scholarly journals Effects of Dexmedetomidine-Fentanyl Infusion on Blood Pressure and Heart Rate during Cardiac Surgery in Children

2010 ◽  
Vol 2010 ◽  
pp. 1-7 ◽  
Author(s):  
Jyrson Guilherme Klamt ◽  
Walter Villela de Andrade Vicente ◽  
Luis Vicente Garcia ◽  
Cesar Augusto Ferreira
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiac Surgery ◽  
Congenital Heart ◽  
Skin Incision ◽  
Open Label ◽  
Effective Adjunct ◽  
Surgical Stimulation ◽  
Dexmedetomidine Infusion ◽  
Fentanyl Infusion

Background. The purpose of this study was to access the effects of dexmedetomidine-fentanyl infusion on blood pressure (BP) and heart rate (HR) before surgical stimulation, on their changes to skin incision, and on isoflurane requirement during cardiac surgery in children.Methods. This study had a prospective, randomized, and open-label design. Thirty-two children aged 1 month to 10 years undergoing surgery for repair congenital heart disease (CHD) with CPB were randomly allocated into two groups: group MDZ received midazolam 0.2 mg·kg−1·h−1and group DEX received dexmedetomidine 1 g·kg−1·h−1during the first hour followed by half of these rates of infusions thereafter. Both group received fentanyl 10 g·kg−1, midazolam 0.2 mg·kg−1and vecuronium 0.2 mg·kg−1for induction. These same doses of fentanyl and vecuronium were infused during the first hour then reduced to half. The infusions started after induction and maintained until the end of surgery. Isoflurane was given briefly to control hyperdynamic response to skin incision and sternotomy.Results. In both groups, systolic blood pressure (sBP) and heart rate (HR) decreased significantly after one hour of infusion of the anesthetic solutions, but there were significantly less increase in diastolic blood pressure, sBP, and HR, and less patients required isoflurane supplementation to skin incision in the patients of the DEX group.Discussion. Dexmedetomidine infusion without a bolus appears to be an effective adjunct to fentanyl anesthesia in control of hemodynamic responses to surgery for repair of CHD in children.

scholarly journals Association between Objectively Measured Physical Activity and Arterial Stiffness in Children with Congenital Heart Disease

2021 ◽  
Vol 10 (15) ◽  
pp. 3266
Author(s):  
Laura Willinger ◽  
Leon Brudy ◽  
Renate Oberhoffer-Fritz ◽  
Peter Ewert ◽  
Jan Müller
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Heart Rate ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Arterial Stiffness ◽  
Systolic Blood Pressure ◽  
Congenital Heart ◽  
Z Score ◽  
Objectively Measured

Background: The association between physical activity (PA) and arterial stiffness is particularly important in children with congenital heart disease (CHD) who are at risk for arterial stiffening. The aim of this study was to examine the association between objectively measured PA and arterial stiffness in children and adolescents with CHD. Methods: In 387 children and adolescents with various CHD (12.2 ± 3.3 years; 162 girls) moderate-to-vigorous PA (MVPA) was assessed with the “Garmin vivofit jr.” for 7 consecutive days. Arterial stiffness parameters including pulse wave velocity (PWV) and central systolic blood pressure (cSBP) were non-invasively assessed by oscillometric measurement via Mobil-O-Graph®. Results: MVPA was not associated with PWV (ß = −0.025, p = 0.446) and cSBP (ß = −0.020, p = 0.552) in children with CHD after adjusting for age, sex, BMI z-score, peripheral systolic blood pressure, heart rate and hypertensive agents. Children with CHD were remarkably active with 80% of the study population reaching the WHO recommendation of average 60 min of MVPA per day. Arterial stiffness did not differ between low-active and high-active CHD group after adjusting for age, sex, BMI z-score, peripheral systolic blood pressure, heart rate and hypertensive agents (PWV: F = 0.530, p = 0.467; cSBP: F = 0.843, p = 0.359). Conclusion: In this active cohort, no association between PA and arterial stiffness was found. Longer exposure to the respective risk factors of physical inactivity might be necessary to determine an impact of PA on the vascular system.

