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Background: Butyrate, a short-chain fatty acid, has shown potential to improve left ventricular (LV) function and induce vasorelaxation in rodents. Butyrate may either be produced by the microbiome in the colon, be ingested or administered intravenously. This study aimed to evaluate effects of butyrate on cardiac output (CO) and associated hemodynamic variables in a porcine model., Methods: In a randomized, blinded crossover study, ten healthy 60-kg pigs were given three hour infusions of 600 mM butyrate and equimolar sodium chloride (control). CO was measured by thermodilution via a pulmonary artery catheter. LV contractility was assessed using pressure-volume admittance catheterization. Additionally, isolated porcine coronary arteries were exposed to butyrate in a wire myograph to evaluate vasorelaxation., Results: Butyrate infusion increased plasma butyrate concentration to 0.53 mM (95 % confidence interval (CI): 0.49 to 0.58 mM, P < 0.58 mM, P < 0.001) and CO by 1.6 L/min (95 % CI: 1.0 to 2.1 L/min, P < 0.001) compared with the control. Heart rate, LV ejection fraction, cardiac efficiency and dP/dt max rose, while systemic vascular resistance, arterial elastance, mean arterial pressure and LV end-systolic volume decreased. Load-independent LV contractility and stroke volume did not significantly differ. In the myograph, porcine coronary arteries relaxed in response to butyrate in a concentration-dependent manner., Conclusion: Butyrate increases cardiac output and lowers vascular resistance in a large animal model, through increased HR and systemic vasorelaxation. Load-independent LV contractility was not significantly altered. We observed indices of increased end-organ perfusion. These potentially beneficial cardiovascular properties of butyrate should be further studied., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.)

Aim: This study aims at comparing the impact of Magnesium Sulfate and Lidocaine sprays on hemodynamic changes after laryngoscopy and tracheal intubation., Design: This double-blind clinical trial (code IRCT20230719058846N1) was conducted on the patients undergoing elective surgery in the city of Karaj., Methods: A total of 100 patients, aged 18 to 40 years and classified as ASA I or II, who were candidates for elective surgery, were randomly assigned to two equal groups. Prior to intubation, patients received lidocaine spray (5 puffs of Lidocaine 10%) in one group, and magnesium sulfate spray (5 puffs of Magnesium 20%) in the other. Induction of anesthesia was the same in both groups. Patients' hemodynamic statuses were measured and compared once before the intubation and also 1, 3, 5, 7 and 10 min after it., Results: Before the intervention, there was no statistically significant difference between the two groups in terms of demographic and hemodynamic variables (P < 0.05). The results showed that the systolic blood pressure at minutes 3, 5, and 7 was significantly lower among the patients receiving magnesium than those receiving lidocaine (P < 0.05). Other hemodynamic variables were not statistically different between the two groups (P < 0.05)., Conclusion: Based on the findings of the present study, magnesium sulfate spray is more effective than lidocaine in controlling hemodynamic complications. Therefore, it can be used to reduce hemodynamic complications following intubation. However, it may be associated with tachycardia, which needs to be taken into account., Competing Interests: Declarations. Ethics approval and consent to participate: This article was approved by the Ethics Committee of Hamadan University of Medical Sciences under the ethics code IR.ABZUMS.REC.1402.086 and registered under IRCT20230719058846N1 on 31/10/2023 in the Iranian Registry of Clinical Trials. All methods performed by the declaration of Helsinki. After explaining the research objectives, we obtained written informed consent from all participants and informed them about the confidentiality of the data. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

To investigate the hemodynamic differences in various brain regions between alcohol dependence (AlcD) patients and healthy controls during a verbal fluency task (VFT) using functional near-infrared spectroscopy (fNIRS), and to further explore the clinical predictive value of fNIRS before therapy for the outcome of relapse in AlcD patients after 3 months. A retrospective survey was conducted on 123 AlcD patients and 149 healthy controls during the same period. Baseline assessment of fNIRS was performed to analyze the hemodynamic differences between the two groups in different brain regions. During hospitalization, AlcD patients underwent a 3-week benzodiazepine substitution therapy, gradually tapering off the medication to achieve alcohol withdrawal treatment goals. Three months after discharge, we conducted follow-up phone calls to assess the relapse status of the patients. Compared to the control group, the AlcD group had significantly lower integral values in the frontal and bilateral temporal lobes, as well as lower β-values in all channels of the frontal lobe except for Ch13, and in all channels of the bilateral temporal lobes (p < 0.005), with no significant difference in the parietal lobe channel(p > 0.05). ROC (Receiver Operating Characteristic Curve) analysis for predicting relapse within 3 months showed that the area under the curve for all channels was highest (0.951, sensitivity 0.924, specificity 0.886). Patients with AlcD exhibit functional impairments in the frontal and temporal lobes. fNIRS channels in the frontal and parietal lobes based on VFT have good clinical predictive value for relapse within 3 months after pharmacotherapy in AlcD and can be applied in clinical practice., Competing Interests: Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: All studies complied with STROBE guidelines. All studies confirm to the principles outlined in the Declaration of Helsinki and have been approved by the Ethics Committee of the First Hospital of Hebei Medical University (Approval No.20220722). Consent for publication: All authors have read and agreed to the published version of the manuscript. Publication permission was granted by the First Hospital of Hebei Medical University., (© 2025. The Author(s).)

