scholarly journals Emergence from Anaesthesia in Supine versus Prone Position in Patients Undergoing Lumbar Laminectomy: A Study of 60 Cases

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Priyanka Goyal ◽  
Manda Nagrale ◽  
Sandeep Joshi
Keyword(s):  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Randomized Trial ◽  
Prone Position ◽  
Supine Position ◽  
Neuromuscular Block ◽  
Vecuronium Bromide ◽  
Before And After ◽  
Complete Reversal

Background. Emergence in supine position in patients undergoing surgery in prone position leads to tachycardia and hypertension, coughing, and the loss of monitoring when patients are rolled to supine position at the end of surgery, aim of this prospective randomized trial was to study whether prone emergence causes less hemodynamic stimulation, coughing, and monitor disconnection compared to supine emergence in patients undergoing lumbar laminectomy. Patients and Methods. This study was conducted on 60 patients who underwent Lumbar laminectomy in prone position. Patients were anaesthetized using injected fentanyl 2 μg kg−1, midazolam 0.1 mg kg−1, and thiopentone 5–6 mg kg−1 and vecuronium bromide. At the end of surgery patients were randomized into prone or supine group of 30 each. Supine group patients were rolled back and prone were left undisturbed. Extubation was done after complete reversal of neuromuscular block. Heart rates and MAP were noted at various points of time. Coughing, vomiting, monitor disconnection if any. Results. Mean arterial pressure and heart rate were significantly higher in supine patients as compared to prone patients before and after extubation (P value < 0.05). Incidence of coughing, vomiting and monitor disconnection was highly significant in prone group than in supine group. Conclusion. Emergence and extubation in prone position can be safely performed in selected group of patients undergoing surgery in prone position.

Emergence from Anesthesia in the Prone versus  Supine Position in Patients Undergoing Lumbar Surgery

2000 ◽  
Vol 93 (4) ◽  
pp. 959-963 ◽  
Author(s):  
Michael A. Olympio ◽  
B. Lee Youngblood ◽  
Robert L. James
Keyword(s):  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Prone Position ◽  
Supine Position ◽  
Volatile Anesthetic ◽  
Baseline Heart Rate ◽  
Lumbar Surgery ◽  
Maximum Increase ◽  
Significant Difference

Background Conventional supine emergence in patients undergoing prone lumbar surgery frequently results in tachycardia, hypertension, coughing, and loss of monitoring as the patient is rolled supine. The prone position might facilitate a smoother emergence because the patient is not disturbed. No data describe this technique. Methods Fifty patients were anesthetized with fentanyl, nitrous oxide, isoflurane, and rocuronium. By the conclusion of surgery, all patients achieved spontaneous ventilation and full reversal of neuromuscular blockade in the prone position, as the volatile anesthetic level was reduced. Baseline heart rate and mean arterial pressure were recorded. Patients were then randomized at time 0 to the supine (n = 24) or prone (n = 21) position as 100% oxygen was administered. Patients in the supine position were then rolled over, while those in the prone position remained undisturbed. Heart rate, mean arterial pressure, and coughs were recorded until extubation. Tracheas were extubated on eye opening or purposeful behavior. Results When compared with the supine group, prone patients had significantly less increase in heart rate (P = 0.0003, maximum increase 9.3 vs. 25 beats/min), less increase in mean arterial pressure (P = 0.0063, maximum increase 4.8 vs. 19 mmHg), less coughing (P = 0.0004, 7.0 vs. 23 coughs), and fewer monitor disconnections (P &lt; 0.0001). Time to extubation from time 0 was similar (4.0 vs. 3.7 min, prone vs. supine). No one required airway rescue. There was no significant difference in need for restraint (three prone, four supine). Conclusions Prone emergence and extubation is associated with less hemodynamic stimulation, less coughing, and less disruption of monitors, without specifically observed adverse effects, when compared with conventional supine techniques.

