomic blockade with methscopolamine and hexamethonium, the pressor sensitivities to AVP and [Phe2,Orn8]oxytocin were similarly increased. Infusion of the V2-receptor agonist had no effect by itself on MAP or HR in conscious intact rats. It also did not alter the pressor responses to the V1 agonist, in either intact or autonomically blocked rats. In the presence of the V2 agonist, the decrease in heart rate induced by the V1 agonist was enhanced. These results indicate that reflex buffering of the pressor response to AVP in the conscious rat is mediated by V1 and not V2 receptors. However, V2 receptors may be involved in modulating the heart rate response to AVP.

scholarly journals Attenuation of extubation responses: Comparison of prior treatment with verapamil and dexmedetomidine

2016 ◽  
Vol 03 (01) ◽  
pp. 033-039 ◽  
Author(s):  
Tuhin Mistry ◽  
Shobha Purohit ◽  
Gunjan Arora ◽  
Nitesh Gill ◽  
Jaya Sharma
Keyword(s):  
Blood Pressure ◽  
Stress Response ◽  
Tracheal Extubation ◽  
Group V ◽  
Airway Response ◽  
Significant Attenuation ◽  
American Society ◽  
Airway Responses ◽  
Group D

Abstract Background: Tracheal extubation is almost always associated with stress response, airway response, and arrhythmias. There are many ways to attenuate this stress response. We have compared verapamil and dexmedetomidine on attenuation of these responses. Materials and Methods: Thirty patients (American Society of Anaesthesiologists Grade I, II) scheduled for spinal surgeries under general anaesthesia were randomly divided into two groups. At the end of surgery, after return of spontaneous efforts (bispectral index >80), in “Group V” verapamil 0.1 mg/kg and in “Group D” dexmedetomidine 0.3 mcg/kg were administered as bolus intravenously over one minute. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded just before (T0) and 2 min after intravenous administration of study medications (TM), just after oral suction (TS), immediately after extubation (TE) and 1, 3, 5 and 10 min postextubation (E1, E3, E5, E10). Duration of emergence and extubation, quality of extubation, Richmond Agitation Sedation Scale (RASS) score and time to reach modified Aldrete score ≥9 were compared. Results: HR, SBP, DBP, MAP were higher in Group V than Group D, but statistically insignificant (P > 0.05). Extubation quality scores was 1 for 20%, 2 for 60% and 3 for 20% patients in Group V, whereas 1 in 80%, 2 in 20% in Group D. There was occurrence of bradycardia within 2 min of administration of drug in one patient in Group D. RASS score was in the range of -1 to +1 in >90% patient in Group V, whereas -3 to -1 in 80% cases in Group D. Conclusion: Single dose of dexmedetomidine (0.3 mcg/kg) given before extubation produced significant attenuation of circulatory and airway responses during extubation as compared to verapamil (0.1 mg/kg).

scholarly journals Habitual cigarette smoking raises pressor responses to spontaneous bursts of muscle sympathetic nerve activity

2019 ◽  
Vol 317 (2) ◽  
pp. R280-R288 ◽  
Author(s):  
Jian Cui ◽  
Rachel C. Drew ◽  
Matthew D. Muller ◽  
Cheryl Blaha ◽  
Virginia Gonzalez ◽  
...  
Keyword(s):  
Heart Rate ◽  
Sympathetic Nerve ◽  
Sympathetic Nerve Activity ◽  
Pressor Response ◽  
Muscle Sympathetic Nerve Activity ◽  
Total Activity ◽  
Nerve Activity ◽  
Baroreflex Control ◽  
Pressor Responses ◽  
Averaging Techniques

