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

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.

Anaesthetic challenges in perioperative management of thoracic paraganglioma in an 8-year-old child

Pheochromocytomas (PCC) are catecholamine-secreting tumours that arise from chromaffin cells of the sympathoadrenal system. These rare catecholamine-secreting tumours arising from adrenal glands are termed as PCC and those from extra-­adrenal sites are termed paraganglioma (PGL). Thoracic PGL is very rarely found. we report the anaesthetic challenges and management of an 8-year-old child with functional thoracic PGL and its successful outcome.

Principles of using esmolol in the practice of anesthesiologists and intensive care physicians

Prevention and reduction of cardiac risk remains an important issue in anesthesiology and intensive care. There is a successful clinical experience in the use of esmolol for the correction of hemodynamic and ischemic disorders in acute coronary syndrome, in the perioperative period with excessive activation of the sympathoadrenal system. A large number of works are devoted to the use of esmolol as a drug that prevents hemodynamic changes due to tracheal intubation. The aim of the study was to evaluate the use of esmolol and dexmedetomidine as intravenous adjuvants in general analgesia during thyroidectomy in patients with thyrotoxicosis. The use of esmolol (Biblock) and dexmedetomidine in anesthesia for thyroidectomy, suppresses the hemodynamic response caused by surgical stress. Both adjuvants stabilize oxygen consumption and maintain a stable metabolism. Both drugs are quite effective as intravenous adjuvants in general analgesia for thyroidectomy in patients with thyrotoxicosis. They are the drugs of choice and can be recommended in practical anesthesiology.

Correlation Differences between Sex and Stress Hormones in Men And Women

The excessive aggression is an actual problem of modern society but the mechanisms of aggressiveness development have not been sufficiently investigated. Women aggression is considered to differ from men one and results obtained on males cannot be extrapolated on females. Sex hormones have a crucial role in the generation of sexually dimorphic aggression circuits during development and their maintenance during adulthood. Hypothalamic pituitary adrenal axis and sympathoadrenal system are major neuroendocrine systems that respond to stress. Stress hormones are involved into behavioral reactions of organism. Gonadal, hypothalamic pituitary adrenal axes, and sympathoadrenal system are tightly interrelated and every of them can influence another one. The purpose of the study was to estimate correlation differences between sex and stress hormones in men and women. Material and methods. Forty healthy young people aged 18 to 22 years with a body mass index of 19-24 (21 women and 19 men) were enrolled in the study. Hormone levels in blood serum were determined by Testosterone, Estradiol, Cortisol ELISA kits (Italy), Epinephrine/Norepinephrine (EPI) ELISA kit (China). Results and discussion. In all phases of the menstrual cycle, the level of cortisol in women was lower than in men, but in the luteal phase these differences were not statistically significant. In all phases of the menstrual cycle, the blood serum norepinephrine content in women was lower than in men, but in the follicular phase these differences were not statistically significant. The level of epinephrine in women during ovulation and luteal phase did not differ from the level of epinephrine in men, but in follicular phase it was significantly lower. Calculations of correlations between individual hormones revealed a significant difference between them in men and women. Positive correlations between testosterone and estradiol and between cortisol and epinephrine; a strong negative correlation between epinephrine and testosterone/norepinephrine ratio were found in men. Positive correlation between testosterone and cortisol and negative correlation between estradiol and cortisol/testosterone ratio were revealed in women. Conclusion. In women, strong correlations were found between cortisol and sex hormones; in men, strong interrelationship was revealed between cortisol and epinephrine. Both in men and in women (in all phases of the menstrual cycle), high positive correlations between testosterone/norepinephrine and cortisol/norepinephrine ratios were observed

Combination of increased situational anxiety and endothelial dysfunction in young athletes as a condition for microcirculation spasm: assessment methods and correction using a specialized honey bar-candy

