Profile Hemodynamics (Blood Pressure And Heart Rate) Changes in The Use of Adrenaline in Cesarean Section With Spinal Anesthesia at Dr Soetomo Surabaya Hospital

Introduction: spinal anesthesia block is one of anesthesia technique that aims to block motor nerves resulting in paresis or anesthesia and paralysis or loss of muscle function in myotomes that are the same level as blocked dermatomes. Caesarean section is one of the surgical actions that are often performed mainly in birth cases. Besides that, the mechanism of the effects of giving birth to the operation of type B autonomic caesarean section autonomic nerve pronglion nerve which results in a decrease in the resistance of peripheral veins and peripheral vasodilatation which results in an imbalance in hemodynamics especially in blood pressure and heart rate and cause of hypotension. Vasopressor, fluid therapy, vasoconstrictor are given to reduce the toxicity of local anesthesia and to overcome hypotension. Objective: To determine hemodynamic changes (blood pressure and pulse) in spinal anesthesia block surgery patients with caesarean section at Dr Soetomo Hospital. Material and Method: This research is descriptive with a retrospective from January - March 2018, the sample taken with total sampling from secondary data from the central medical record at RSUD Dr. Soetomo. Results and Discussion: 68 samples were obtained from inclusion and exclusion criteria there was a change in blood pressure and pulse in patients with caesarean section with spinal anesthesia block with the addition of vasoconstrictors. There was a decrease in average systolic pressure 13.25, diastole 18.25 and pulse 4.5 and in no increase. There was a decrease in average systolic pressure 11.9286, diastole 13.8929 and pulse 5.6429 and no addition of p> 0.05 the two are not significantly different. Conclusion: addition of adrenaline to spinal anesthesia in caesarean section patients was not cause significant hemodynamic (blood pressure and heart rate) changes.

A comparative study of effects of nebivolol and atenolol on blood pressure and lipid profile in patients of mild to moderate hypertension

Background: Beta blockers have been used in the treatment of hypertension, since last four decades and are widely accepted as the first-line treatment for hypertension. Nebivolol, a third generation β-blocker has highest β1 selectivity and is devoid of intrinsic sympathomimetic activity. Along with peripheral vasodilatation and nitric oxide (NO)-induced benefits such as antioxidant activity and reversal of endothelial dysfunction, nebivolol promotes better protection from cardiovascular events. The objective of the study was to compare the effects of atenolol and nebivolol on both blood pressure and lipid profile in patients of mild to moderate hypertension.Methods: This was a prospective, randomized, parallel, open labelled study. Patients were recruited from the medicine out-patient department (OPD) and cardiology OPD. A total of 100 patients were enrolled in the study. 50 patients were allocated to atenolol group and 50 patients to nebivolol group. BP and baseline investigations such as lipid profile were performed. Tests to determine lipid profile were performed on the first visit (Week 0) and at 24 weeks. Continuous variables between the two treatment groups were analyzed by unpaired t-test. Efficacy endpoints within the group were analyzed by using paired t-test.Results: All the lipid levels except HDL-C were increased with atenolol therapy. At 24 weeks, atenolol therapy led to increase in LDL-C, VLDL-C, TC and TG which was highly significant (p<0.0001). HDL levels were decreased at 24 weeks which was also statistically highly significant (p<0.0001). The mean values of lipids in nebivolol group at baseline and at 24 weeks. At 24 weeks, nebivolol therapy led to changes in LDL-C, VLDL-C, HDL-C, TC and TG which was not statistically significant (p>0.05).Conclusions: From study it can be concluded that atenolol and nebivolol are equally effective in reducing BP but atenolol worsens lipid profile as compared to nebivolol.

Hubungan Ketinggian Blok Spinal Anestesi dengan Kejadian Menggigil (shivering) Intra Operatif di Instalasi Bedah Sentral RSUD dr. Soedirman

Regional anesthesia (Sub ArachnoidBlock) produces sympathetic blocks of muscle relaxation and sensory block against peripheral temperature receptors thereby inhibiting the compensatory response to temperature. Factors that may cause adecrease in core temperature and disruption of the information path derived from the first receptor are sympathetic blockades that may couse peripheral vasodilatation. To know the relationship between the height of the anesthetic spinal block with the intra operative shivering incidence at Central Surgery RSUD Dr. Soedirman Kebumen The research design was cross sectional. The research sampel were 72 respondents spinal anesthesia patients. The technique of sampling were consecutive sampling. The statistical test was chi square. Of 16 people with high spinal block, (75%) had shivering and 4 people (25%) had no shivering. of 36 people with moderate spinal block 21 people (58,3%) had shivering and 15 people (41,7%) had no shivering. of 20 people with low spinal block 14 people (70%) had shivering and 6 people (30%) had no shivering. Statistical test result using chi square obtained a significant relationship with p value of 0,021 smaller than 0,05 (0,021<0,05). There is a relationship between the height of the anethetic spinal block intra operative shivering incidence at Central Surgery RSUD Dr. Soedirman Kebumen

Postexercise hypotension after maximal short-term incremental exercise depends on exercise modality

This study investigated postexercise hypotension (PEH) after maximal cardiopulmonary exercise testing (CPET) performed using different exercise modalities. Twenty healthy men (aged 23 ± 3 years) performed 3 maximal CPETs (cycling, walking, and running), separated by 72 h in a randomized, counter-balanced order. Systolic (SBP) and diastolic blood pressure (DBP), heart rate, cardiac output, systemic vascular resistance (SVR), autonomic function (spontaneous baroreflex sensitivity (BRS) and heart rate variability (HRV)), and energy expenditure (EE) were assessed during a 60-min nonexercise control session and for 60 min immediately after each CPET. Total exercise volume (EE during CPET plus 60 min recovery) was significantly higher in running versus cycling and walking CPETs (P ≤ 0.001). Compared with control, only SBP after running CPET was significantly reduced (Δ = −6 ± 8 mm Hg; P < 0.001). Heart rate and cardiac output were significantly increased (P < 0.001) and SVR significantly decreased (P < 0.001) postexercise. BRS and HRV decreased after all CPETs (P < 0.001), whereas sympatho-vagal balance (low- and high-frequency (LF:HF) ratio) increased significantly after all exercise conditions, especially after running CPET (P < 0.001). Changes in SVR, BRS, sympathetic activity (low-frequency component of HRV), and LF:HF ratio were negatively correlated to variations in SBP (range −0.69 to −0.91; P < 0.001) and DBP (range −0.58 to −0.93; P ≤ 0.002). These findings suggest that exercise mode or the total exercise volume are major determinants of PEH magnitude in healthy men. Because of the running CPET, the PEH was primarily related to a decrease in SVR and to an increase in sympatho-vagal balance, which might be a reflex response to peripheral vasodilatation after exercise.