Effects of Ambulation and Nondependent Transfers on Vital Signs in Patients Receiving Norepinephrine

2017 ◽  
Vol 26 (1) ◽  
pp. 31-36 ◽  
Author(s):  
Rosario Arcaya Nievera ◽  
Ann Fick ◽  
Hilary K. Harris
Keyword(s):  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Physical Therapy ◽  
Arterial Pressure ◽  
Low Dose ◽  
Vital Signs ◽  
Activity Level ◽  
Significant Difference ◽  
Before And After ◽  
Norepinephrine Dose

Purpose To assess the safety of mobilizing patients receiving low-dose norepinephrine (0.05 μg/kg per min) by examining mean arterial pressure and heart rate before and after activity with parameters set by the physician. Background Norepinephrine is a peripheral vasoconstrictor administered for acute hypotension. During activity, blood flows to the periphery to supply muscles with oxygen, which may oppose the norepinephrine vasoconstriction. The safety of mobilizing patients receiving norepinephrine is unclear. Methods Heart rate, mean arterial pressure, norepinephrine dose, and activity performed were extracted retrospectively from charts of 47 cardiothoracic surgery patients during the first patient transfer to chair or ambulation with norepinephrine infusing. Mean arterial pressure and heart rate were compared before and after physical therapy (paired t tests). Differences among norepinephrine doses and physical activity levels were evaluated (Kruskal-Wallis test). Results Forty-one of the 47 patients (87%) tolerated the activity within safe ranges of vital signs. The change in patients’ mean arterial pressure from before to after activity was not significant (P = .16), but a significant increase in heart rate occurred after activity (P &lt; .001). A Kruskal-Wallis test showed no significant difference in the norepinephrine dose and activity level (χ2 = 6.34, P = .17). No instances of cardiopulmonary or respiratory arrest occurred during any physical therapy sessions. Conclusions Infusion of low-dose norepinephrine should not be considered an automatic reason to keep patients on bed rest.

Clinical Trial of the β-Adrenoreceptor-Blocking Agent Tolamolol with the use of 24 Hour Blood Pressure Recordings

1976 ◽  
Vol 51 (s3) ◽  
pp. 545s-547s
Author(s):  
M. J. West ◽  
P. Sleight ◽  
A. J. Honour
Keyword(s):  
Blood Pressure ◽  
Clinical Trial ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Blocking Agent ◽  
Average Blood Pressure ◽  
Before And After

1. The average blood pressure over 24 h and its variability were measured in eight unrestricted subjects before and after commencing therapy with a new β-adrenoreceptor-blocking agent, tolamolol. 2. The drug caused a fall of 15±6 mmHg in mean arterial pressure and heart rate fell by 13 beats/min. The variation in blood pressure and heart rate over 24 h was unchanged after treatment.

Sympathetic and Parasympathetic Components of Reflex Cardiostimulation during Vasodilator Treatment of Hypertension

1978 ◽  
Vol 55 (s4) ◽  
pp. 329s-332s ◽  
Author(s):  
A. J. Man in 't Veld ◽  
G. J. Wenting ◽  
R. P. Verhoeven ◽  
M. A. D. H. Schalekamp
Keyword(s):  
Heart Rate ◽  
Cardiac Output ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Total Peripheral Resistance ◽  
Peripheral Resistance ◽  
Hypertensive Patients ◽  
Treatment Of Hypertension ◽  
Before And After ◽  
Vasodilator Treatment

1. Haemodynamic responses to diazoxide (300 mg intravenously) were studied in 15 hypertensive patients before and after chronic β-adrenoreceptor blockade by 320 mg of propranolol daily. After diazoxide alone, mean arterial pressure and total peripheral resistance were lowered by 24 ± 3 and 35 ± 5% (mean ± sem) respectively. Cardiac output and heart rate rose by 25 ± 9 and 21 ± 3%. During β-adrenoreceptor blockade, the percentage changes of mean arterial pressure, heart rate, cardiac output and total peripheral resistance after vasodilatation were not significantly different from those after diazoxide alone. 2. Atropine, 0·04 mg/kg body weight, was given to 12 hypertensive patients chronically treated with β-adrenoreceptor blockade, before acute vasodilatation by diazoxide. Diazoxide caused no increase in heart rate after combined β-adrenoreceptor and parasympathetic blockade. However, cardiac output rose by 14 ± 5%. 3. We conclude that withdrawal of parasympathetic tone is an important determinant of circulatory homeostasis after acute vasodilatation during β-adrenoreceptor blockade.

