COMPARISON OF INTRAOCULAR PRESSURE AND HAEMODYNAMIC RESPONSES TO INSERTION OF THE I - GEL AND ENDOTRACHEAL TUBE IN ELECTIVE OPHTHALMOLOGICAL SURGERIES

Objective: To compare I–Gel versus endotracheal tube effects on hemodynamic stability and intraocular pressure in patients undergoing elective ophthalmological surgeries. Study Design: Quasi-experimental study. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Nov 2019 to Oct 2020. Methodology: A total of 108 patients undergoing elective ophthalmological surgeries under general anesthesia from both genders, age range between 18-45 years, American Society of Anesthesiologists status I or II were included. General anesthesia given following standard procedures and monitoring. Heart rate, Systolic & Diastolic blood pressure monitored and intraocular pressure measured in each eye with Reichert ton open at baseline, upon insertion of airway device and 5 minutes after insertion. Results: Total 108 patients enrolled in the study with a mean age of 37.74 ± 6.0 years and age-range of 18-45. Heart rate at Insertion in I-Gel group was 78.14 ± 3.41 beats per minute whereas in intubated group was 97.20 ± 2.84 beats per minute, mean systolic blood pressure at insertion in group A and B was 115.28 ± 5.3 and 130.44 ± 2.81mm of Hg respectively. Intraocular pressure at insertion right eye in group A and B was 12.04 ± 0.48 and 17.98 ± 0.42 mm of Hg respectively. Intraocular pressure at insertion left eye in group A was 12.12 ± 0.45 whereas in group B was 17.95 ± 0.38mm of Hg (p-value=0.001). Conclusion: I–Gel provides better hemodynamic profile and intraocular pressure stability when compared with endotracheal tube.

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Evaluating the effect of calcium chloride in combination with neostagmine and atropine against residual neuromuscular blockade at the end of general anesthesia

QJM ◽

10.1093/qjmed/hcaa039.016 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

M M Marzouk ◽

R A Shoukry ◽

S A Refaat ◽

A M Fathi

Keyword(s):

General Anesthesia ◽

Endotracheal Tube ◽

Calcium Chloride ◽

Neuromuscular Blockade ◽

P Value ◽

Double Blind ◽

Residual Neuromuscular Blockade ◽

Significant Difference ◽

Group A ◽

Group B

Abstract Background Muscle relaxants used in general anesthesia during the insertion of an endotracheal tube (ETT) to relax the muscles of the neck and throat, which reduces the risk of injury. They also are used to relax the chest muscles when an endotracheal tube is used to aid mechanical ventilation. Objective The aim of this study has been to evaluate the effect of calcium chloride coadministered with neostigmine and atropine on neuromuscular blockade recovery time at the end of general anesthesia. And compare it’s effect against usual neuromuscular reverse of neostigmine and atropine. Patients and Methods In this present study we use Double blind prospective randomized Clinical trial study, 30 patients were enrolled. They were divided in two groups each of which contains 15 patients: Group (A): received 5 mg/kg of calcium chloride coadministered with 25 μg/kg of neostigmine and 15 μg/kg of atropine at the end of surgery. Group (B): received the same volume of normal saline coadministered with 25 μg kg of neostigmine and 15 μg / kg of atropine at the end of surgery. Results Comparison between calcium and neostigmine groups according TOF at 5 minutes and 10 minutes using Independent t-test, P- value was less than 0.01 which means that there is high significant difference between 2 groups. On the other hand, TOF at 20 minutes in calcium and neostigmine groups shows no difference at all. Conclusion So Calcium chloride elevate serum calcium level, calcium has antineuromuscular blockade effect, therefore calcium chloride increase TOF and enhance neuromuscular recovery and decrease the PORC after neostigmine administration.