Smoking is a risk factor for cardiovascular diseases. Prior reports showed a transient increase in blood pressure (BP) following a spontaneous burst of muscle sympathetic nerve activity (MSNA). We hypothesized that this pressor response would be accentuated in smokers. Using signal-averaging techniques, we examined the BP (Finometer) response to MSNA in 18 otherwise healthy smokers and 42 healthy nonsmokers during resting conditions. The sensitivities of baroreflex control of MSNA and heart rate were also assessed. The mean resting MSNA, heart rate, and mean arterial pressure (MAP) were higher in smokers than nonsmokers. The MAP increase following a burst of MSNA was significantly greater in smokers than nonsmokers (Δ3.4 ± 0.3 vs. Δ1.6 ± 0.1 mmHg, P < 0.001). The baroreflex sensitivity (BRS) of burst incidence, burst area, or total activity was not different between the two groups. However, cardiac BRS was lower in smokers than nonsmokers (14.6 ± 1.7 vs. 24.6 ± 1.5 ms/mmHg, P < 0.001). Moreover, the MAP increase following a burst was negatively correlated with the cardiac BRS. These observations suggest that habitual smoking in otherwise healthy individuals raises the MAP increase following spontaneous MSNA and that the attenuated cardiac BRS in the smokers was a contributing factor. We speculate that the accentuated pressor increase in response to spontaneous MSNA may contribute to the elevated resting BP in the smokers.

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.

A Randomized Comparative Trial to Study the effect of Preoperative single shot Epidural with Ropivacaine in Lumbar Laminectomy

2021 ◽  
pp. 2945-2949
Author(s):  
Karuna Taksande ◽  
G. Swathi Reddy
Keyword(s):  
Heart Rate ◽  
Blood Loss ◽  
General Anesthesia ◽  
General Anaesthesia ◽  
Anesthetic Management ◽  
Comparative Trial ◽  
Single Shot ◽  
General Anesthetics ◽  
Rescue Analgesia ◽  
Randomised Study

Background: laminectomy surgeries are usually performed in cases of spinal canal stenosis, disc prolapse etc. It has been reported that the use of regional anesthesia techniques in combination to general anaesthesia has shown better heamodynamic stability intraoperatively, better pain scores and reduced intraoperative blood loss. The present study was conducted to evaluate the efficacy of fusion technique of combining epidural and general anaesthesia in patients undergoing lumbar laminectomies. Aim: To evaluate the efficacy of combined epidural general anesthesia for lumbar laminectomy surgeries with epidural ropivacaine. Materials and Methods: A prospective randomised study was conducted in 100 patients who are scheduled for lumbar laminectomy surgeries belonging to ASA Class I and II age between 40-60 years were randomly allocated into two groups (Group E and Group F) of 50 each. Group E: 12ml of 0.5% Ropivacaine and 50µg fentanyl epidurally. Group F:12ml of Normal Saline and 50µg fentanyl epidurally. The parameters recorded were intraoperative analgesia by heart rate and blood pressure, Rescue analgesia, Blood loss. Results: Intraoperatively requirement of general anesthetics, Heart rate, MBP, Blood loss, is lesser in Group E when compared with Group F. It was observed that longer time to rescue analgesia in group E than in group F. Conclusion: combined epidural general anesthesia with local anesthetic (ropivacaine) with narcotic (fentanyl) is a better technique for anesthetic management of patients posted for lumbar laminectomy. Thus from our study we conclude that combined epidural general anesthesia technique with epidural ropivacaine is a better alternative to general anesthesia providing stable hemodynamics, reducing dose of general anesthetics, less blood loss.

Pressor response buffering by beta-adrenergic and cholinergic vasodilation in tranquilized dogs

1979 ◽  
Vol 236 (1) ◽  
pp. H165-H173 ◽  
Author(s):  
J. M. Evans ◽  
C. F. Knapp ◽  
T. R. Lowery
Keyword(s):  
Heart Rate ◽  
Pressor Response ◽  
Peripheral Resistance ◽  
Aortic Pressure ◽  
Beta Blockade ◽  
Lower Heart Rate ◽  
Beta Adrenergic ◽  
Intravenous Injections ◽  
Pressor Responses ◽  
Control State

