COMPARISON OF DEXMEDETOMIDINE AND FENTANYL ON AIRWAY RESPONSE AND HEMODYNAMICS DURING TRACHEAL EXTUBATION

Background: Extubation is associated with various circulatory and airway responses. Various pharmacological measures including fentanyl and dexmedetomidine have been used to blunt the reflex without compromising the spontaneous respiration. In this study we wanted to compare dexmedetomidine and fentanyl on airway response, smoothness of extubation and hemodynamic changes. Methodology: A total of 68 patients undergoing surgery under general anesthesia with endotracheal intubation, were randomized into two groups. Group A received dexmedetomidine 0.5 mcg/kg and Group B received 1 mcg/kg of fentanyl with the start of skin suturing over a period of 10 minutes via syringe pump. Airway reflex during suction and smoothness of extubation were assessed. Level of sedation during suction, extubation and then every 5 minutes post extubation for 15 minutes were recorded. Hemodynamic parameters were assessed every 5 minutes with start of test solution till extubation and then every 5 minutes for 15 minutes. Results: A total of 68 patients were evaluated in the study. In dexmedetomidine group, 67.6% of patients had no cough on extubation while in fentanyl group 35.3% of patients had no cough on extubation which was statistically significant (p value 0.015). Mean heart rate during extubation increased in both the groups but the increase was 39% in Group B and 11% in Group A from baseline which was statistically significant (p value < 0.001). There was rise in mean systolic and mean arterial pressure during extubation in both the groups but the increase was significantly higher in fentanyl group. Patients in dexmedetomidine group were more sedated but there were no any adverse events. Conclusion: With the results obtained from the study, it is concluded that dexmedetomidine 0.5 mcg/kg over 10 minutes before extubation is effective in alleviating airway response and haemodynamics compared to fentanyl 1 mcg/kg.

Treating Agitation in Patients with Dementia with a Therapy Dog in a Milieu Therapy Setting on a Geropsychiatric Ward

<b><i>Background:</i></b> Animal-assisted intervention has become a common therapeutic practice used for patients with dementia in home-dwelling and institutions. The most established procedure is a visiting service by specially trained dogs and their owners to improve social interactions and reduce symptoms of agitation. <b><i>Objectives:</i></b> The study aims to investigate the effects of a therapy dog on agitation of inpatients with dementia in a gerontopsychiatric ward. <b><i>Materials and Methods:</i></b> The severity of agitation was assessed by a rater blinded for the presence of the dog via the Overt Agitation Severity Scale (OASS). The scale was conducted on 1 day with the dog and his handler present (resident doctor on the ward) and on another day with only the handler present. Each patient was his/her own control. Heart rate variability (HRV) and serum level of brain-derived neurotrophic factor (BDNF) of the patients were measured on both days. 26 patients with the Mini-Mental Status Examination (MMSE) score &#x3c;21 and the diagnosis of dementia were included in the study. <b><i>Results:</i></b> A significant reduction of agitation in the OASS could be shown when the dog was present (<i>p</i> = 0.006). The data neither demonstrated a difference in the HRV for the parameters mean heart rate (<i>p</i> = 0.65), root mean square of successive differences (<i>p</i> = 0.63), and high frequencies (<i>p</i> = 0.27) nor in serum BDNF concentrations (<i>p</i> = 0.42). <b><i>Discussion:</i></b> Therapy dogs can be implemented as a therapeutic tool in a gerontopsychiatric ward to reduce symptoms of agitation in patients with dementia. The study was registered in the German Clinical Trials Register (DRKS00024093).