Objective: study of psychoemotional-volitional sphere and endothelium-dependent factors of cardiovascular risk, the level of performance and recovery time in athletes before and after a 2-month intake of a specialized athlete’s nutrition product (SANP) honey bar-candy “Gold F25 ApiSpeis Light”.Materials and methods: the main group of 58 athletes (under the age of 18) used SANP for 2 months. Control group-1 included 32 schoolchildren and students, not athletes, to assess the age limits of endothelium-dependent vasodilation, blood composition and the presence of risk factors for atherosclerosis in young athletes. The control group-2 included 30 young athletes under 18 years old without the use of SANP to compare the indicators in the main group before and after taking the honey bar. The psycho-emotional sphere was studied using the Spielberger-Hanin scale of anxiety and WAM testing: Well-being, Activity and Mood. In addition, the maximum achieved load, maximum oxygen consumption, time to reach the threshold of anaerobic metabolism, systolic blood pressure, heart rate, neurovegetative stress index and recovery time after exercise were determined. Also, tests with reactive hyperemia (TRH) and hyperventilation (TGV) on the brachial artery were performed to assess endothelium-dependent vasodilation and vasoconstriction, conjunctival biomicroscopy on a slit lamp with calibrometry of arterioles and venules, general and biochemical blood tests.Results: the normalization of situational anxiety, psychoemotional stress and hyperfunction of the sympathoadrenal system was established. There was a decrease in the levels of cortisol, neurovegetative stress index, improvement of well-being, activity and mood against the background of elimination of endothelial dysfunction, improved performance and reduced recovery time after work. The analysis of multiple canonical correlations revealed a close relationship between the psychoemotional state, endothelial dysfunction and microcirculation spasm (R = 0.86; p < 0.0001).Conclusion: it has been proven that a combination of increased situational anxiety, neurovegetative overexertion, hyperfunction of the sympathoadrenal system and endothelial dysfunction can form a spastic type of peripheral circulation and provoke the onset of arterial hypertension. It was found that the course intake of honey ingot has anti-stress, antioxidant, erythropoietic, vasodilating and antispastic effects, improves performance and recovery after stress. Ingot “Gold F25 ApiSpeis Light” is included in the FMBA Formulary as a specialized product for the nutrition of young athletes of the Russian national teams.

Dynamics of adreneractivity after transfer of myocardial infarction: annual observation

Aim. To study the change in the -adrenergic reactivity of red blood cell membranes in patients during the first year after acute myocardial infarction. Materials and methods. The study included 25 patients with acute myocardial infarction (AMI) who signed informed consent to participate in the study. The erythrocyte membrane -adrenoreactivity index (-ARM) was determined in venous blood samples upon admission to the intensive care unit, one day after admission, 6 and 12 months after the index MI was transferred using the BETA-ARM-AGAT reagent kit (Agat-Med, Russia). Results. According to the results of dynamics assessment of -APM during the first day, patients included in the study were divided into 2 groups. Group 1 (n=14) included patients who had an increase in -APM in the first day, and group 2 (n=21) included patients in whom -ARM either did not change or decreased. At the time of admission to the hospital in the formed groups, there were no differences in the -APM index and clinical and anamnestic characteristics. A day after hospitalization, the value of -APM in group 1 significantly exceeded the same indicator in group 2 (p=0.02). At the periods of 6 and 12 months, the -APM indices in the groups did not differ. In the 2nd group of patients, the progression of chronic heart failure to one or more functional classes (NYHA) was significantly more often compared with the 1st group. Conclusion. The study showed that on the first day in patients with AMI, both an increase and a decrease in the activity of the sympathoadrenal system are possible with a further leveling of these differences over the next year. For a group of patients with decreased activity of sympathoadrenal system on the first day, a more unfavorable course of heart failure in the post-infarction period is characteristic.