Objective: This study aimed to compare the clinical outcomes of midazolam and dexmedetomidine combined with ropivacaine-induced thoracic paravertebral nerve block (TPVB) in radical lung cancer surgery., Methods: To retrospectively analyze the clinical data of elderly patients who underwent thoracoscopic radical lung cancer surgery from March 2020 to February 2023 in our hospital. All patients underwent a single two-site method of TPVB at the levels of T4 and T7 under ultrasound guidance. The patients were divided into midazolam group (0.25 % ropivacaine + 0.1 mg/kg midazolam) and dexmedetomidine group (0.25 % ropivacaine + 0.8 μg/kg dexmedetomidine) according to the application of sedative drugs, with 78 cases in each group. Ramsay sedation score, mean arterial pressure (MAP), heart rate (HR), electroencephalographic bispectral index (BIS), and blood oxygen saturation (SpO2), as well as the serum levels of C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), epinephrine (E), cortisol (Cor), and norepinephrine (NE) were recorded at 6, 12, 24, 36 and 48 h postoperatively, respectively. The patients' cognitive function was assessed using the Brief Mental State Evaluation Scale (MMSE) at 1 d preoperatively, 1 d postoperatively, and 7 d postoperatively., Results: The amount of intraoperative sufentanil in the dexmedetomidine group was lower than that in the midazolam group (P < 0.05). The rate of atropine use was higher in the dexmedetomidine group than that in the midazolam group (P < 0.05). There was no significant difference in the occurrence of overall intraoperative adverse reactions (P > 0.05), but the incidence of respiratory depression in the dexmedetomidine group was significantly lower than that in the midazolam group, and the incidence of bradycardia in the dexmedetomidine group was significantly higher than that in the midazolam group (P < 0.05). At T0 ∼ T4, BIS and MAP showed a decreasing trend in both groups. 12, 24, 36 and 48 h postoperatively, the Ramsay sedation score was higher in the dexmedetomidine group than in the midazolam group (P < 0.05). At 36 and 48 h postoperatively, the serum Cor, E, NE, CRP, TNF-α, and IL-6 levels were lower in the dexmedetomidine group than in the midazolam group (P < 0.05). Compared with the preoperative 1d, the MMSE scores were significantly lower in both groups on one day postoperative, while the MMSE scores were significantly higher at postoperative day 7 than on postoperative day 1 (P < 0.05). At postoperative day 1, the MMSE score was significantly higher in the dexmedetomidine group than in the midazolam group (P < 0.05). The difference in the incidence of adverse events within 72 h postoperatively between the two groups was not statistically significant (3.95 % vs. 1.28 %, χ2 = 0.284, P = 0.594)., Conclusion: Dexmedetomidine compounded with ropivacaine-induced ultrasound-guided thoracic paravertebral nerve block is superior to midazolam for sedation, anti-inflammation, and anti-stress in elderly lung cancer patients., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

This study investigated, for the first time, the potential role of Astragalus polysaccharide (APS) and APS nanoparticles on testicular blood flow (TBF) and semen quality in Ossimi rams. Fifteen sexually mature Ossimi rams were allocated randomly into two treated groups that orally administered either nano APS (2 g/ram/day; n = 5) or APS (20 g/ram/day; n = 5) for four weeks and a control group (n = 5). The nano-emulsion was prepared by adding corn oil to the APS solution, sonicated, centrifuged at 20,000 rpm, then washed 3-4 times, and vacuum dried overnight at 40 °C. The antioxidant activity of APS and APS nano-emulsion was evaluated in vitro. Blood collection and ultrasonographic assessment of the testes and supratesticular arteries (STAs) were conducted immediately before treatment (W0) and once weekly for 6 successive weeks after APS and nano APS administration (W1-W6). Serum testosterone (T) and estradiol (E 2 ) concentrations were determined by ELISA kits, while nitric oxide (NO) and total antioxidant capacity (TAC) were measured spectrophotometrically. Moreover, semen collection and evaluation of some sperm parameters were performed once a week. Results revealed decreases (P < 0.05) in the Doppler indices (resistive index; RI, pulsatility index; PI, and systolic/diastolic; S/D) of the testicular arteries at most time points of the study in the nano APS and APS groups. Pixel intensity (PIX) and integrated density (IND) of testicular parenchyma were significantly reduced (P ˂ 0.05) in the treated groups compared