0744 Cardiac Safety Profile of Pitolisant in Patients with Narcolepsy

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A283-A283
Author(s):  
W Winter ◽  
S P Wanaski ◽  
A Patroneva ◽  
J M Dayno
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Pooled Analysis ◽  
Mean Difference ◽  
Qtc Interval ◽  
Cardiac Safety ◽  
Open Label ◽  
Long Term Study ◽  
End Of Treatment

Abstract Introduction Cardiovascular diseases are comorbid in patients with narcolepsy. Cardiovascular adverse effects are of concern with narcolepsy medications because of this comorbidity and most patients require lifelong pharmacotherapy. Pitolisant, a selective histamine 3 (H3)-receptor antagonist/inverse agonist, increases histamine transmission in the brain. In a QT study of healthy volunteers, pitolisant (35.6 mg/day) led to a mean increase of 4.2 msec in QTc interval. This analysis further characterized the cardiac safety of pitolisant (maximum dose, 35.6 mg/day) in adults with narcolepsy. Methods Data were obtained from a pooled analysis of 2 randomized, placebo-controlled, 7- or 8-week studies and from a 12-month, open-label study. Results Pooled analysis included 166 patients (pitolisant, n=85; placebo, n=81). Mean change in heart rate from baseline to end-of-treatment was -0.5 beats/min with pitolisant and -0.2 beats/min with placebo (LS mean difference, -0.4; P=0.744). Mean change was also similar for pitolisant versus placebo in systolic (LS mean difference, 0.0; P=0.983) and diastolic (LS mean difference, -0.6; P=0.552) blood pressure, as was mean change in QTc interval (LS mean difference, 0.4; P=0.911). Cardiac adverse events with pitolisant included heart rate increase (n=4), right bundle branch block (n=1), sinus tachycardia (n=1), and palpitations (n=1), and with placebo included blood pressure increase (n=1). In the long-term study, mean change from baseline in QTc interval was 3.1 msec at Month 6 (n=70) and 6.1 msec at Month 12 (n=67); 3 patients had a postbaseline increase >60 msec but none had QTc >500 msec. Conclusion In this analysis, no cardiac safety signals were observed during treatment with pitolisant administered up to the maximum recommended dose. Because concomitant use of pitolisant with other drugs known to increase the QT interval may add to the QT effects of pitolisant, avoid use of pitolisant in combination with these medications. Support Bioprojet Pharma and Harmony Biosciences, LLC.

The pharmacodynamics of dexmedetomidine in elderly cardiac patients undergoing analgosedation in the ICU

2018 ◽  
Vol 86 (4) ◽  
pp. 265
Author(s):  
Justyna Alicja Ber ◽  
Mirosław Malec ◽  
Agnieszka Bienert ◽  
Małgorzata Nowicka ◽  
Łukasz Żurański ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Single Dose ◽  
Cardiac Index ◽  
Mean Arterial Blood Pressure ◽  
Bispectral Index ◽  
Cardiac Patients ◽  
Health Conditions ◽  
Arterial Blood ◽  
Dexmedetomidine Infusion

Aim. This study aimed to evaluate the pharmacodynamics of dexmedetomidine in elderly cardiac patients.Material and Methods. Twelve patients of 60 years or older and need for analgesia after surgery or as a result of critical health conditions were included into our study. Dexmedetomidine was administered intravenously as a continuous infusion without the initial dose. At the beginning the infusion was started at the rate of 0.7 μg/kg/h and then it was continued in the range of 0.17–1.39 μg/kg/h according to desired level of sedation. Information about heart rate, systolic, diastolic and mean arterial blood pressure, bispectral index and cardiac index were collected a few minutes before, during and in 12 hours after infusion of dexmedetomidine.Results. The hemodynamic data as well as BIS level were collected from 12 patients. The duration of dexmedetomidine infusion was less than 9 hours. For each patient the reduction in blood pressure and heart rate compared to the value before dexmedetomidine infusion was observed. We did not observe bradycardia in any patient. Appropriate sedation level was achieved using only dexmedetomidine and ranged from 60 to 80. In only 2 cases it was necessary to give a single dose of another sedative.Conclusions. To conclude, in the patients’ population involved in the study, which included older cardiac patients dexmedetomidne has been shown as a sedative agent which enabled to achieve desire level of sedation in the recommended ranges without episodes of bradycardia, however hypotension events were noted.

scholarly journals TAP Block in Children: Does Inflammation Affect on Pain Score?

