A comparative study of dexmedetomidine propofol and midazolam with respect to changes in mean arterial pressure and SpO2 after sedation at tertiary health care centre

2021 ◽  
Vol 16 (3) ◽  
pp. 148-152
Author(s):  
Surabhi Gupta ◽  
Keyword(s):  
Blood Pressure ◽  
Health Care ◽  
Age Distribution ◽  
Cardiovascular Responses ◽  
P Value ◽  
Open Label ◽  
Health Care Centre ◽  
Male Predominance ◽  
Midazolam Group ◽  
Arterial Blood

Background: Sedation is an important component of compassionate care in ICU patients to promote rest and sleep. The sedatives used most often include propofol and midazolam. These medications provide adequate sedation but also can cause oversedation. The α2 agonist dexmedetomidine have unique sedative properties that it produces only mild cognitive impairment, allowing easy communication between health-care provider and patient in the ICU. We therefore compared the sedative and analgesic properties, cardiovascular responses, ventilation and extubation characteristics, and patient perceptions of dexmedetomidine with those of the commonly used i.v. sedative agent propofol in the ICU. Material and Methods: Present study was a randomized. open label trial conducted in the ICU ppatients >18 years of age, who required immediate sedation as to permit the initiation and tolerance of mechanical ventilation. 30 patients each were randomly allocated to dexmedetomidine, propofol & midazolam group. Results: Male predominance was noted, in all groups (dexmedetomidine, propofol & midazolam), M:F ratio was 1.3 : 1. According to age distribution most common age group in dexmedetomidine, propofol & midazolam group was 31-45 years (40 %). At all times the difference in systolic blood pressure, diastolic blood pressure, SpO2, mean arterial blood pressure among all the three groups calculated by ANOVA test was not statistically significant (P>0.05). The mean time (hours) from cessation of sedation to extubation for dexmedetomidine is 7.4 hours, for propofol is 5.6 hours and for midazolam is 16.9 hours. P-value of dexmedetomidine, propofol and midazolam group is <0.001, which is statistically significant. Conclusion: Dexmedetomidine provides hemodynamic stability and have no clinically important adverse effects on respiration in terms of mean SpO2. Tracheal extubation was earlier in patients receiving dexmedetomidine and propofol than from midazolam.

scholarly journals Plasticity in breathing and arterial blood pressure following acute intermittent hypercapnic hypoxia in infant rat pups with a partial loss of 5-HT neurons

2015 ◽  
Vol 309 (10) ◽  
pp. R1273-R1284 ◽  
Author(s):  
Jennifer Magnusson ◽  
Kevin J. Cummings
Keyword(s):  
Blood Pressure ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Arterial Blood Pressure ◽  
Cardiovascular Responses ◽  
Partial Loss ◽  
Rat Pups ◽  
Arterial Blood ◽  
Hypercapnic Hypoxia ◽  
Long Term Facilitation

The role of serotonin (5-HT) neurons in cardiovascular responses to acute intermittent hypoxia (AIH) has not been studied in the neonatal period. We hypothesized that a partial loss of 5-HT neurons would reduce arterial blood pressure (BP) at rest, increase the fall in BP during hypoxia, and reduce the long-term facilitation of breathing (vLTF) and BP following AIH. We exposed 2-wk-old, 5,7-dihydroxytryptamine-treated and controls to AIH (10% O2; n = 13 control, 14 treated), acute intermittent hypercapnia (5% CO2; n = 12 and 11), or acute intermittent hypercapnic hypoxia (AIHH; 10% O2, 5% CO2; n = 15 and 17). We gave five 5-min challenges of AIH and acute intermittent hypercapnia, and twenty ∼20-s challenges of AIHH to mimic sleep apnea. Systolic BP (sBP), diastolic BP, mean arterial pressure, heart rate (HR), ventilation (V̇e), and metabolic rate (V̇o2) were continuously monitored. 5,7-Dihydroxytryptamine induced an ∼35% loss of 5-HT neurons from the medullary raphe. Compared with controls, pups deficient in 5-HT neurons had reduced resting sBP (∼6 mmHg), mean arterial pressure (∼5 mmHg), and HR (56 beats/min), and experienced a reduced drop in BP during hypoxia. AIHH induced vLTF in both groups, reflected in increased V̇e and V̇e/V̇o2, and decreased arterial Pco2. The sBP of pups deficient in 5-HT neurons, but not controls, was increased 1 h following AIHH. Our data suggest that a relatively small loss of 5-HT neurons compromises resting BP and HR, but has no influence on ventilatory plasticity induced by AIHH. AIHH may be useful for reversing cardiorespiratory defects related to partial 5-HT system dysfunction.