Cardiovascular and sympathoadrenal responses to mental stress: influence of beta-blockade

1988 ◽  
Vol 255 (6) ◽  
pp. H1443-H1451 ◽  
Author(s):  
U. Freyschuss ◽  
P. Hjemdahl ◽  
A. Juhlin-Dannfelt ◽  
B. Linde
Keyword(s):  
Heart Rate ◽  
Cardiac Output ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Mental Stress ◽  
Beta Blockade ◽  
Rate Dependent ◽  
Before And After ◽  
Peripheral Vasodilatation ◽  
Arterial Plasma

Cardiovascular, sympathoadrenal, and subjective responses to mental stress induced by a color-word conflict test (CWT) were studied in 30 healthy males before and after intravenous administration of either placebo, beta 1-blockade by metoprolol (0.15 mg/kg), or nonselective beta-blockade by propranolol (0.15 mg/kg). CWT responses were reproducible. Mean arterial pressure increased by 20%. A mainly heart rate-dependent 65% increase in cardiac output (thermodilution) was associated with 25% decreases of both systemic (SVR) and calf vascular (CVR) resistances. Arterial plasma epinephrine (Epi) was doubled, and norepinephrine (NE) increased by 50%. Self-evaluated stress score correlated positively with changes in cardiac output and inversely with changes in SVR during CWT. Both metoprolol and propranolol halved heart rate responses; whereas increases in mean arterial pressure, Epi, and NE were uninfluenced. Metoprolol reduced the increase in stroke volume, and propranolol abolished it. SVR and CVR responses were attenuated by metoprolol and abolished by propranolol. The results suggest that mental stress accelerates the heart through neurogenic mechanisms and that peripheral vasodilatation is achieved through the concerted actions of reduced vasoconstrictor activity and elevated circulating Epi.

Effects of inspiratory loading on left ventricular myocardial blood flow and metabolism

1992 ◽  
Vol 72 (4) ◽  
pp. 1488-1492 ◽  
Author(s):  
S. Khilnani ◽  
L. M. Graver ◽  
K. Balaban ◽  
S. M. Scharf
Keyword(s):  
Heart Rate ◽  
Blood Flow ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Venous Blood ◽  
Median Sternotomy ◽  
Left Ventricular ◽  
Coronary Resistance ◽  
Ventricular Afterload ◽  
Before And After

With airways obstruction, mean pleural pressure decreases. It has been postulated that associated increases in left ventricular afterload increase myocardial O2 demand (MvO2) and coronary blood flow (CBF). We tested this hypothesis in 12 anesthetized mixed-breed dogs. Through a median sternotomy, dogs were instrumented for the measurement of mean arterial pressure, cardiac output, and left anterior descending CBF. A catheter placed in the coronary sinus allowed sampling of left ventricular venous blood. MvO2 was calculated as CBF x (arteriovenous content difference), and coronary resistance was calculated as (mean arterial pressure)/CBF. After closure of the thoracotomy, animals were studied before and during inspiratory threshold loading (IL) of -20 to -25 cmH2O while breathing 100% O2 before and after bilateral cervical vagotomy. During IL, heart rate fell [approximately 20 beats/min (NS prevagotomy, P less than 0.05 postvagotomy)], arterial PCO2 increased [45 to 66 Torr prevagotomy, 45 to 50 Torr postvagotomy (P less than 0.01)], and arterial O2 content was unchanged. CBF increased with IL:41% prevagotomy (P less than 0.01), 18% postvagotomy (P less than 0.02). However, with IL, MvO2 did not increase significantly either pre- or postvagotomy. Coronary resistance decreased with IL [30% prevagotomy, 24% postvagotomy (P less than 0.01)]. In eight dogs, PCO2 was increased by increasing dead space while the animals were mechanically ventilated and paralyzed. Although there was little change in CBF, heart rate fell by an amount equal to that with IL. We conclude that 1) IL causes coronary vasodilation not related to changes in MvO2, PCO2, or vagal tone; 2) MvO2 does not increase with IL; and 3) decreased heart rate with IL is related to hypercapnia and/or acidosis.