2018 ◽  
Vol 3 (09) ◽  
Author(s):  
Odgerel B. ◽  
Sergelen O. ◽  
Ganbold L.
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Pain Intensity ◽  
Skin Incision ◽  
Control Group ◽  
Study Group ◽  
Tap Block ◽  
Ultrasound Guided ◽  
Analgesic Requirement ◽  
Open Laparotomy

Objective: The aim of this study was to evaluate of analgesic effect of ultrasound guided transversus abdomines plane (TAP) block in children undergoing open laparotomy surgery and compare to children were used general anesthesia (GA) alone. Methods: 60 children aged 3-18 years with ASA I-III classification were randomly enrolled in this study. We divided these children in to two groups: control group (GA alone, n=31) and study group (GA+TAP block, n=29) and also divided each group in two subgroups which were with inflammation and without inflammation. All children were received GA with same techniques. Study group (TAP block group) were assigned to receive ultrasound guided block in both side of abdomen using 0.3 ml/kg of Bupivacaine 0.25%, but not more than 12 ml in each side. Hemodynamic variables such as heart rate, blood pressure were measured at baseline (T0), after induction (T1), after skin incision (T2), and end of surgery (T3), and in the recovery room or ICU, at the 2nd, 4th, 6th hours  postoperatively and examined pain intensity and analgesic requirement and frequency, also correllation between inflamatory process and pain intensity were studied. Statistic analysis was made in Excel using ANOVA, descriptive analysis, correlation and regression analysis. A p-value<0.05 was considered significant. Results: There was no differencies between the two studied groups regarding demographic and clinical characteristics. Intraoperative heart rate elevation was higher in GA group with an inflammation (13.3%) and the systolic blood pressure changes was higher (4.2%) after skin incision than study group and GA group without inflammation.  Level of WBC had very weak positive and statistically significant correlation with intraoperative opioid usage (GA+Inf: r=0.029, p=0.023; ТAP+Inf: r=0.18, p=0.016; GA-Inf: r=0.018, p=0.014) but there was not observed correlation in TAP-Inf group. Postopeative pain score was higher in control group and an analgesic requirement and frequency was much more. Conclusion: Transversus abdomines plane block under ultrasound guidance was easy, safe, reliable and effective analgesic in children undergoing open laparotomy surgery and TAP block is a good component of postoperative multimodal analgesia. The inflammatory process increases pain intensity and intra and postoperative analgesic requirements.

scholarly journals Treatment of intraoperative hypotension with cafedrine/theodrenaline versus ephedrine

2020 ◽  
Author(s):  
L. Eberhart ◽  
◽  
G. Geldner ◽  
A. Kowark ◽  
T.-P. Zucker ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Treatment Satisfaction ◽  
Open Label ◽  
Post Hoc Analysis ◽  
Intraoperative Hypotension ◽  
Sympathomimetic Drugs ◽  
Restore Blood Pressure ◽  
Secondary Endpoints ◽  
Post Hoc

Abstract Background Sympathomimetic drugs are a therapeutic cornerstone for the management of hypotensive states like intraoperative hypotension (IOH). While cafedrine/theodrenaline (C/T) is widely used in Germany to restore blood pressure in patients with IOH, more research is required to compare its effectiveness with alternatives such as ephedrine (E) that are more commonly available internationally. Methods HYPOTENS (NCT02893241, DRKS00010740) was a prospective, national, multicenter, open-label, two-armed, non-interventional study that compared C/T with E for treatment of IOH. We describe a prospectively defined cohort of patients ≥50 years old with comorbidities undergoing general anesthesia induced with propofol and fentanyl. Primary objectives were to examine treatment precision, rapidity of onset and the ability to restore blood pressure without relevant increases in heart rate. Secondary endpoints were treatment satisfaction and the number of required additional boluses or other accompanying measures. Results A total of 1496 patients were included in the per protocol analysis. Overall, effective stabilization of blood pressure was achieved with both C/T and E. Post-hoc analysis showed that blood pressure increase from baseline was more pronounced with C/T. Fewer additional boluses or other accompanying measures were required in the C/T arm. The incidence of tachycardia was comparable between groups. Post-hoc analysis showed that E produced dose-dependent elevated heart rate values. By contrast, heart rate remained stable in patients treated with C/T. Physicians reported a higher level of treatment satisfaction with C/T, with a higher proportion of anesthetists rating treatment precision and rapidity of onset as good or very good when compared with E. Conclusion Neither drug was superior in restoring blood pressure levels; however, post-hoc analyses suggested that treatment is more goal-orientated and easier to control with C/T. Heart rate was shown to be more stable with C/T and fewer additional interventions were required to restore blood pressure, which could have contributed to the increased treatment satisfaction reported by anesthetists using C/T.