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EVALUATION OF DEXMEDETOMIDINE ON HEMODYNAMIC STRESS RESPONSE DURING LARYNGOSCOPY AND INTUBATION

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i6.6584 ◽

2021 ◽

Vol 71 (6) ◽

pp. 2126-30

Author(s):

Abdul Raafeh Jamal ◽

Bilal Yaseen ◽

Mohammad Saeed ◽

Rao Ali Shan Khan ◽

Syed Hamid Ali Shah ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Stress Response ◽

Systolic Blood Pressure ◽

Military Hospital ◽

P Value ◽

Hemodynamic Stress ◽

Group A ◽

The Mean ◽

Group B

Objective: To compare the efficacy of Dexmedetomidine (Precedex) in addressing the mean haemodynamic stress response to laryngoscopy and endotracheal intubation (L&I). Study Design: Quasi-experimental study. Place and Duration of Study: Anesthesiology Department, Combined Military Hospital, Rawalpindi, from Jun 2019 Jun 2020. Methodology: The patients were divided into two groups. Group A was given Inj. Dexmedetomidine and group B (placebo). Operation theatre assistant randomly assigned the patients to either group A or group B each day. The second person administered the drug or placebo. The third person (researcher) recorded all the parameters mentioned in the proforma. Results: There were 100 patients with an age range of 18-60 years. The majority of the patients were ASA-I physical status. The main surgical procedure was laparoscopic cholecystectomy. Recording of heart rate and systolic blood pressure during laryngoscopy and intubation, after administration of drug or placebo, showed mean heart rate less than mean basal value in group-A and 22% above mean basal value in group-B, and it was statistically highly significant (p-value <0.001). Whereas mean systolic blood pressure in group-A was 122.42 ± 14.91 (less than the mean basal value) as compared to group B, 155.00 ± 18.32/min (20% above mean basal value). This change was also statistically highly significant (p-value <0.001). Conclusion: It is concluded that dexmedetomidine showed statistically significant stabilizing effects on the expected changes of the hemodynamic stress response.

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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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The Effect of Prophylactic Ephedrine on Systemic Hypotension Caused by Induction of Anaesthesia with Propofol and Sufentanil in Elderly Hypertensive Patients: A Prospective Randomized, Double-blind Placebo-controlled Clinical Trial

10.22514/sv.2020.16.0081 ◽

2020 ◽

Keyword(s):

Blood Pressure ◽

General Anesthesia ◽

Normal Saline ◽

Saline Group ◽

Normal Saline Group ◽

Hypertensive Patients ◽

Group A ◽

Elderly Hypertensive ◽

Elderly Hypertensive Patients ◽

Group B

Objective: To study the effectiveness of prophylactic ephedrine to prevent hypotension caused by induction of anesthesia with propofol and sufentanil in elderly hypertensive patients. Methodology: 70 elderly ASA grade II-III hypertensive patients undergoing elective general anesthesia were randomized into two groups to receive either intravenous ephedrine,100 ug/kg in 5ml normal saline (Group B), or an equal volume of normal saline (Group A) before induction. Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Heart Rate (HR) were recorded at T0 (after entry to the operating room), T1 (1 min after induction), T2 (2 min after induction), T3 ( 3 min after induction), T4 (4 min after induction), T5 (when intubated), T6 (2 min after intubation), and T7 (at the start of the procedure), as well as the incidence of hypotension and bradycardia. Results: SBP, DBP and HR were not significantly different at T0 and were significantly different at T1 to T7 after anesthesia induction. There were statistically significant effect on hypotension and bradycardia between the two groups and group B have a lower risk of hypotension and bradycardia relative to group A. SBP and DBP decreased significantly after induction in both groups. HR decreased significantly in group A while increased in group B. Conclusion: Ephedrine pretreatment can minimize hypotension and bradycardia caused by propofol and sufentanil during the induction of general anesthesia in elderly patients with hypertension.

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Effect of intravenous oxycodone on the physiologic responses to extubation following general anesthesia

BMC Anesthesiology ◽

10.1186/s12871-021-01350-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Menglu Jiang ◽