Interactions between ANG II, sympathetic nervous system, and baroreceptor reflexes in regulation of blood pressure

1992 ◽  
Vol 262 (6) ◽  
pp. E763-E778 ◽  
Author(s):  
I. A. Reid
Keyword(s):  
Blood Pressure ◽  
Nervous System ◽  
Sympathetic Nervous System ◽  
Blood Pressure Control ◽  
Cardiovascular Responses ◽  
Pressure Control ◽  
Ang Ii ◽  
Arterial Blood ◽  
Baroreceptor Reflexes ◽  
Sympathetic Nervous

The renin-angiotensin system plays an important role in the regulation of arterial blood pressure and in the development of some forms of clinical and experimental hypertension. It is an important blood pressure control system in its own right but also interacts extensively with other blood pressure control systems, including the sympathetic nervous system and the baroreceptor reflexes. Angiotensin (ANG) II exerts several actions on the sympathetic nervous system. These include a central action to increase sympathetic outflow, stimulatory effects on sympathetic ganglia and the adrenal medulla, and actions at sympathetic nerve endings that serve to facilitate sympathetic neurotransmission. ANG II also interacts with baroreceptor reflexes. For example, it acts centrally to modulate the baroreflex control of heart rate, and this accounts for its ability to increase blood pressure without causing a reflex bradycardia. The physiological significance of these actions of ANG II is not fully understood. Most evidence indicates that the actions of ANG to enhance sympathetic activity do not contribute significantly to the pressor response to exogenous ANG II. On the other hand, there is considerable evidence that the actions of endogenous ANG II on the sympathetic nervous system enhance the cardiovascular responses elicited by activation of the sympathetic nervous system.

Ascending pathways mediating somatoautonomic reflexes in exercising dogs

1987 ◽  
Vol 62 (3) ◽  
pp. 1186-1191 ◽  
Author(s):  
J. W. Kozelka ◽  
G. W. Christy ◽  
R. D. Wurster
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Surgical Techniques ◽  
Arterial Occlusion ◽  
Cardiovascular Responses ◽  
Spinal Pathways ◽  
Arterial Blood ◽  
Bilateral Carotid ◽  
Dorsolateral Funiculus ◽  
Carotid Arterial

The ascending spinal pathways mediating somatocardiovascular reflexes during exercise were studied in unanesthetized dogs by placing lesions in the lumbar spinal cord. After training to run on a treadmill with hindlimbs only, 20 dogs were anesthetized and instrumented using sterile surgical techniques. To chronically record heart rate and arterial blood pressure, the aorta was cannulated via the omocervical artery. To test the intactness of descending spinal sympathetic pathways, reflex pressor responses to baroreceptor hypotension were produced by bilateral carotid arterial occlusion using pneumatic vessel occluders placed around the common carotid arteries. To generate transient ischemic exercise (120 s), a pneumatic occluder was placed around the left iliac artery. Eight to 10 days after instrumentation, blood pressure and heart rate were monitored at rest and during hindlimb running with and without simultaneous iliac arterial occlusion. The modest pressor response and tachycardia elicited by hindlimb exercise were markedly augmented by simultaneous hindlimb ischemia (i.e., iliac arterial occlusion). Lesion placement in the dorsolateral sulcus area and the dorsolateral funiculus at L2 significantly reduced the blood pressure and heart rate responses to simultaneous exercise occlusion. The cardiovascular responses to nonischemic exercise and bilateral carotid arterial occlusion were not altered by such spinal sections. It is concluded that in the dog the ascending spinal pathways mediating cardiovascular responses to ischemic exercise are located in the lateral funiculus, including the dorsolateral sulcus area and dorsolateral funiculus.

scholarly journals Immunisation-related Knowledge, Attitudes and Promotive Practices among Mothers in an Urban Primary Health Care Centre in South-East Nigeria: a Call for Improved Clinic-based Education

2020 ◽  
Vol 3 (2) ◽  
pp. 1-16
Author(s):  
I Okedo-Alex ◽  
I Akamike ◽  
A Adeke ◽  
C Uneke
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Maternal Education ◽  
Primary Health Care Centre ◽  
Childhood Vaccination ◽  
P Value ◽  
Care Centre ◽  
Health Care Centre ◽  
Adequate Knowledge ◽  
Primary Health