Buffering of alpha-receptor-mediated pressor responses by beta-adrenergic or cholinergic vasodilation in tranquilized, chronically instrumented gos was investigated. Increases in aortic pressure were produced in the same animal by intravenous injections of phenylephrine in the control state and in three successive experimental states by 1) pacing the heart to remove the reflex capability to lower heart rate, 2) pacing the heart and beta-blockade to remove beta-adrenergic vascular buffering, and 3) beta-blockade plus atropine to also remove cholinergic vascular buffering. The pressor response in each experimental state was greater than that in the state preceding it. With the combined beta-adrenergic and cholinergic blockade, the pressor response to an alpha-receptor stimulation was three times greater than that of the control state. From an analysis of the components of the pressor response, cardiac output, and peripheral resistance, it is suggested that normal buffering of an alpha-mediated pressor response may include beta-adrenergic and cholinergic vascular dilation in addition to a decrease in heart rate.

scholarly journals Comparison of Intravenous Dexmedetomidine versus Labetalol for Their Effectiveness in Suppression of Haemodynamic Response during Extubation

2021 ◽  
Vol 8 (11) ◽  
pp. 286-292
Author(s):  
Parth M. Shah ◽  
Divya Divya Kheskani
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Nervous System ◽  
Body Weight ◽  
Autonomic Nervous System ◽  
Diastolic Blood Pressure ◽  
Tracheal Extubation ◽  
Drug Injection ◽  
Sympathoadrenal System ◽  
Group D

Background: Tracheal extubation causes autonomic nervous system disturbances which causes tachycardia, hypertension which are harmful in susceptible patients.so we conducted a study between iv Dexmedetomidine and iv Labetalol to assess their effectiveness in decreasing haemodynamic disturbances during extubation. Materials and Methods:we included 100 participants of age of 18-55 yrs with ASA grading I & II and divided them into 2 groups. Group D was given injection Dexmedetomidine 0.6mcg/kg iv and Group L was given injection Labetalol 0.25mg/kg body weight. We recorded Heart rate, systolic and diastolic blood pressure at baseline, 2,5,8 minutes post drug injection, at extubation and 1,3,5,8,10 and 15 minutes after extubation. Results: Group D had better decreased heart rate, systolic and diastolic blood pressure at the time of extubation, and also 15 minutes post extubation in comparison to Group L. Conclusion: Injection Dexmedetomidine 0.6µg/kg has showed a better attenuating effect on sympathoadrenal system during extubation than injection Labetalol 0.25mg/kg Keywords: Dexmedetomidine, labetalol, extubation,hemodynamics.

scholarly journals Comparison of the effects of nefopam and tramadol on postoperative analgesia in dogs undergoing ovariohysterectomy

2017 ◽  
Vol 62 (No. 3) ◽  
pp. 131-137
Author(s):  
S. Zhang ◽  
JN Li ◽  
L. Luan ◽  
W. Guan ◽  
XY Hu ◽  
...  
Keyword(s):  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Postoperative Analgesia ◽  
Pain Scale ◽  
Composite Measure ◽  
Rescue Analgesia ◽  
Analgesic Effects ◽  
Pain Scores ◽  
Mixed Breed ◽  
Group D