The restriction of sympathoadrenal system activity and the body’s resistance to stress

На основании анализа монографий, результатов, опубликованных в физиологических и медицинских журналах, а также представленных на интернет – ресурсах (поисковые системы Google, Pubmed, eLIBRARY, отбор литературных источников по ключевым словам – глюкокортикоиды, гормоны щитовидной железы), установлено, что симпатэктомия (химическая – введение препаратов, тормозящих передачу возбуждения в синапсах симпатической нервной системы, например, гуанетидина, 6-гидроксидофамина, резерпина и др.; хирургическая – удаление симпатических ганглиев; иммунная – введение антител к фактору роста нервов) снижает резистентность организма к стрессу, поскольку значительно ослабляет ответ гипоталамо-гипофизарно-надпочечниковой и симпатоадреналовой систем, делая невозможной реализацию адаптивных эффектов гормонов их эффекторного звена в этих условиях. Установлены следующие механизмы снижения стрессоустойчивости при блокаде передачи возбуждения в адренергических синапсах: интенсификация перекисного окисления липидов и протеолиза; нарушения белкового и углеводного обмена, вызывающие появление дистрофических изменений в различных тканях; нарушение функции сердца, которое обеспечивает деятельность всех систем, осуществляющих адаптацию к стрессорным воздействиям.

The levels of catecholamines among industrial city patients with non-valvular paroxysmal atrial fibrillation

Atrial fibrillation is one of the most complex health problems in the world, as the incidence of embolic complications is 2.1 % per year among patients with paroxysmal atrial fibrillation. Currently, atrial fibrillation is considered a potentially fatal arrhythmia, given the wide range of its negative consequences associated not only with a significant deterioration in the quality of life, but also with a significant increase in the frequency of serious complications. One of the most important roles in the genesis of cardiac arrhythmias is played by the sympathoadrenal system. Elevated catecholamines levels have arrhythmogenic properties and may contribute to recurrent arrhythmias. To evaluate catecholamine levels among industrial city patients with non-valvular paroxysmal atrial fibrillation. The daily excretion of norepinephrine in the 1 group was 25.95 [23.10; 32.50] mcg/day, and in the 2 group 27.90 [23.40; 32.80] mcg/day and was significantly higher in the groups of patients by 12.6 and 18.0 %, respectively, compared with the 3 group of healthy individuals, where the level of this indicator was 24.20 [22.60; 26.70] mcg/day (p < 0.05). The level of norepinephrine had the largest area under the curve (AUC = 0.64, 95% CI 0.53-0.74) among the analyzed catecholamines in the urine for the development of recurrent arrhythmia, with a cutoff point > 24.8 mcg/day sensitivity of 75.00% and specificity of 54.41 %. For norepinephrine levels > 24.8 mcg/day, the relative risk of arrhythmia recurrence was 2.63.95 % CI 1.15-6.03. The results obtained in our work indicate the involvement of the sympathoadrenal system in the course of paroxysmal atrial fibrillation. The level of norepinephrine had the highest quality model for the development of arrhythmia recurrence among the analyzed catecholamines, with its level exceeding 24.8 mcg/day increasing the relative risk of arrhythmia recurrence.

Neurobiology of Cancer: The Role of β-Adrenergic Receptor Signaling in Various Tumor Environments

The development and progression of cancer depends on both tumor micro- and macroenvironments. In addition, psychosocial and spiritual “environments” might also affect cancer. It has been found that the nervous system, via neural and humoral pathways, significantly modulates processes related to cancer at the level of the tumor micro- and macroenvironments. The nervous system also mediates the effects of psychosocial and noetic factors on cancer. Importantly, data accumulated in the last two decades have clearly shown that effects of the nervous system on cancer initiation, progression, and the development of metastases are mediated by the sympathoadrenal system mainly via β-adrenergic receptor signaling. Here, we provide a new complex view of the role of β-adrenergic receptor signaling within the tumor micro- and macroenvironments as well as in mediating the effects of the psychosocial and spiritual environments. In addition, we describe potential preventive and therapeutic implications.