Background: Nigeria is among the five countries accounting for half of the world’s unimmunised children. Maternal knowledge and attitude play key roles in uptake and timeliness of routine childhood vaccination. This study assessed immunisation-related knowledge, attitudes and promotive practices among mothers in Abakaliki Ebonyi State Nigeria. Methods: This was a cross-sectional study among 117 mothers with children aged 0-23 months attending a Primary Health Care Centre in Abakaliki, Ebonyi State. Data were collected using an interviewer-administered questionnaire and analysed using SPSS version 20 with a p value of ≤ 0.05 considered statistically significant.Results: Over half (55.6%) of the respondents were aged 26-35years while 47% had secondary school education. Majority (91.5%) had previously vaccinated their children, but only 31.7% knew the dosing of polio vaccine. Less than half (42%) of the mothers had adequate knowledge about routes of vaccine administration. About half (49.7%) had adequate knowledge about the children’s next vaccination appointments. Most (94%) considered immunisation important in preventing childhood diseases with up to 95% of them willing to bring their children for immunisation. Only 57.3% were satisfied with the adequacy of immunisation-related information received from the clinic. Majority (81.2%) were timely in accessing immunisation for their babies. Educational status (P=0.035) and child’s age (P=0.008) were associated with knowledge and practice of immunisation respectively. Conclusion: Mothers in this study had good immunisation-related practices and positive attitude towards immunisation. Although majority had good knowledge, some knowledge gaps were identified. We recommend improved maternal education and content of clinic-based education on immunisation.

scholarly journals Clinical and Morphological Profile of Immune Thrombocytopenic Purpura in Children - A Five Year Study in a Paediatric Tertiary Health Care Centre of South India

2020 ◽  
Vol 7 (46) ◽  
pp. 2724-2729
Author(s):  
Ashida M. Krishnan ◽  
Deepthi Raj M.L ◽  
Priya V.S ◽  
Arya R.S
Keyword(s):  
Health Care ◽  
Bone Marrow ◽  
Immune Thrombocytopenic Purpura ◽  
Peripheral Blood ◽  
South India ◽  
P Value ◽  
Severe Thrombocytopenia ◽  
Care Centre ◽  
Health Care Centre ◽  
Thrombocytopenic Purpura

BACKGROUND Immune Thrombocytopenic Purpura (ITP) is one of the most commonly encountered disease in paediatric practice. Thorough clinical and morphological study of peripheral blood and bone marrow is required for confirming ITP. Clinicomorphological aspects of paediatric ITP is a less studied topic especially in developing countries like India. The objective was to study the clinical and morphological profile of paediatric cases of ITP. METHODS This is a 5-year record based retrospective study conducted in a paediatric tertiary health care centre in Kerala, South India. Data of all paediatric cases diagnosed as ITP including clinical presentation, clinical findings, blood counts, peripheral blood morphology, bone marrow morphology, and treatment response was collected and entered in SPSS software version 16.0 and analysed. For assessing correlation, chi-square test was used. RESULTS The age of children ranged from 3 months to 15 years. H/o viral fever was noted in 53 % cases. Cases which had moderate and severe thrombocytopenia were 74 % and 21 % respectively. Isolated thrombocytopenia was the most common peripheral blood picture observed with few cases showing coexisting eosinophilia and anaemia. All cases showed megakaryocyte proliferation in marrow with 9 % cases showing coexisting iron deficiency anaemia. Majority of cases showed rapid response to steroid / IVIG therapy and the response had no correlation with grade of thrombocytopenia (p value < 0.05). CONCLUSIONS Paediatric cases of ITP usually present following viral infections or vaccination, with worrisome bleeding episodes, petechiae, ecchymosis or purpura. KEYWORDS ITP, Paediatrics, Platelet Count, Thrombocytopenia, Vaccination

scholarly journals Waist Circumference, Blood Pressure and Lifestyle of Sudanese Population, Khartoum Locality, Sudan 2016

2019 ◽  
pp. 1-8
Author(s):  
Asma Abdelaal Abdalla ◽  
Siham Ahmed Balla ◽  
Amna Abdalla Babiker ◽  
Safaa Abdelhameed Medani ◽  
Rania Abdalla Osman Khalfa ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Waist Circumference ◽  
Physical Exercise ◽  
Age Distribution ◽  
Cross Sectional Study ◽  
P Value ◽  
Cross Sectional ◽  
Men And Women ◽  
Study Population ◽  
The Mean