Inhalational Anesthetic Technique in Microlaryngeal Surgery: A Comparison between Sevoflurane-Remifentanil and Sevoflurane-Alfentanil Anesthesia

2003 ◽  
Vol 112 (4) ◽  
pp. 373-378 ◽  
Author(s):  
Ageliki K. Pandazi ◽  
Antonios A. Louizos ◽  
John M. Stivaktakis ◽  
Dimitrios J. Davilis ◽  
Loucas G. Georgiou
Keyword(s):  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Side Effects ◽  
Arterial Pressure ◽  
Anesthetic Technique ◽  
Before And After ◽  
Inhalational Anesthetic ◽  
The Mean ◽  
Microlaryngeal Surgery ◽  
Cardiovascular Stability

We studied the effects of sevoflurane, remifentanil hydrochloride, and alfentanil anesthesia in terms of the hemodynamic responses and emergence characteristics of patients scheduled for elective microlaryngeal surgery. Sixty patients (ASA I to III) were randomly allocated into 2 groups: group S-R (sevoflurane-remifentanil) and group S-A (sevoflurane-alfentanil; 1:20 and 1:4 ratios of remifentanil to alfentanil for induction and maintenance of anesthesia, respectively; doses not strictly equipotent). The mean arterial pressure and heart rate were measured before and after induction of anesthesia, 1 and 3 minutes after endotracheal intubation, at the insertion of the operating laryngoscope, and every 3 minutes during surgery. The emergence times and side effects during the first 30 minutes after surgery were also recorded. The mean arterial pressure values at the insertion of the operating laryngoscope and throughout the procedure were significantly greater (p < .05) in group S-A than in group S-R. The emergence times and postoperative side effects did not differ, except for the greater pain score (p < .05) in group S-R. In conclusion, sevoflurane with remifentanil seems to maintain cardiovascular stability during microlaryngeal surgery more effectively than sevoflurane with alfentanil. Both anesthetic regimens seem to provide rapid and uneventful emergence.

Effects of a specific antidiuretic agonist on cardiac output and its distribution in intact and anephric dogs

1988 ◽  
Vol 74 (3) ◽  
pp. 293-299 ◽  
Author(s):  
Jean-Francois Liard
Keyword(s):  
Heart Rate ◽  
Blood Flow ◽  
Cardiac Output ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Total Peripheral Resistance ◽  
Regional Blood Flow ◽  
Peripheral Resistance ◽  
Electromagnetic Flowmeter ◽  
Before And After

1. The specific antidiuretic agonist [4-valine, 8-d-arginine]vasopressin (VDAVP) was administered intravenously to seven conscious dogs at a rate of 10 ng min−1 kg−1. Cardiac output (aortic electromagnetic flowmeter), mean arterial pressure and regional blood flows (radioactive microspheres) were measured before and after 30 min of infusion. 2. Mean arterial pressure fell from 89.9 ± 4.5 (mean ± sem) to 82.3 ± 5.9 mmHg and cardiac output increased from 115.4 ± 8.7 to 163.0 ± 14.4 ml min−1 kg−1. Total peripheral resistance decreased from 41.6 ± 3.7 to 27.8 ± 3.6 units and heart rate increased from 79.2 ± 5.9 to 123.2 ± 5.9 beats/min. Blood flow increased significantly in the myocardium, fat and skeletal muscle vascular bed. 3. In another group of six dogs subjected to a similar protocol 24 h after bilateral nephrectomy, mean arterial pressure fell from 102.2 ± 5.3 to 82.7 ± 3.4 mmHg and cardiac output increased from 125.6 ± 3.0 to 171.2 ± 4.0 ml min−1 kg−1. Total peripheral resistance decreased from 39.3 ± 3.4 to 23.4 ± 1.3 units and heart rate increased from 84 ± 4.9 to 113.3 ± 4.3 beats/min. The increase in cardiac output and the fall in total peripheral resistance did not differ significantly between intact and anephric dogs. Regional blood flow responses differed in some respects in the two groups studied, but there was no evidence that the vasodilatory action of VDAVP depended on the presence of the kidneys. 4. These results indicate that the vasodilatation elicited by the antidiuretic agonist VDAVP in intact dogs is limited to a few vascular beds. Furthermore, this vasodilatation appears to be independent from the renal V2-vasopressin receptors.

scholarly journals Effect of Dexmedetomidine on Perioperative Stress Response and Immune Function in Patients With Tumors

2020 ◽  
Vol 19 ◽  
pp. 153303382097754
Author(s):  
Lihong Zheng ◽  
Juan Zhao ◽  
Likun Zheng ◽  
Shuangfeng Jing ◽  
Xiaoting Wang
Keyword(s):  
Heart Rate ◽  
Stress Response ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Immune Function ◽  
Spontaneous Respiration ◽  
General Anesthetics ◽  
Ifn Γ ◽  
Group D ◽  
Perioperative Stress