to the control one. T, E 2 , NO, and TAC concentrations increased (P < 0.05) in the treated groups compared to the control one. Increases (P < 0.05) were noticed in the mass motility, progressive motility %, live sperm %, and membrane integrity % in nano APS and APS groups, compared to the control. Rams in the nano APS group had significantly higher (P < 0.05) sperm cell concentration than the control one. In conclusion, this study extrapolated that the dietary administration of APS and its nanoparticles can improve TBF, testicular echotexture, sperm characteristics, and the concentration of serum T, E 2 , NO, and TAC with a more significant effect in the APS nanoparticles compared with APS. So, it could be recommended as a dietary supplementation (2 g/ram/day) for enhancing the reproductive performance of rams., Competing Interests: Declarations. Animal ethics and consent to participate: All methods in this study were performed following the rules and regulations of the Ethics Committee for Animal Use at the Faculty of Veterinary Medicine, Cairo University, Egypt (approval number: Vet CU 25122023867). All authors participate in the final version of the manuscript. Consent to Publish: The manuscript is not under consideration in other journals. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Canagliflozin can reduce the risk of cardiovascular disease in patients except for its targeted antidiabetic effects. However, it remains unknown whether canagliflozin alleviates the post-resuscitation myocardial dysfunction (PRMD) in type 2 diabetes mellitus., Objective: To explore the effects and potential mechanisms of canagliflozin on myocardial function after cardiac arrest (CA) and cardiopulmonary resuscitation (CPR) in a type 2 diabetic rat model., Methods: Twenty-four type 2 diabetic rats were randomized into four groups: (1) sham + canagliflozin, (2) sham + placebo, (3) CPR + placebo, and (4) CPR + canagliflozin. Except for the sham + canagliflozin and placebo groups, both the CPR + placebo and canagliflozin groups underwent 8 min of CPR after the induction of ventricular fibrillation for 6 min. Myocardial function and hemodynamics were assessed at baseline and within 6 h after autonomous circulation (ROSC) return. Left ventricular tissues were sampled to determine the expressions of relevant proteins in the NLRP3 inflammasome pathway., Results: The results demonstrated that the mean arterial pressure (MAP) was significantly improved in the CPR + canagliflozin group after ROSC compared with the CPR + placebo group (p < 0.05). Meanwhile, both ejection fraction (EF) and fraction shortening (FS) were dramatically increased in the CPR + canagliflozin group when compared with the CPR + placebo group at 2h, 4h, and 6h after ROSC (p < 0.05). In addition, the levels of NT-proBNP, cTn-I, and NLRP3 inflammatory inflammasome-associated proteins were significantly decreased in the CPR + canagliflozin group compared with the CPR + placebo group., Conclusions: In type 2 diabetic rats, pretreatment of canagliflozin alleviates PRMD. The potential mechanisms may include inhibition of the NLRP3/caspase-1 signaling pathway., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: To compare the efficacy of dexmedetomidine and fentanyl to reduce hemodynamic and biochemical stress markers associated with endotracheal intubation under general anesthesia., Methods: We performed a prospective randomized controlled study of 80 patients and 20 healthy controls at Assiut University from January to June 2024. The patients were allocated to two groups: Group D received dexmedetomidine and Group F received fentanyl. Blood samples were collected at four time points: T0 (baseline), T1 (2 minutes after induction of anesthesia), T2 (1 minute after intubation), and T3 (10 minutes post-intubation), for stress marker analysis., Results: Intubation significantly increased stress markers in both groups compared to baseline. Group D showed significantly lower cortisol, norepinephrine, and lactate concentrations at T1, T2, and T3; and hemodynamic parameters at T2; whereas Group F demonstrated earlier post-operative recovery., Conclusions: Both drugs increased stress markers, but dexmedetomidine more effectively reduced biochemical marker concentrations, suggesting better stress control, whereas fentanyl use led to quicker recovery. Dexmedetomidine is more effective at reducing intubation-induced stress, whereas fentanyl facilitates faster post-operative recovery., Competing Interests: Declaration of conflicting interestThe authors declare that there is no conflict of interest.