Relieving perioperative pain can reduce postoperative suffering and improve recovery from anaesthesia in animals. The aim of this study was to compare the analgesic effects of nefopam and tramadol in dogs undergoing ovariohysterectomy. Twenty-four adult mixed-breed female dogs were randomly divided into three groups (n = 8) and received their respective treatments immediately after surgery: Group T (2 mg/kg tramadol, i.v.), Group C (1 mg/kg nefopam, i.v.) and Group D (2 mg/kg nefopam, i.v.). The heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR) and rectal temperature (RT) were measured and the level of analgesia was assessed using the Glasgow Composite Measure Pain Scale (CMPS-SF). The CMPS-SF was performed at least two days before premedication (baseline), every 2 h for the first 8 h (post-extubation), at 12 h and at 24 h. Results showed that the HR in all groups was significantly (P &lt; 0.05) higher at 2 and 6 h than at baseline. The RR in Group T was significantly higher (P &lt; 0.05) at 0 and 2 h than at baseline. Rescue analgesia (0.2 mg/kg morphine, i.v.) was provided if CMPS-SF pain scores greater than or equal to six. Four dogs required rescue analgesia: one dog in Group T at 2 h and three dogs in Group C at 2 and 6 h. No dogs in Group D required rescue analgesia. The CMPS-SF pain scores of dogs in Group C were significantly higher (P &lt; 0.05) than those in Group T at 6, 8 and 12 h. The scores in Group D were significantly lower (P &lt; 0.05) than those in Group C at 2, 4, 6, 8 and 12 h. The scores in Group D were significantly lower (P &lt; 0.05) than those in Group T at 2 and 4 h. However, the scores in Group D were not significantly different compared with Group T. In conclusion, this study suggests that nefopam at 2 mg/kg i.v. produces better postoperative analgesia compared with tramadol at 2 mg/kg i.v. or nefopam at 1 mg/kg i.v. in dogs undergoing ovariohysterectomy.

Activation of GABAA but not GABAB receptors in the NTSblocked bradycardia of chemoreflex in awake rats

1999 ◽  
Vol 276 (6) ◽  
pp. H1902-H1910 ◽  
Author(s):  
João Carlos Callera ◽  
Leni G. H. Bonagamba ◽  
Anne Nosjean ◽  
Raul Laguzzi ◽  
Benedito H. Machado
Keyword(s):  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Nucleus Tractus Solitarius ◽  
Pressor Response ◽  
Potassium Cyanide ◽  
Gabab Receptors ◽  
Basal Heart Rate ◽  
Pressor Responses ◽  
Awake Rats

In the present study we analyzed effects of bilateral microinjections of muscimol (a GABAA agonist) and baclofen (a GABAB agonist) into the nucleus tractus solitarius (NTS) on bradycardic and pressor responses to chemoreflex activation (potassium cyanide, 40 μg/rat iv) in awake rats. Bilateral microinjections of muscimol (25 and 50 pmol/50 nl) into the NTS increased baseline mean arterial pressure (MAP): 119 ± 8 vs. 107 ± 2 mmHg ( n = 6) and 121 ± 8 vs. 103 ± 3 mmHg ( n= 6), respectively. Muscimol at 25 pmol/50 nl reduced the bradycardic response to chemoreflex activation 5 min after microinjection; with 50 pmol/50 nl the bradycardic response to chemoreflex activation was reduced 5, 15, 30, and 60 min after microinjection. Neither muscimol dose produced an effect on the pressor response of the chemoreflex. Effects of muscimol (50 pmol/50 nl) on basal MAP and on the bradycardic response of the chemoreflex were prevented by prior microinjection of bicuculline (a GABAA antagonist, 40 pmol/50 nl) into the NTS. Bilateral microinjections of baclofen (12.5 and 25 pmol/50 nl) into the NTS produced an increase in baseline MAP [137 ± 9 vs. 108 ± 4 ( n= 7) and 145 ± 5 vs. 105 ± 2 mmHg ( n = 7), respectively], no changes in basal heart rate, and no effects on the bradycardic response; 25 pmol/50 nl only attenuated the pressor response to chemoreflex activation. The data show that activation of GABAA receptors in the NTS produces a significant reduction in the bradycardic response, whereas activation of GABAB receptors produces a significant reduction in the pressor response of the chemoreflex. We conclude that 1) GABAA but not GABAB plays an inhibitory role in neurons of the lateral commissural NTS involved in the parasympathetic component of the chemoreflex and 2) attenuation of the pressor response of the chemoreflex by activation of GABAB receptors may be due to inhibition of sympathoexcitatory neurons in the NTS or may be secondary to the large increase in baseline MAP produced by baclofen.

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