Non-contrast myocardial perfusion in rest and exercise stress using systolic flow-sensitive alternating inversion recovery

Objective To evaluate systolic flow-sensitive alternating inversion recovery (FAIR) during rest and exercise stress using 2RR (two cardiac cycles) or 1RR intervals between inversion pulse and imaging. Materials and methods 1RR and 2RR FAIR was implemented on a 3T scanner. Ten healthy subjects were scanned during rest and stress. Stress was performed using an in-bore ergometer. Heart rate, mean myocardial blood flow (MBF) and temporal signal-to-noise ratio (TSNR) were compared using paired t tests. Results Mean heart rate during stress was higher than rest for 1RR FAIR (85.8 ± 13.7 bpm vs 63.3 ± 11.1 bpm; p < 0.01) and 2RR FAIR (83.8 ± 14.2 bpm vs 63.1 ± 10.6 bpm; p < 0.01). Mean stress MBF was higher than rest for 1RR FAIR (2.97 ± 0.76 ml/g/min vs 1.43 ± 0.6 ml/g/min; p < 0.01) and 2RR FAIR (2.8 ± 0.96 ml/g/min vs 1.22 ± 0.59 ml/g/min; p < 0.01). Resting mean MBF was higher for 1RR FAIR than 2RR FAIR (p < 0.05), but not during stress. TSNR was lower for stress compared to rest for 1RR FAIR (4.52 ± 2.54 vs 10.12 ± 3.69; p < 0.01) and 2RR FAIR (7.36 ± 3.78 vs 12.41 ± 5.12; p < 0.01). 2RR FAIR TSNR was higher than 1RR FAIR for rest (p < 0.05) and stress (p < 0.001). Discussion We have demonstrated feasibility of systolic FAIR in rest and exercise stress. 2RR delay systolic FAIR enables non-contrast perfusion assessment during stress with relatively high TSNR.

Safety Comparison of Conventional Versus Extended Infusion of Pulse Methylprednisolone in Multiple Sclerosis Exacerbation Retrospective Study

Objective: - To ascertain the adverse events and changes in vital signs (heart rate (HR), systolic (SBP), diastolic blood pressure (DBP), and serum potassium level during and after intravenous methylprednisolone (IVMP) in multiple sclerosis exacerbation.Design: retrospective review study conducted at Hamad General Hospital (HGH), all patients who are admitted 2019-2020 with MS exacerbation without any other comorbidities will be categorized into 2 groups depending on infusion rate, one group received conventional intravenous methylprednisolone pulse dose over 30minutes to one hour, while the second group received methylprednisolone pulse dose intravenously over an extended period)(four to six hours). Multiple readings of vital signs and, potassium level through steroid administration time will be assessed to determine if there is an infusion-related significant difference in adverse events between both groups.Methods: 74 adult patients with MS relapse who have been admitted at Hamad General Hospital (HGH) and satisfied pre-specified inclusion criteria were invited to participate in the study.Results: 74 patients with MS included in the study, 61 patients (83.6%) were received methylprednisolone dose 500 mg -1000 mg in conventional infusion rate while 12 patients (16.4%) were received pulse steroid in extended duration. There was no significant difference in mean blood pressure before and after IVMP in both groups. There was a small but statistically significant increase in mean heart rate in the conventional group immediately after first and second but not 3rd dose of IVMP compared to baseline 3.5± 8.9 and 4.85± 13.9 P < 0.003. There was a minimal non-significant increase in potassium level in the conventional group (P = 0.17), while there is a non-significant decrease in potassium level in the extended group (P=0.72).Conclusion: IVMP is considered safe and effective in the treatment of MS exacerbation regardless of intravenous infusion duration. There was no significant difference in vital signs among different infusion rates. However, there was a small but statistically significant increase in mean heart rate in the conventional group immediately after first and second but not 3rd dose of IVMP compared to baseline. No significant difference was observed in potassium levels before and after IVMP. We, therefore, recommend that potassium level monitoring should be only restricted to patients with other risk factors of hypokalemia.