Objective: To determine the effects of esketamine combined with iliac fascia block on haemodynamics and inflammatory stress response in elderly patients undergoing proximal femoral nail anti-rotation (PFNA) surgery., Study Design: A single-centre randomised controlled trial. Place and Duration of the Study: Deparment of Anaesthesiology, the 904th Hospital of the Joint Logistic Support Force of PLA, Wuxi, Jiangsu Province, China, from January to December 2023., Methodology: Eighty elderly patients undergoing PFNA surgery in the authors' hospital were selected as the research objects, regardless of gender, aged >65 years, with a body mass index (BMI) of 18-28 kg/m2, and the American Society of Anaesthesiologists (ASA) scores of II-III. Eighty elderly patients were randomly divided into the following two groups: The observation group (esketamine combined iliac fascia block) and the control group (remifentanil combined iliac fascia block). Heart rate (HR), mean arterial pressure (MAP), and pulse oxygen saturation (SpO2) were recorded at entry (T0), incision (T1), 15 minutes after incision (T2), and at the completion of surgery (T3). Before and 24 hours after surgery, interleukin-6 (IL-6) and C-reactive protein (CRP) were measured. Recovery quality was recorded 24 hours after surgery. The patients' anaesthesia-effect on adverse reactions were recorded during and after surgery., Results: There was a significant difference between the two groups in the following indices: HR, MAP, and SpO2 at T1 (p <0.05). The values of IL-6 and CRP in the control group were prominently higher than those in the observation group 24 hours after surgery (p <0.05). The quality of recovery-15 (QoR-15) score of the control group was prominently lower than that of the observation group. The total incidence of adverse reactions of the control group was prominently higher than that of the observation group (p <0.05)., Conclusion: Implementing an anaesthesia regimen of esketamine combined with iliac fascia block for elderly patients undergoing PFNA surgery can help maintain haemodynamic stability and suppress the inflammatory stress responses., Key Words: Esketamine, Iliac fascia block, Internal fixation with anti-rotation intramedullary nails in the proximal femur, Haemodynamics, Inflammatory stress response.

Purpose: Dobutamine, a sympathomimetic agent, is widely used clinically, influencing cardiac output, heart rate (HR), and blood pressure (BP), which may impact cerebral blood flow (CBF), critical for brain metabolism. However, the effects of dobutamine on CBF and internal carotid artery (ICA) blood flow remain unclear, with contradictory reported in both clinical and animal studies. It is necessary to investigate the effects of dobutamine on cervical and cerebral hemodynamics. This study aimed to evaluate the effects of dobutamine infusion on ICA blood flow and CBF, explore their relationship, and identify factors influencing CBF to facilitate timely monitoring in clinical practice., Methods: Forty-eight healthy volunteers underwent physiological assessment, ICA ultrasound, and brain magnetic resonance imaging (MRI) data before and after the administration of dobutamine. Paired t and Wilcoxon signed-rank tests were used to analyze changes, while logistic regression explored associations between hemodynamic factors and CBF., Results: Dobutamine infusion significantly increased HR, respiration rate, systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure, while blood oxygen remained stable. Compared with those in the resting state, the peak systolic velocity (Vs), resistance index, pulsatility index, and systolic/diastolic ratio (S/D) increased, whereas end-diastolic velocity (Vd) decreased. ICA diameter and mean velocity showed no significant changes. CBF significantly decreased in the anterior and middle cerebral arteries. Logistic regression identified SBP, DBP, and S/D difference as key factors associated with CBF reduction., Conclusions: Dobutamine altered ICA hemodynamics and reduced CBF in anterior and middle cerebral arteries. Real-time ICA ultrasound monitoring provides valuable guidance during clinical use., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests., (Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.)