Jiawei Ji ◽

Xin Li ◽

Zhenqing Liu

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

General Anesthesia ◽

Control Group ◽

Study Group ◽

Clinical Trial Registry ◽

Blood Oxygen Saturation ◽

Blood Concentrations ◽

Number Of Patients ◽

Blood Hormones

Abstract Background Endotracheal intubation and extubation may cause undesirable hemodynamic changes. Intravenous oxycodone has recently been introduced and used for relieving hemodynamic alterations in response to intubation, but there is insufficient information regarding its application in stabilizing hemodynamics during extubation in the patients emerging from general anesthesia. Methods One hundred patients, who had undergone assorted laparoscopic surgeries under general anesthesia, were randomly assigned to Control group (saline injection, 50 cases) and Study group (intravenous injection of 0.08 mg/kg oxycodone immediately after completion of the surgical procedure, 50 cases). Blood pressure, heart rate, blood oxygen saturation (SpO2) as well as blood concentrations of epinephrine, norepinephrine, and cortisol were recorded or measured immediately before extubation (T0), during extubation (T1), as well as one minute (T2), 5 min (T3), and 10 min after extubation (T4). In addition, coughing and restlessness, time of eye-opening, and duration from completing surgery to extubation as well as Ramsay Sedation Scale were analyzed. Results Blood pressure and heart rate as well as blood concentrations of epinephrine, norepinephrine, and cortisol were significantly higher in the Control group compared with the Study group at the time of extubation as well as 1, 5, and 10 min after extubation (P < 0.05). When the patients emerged from general anesthesia, 70 % of the Control group had cough, which was significantly higher than that of Study group (40 %, P < 0.05). Significantly higher number of patients manifested restlessness in the Control group before (40 %) and after extubation (20 %) compared with that in the Study group (20 and 2 %, respectively, P < 0.05). In addition, patients of Control group had lower Ramsay score at extubation (1.7 ± 0.7) as well as 30 min after extubation (2.4 ± 0.9) compared to that of the patients of Study group (2.2 ± 0.9, and 3.0 ± 0.8, respectively, P = 0.003 and 0.001). Conclusions Intravenous oxycodone attenuated alterations of hemodynamics and blood hormones associated with extubation during emergence from general anesthesia. Trial registration Chinese Clinical Trial Registry: ChiCTR2000040370 (registration date: 11-28-2020) “‘retrospectively registered”.

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Pengaruh Terapi Musik Klasik terhadap Respon Fisiologis pada Pasien yang Mengalami Kecemasan Praoperatif Ortopedi

Jurnal Kesehatan Komunitas ◽

10.25311/jkk.vol1.iss4.30 ◽

2012 ◽

Vol 1 (4) ◽

pp. 205-209

Author(s):

Armansyah . ◽

Yecy Anggreny

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Music Therapy ◽

Classical Music ◽

Physiological Responses ◽

Respiratory Frequency ◽

P Value ◽

Relaxation Effects ◽

The Mind ◽

Patients Experience

Preparation of patients mental before to surgery is needed. If patients experience severe anxiety and panic operating plan will be delayed, it will allow a greater risk of infection. From various research show that music has a strong influence on health, especially in calming the mind, reduce physical tension and create a relaxed state, if the patient in a relaxed state is expected to affect physiological responses. The purpose of this study was to determine the effect of classical music therapy on physiological responses in patients who underwent orthopedic praoperatif anxiety. The study design is pre-experiment with a sample of 30 people using purposive sampling. Music therapy is given for ± 30 minutes. The analysis used were Paired Sample T Test and Wilcoxon. Obtained mean systolic blood pressure was 120.2 mmHg before therapy, after therapy 119.6 mmHg, p value = 0.227. Mean diastolic blood pressure before treatment was 74.1 mmHg, 73.2 mmHg after therapy is, p value = 0.133. Mean heart rate before treatment was 81.8 x / min, after therapy was 79 x / minute, p value = 0.005. Median respiratory frequency before treatment was 23 x / minute, after the therapy is 21 x / minute, p value = 0.001. This shows the classical music therapy has an influence on heart rate and respiratory frequency in patients who underwent orthopedic praoperatif anxiety. Researchers recommend the use of classical music therapy with a frequency of 2 to 3 times a day before patients undergo surgery in order to obtain an optimal relaxation effects.

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EFFECT OF SUBCUTANEOUS RECOMBINANT HUMAN ERYTHROPOIETIN ON BLOOD PRESSURE IN PRE-DIALYSIS CHRONIC KIDNEY DISEASE (CKD) PATIENTS

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i1.2489 ◽

2021 ◽

Vol 71 (1) ◽

pp. 261-65

Author(s):

Muhammad Sajid Hussain ◽

Qasim Raza ◽

Muhammad Omer Aamir ◽

Nadia Murtaza ◽

Sadia Naureen ◽

...