Abstract 200: Glycopyrrolate Does Not Ameliorate Bradycardia During Prolonged Cooling in Awake Subjects

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Jon C Rittenberger ◽  
Alex Weissman ◽  
Kate Flickinger ◽  
Francis X Guyette ◽  
Melissa Repine ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Arterial Blood Pressure ◽  
Core Temperature ◽  
Mean Arterial Blood Pressure ◽  
Anticholinergic Drugs ◽  
Surface Cooling ◽  
Vessel Occlusion ◽  
Arterial Blood ◽  
Dexmedetomidine Infusion

Introduction: Hypothermia may help improve outcomes in patients with large vessel occlusion cerebrovascular accidents or other reversible ischemia. Dexmedetomidine infusion reduces shivering in awake subjects undergoing hypothermia but has dose-limiting bradycardia. If vagally mediated, anticholinergic drugs might reduce bradycardia. Hypothesis: Glycopyrrolate prevents bradycardia during dexmedetomidine-assisted prolonged hypothermia. Methods: Eight healthy subjects were randomly assigned to 0.4mg glycopyrrolate bolus, glycopyrrolate rescue (0.01mg every 3 minutes as needed for heart rate <50), or no glycopyrrolate during three separate sessions of 3 hours cooling. Following 1mg/kg dexmedetomidine bolus, subjects received 20cc/kg of (4 0 C) cold saline and surface cooling (EM COOLS, Weinerdorf Austria). Dexmedetomidine infusion was titrated to suppress shivering but allow arousal to verbal stimuli. After 3 hours of cooling, we allowed subjects to rewarm. We compared heart rate, core temperature, and mean arterial blood pressure between groups using Kruskal-Wallis test and ANOVA. Results: Mean age was 27 (SD 6) years and most (N=6, 75%) were male. Mean pre-treatment resting heart rate was 73 [SD 13] bpm. Neither heart rate nor core temperature differed between the groups during the stable hypothermia period (p>0.05). (Figure) Mean arterial blood pressure was higher in the glycopyrrolate bolus group than the other two groups during the study period (p<0.048). Conclusions: Glycopyrrolate did not prevent the bradycardic response to hypothermia and dexmedetomidine. Mean arterial blood pressure was higher in subjects receiving a bolus of glycopyrrolate before induction of hypothermia.

Effect of a music intervention on noise annoyance, heart rate, and blood pressure in cardiac surgery patients

1997 ◽  
Vol 6 (3) ◽  
pp. 183-191 ◽  
Author(s):  
JF Byers ◽  
KA Smyth
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Critical Care ◽  
Cardiac Surgery ◽  
Systolic Blood Pressure ◽  
Repeated Measures ◽  
Critical Care Unit ◽  
Noise Sensitivity ◽  
Music Intervention ◽  
Noise Annoyance

BACKGROUND: Exposure to noise in a critical care unit may trigger a response by the sympathetic nervous system, thereby increasing cardiovascular work in patients recovering from cardiac surgery. OBJECTIVE: To investigate the effects of a music intervention given twice on the first postoperative day on noise annoyance, heart rate, and arterial blood pressure in subjects with high (n = 22) and low (n = 18) sensitivity to noise. METHODS: A prospective, quasi-experimental, repeated-measures design was used. Based on results of power analysis, the sample size was 40. Subjects were recruited preoperatively, and their sensitivity to noise was assessed. On the first postoperative day, repeated-measures data were collected on levels of noise annoyance and physiological variables during 15 minutes of baseline and 15 minutes of music intervention on two occasions. Subjects completed a follow-up questionnaire regarding their perceptions of the noise in the critical care unit and the music intervention. RESULTS: Repeated-measures analysis of variance showed that subjects had lower levels of noise annoyance during music intervention than at baseline. Heart rate and systolic blood pressure decreased during the music intervention compared with baseline. Diastolic blood pressure decreased during the music intervention from baseline during time 2, but not time 1. Subjects with high baseline scores of noise sensitivity preoperatively had higher baseline levels of noise annoyance in the critical care unit the first postoperative day. Subjects rated the music intervention as highly enjoyable regardless of their baseline noise sensitivity or noise annoyance. CONCLUSION: Results of this study support the idea that noise annoyance is a highly individual phenomenon, influenced by a transaction of personal and environmental factors. Use of a music intervention with cardiac surgery patients during the first postoperative day decreased noise annoyance, heart rate, and systolic blood pressure, regardless of the subject's noise sensitivity.

