Agreement between oscillometric and direct blood pressure measurements in anesthetized captive chimpanzees (Pan troglodytes)

OBJECTIVE To evaluate the level of agreement (LOA) between direct and oscillometric blood pressure (BP) measurements and the ability of oscillometric measurements to accurately detect hypotension in anesthetized chimpanzees (Pan troglodytes). ANIMALS 8 captive, adult chimpanzees. PROCEDURES During prescheduled annual examinations, each chimpanzee underwent general anesthesia and patient monitoring for their examination, echocardiography for a concurrent study, and measurement of direct BP with the use of tibial artery catheterization and oscillometry with the use of a cuff placed around a brachium and a cuff placed around the second digit of the contralateral forelimb for the present study. Bland-Altman plots were generated to compare results for direct and oscillometric BP measurements. Mean bias and 95% LOAs were calculated for oscillometric measurements of systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and mean arterial pressure (MAP) for each cuff site. Sensitivity and specificity in detecting hypotension were also determined for each cuff site. RESULTS There were 74 paired direct and brachial oscillometric measurements of each, SAP, MAP, and DAP and 66 paired direct and digit oscillometric measurements of each, SAP, MAP, and DAP. Only brachial oscillometric measurements of MAP had adequate sensitivity (78%) and specificity (95%) to accurately detect hypotension, and this technique also had the least mean bias (0.8 mm Hg; 95% LOA, –29 to 31 mm Hg). CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that brachial oscillometric measurement of MAP provided reasonable agreement with tibial arterial direct MAP measurement and performed well in diagnosing hypotension in anesthetized chimpanzees.

Intravenous Application of Metronidazole, Ceftriaxone and Enrofloxacin in Dogs Anesthetized with Isoflurane: Impact of Hemodynamic and Cardiorespiratory Parameters

Background: The prophylactic use of antimicrobials in patients undergoing surgery is widely performed due to its power to reduce and control infections in the surgical site. Metronidazole, ceftriaxone and enrofloxacin are drugs widely used in veterinary medicine, even during anesthesia, either in healthy patients or under critical conditions. Despite several reports on hemodynamic reactions after intravenous application of antimicrobials in dogs, there are few studies on these effects in dogs undergoing anesthesia. The objective of this study was to evaluate the hemodynamic and cardiorespiratory effects of metronidazole, ceftriaxone and enrofloxacin in dogs anesthetized with isoflurane.Materials, Methods & Results: Forty healthy bitches were used, equally divided into four experimental groups of 10 animals each: placebo group (PG), metronidazole group (MG), ceftriaxone group (CG) and enrofloxacin group (EG). After the experimental phase of data collection, all animals were submitted to ovariohysterectomy using the minimally invasive approach. A catheter was placed in the dorsal metatarsal artery for direct blood pressure monitoring, with systolic (SBP), mean (MBP) and diastolic (DBP) blood pressures were continuously monitored by means of a transducer connected to a multiparametric monitor. The others measured data were heart rate (HR), respiratory rate (RR), body temperature (T°C), carbon dioxide expired fraction (ETCO2), oxygen saturation of hemoglobin (SpO2) in T0 (time immediately before performing the treatment), 5 (T5), 10 (T10), 15 (T15), 20 (T20) and 30 (T30) minutes after administration of the antimicrobial. Anesthetic induction was performed with propofol and anesthetic maintenance was performed with isoflurane. After reaching anesthesia with a surgical plan, all parameters were measured before treatments were performed (T0). Then the sodium chloride solution (0.9% NaCl), 25 mg/kg of metronidazole, 30 mg/kg of ceftriaxone or 5 mg/kg of enrofloxacin was administered in cefalic vein. No complications were observed during anesthesia and surgery in all groups. The animals were monitored for three h after the end of the surgery, and then dispensed without prescription of antimicrobials in the recovery period. The HR showed a significant reduction in T5 and T30 compared to the baseline in EG. The RR had a significant increase in T30 in relation to T0 after the administration of 0.9% NaCl in PG. There were no statistically significant changes in HR for groups PG, MG and CG, and RR for groups EG, MG and CG. SBP and MBP had a significant decrease after 30 min of ceftriaxone application. There was a significant decrease in MBP at T5, T10 and T15 compared to baseline in EG. No changes in blood pressure were detected in PG and MG. The ToC showed a significant reduction from T10 to T30 in the GP, from T5 to T30 in the SG, in the T30 in the GM from T20 to T30 in the GC. For all groups, there were no changes in SpO2, ETCO2 and PAD during the study.Discussion: It was concluded that all studied antimicrobials can be used in prophylactic therapy in dogs, in doses recommended by the literature, as the observed changes are subject to correction and can be easily controlled by a qualified anesthetist. The antimicrobial that did not show cardiorespiratory and hemodynamic changes after intravenous application in bitches anesthetized with isoflurane was metronidazole, so its administration was considered safer when compared to enrofloxacin and ceftriaxone, under the conditions of this study, however its indication is punctual, being restricted to cases of infections by anaerobic agents.