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Body Weight ◽

Kidney Disease ◽

Recombinant Human Erythropoietin ◽

Case Series ◽

Military Hospital ◽

P Value ◽

Human Erythropoietin ◽

Age Range

Objective: To determine the effect of subcutaneous recombinant human erythropoietin on blood pressure in predialysis chronic kidney disease (CKD) patients. Study Design: Case-series descriptive study. Place and Duration of Study: Combined Military Hospital Peshawar, from Mar 2016 to Sep 2016. Methodology: A total of 100 cases were enrolled. Inclusion criteria was patients of 18 to 60 years of both gender & estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73 m2 having Hb <10g/dL and pre-dialysis while Exclusion Criteria was pregnancy or lactation, BP more than 140/90 mmHg, patients on Haemodialysis and worsening renal function. Baseline BP, body weight and eGFR of anaemic chronic kidney disease patients were recorded prior to EPO Alpha therapy. Erythropoiesis-stimulating agents (ESAs) i.e. EPO Alpha (50-100 Units/kg thrice or once weekly) was administered subcutaneously. Subsequent blood pressure, body weight and eGFR monitoring was done after 2 and 4 weeks post EPO Alpha injection. Results: Mean age range was 46.71 years with range of 20-60 years, 73 (73%) were male while 27 (27%) werefemales. Mean ± SD for other quantitative variables like eGFR was 23.12 ± 5.28, Hb levels (g/dL) was 8.62 ± 0.85,Weight (kg) was 56.66 ± 6.62 and duration of CKD was 9.87 ± 4.02. Frequency of Hypertension (post EPO) was 2(2%) and p-value was 0.453. Conclusion: We concluded that the frequency of hypertension in pre-dialysis patients with chronic kidney disease (CKD) receiving recombinant human erythropoietin (rhEPo) subcutaneously (SC) in low doses, is very low, so rhEPo can be used subcutaneously......................

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COMPARISON STUDY OF IVABRADINE WITH METOPROLOL IN MANAGEMENT OF ACUTE CORONARY SYNDROME

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i9.2201 ◽

2021 ◽

Vol 5 (9) ◽

Author(s):

Rishman Tandi ◽

Tanvi Kumar ◽

Amritpal Singh Kahlon ◽

Aaftab Sethi

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Acute Coronary Syndrome ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Beta Blocker ◽

Beta Blockers ◽

Coronary Syndrome ◽

Group A ◽

Group B

Introduction: Acute coronary syndrome remains as one of the most important causes for morbidity and mortality in developed countries. Therefore, evidence-based management strategy is required to offset the loss of health during an acute coronary syndrome. An effective approach includes both medical and surgical methods. This study was conducted to evaluate the medical method of management. Objective: To study blood pressure and heart rate variability after administration of Ivabradine or metoprolol in cases with acute coronary syndrome. Materials and methods: The study was a Prospective single center observational study conducted in patients attending Cardiology Intensive Care Unit in Nayyar Heart and Superspecialty Hospital, a tertiary care centre located in an urban area. All patients with Acute coronary syndrome admitted to the emergency or cardiac care unit were analysed with ECG as a preliminary diagnostic test and confirmed with troponin markers. They were either given Ivabradine or Metoprolol. Baseline evaluation and follow up was done and necessary data was collected and analysed. Results: 100 patients were included in the study out of which 50 were given Metoprolol (Group A) and 50 were given Ivabradine (Group B). Themean age of studied cases was found to be 66.54 years in group A and 68.69 years in group B. It was observed that there was a fall in heart rate by 26.8 beats per minute with beta blocker and 24.4 beats per minute with Ivabradine. In case of blood pressure measurement, in patients with beta blocker administration, there was a fall of 25 mm Hg in systolic blood pressure and 17 mm Hg in diastolic blood pressure However, with Ivabradine there was only a fall of 8mm Hg in systolic Blood pressure and 6 mm Hg in diastolic blood pressure. Conclusion: Although Metoprolol is the drug of choice to decrease heart rate and blood pressure in acute coronary syndrome, Ivabradine is being increasingly used in cases where beta blockers are contraindicated as it has similar efficacy in lowering heart rate without compromising contractility of cardiac muscle, thereby maintaining LVEF and blood pressure. Keywords: Acute coronary syndrome, Beta Blockers, Metoprolol, Ivabradine.