Comparison of Adenosine and Remifentanil Infusions as Adjuvants to Desflurane Anesthesia 

1999 ◽  
Vol 90 (4) ◽  
pp. 956-963 ◽  
Author(s):  
Eduardo Zarate ◽  
Monica M. Sa Rego ◽  
Paul F. White ◽  
Larry Duffy ◽  
Vance E. Shearer ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Nitrous Oxide ◽  
Systolic Blood Pressure ◽  
Opioid Analgesic ◽  
Opioid Analgesics ◽  
Skin Incision ◽  
Treatment Groups ◽  
Intraoperative Period ◽  
Double Blinded

Background Because adenosine has been alleged to produce both anesthetic and analgesic sparing effects, a randomized, double-blinded study was designed to compare the perioperative effects of adenosine and remifentanil when administered as intravenous adjuvants during general anesthesia for major gynecologic procedures. Methods Thirty-two women were assigned randomly to one of two drug treatment groups. After premedication with 0.04 mg/kg intravenous midazolam, anesthesia was induced with 2 micro/kg intravenous fentanyl, 1.5 mg/kg intravenous propofol, and 0.6 mg/kg intravenous rocuronium, and maintained with desflurane, 2%, and nitrous oxide, 65%, in oxygen. Before skin incision, an infusion of either remifentanil (0.02 microg x kg(-1) x min(-1)) or adenosine (25 microg x kg(-1) x min(-1)) was started and subsequently titrated to maintain systolic blood pressure, heart rate, or both within 10-15% of the preincision values. Results Adenosine and remifentanil infusions were effective anesthetic adjuvants during lower abdominal surgery. Use of adenosine (mean +/- SEM, 166+/-17 microg x kg(-1) x min(-1)) was associated with a significantly greater decrease in systolic blood pressure and higher heart rate values compared with remifentanil (mean +/- SEM, 0.2+/-0.03 microg kg(-1) x min(-1)). Total postoperative opioid analgesic use was 45% and 27% lower in the adenosine group at 0-2 h and 2-24 h after surgery, respectively. Conclusions Adjunctive use of a variable-rate infusion of adenosine during desflurane-nitrous oxide anesthesia was associated with acceptable hemodynamic stability during the intraoperative period. Compared with remifentanil, intraoperative use of adenosine was associated with a decreased requirement for opioid analgesics during the first 24 h after operation.

Effect of position on selected hemodynamic parameters in postoperative cardiac surgery patients

1994 ◽  
Vol 3 (4) ◽  
pp. 289-299 ◽  
Author(s):  
RJ Emerson ◽  
JL Banasik
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiac Surgery ◽  
Central Venous Pressure ◽  
Lung Disease ◽  
Artery Bypass ◽  
Venous Pressure ◽  
Bypass Graft ◽  
Central Venous ◽  
Noninvasive Blood Pressure

BACKGROUND: Indirect/noninvasive blood pressure, heart rate and central venous pressure are frequently monitored hemodynamic parameters in postoperative cardiac surgery patients. No previous studies have explored the effect of lateral position on these variables in this population. OBJECTIVES: To determine differences in (1) blood pressure, central venous pressure, or heart rate measurements among postoperative cardiac surgery patients due to position (supine, 45 degrees right lateral, and 45 degrees left lateral), (2) responses to position between patients having cardiac surgery in which the myocardium was opened (valvular replacement) and those in which it was not (coronary artery bypass graft), and (3) responses to position between cardiac surgery patients having preoperatively diagnosed lung disease and those without lung disease. METHODS: Phlebostatic axis in lateral positions was determined by echocardiography and geometric diagrams prior to the initiation of data collection. Postoperative cardiac surgery patients (N = 120) were studied in the three positions in random sequences. In each position, simultaneous blood pressure measurements were obtained from each arm, and central venous pressure and heart rate were recorded. RESULTS: Statistically significant differences were found in response to position in systolic and diastolic blood pressure, central venous pressure, and heart rate. Certain positions produced greater changes in selected variables, both in the total group and within specific subgroups. No differences were found between coronary artery bypass graft and valve (closed or opened myocardium) subgroups or between subgroups with and without lung disease. CONCLUSIONS: Lateral positioning of postoperative cardiac surgery patients appears to cause no detrimental effects on indirect/noninvasive blood pressure or heart rate measurements. However, significant differences in central venous pressure may occur and supine positioning for determination of central venous pressure is recommended.

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