Dexmedetomidine decreases heart rate (HR) and increases high frequency (HF) component of HR variability (HRV). Analgesia Nociception Index (ANI) measures nociception by analyzing the influence of respiration on HF component of HRV while surgical pleth index (SPI) derives this information from photoplethymographic signals of finger arterioles. Therefore, during administration of dexmedetomidine, reliability of ANI may vary. This study compared the changes in ANI, SPI and hemodynamics (HR and mean arterial pressure [MAP]) during various noxious stimuli with fentanyl and dexmedetomidine intraoperative analgesia. In this trial, patients undergoing elective supratentorial surgery under general anesthesia were randomized to receive either fentanyl or dexmedetomidine infusion for intraoperative analgesia. ANI (instantaneous and mean), SPI, HR and MAP were compared before and after noxious stimuli (intubation, skull pin insertion, skin incision and craniotomy) with respect to magnitude of maximum change in the variable and the time taken for the maximal change (defined as response time) between the groups. A total of 58 patients, 29 in each group were recruited into the study. At intubation, SPI changed significantly more in the fentanyl group compared to dexmedetomidine group (37 versus 20 units, p = 0.007). At skull pinning, ANI values (both instantaneous and mean) changed more in dexmedetomidine group (p = 0.024 and 0.009) with significantly longer response time (p = 0.039). There was no difference between the groups with respect to any of the variables at skin incision and craniotomy. ANI during use of dexmedetomidine and SPI while using fentanyl, might be the better choices as intraoperative nociception monitors., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Introduction: The use of anabolic steroids is widely adopted for aesthetic purposes and sports performance. In supraphysiological doses, they can impair various physiological systems. However, we know little about their effects on the heart, especially when combined with strength training. In this regard, we investigated the effects of nandrolone decanoate at supraphysiological doses, combined with strength training, on cardiac hemodynamic, morphological, and functional parameters using different approaches., Methods: Male Wistar rats (N = 64, 18 weeks old) were divided into two groups (N = 32): vehicle-treated (VEH; peanut oil, 0.2 ml/kg) and nandrolone decanoate-treated (NAN, 5 mg/kg). Half of each group (N = 16) underwent strength training following a progressive load stair protocol three times per week for 12 weeks (T-VEH and T-NAN). All groups had their cardiac hemodynamic, morphological, and functional parameters recorded through two-dimensional echocardiography, while coronary perfusion pressure and left ventricular pressure (LVP) were measured using the Langendorff technique in isolated hearts., Results: Both nandrolone decanoate-treated groups showed higher values of relative cardiac mass, interventricular septum thickness, and final diastolic and systolic diameters of the left ventricle compared to vehicle-treated groups (VEH and T-VEH). The NAN group exhibited reductions in coronary perfusion pressure, LVP, and maximum and minimum dP/dT compared to the VEH and T-VEH groups, while the T-NAN group showed reduced values for coronary perfusion pressure and LVP compared to the VEH group., Conclusions: Nandrolone decanoate treatment at supraphysiological doses reduced left ventricular performance. In turn, strength training appeared to provide minimal attenuation of these impairments., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Type 2 diabetes (T2D) is a metabolic disease associated with cardiovascular dysfunction. The myocardium preferentially uses ketones over free fatty acids as a more energy-efficient substrate. The primary aim was to assess the effects of ketone monoester (K me ) ingestion on cardiac output index ([Formula: see text]i). The secondary aims were to assess the effects of K me ingestion on markers of cardiac hemodynamics, muscle oxygenation, and vascular function at rest, during and following step-incremental cycling. We undertook a double-blind, randomized, crossover design study in 13 adults [age, 66 ± 10 yr; body mass index (BMI), 31.3 ± 7.0 kg·m -2 ] with T2D. Participants completed two conditions, where they ingested a K me (0.115 g·kg -1 ) or a placebo taste-matched drink. Cardiac function was measured using thoracic impedance cardiography, and muscle oxygenation of the calf was determined via near-infrared spectroscopy. Macrovascular endothelial function was measured by flow-mediated dilation (FMD), and microvascular endothelial function was measured via transdermal delivery of acetylcholine (ACh) and insulin. Circulating β-hydroxybutyrate [β-Hb] was measured throughout. K me ingestion raised circulating β-Hb throughout the protocol (peak 1.9 mM; P = 0.001 vs. placebo). K me ingestion increased [Formula: see text]i by 0.75 ± 0.5 L·min -1 ·m -2 ( P = 0.003), stroke volume index by 7.2 ± 4.5 mL·m -2 ( P = 0.001), and peripheral muscle oxygenation by 9.9 ± 7.1% ( P = 0.001) and reduced systemic vascular resistance index by -420 ± -225 dyn·s -1 ·cm -5 ·m -2 ( P = 0.031) compared with the placebo condition. There were no differences between K me and placebo in heart rate ( P = 0.995), FMD ( P = 0.542), ACh max ( P = 0.800), and insulin max ( P = 0.242). Ingestion of K me improved [Formula: see text], stroke volume index, and peripheral muscle oxygenation but did not alter macro- or microvascular endothelial function in people with T2D. NEW & NOTEWORTHY For the first time, we show that acute ketone monoester ingestion (K me ) can increase cardiac output and stroke volume and reduce systemic vascular resistance at rest and during exercise in sodium glucose transporter inhibitors naïve (i.e. no drug-induced ketosis) people with type 2 diabetes. Acute K me ingestion improves peripheral skeletal muscle oxygenation during moderate intensity and maximal exercise. K me has no effect on macro- or microvascular endothelial function in people with type 2 diabetes.