Aims: To measure the waist circumference of Sudanese adults in Khartoum Locality and its relationship to blood pressure and lifestyle  during celebration of international day of hypertension in May 2016 . Study Design: It was a descriptive cross-sectional study. Place of the Celebration: Khartoum Locality at Alsahaa Alkhadraa (The Green Park). Methodology: A total of 364 adult participants, 196 men and 168 women were interviewed using structured questionnaire. Blood pressure (BP) was measured considering hypertension as ≥ 140 mmHg and ≥ 90 mmHg for systole and diastole BP respectively. Waist circumference was measured using an anthropometric measuring tape at cut-off point of 94 cm and 80 cm for men and women respectively. Data was managed by SPSS version 20 and Chi-square test at 95% CL was used to test the association between waist circumference, blood pressure and life style characteristics. Results: Age distribution of the study population showed 48.2% females and 45.4% males in the middle age group (38-57 years). Two thirds of the study population were hypertensive, 62.8% of males and 64.3% of females. The mean waist circumference of men was 97.82 cm + 16.7, mean Systolic BP was 127 + 22 and mean Diastolic BP was 85 + 15. The mean waist circumference of women was 99.31 + 16.2, mean Systolic was 128 + 24 and mean Diastolic BP was 84 +17. Abnormal waist circumference was found in 61.2% of males and 86.9% of females. Fifty nine (30.1%) of the males and 86 (51.2%) of the females with abnormal waist circumference were hypertensive. The association between abnormal waist circumference and high blood pressure was significant among both sexes, P value = 0.001. Physical exercise and fat and salt foods were not significantly associated waist circumference in both men and women. Conclusion: Two thirds of women and men in the celebrating areas were hypertensive.  Half of women and one third of men were significantly hypertensive and having abnormal waist circumference. Doing physical exercise, avoiding fat and salt foods was insignificantly associated with normal waist circumference. Large survey with representative sample is needed to estimate the real Sudanese waist circumference.  

ACE gene and physical activity, blood pressure, and hypertension: a population study in Finland

2002 ◽  
Vol 92 (6) ◽  
pp. 2508-2512 ◽  
Author(s):  
Ricardo M. Fuentes ◽  
Markus Perola ◽  
Aulikki Nissinen ◽  
Jaakko Tuomilehto
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Leisure Time Physical Activity ◽  
Population Based ◽  
Moderate Intensity ◽  
P Value ◽  
Arterial Blood ◽  
Main Effect ◽  
History Of ◽  
Middle Aged Adults

The study evaluated the association of the insertion/deletion polymorphism of the angiotensin-converting enzyme gene (ACE I/D) with self-reported moderate-intensity leisure time physical activity (MILTPA), arterial blood pressure (BP) and history of hypertension (HT). A representative population-based sample of 721 middle-aged adults (358 women) from two areas of Finland was genotyped for the ACE I/D. After exclusion criteria were applied, 455 subjects (288 women) were selected for the analysis. The distribution of the ACE I/D genotypes did not differ significantly among frequent vs. nonfrequent MILTPA groups (χ2 = 2.556; df = 2; P value = 0.279). The main predictors of BP were male gender, age, body mass index, and arterial pulse. Additionally, tobacco smoking and alcohol consumption also had a significant main effect on diastolic BP. HT was significantly more frequent in subjects with obesity, family history of cardiovascular disease, or lower educational level. As for BP, neither ACE I/D nor MILTPA was associated with HT. The study confirmed recent reports from population-based studies of no association between ACE I/D and physical fitness. The study also confirmed a lack of association between ACE I/D and BP or HT.

scholarly journals Cardiovascular Responses During Downhill Treadmill Walking at Self-Selected Intensity in Older Adults

2013 ◽  
Vol 21 (3) ◽  
pp. 335-347 ◽  
Author(s):  
Mandy L. Gault ◽  
Richard E. Clements ◽  
Mark E.T. Willems
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Peripheral Resistance ◽  
Cardiovascular Responses ◽  
Treadmill Walking ◽  
Metabolic Demand ◽  
Arterial Blood ◽  
Cardiac Strain ◽  
Downhill Walking ◽  
Future Work