The Influence of an Alpha Band Neurofeedback Training in Heart Rate Variability in Athletes

Neurofeedback training is a technique which has seen a widespread use in clinical applications, but has only given its first steps in the sport environment. Therefore, there is still little information about the effects that this technique might have on parameters, which are relevant for athletes’ health and performance, such as heart rate variability, which has been linked to physiological recovery. In the sport domain, no studies have tried to understand the effects of neurofeedback training on heart rate variability, even though some studies have compared the effects of doing neurofeedback or heart rate biofeedback training on performance. The main goal of the present study was to understand if alpha-band neurofeedback training could lead to increases in heart rate variability. 30 male student-athletes, divided into two groups, (21.2 ± 2.62 year 2/week protocol and 22.6 ± 1.1 year 3/week protocol) participated in the study, of which three subjects were excluded. Both groups performed a pre-test, a trial session and 12 neurofeedback sessions, which consisted of 25 trials of 60 s of a neurofeedback task, with 5 s rest in-between trials. The total neurofeedback session time for each subject was 300 min in both groups. Throughout the experiment, electroencephalography and heart rate variability signals were recorded. Only the three sessions/week group revealed significant improvements in mean heart rate variability at the end of the 12 neurofeedback sessions (p = 0.05); however, significant interaction was not found when compared with both groups. It is possible to conclude that neurofeedback training of individual alpha band may induce changes in heart rate variability in physically active athletes.

Age-Related Differences in Cardiac Autonomic Control at Resting State and in Response to Mental Stress

Our goal was to investigate age-related differences in cardiac autonomic control by means of heart rate variability (HRV). For this purpose, 30 healthy older and 34 younger adults were studied during three different conditions: (i) during resting state, (ii) during the execution of two cognitive tasks, and (iii) during the subsequent recovery phase. Mean heart rate and HRV parameters were higher in younger compared to older participants during all three conditions. While the mean heart rate was higher in older adults during the cognitive tasks compared to the resting state, it did not change in younger adults. In contrast, the change in HRV during the three conditions did not differ between age groups. Our results suggest decreased parasympathetic activity reflecting declined cardiac autonomic control with aging. In conclusion, HRV analysis could support the assessment of normal age-related alterations in cardiac autonomic control at resting state and in response to cognitive demands.

Heart Rate Variability during wake and sleep in Huntington’s Disease patients. An observational, cross-sectional, cohort study.

Introduction Autonomic dysfunction has been reported as one of non-motor manifestations of both pre-symptomatic and manifest Huntington’s Disease (HD). The aim of our study was to evaluate heart rate variability (HRV) during wake and sleep in a cohort of patients with manifest HD. Methods Thirty consecutive patients with manifest HD were enrolled, 14 men and 16 women, mean age 57.3±12.2 years. All patients underwent full-night attended video-polysomnography. HRV was analyzed during wake, NREM and REM sleep, in time and frequency domain. Results were compared with a control group of healthy volunteers matched for age and sex. Results During wake HD patients presented significantly higher mean heart rate than controls (72.4±9.6 vs 58.1±7.3 bpm; p<0.001). During NREM sleep, HD patients showed higher mean heart rate (65.6±11.1 vs 48.8±4.6 bpm; p<0.001) and greater Low Frequency (LF) component of HRV (52.9±22.6 vs 35.5±17.3 n.u.; p=0.004). During REM sleep, we observed lower standard deviation of the R-R interval (SDNN) in HD subjects (3.4±2.2 vs 3.7±1.3 ms; p=0.015). Conclusion Our results showed that HD patients have higher heart rate than controls, during wake and NREM, but not during REM sleep. Among HRV variability parameters, the most relevant difference regarded the LF component, which reflects, at least partially, the ortho-sympathetic output. Our results confirm the involvement of autonomic nervous system in HD and demonstrate that it is evident during both wake and sleep.

Gender based comparison of blood pressure and heart rate in adolescent population.