Lowering mean pulmonary arterial pressure (mPAP) without reducing cardiac output is essential in treating pulmonary hypertension (PH). Isosorbide dinitrate (ISDN) potentially achieves this in post-capillary PH but can decrease cardiac output and blood pressure (BP), especially in pre-capillary PH. However, post-capillary PH and pre-capillary PH can overlap, and their clear discrimination is difficult. The aim of the study was to examine to what extent bolus ISDN injection reduces mPAP and BP, and changes mixed venous oxygen saturation (SvO 2 ), an indicator of cardiac output in PH with various cardiopulmonary comorbidities in the context of treatment modifications. We retrospectively examined the hemodynamic effects of bolus ISDN injection in patients with PH who underwent right heart catheterization and their subsequent treatment modification. Our sample comprised 13 PH patients. In seven with pre-capillary PH, ISDN significantly lowered mPAP from the median 34 (interquartile range 32-39) to 28 (28-30) mmHg and the mean BP (mBP) from 90 (79-92) to 72 (68-87) mmHg. In six with post-capillary PH, ISDN lowered mPAP from 40 (29-44) to 27 (23-31) mmHg and mBP from 91 (87-110) to 87 (82-104) mmHg. There was a significant decrease in SvO 2 from 69.8% (64.9%-78.1%) to 63.9% (60.5%-71.5%) in pre-capillary PH, but not in post-capillary PH including combined post- and pre-capillary PH and some patients showed a large increase in SvO 2 . In all patients showing an SvO 2 increase, diuretics or hemodialysis were up-titrated or continued. Bolus ISDN injection lowered mPAP. However, in pre-capillary PH, it caused a significant decrease in SvO 2 and a notable reduction in blood pressure. In post-capillary PH, including combined post- and pre-capillary PH, it clarified whether systemic preload and afterload reduction increased or decreased SvO 2 in each patient, which may aid in treatment modification., Competing Interests: Declarations. Conflict of interest: The authors declare that they have no conflicts of interest concerning this study., (© 2024. Springer Nature Japan KK, part of Springer Nature.)