Cardiovascular responses of older adults to downhill (DTW, –10% incline) and level treadmill walking (0%) at self-selected walking speed (SSWS) were examined. Fifteen participants (age 68 ± 4 yr, height 1.69 ± 0.08 m, body mass 74.7 ± 8.1 kg) completed two 15-min walks at their SSWS (4.6 ± 0.6 km/hr). Cardiovascular responses were estimated using an arterial-volume finger clamp and infrared plethysmography. Oxygen consumption was 25% lower during DTW and associated with lower values for stroke volume (9.9 ml/beat), cardiac output (1.0 L/min), arteriovenous oxygen difference (a-v O2 diff, 2.4 ml/L), and systolic blood pressure (10 mmHg), with no differences in heart rate or diastolic and mean arterial blood pressure. Total peripheral resistance (TPR) was higher (2.11 mmHg) during DTW. During downhill walking, an exercise performed with reduced cardiac strain, endothelial changes, and reduced metabolic demand may be responsible for the different responses in TPR and a-v O2 diff. Future work is warranted on whether downhill walking is suitable for higher risk populations.

Life Events, Cardiovascular Reactivity, and Risk Behavior in Adolescent Boys

PEDIATRICS ◽  
1995 ◽  
Vol 96 (6) ◽  
pp. 1101-1105
Author(s):  
Sai-Woon Liang ◽  
John M. Jemerin ◽  
Jeanne M. Tschann ◽  
Charles E. Irwin ◽  
Diane W. Wara ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Risk Behavior ◽  
Arterial Blood Pressure ◽  
Life Events ◽  
Cardiovascular Reactivity ◽  
Mean Arterial Blood Pressure ◽  
Cardiovascular Responses ◽  
Adolescent Boys ◽  
Positive Life Events ◽  
Arterial Blood

Background. Risk behavior contributes to injuries, one of the most important sources of morbidity and mortality in adolescents. Although research has shown that environmental stress makes adolescents more likely to engage in risk behavior and to sustain injuries, the magnitude of these associations has been small. Little is known about the role of individual differences in psychobiologic reactivity to stress in moderating the impact of stressful events. In this study, we examined associations among environmental stressors, cardiovascular reactivity to stress, and the level of risk behavior in adolescent boys. Methods. Twenty-four 14- to 16-year-old boys underwent a laboratory protocol designed to measure responses to psychologically and physically stressful tasks. Changes in heart rate and mean arterial blood pressure were measured serially at standard points in the protocol, and levels of positive and negative life events and recent risk behavior were measured using self-report questionnaires. Results. Neither life events nor cardiovascular reactivity were independently associated with risk behavior. Positive life events and mean arterial blood pressure reactivity significantly interacted, however, in predicting risk behavior (R2 increment = .25). Boys with high reactivity who reported numerous positive life events engaged in markedly less risk behavior than their peers. Conclusion. We conclude that adolescents with exaggerated cardiovascular responses to laboratory stressors are associated with less risk behavior in a setting of positive life circumstances. This result suggests that reactivity may exert protective, rather than harmful, influences in some environments.

scholarly journals Prospective observational study to evaluate the efficacy of labetalol versus nifedipine in the management of preeclampsia

2020 ◽  
Vol 9 (4) ◽  
pp. 1448
Author(s):  
Sarulatha D. ◽  
Menaga M.
Keyword(s):  
Blood Pressure ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Tertiary Care ◽  
Age Distribution ◽  
Unknown Etiology ◽  
P Value ◽  
Maternal Risk ◽  
Medical Disorders ◽  
Number Of Patients

Background: Hypertensive disorders of pregnancy are the common medical disorders in pregnancy. It has effects both on expectant mother and fetus. Pre-eclampsia is a pregnancy specific multisystem disorder of unknown etiology, and accounts for 12-18% of maternal mortality. There is general consensus that maternal risk is decreased by antihypertensive treatment that lowers very high blood pressure. Objective of this study was to study the efficacy of oral labetalol versus oral Nifedipine in the management of preeclampsia in the antepartum and intrapartum period.Methods: The present study was conducted in a tertiary care centre, Chennai from October 2013 to September 2014. It was a prospective observational study done in antenatal ward and labor ward. All antenatal women diagnosed to have pre-eclampsia, irrespective of gestation are included in this study.Results: Age distribution of PIH patients and the maximum number of patients were 20-25 years of age. maximum patients of severe preeclampsia were primigravida. Both systolic and diastolic BP in the two groups (oral labetalol and oral Nifedipine groups) were not statistically significant as the p value is >0.005.Conclusions: From this study, authors found that both oral labetalol and oral nifedipine are effective and well tolerated when used for rapid control of blood pressure in severe hypertension of pregnancy.

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