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Effects of Preoperative Intravenous Clonidine in Patients Undergoing Cataract Surgery: A Double-Blind, Randomized Trial

Journal of Ophthalmology ◽

10.1155/2014/346549 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Ana Ellen Queiroz Santiago ◽

Adriana Machado Issy ◽

Rioko Kimiko Sakata

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Intraocular Pressure ◽

Myocardial Ischemia ◽

Cataract Surgery ◽

The Other ◽

Intraocular Lens Implantation ◽

Double Blind ◽

Lens Implantation ◽

Lidocaine Gel

Objectives. The aim of this study was to assess the effects of clonidine on intraoperative analgesia, sedation, intraocular and blood pressure, arrhythmia, and ischemia.Methods. Forty patients undergoing cataract surgery were allocated into two groups. They were monitored with Holter machine, the pupil was dilated, and 30 minutes later, 20 patients received clonidine (4 µg/kg), while the other 20 patients were given a 0.9% saline intravenously. Twenty minutes later, 2% lidocaine gel was applied. There were assessed intraoperative analgesia, intraocular pressure, blood pressure, heart rate, and the occurrence of arrhythmias and myocardial ischemia.Results. Pain intensity was lower in G1 during the phacoemulsification, irrigation, aspiration, and intraocular lens implantation. The HR and BP were lower with clonidine. The IOP was lower with clonidine after 15 minutes and at the end of the surgery. Sedation was higher with clonidine. The incidence of arrhythmia was lower at the end of surgery with clonidine. The incidence of myocardial ischemia did not differ between the groups.Conclusions. Clonidine (4 µg/kg) before a phacoemulsification reduced the intensity of pain during cataract surgery. It also induced sedation, reduction of BP, HR, and incidence of arrhythmia at the end of the surgery, and did not alter myocardial ischemia. This trial is registered with Clinicaltrials.govNCT01677351.

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A randomized trial to evaluate a modified tracheal catheter with upper and lower balloons for anesthetic administration: effect on the cardiovascular, stress response, and comfort in patients undergoing laparoscopic cholecystectomy

BMC Anesthesiology ◽

10.1186/s12871-019-0883-7 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Yuenong Zhang ◽

Zhiwen Zeng ◽

Guangwen Xiao ◽

Weiqiang Zhang ◽

Weixiong Lin ◽

...

Keyword(s):

Blood Pressure ◽

Clinical Trial ◽

Heart Rate ◽

Laparoscopic Cholecystectomy ◽

Stress Response ◽

Angiotensin Ii ◽

Tracheal Intubation ◽

Systolic Blood Pressure ◽

Group A ◽

Endotracheal Anesthesia

Abstract Background We aimed to evaluate a modified endotracheal tube containing upper and lower balloons for anesthetic administration among patients undergoing laparoscopic cholecystectomy. Methods Ninety patients scheduled to undergo laparoscopic cholecystectomy were randomly allocated to 3 equal groups: group A (conventional tracheal intubation without endotracheal anesthesia); B (conventional tracheal intubation with endotracheal anesthesia); and C (tracheal intubation using a modified catheter under study). Blood pressure, heart rate, angiotensin II level, blood glucose level, airway pressure before anesthesia (T1) were measured immediately after intubation (T2), 5 min after intubation (T3), and immediately after extubation (T4). The post-extubation pain experienced was evaluated using the Wong-Baker Face Pain scale. Adverse reactions within 30 min after extubation were recorded. Results Systolic blood pressure, diastolic blood pressure, angiotensin II, and blood sugar level in group C at T2, T3 and T4, and heart rate at T2 and T4 were significantly lower than those in group A (P < 0.05); systolic blood pressure and blood sugar at T4, and angiotensin II levels at T2, T3, and T4 were significantly lower than those in group B (P < 0.05). Patients in group C reported the lowest post-extubation pain (P < 0.05 vs. Group A), and the lowest incidence of adverse events such as nausea, vomiting, and sore throat than that in groups A and B (P < 0.05). Conclusion The modified endotracheal anesthesia tube under study is effective in reducing cardiovascular and tracheal stress response, and increasing patient comfort, without inducing an increase in airway resistance. Trial registration The clinical trial was retrospectively registered at the Chinese Clinical Trial Registry with the Registration Number ChiCTR1900020832 at January 20th 2019.

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