Background: Infusion therapy is widely used in clinical settings, particularly in intensive care units., Aim: to explore the influence of simulated cardiac output on "bolus" or "backflow" events that can occur during syringe pump changeover, considering several factors that have been previously outlined in published research. Syringe infusion pumps are commonly used for precise continuous intravenous drug delivery. Syringe pump changeover can be a challenging procedure., Methods: Bench-top study in a laboratory setting. An extracorporeal circuit was used to simulate a cardiac output of 5 l/min. The following variables were used: three levels of vertical position of the syringe pump (-50 cm, 0, +50 cm), three levels of Central Venous Pressure (-5, 10, and 15 mmHg), presence/absence of carrier infusion (5 ml/h), and presence/absence of a needle-free connector between the syringe and extension line., Results: A total of 108 syringe pump changes were performed with different combinations of the investigated variables. The mean time for syringe pump changeover was equal to 9.48 ± 2.45 s and the overall fluid displacement was 8 ± 40 µL (microlitres) (range, -262-156 µL). The CVP level and vertical position of the pump always statistically affected the overall displacement during syringe pump changeover. When a second infusion with an equal velocity rate to that of a syringe pump infusion is present in the same lumen, the presence of a needle-free device reduces the overall volume of displacement., Conclusions: Syringe pump changeover can be a critical moment for patients when vasoactive drugs are administered., Implications for Clinical Practice: In a simulated environment with a cardiac output of 5 L/min, the CVP level and vertical position of the syringe pump generated bolus or backflow events during the syringe pump changeover. The application of carrier infusion appeared to intensify these phenomena. Employing a neutral, needle-free system can potentially aid in reducing the development of boluses or backflows., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: The acute hypoxic ventilatory response is a critical chemoreflex originating at the carotid bodies. This study investigates the impact of low-dose i.v. esketamine on the ventilatory response to 20 min of isocapnic hypoxia to test the hypothesis that esketamine does not affect hypoxic ventilation., Methods: In this open-label study, 18 healthy subjects received a 3-h escalating i.v. infusion of esketamine, totalling 1.0 mg kg -1 . Before the esketamine infusion (control condition) and during the last 30 min of infusion, the ventilatory response to 20 min of isocapnic hypoxia (oxygen saturation ∼80%) was measured. We assessed the increase in ventilation from baseline to its peak during the first 5 min of isocapnic hypoxia (hypoxic ventilatory response) and the increase in ventilation from baseline to 20 min of isocapnic hypoxia (sustained hypoxia). Haemodynamics and acute brain function were also measured., Results: Independent of hypoxia, a small excitatory effect of ketamine on isocapnic ventilation was observed: the mean increase in ventilation (95% confidence interval) was 3.1 (2.4-3.7) L min -1 (P<0.0001). Esketamine had no effect on the isocapnic ventilatory response to acute and sustained hypoxia but increased MAP (+10 mm Hg) and heart rate (+10 beats min -1 ), similarly during normoxia and hypoxia. Esketamine increased anxiety and alertness and affected external perception., Conclusions: I.V. esketamine up to 1 mg kg -1 does not affect the ventilatory response to hypoxia, but affects haemodynamics and acute brain function. Increases in anxiety and alertness could be a cause of the sustained ventilatory response to hypoxia during esketamine infusion., Clinical Trial Registration: The trial was registered at the ISRCTN registry on June 27, 2023 under identifier ISRCTN 42617929 (https://www.isrctn.com/ISRCTN42617929)., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

We investigated the mechanism of action of atropine in myopia control by examining its effect on choroidal hemodynamics. Blood flow was evaluated using indocyanine green (ICG) fluorescence and molecular variation during the development of form-deprivation myopia (FDM) and atropine treatment in guinea pigs. Guinea pigs were divided randomly into the normal control (NC), FDM, and FDM + 1% atropine (ATR) groups, and evaluated by spherical equivalent refractive error (SE) and axial length (AL). Choroidal hemodynamic parameters were measured via ICG fluorescence imaging including the maximal ICG fluorescence intensity (I max ), rising time (T rising ), blood flow index (BFI), and mean transit time (MTT). Additionally, the expression in the choroid-RPE complex of choroidal vascular endothelial growth factor A (VEGFA) and HIF-1 α were assessed via Western blotting. Atropine inhibited the development of FDM, with effects of FD on both SE and AL being reduced. ICG fluorescence hemodynamic wide-field maps and time-series curves revealed that the atropine significantly accelerated choroidal blood flow, with reduced T rising and MTT, while increasing I max , BFI and the number of lobulated choriocapillaris structures compared with the FDM group. In terms of