Hubungan Lingkar Perut dan Lingkar Pinggul dengan Tekanan Darah pada Pegawai Fakultas Kedokteran Universitas Sam Ratulangi Manado

Increased abdominal circumference and hip circumference will potentially increase blood pressure. Blood pressure can be used as an indicator to assess the cardiovascular system. This study was aimed to determine the relationship between waist circumference as well as hip circumference and blood pressure among employees at Faculty of medicine Sam Ratulangi University Manado. This was an analytical study with a cross sectional design. Samples were obtained by using the accidental sampling method. Measurements of abdominal circumference, hip circumference and direct blood pressure were performed on all subjects. Data were analysed univariately and bivariately using the Pearson test. The results showed that there were 30 employees as subjects consisted of 17 males and 13 females. The mean of abdominal circumference and hip circumference in males and females were 80.03 ± 11.14 cm and 83.76 ± 12.61 cm consecutively. There were 33.3% of the employees that had high blood pressure (hypertension). In male employees, there was a moderate significant correlation between hip circumference and diastolic blood pressure (r=0.48; P=0.004) meanwhile in female employees there was a moderate significant correlation between waist circumference and systolic blood pressure (r=0.489; P=0.006). Conclusion: There was a significant relationship between hip circumference and diastolic blood pressure among male employees as well as between waist circumference and systolic blood pressure among female employees.Keywords: waist hip circumference ratio, blood pressureAbstrak: Peningkatan lingkar perut dan lingkar pinggul berpotensi meningkatkan tekanan darah. Tekanan darah dapat dipakai sebagai indikator untuk menilai sistem kardiovaskular. Penelitian ini bertujuan untuk mengetahui hubungan lingkar perut dan lingkar pinggul dengan tekanan darah pada pegawai Fakultas Kedokteran Universitas Sam Ratulangi Manado. Jenis penelitian ialah observasional. Sampel diperoleh dengan menggunakan metode accidental sampling dari pengukuran lingkar perut, lingkar pinggul, dan tekanan darah langsung. Analisis data menggunakan univariat dan bivariat dengan uji Pearson. Hasil penelitian mendapatkan sebanyak 30 orang pegawai sebagai subyek penelitian, terdiri dari 17 laki-laki dan 13 perempuan. Rerata lingkar perut dan lingkar pinggul pada laki-laki dan perempuan ialah 80,03±11,14 cm dan 83,76±12,61 cm. Sebesar 33,3% pegawai memiliki tekanan darah tinggi (hipertensi). Pada subyek laki-laki terdapat korelasi sedang dan bermakna antara lingkar pinggul dan tekanan darah diastolik (r=0,48; P=0,004) sedangkan pada subyek perempuan terdapat korelasi sedang dan bermakna antara lingkar perut dengan tekanan darah sistolik (r=0,489; P=0,006). Simpulan: Pada laki-laki terdapat hubungan bermakna antara lingkar pinggul dan tekanan darah diastolik sedangkan pada perempuan terdapat hubungan bermakna antara lingkar perut dengan tekanan darah sistolik.Kata kunci: RLPP, tekanan darah

Management of caesarean section postpartum hemorrhage

Introduction . Postpartum haemorrhage is an important cause of maternal mortality and morbidity. The most common causes are: uterine atonia, lacerations, abnormal placental adhesions and coagulopathy. Materials and method. We have reviewed international medical databases with randomized studies, meta-analyzes of current trends in postpartum hysterectomy and alternative techniques in postpartum hemorrhage. Results. The incidence of postpartum hemorrhage is 1% under a rapid therapeutic attitude. The treatment is directed to the cause. Thus, for initial uterine atony, pharmacological means and subsequent surgical gestures such as ligature of the uterine artery - O’Leary or ligature of the hypogastric artery are initiated. Sutura B-Lynch and its variants are designed to perform the compression of the uterus by mechanical force. Uterine balloons are designed to perform placental bleeding areas buffering. This is the most effective method because the catheter applies direct blood pressure to the bleeding site. Uterine bladder devices specifically designed for uterine tamponade after vaginal or caesarean birth include: Foley catheter, Bakri baloon, B-T Cath device and double-bladder device Ebb, which is also designed for cervical haemostasis. Interventional radiology requires advanced, minimally invasive management of postpartum hemorrhage. Conclusions . The use of uterotonics, pelvic vascular ligatures and balloon buffers are the first steps in the therapeutic approach to postpartum hemorrhage. Appropriate conduct consists of a pro-active attitude, often with a multidisciplinary team.

Cerebral Autoregulation-oriented Therapy at the Bedside

This comprehensive review summarizes the evidence regarding use of cerebral autoregulation-directed therapy at the bedside and provides an evaluation of its impact on optimizing cerebral perfusion and associated functional outcomes. Multiple studies in adults and several in children have shown the feasibility of individualizing mean arterial blood pressure and cerebral perfusion pressure goals by using cerebral autoregulation monitoring to calculate optimal levels. Nine of these studies examined the association between cerebral perfusion pressure or mean arterial blood pressure being above or below their optimal levels and functional outcomes. Six of these nine studies (66%) showed that patients for whom median cerebral perfusion pressure or mean arterial blood pressure differed significantly from the optimum, defined by cerebral autoregulation monitoring, were more likely to have an unfavorable outcome. The evidence indicates that monitoring of continuous cerebral autoregulation at the bedside is feasible and has the potential to be used to direct blood pressure management in acutely ill patients.