Objective: To evaluate the gender based comparison of blood pressure and heart rate in adolescent population. Study Design: Comparative Cross Sectional Study. Setting: Department of Physiology, Baqai Medical University. Period: 15 February to 15 August in 2017. Material & Methods: A total of 500 student of MBBS, BDS and DPT of Baqai medical university were enrolled in this study by non-probabilty, purposive sampling, after taking ethical approval. Blood pressure was measured by using stethoscope and mercury sphygmomanometer, which is applied to the arm. Heart rate is measured by palpating the radial artery. This collected data were analyzed by using SPSS version 22.0.This data of male and female adolescents were analyzed separately due to autonomic regulation. Results: It was observed that Gender based comparison of mean weight, mean body mass index (BMI), mean Systolic Blood Pressure, mean Diastolic Blood Pressure, and mean heart rate between males and females had statistically significant (p-value<0.05) differences. Among the categories of Diastolic Blood Pressure, only mean Normotensive blood pressure comparison in males and females showed statistically significant (p-value<0.05) difference, while Age, categories of systolic blood pressure (Normotensive, Prehypertension, Hypertension) and Diastolic blood pressure (Prehypertension, Hypertension) had showed statistically non-significant (p-value>0.05) gender difference in study participants. Conclusion: In our study results the mean BMI, mean Systolic Blood Pressure, mean Diastolic Blood Pressure, and mean heart rate had statistically significant (p-value<0.05) differences in gender.

Non-Contrast Myocardial Perfusion in Rest and Exercise Stress Using Systolic Flow-Sensitive Alternating Inversion Recovery

Objective: To evaluate systolic flow-sensitive alternating inversion recovery (FAIR) during rest and exercise stress using 2RR (two cardiac cycles) or 1RR intervals between inversion pulse and imaging. Materials and Methods: 1RR and 2RR FAIR was implemented on a 3T scanner. Ten healthy subjects were scanned during rest and stress. Stress was performed using an in-bore ergometer. Heart rate, mean myocardial blood flow (MBF) and temporal signal-to-noise ratio (TSNR) were compared using paired t-tests. Results: Mean heart rate during stress was higher than rest for 1RR FAIR (85.8±13.7bpm vs 63.3±11.1bpm; p<0.01) and 2RR FAIR (83.8±14.2bpm vs 63.1±10.6bpm; p<0.01). Mean stress MBF was higher than rest for 1RR FAIR (2.97±0.76ml/g/min vs 1.43±0.6 ml/g/min; p<0.01) and 2RR FAIR (2.8±0.96 ml/g/min vs 1.22±0.59 ml/g/min; p<0.01). Resting mean MBF was higher for 1RR FAIR than 2RR FAIR (p<0.05), but not during stress. TSNR was lower for stress compared to rest for 1RR FAIR (4.52±2.54 vs 10.12±3.69; p<0.01) and 2RR FAIR (7.36±3.78 vs 12.41±5.12; p<0.01). 2RR FAIR TSNR was higher than 1RR FAIR for rest (p<0.05) and stress (p<0.001). Discussion: We have demonstrated feasibility of systolic FAIR in rest and exercise stress. 2RR delay systolic FAIR enables non-contrast perfusion assessment during stress with relatively high TSNR.

Management of adolescent anorexia with symptomatic bradycardia and frequent premature ventricular contractions: a case report

Syncope associated with bradycardia and ventricular arrhythmia is an indication of cardiac intervention. However, in adolescent patients with anorexia nervosa, the management of syncope and arrhythmia can be different. We present a case of a 17-year-old boy who was admitted to the hospital because of syncope during exercise. Electrocardiographic monitoring showed that his mean heart rate was 41 beats/minute, with many long pauses and frequent premature ventricular contractions. These results suggested that the syncope was probably caused by arrythmia. He had been on a diet and had lost 20 kg in the past 6 months, with a body mass index of only 15.3 kg/m2. He was diagnosed with anorexia nervosa. Pacemaker implantation or ablation was not performed. Refeeding therapy was performed with mirtazapine. A follow-up showed a stepwise increase in his heart rate and a stepwise decrease in premature ventricular contractions, with an increase in his body weight. The findings from this case show that vagal hyperactivity associated with anorexia nervosa might lead to multiple premature ventricular contractions and bradycardia.