Objective: This study aims to investigate the effect of dexmedetomidine on perioperative stress response and immune function in patients with tumors. Methods: Sixty patients who underwent selective radical gastrectomy for cancer were randomly divided into 3 groups: remifentanil group (group R), dexmedetomidine group (group D), and sufentanil group (group S). Remifentanil, dexmedetomidine, and sufentanil were used as general anesthetics. Endotracheal intubation and mechanical ventilation were performed after the spontaneous respiration disappeared. Then, the data were recorded, and blood samples were collected at all time points. Results: The heart rate significantly increased ( P < 0.05) at T1 in group S, and both heart rate and mean arterial pressure significantly increased ( P < 0.05) in group R when compared to group D. The heart rate significantly increased ( P < 0.05) at T2 in group S and group R. Furthermore, the heart rate significantly increased ( P < 0.05) at T3 and T4 in group S and group R. Intra-group comparison: The heart rate at T1–T4 and mean arterial pressure at T1–T4 significantly increased ( P < 0.05) in group S, and the heart rate at T1 and T4, and mean arterial pressure at T2–T4 significantly increased ( P < 0.05) in group R when compared to T0. The serum IL-6, IFN-γ, and β-EP significantly increased ( P < 0.05) at T0’ in group S and group R when compared to group D. Blood glucose, and serum IL-10, IFN-γ, and β-EP significantly increased ( P < 0.05), while IL-18 significantly decreased ( P < 0.05) at T1’ in group S and group R. Conclusion: Continuous infusion of dexmedetomidine in combination with the inhalation of sevoflurane is superior to sevoflurane + remifentanil or sufentanil in patients undergoing tumor surgery.

scholarly journals Preclinical Pharmacology in the Rhesus Monkey of CW 1759-50, a New Ultra-short Acting Nondepolarizing Neuromuscular Blocking Agent, Degraded and Antagonized by L-Cysteine

2018 ◽  
Vol 129 (5) ◽  
pp. 970-988 ◽  
Author(s):  
John J. Savarese ◽  
Hiroshi Sunaga ◽  
Jeff D. McGilvra ◽  
Matthew R. Belmont ◽  
Matthew T. Murrell ◽  
...  
Keyword(s):  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Neuromuscular Blockade ◽  
Blocking Agent ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agent ◽  
Duration Of Action ◽  
Short Acting ◽  
Circulatory Effects

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Structure–activity studies were performed to identify a new neuromuscular blocking agent retaining the ultra-short acting characteristics of gantacurium, including degradation and reversal by l-cysteine, but lacking its histaminoid properties in man. CW 1759-50 has emerged from this program. Methods Adduction of CW 1759-50 with l-cysteine was studied by high-performance liquid chromatography and mass spectrometry. Institutional Animal Care and Use Committee–approved comparisons of CW 1759-50 to gantacurium were performed in rhesus monkeys. ED95 for neuromuscular blockade was established. Spontaneous recovery was compared to reversal by l-cysteine in paired studies of boluses or infusions. In addition, changes in mean arterial pressure and heart rate after very large doses of 15 to 60 × ED95 were compared. Results The half-time of adduction of l-cysteine to CW 1759-50 in vitro was 2.3 min. The ED95 of CW 1759-50 was 0.069 ± 0.02 mg/kg; ED95 of gantacurium was 0.081 ± 0.05 mg/kg (P = 0.006). Duration of action (recovery to 95% twitch height after 98 to 99% blockade) was as follows: CW 1759-50, 8.2 ± 1.5 min; and gantacurium, 7.4 ± 1.9 min; (n = 8 and 9, P = 0.355). Administration of l-cysteine (30 mg/kg) shortened recovery (i.e., induced reversal) from CW 1759-50 after boluses or infusions (P always less than 0.0001). Recovery intervals (5 to 95% twitch) ranged from 6.1 to 6.7 min (and did not differ significantly) after boluses of 0.10 to 0.50 mg/kg, as well as control infusions (P = 0.426 by analysis of variance). Dose ratios comparing changes of 30% in mean arterial pressure or heart rate to ED95 for neuromuscular blockade (ED 30% Δ [mean arterial pressure or heart rate]/ED95) were higher for CW 1759-50 than for gantacurium. Conclusions CW 1759-50, similar to gantacurium, is an ultra-short acting neuromuscular blocking agent, antagonized by l-cysteine, in the monkey. The circulatory effects, however, are much reduced in comparison with gantacurium, suggesting a trial in humans.

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