molecular markers, atropine inhibited the effect of FDM, increasing VEGFA levels and reducing HIF-1α expression. These findings suggest that atropine improved choroidal hemodynamics and changed vascular markers, potentially contributing to its role in inhibiting the progression of myopia in the FDM model., Competing Interests: Declaration of competing interest No potential conflict of interest was reported by the authors., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Aims: To investigate the effect of sodium-glucose co-transporter 2 inhibitor [SGLT-2i] therapy on renal haemodynamics in T2D patients with glomerular hyperfiltration., Materials and Methods: Sixty T2D patients with elevated [HYPER] and normal [NORMO] GFR were randomized to dapagliflozin 10 mg/day [DAPA/HYPER, n = 15; DAPA/NORMO, n = 15] or to metformin/glipizide [CONTROL/HYPER, n = 15; CONTROL/NORMO, n = 15] to reach similar glycaemic control after 4 months. GFR was measured with Iohexol and hyperfiltration was empirically defined as >125 mL/min/1.73 m 2 . GFR, renal plasma flow [RPF], mean arterial pressure [MAP], filtration fraction [FF], and renal vascular resistance [RVR] were determined before/after therapy., Results: HbA1c decreased similarly in all 4 groups. GFR declined by ~18% in DAPA/HYPER and by ~7% in DAPA/NORMO and did not change in CONTROLS (p < 0.05 vs. DAPA). RPF remained unchanged in all four groups. Thus, FF (%) declined from 0.23 ± 0.01 to 0.18 ± 0.01 in DAPA/HYPER and from 0.17 ± 0.01 to 0.15 ± 0.01 in DAPA/NORMO and remained unchanged in CONTROLS (p < 0.05 vs. DAPA). MAP (mmHg) decreased from 95.4 ± 1.4 to 88.1 ± 1.3 in DAPA/HYPER and from 95.6 ± 1.3 to 91.8 ± 0.8 in DAPA/NORMO and remained unchanged in CONTROLS (p < 0.05 vs. DAPA). RVR [mmHg/L/min] declined in DAPA/HYPER (92.7 ± 7.8 to 80.4 ± 6.1) and DAPA/NORMO (90.1 ± 3.0 to 81.4 ± 2.1) but not in CONTROLS (p < 0.05 vs. DAPA)., Conclusions: Despite comparable glycaemic control, dapagliflozin treatment, but not metformin and /or glipizide, reduced glomerular hyperfiltration in T2D patients and decreased both filtration fraction and renal vascular resistance. These findings suggest that a post-glomerular vasodilatory action of SGLT2 inhibitors contributes to their renal protective effect in T2D., (© 2024 John Wiley & Sons Ltd.)

Aims: Cardiogenic shock (CS) is linked to high morbidity and mortality rates, posing a challenge for clinicians. Interventions to improve tissue perfusion and blood pressure are crucial to prevent further deterioration. Unfortunately, current inotropes, which act through adrenergic receptor stimulation, are associated with malignant arrhythmias and poorer outcomes. Due to its unique mechanism of action, istaroxime should improve haemodynamics without adrenergic overactivation. The SEISMiC study is designed to examine the safety and efficacy (haemodynamic effect) of istaroxime administrated in pre-CS patients., Methods and Results: The SEISMiC study is a multinational, multicentre, randomized, double-blind, placebo-controlled safety and efficacy study with two parts (A and B). The study enrols patients hospitalized for decompensated heart failure (pre-CS, not related to myocardial ischaemia) with persistent hypotension [systolic blood pressure (SBP) 70-100 mmHg for at least 2 h] and clinically confirmed congestion, NT-proBNP ≥1400 pg/mL, and LVEF≤40%. Subjects must not have taken intravenous (iv) vasopressors, inotropes or digoxin in the past 6 h. Eligible patients are randomized to receive IV infusion of istaroxime (different doses and regimens in Parts A and B) or placebo for up to 60 h. Central haemodynamics, ECG Holter monitoring, cardiac ultrasound and biomarkers are recorded at predefined time points during the trial. The study's primary efficacy endpoint is the SBP area under the curve from baseline curve from baseline to 6 and 24 h in the combined SEISMiC Parts A and B population. Key secondary efficacy endpoints include haemodynamic, laboratory and clinical measures in SEISMiC B alone in the combined SEISMiC A and B studies., Conclusions: The study results will contribute to our understanding of the role of istaroxime in pre-CS patients and potentially provide insight into the drug's haemodynamic effects and safety in this population., (© 2024 The Author(s). ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

This study assesses the effect of carotid sinus blockade applied with a local anesthetic on hemodynamic parameters during carotid endarterectomy (CEA) operations performed under general anesthesia. The medical records of patients who underwent CEA under general anesthesia between January 2020 and December 2022, were retrospectively reviewed. It was recorded whether the patients received carotid sinus block with 2 mL of 2% prilocaine. Intraoperative and 48-hour postoperative hemodynamic data were examined in the patients included in the study. A total of 129 patients were evaluated in the study, with 70 patients who received carotid sinus blockade (Group I) and 59 patients who did not receive blockade (Group II) during CEA. The comparison of heart rate variability immediately before clamping, immediately after clamping, and at 5, 10, and 20 minutes post-clamping indicated a significantly greater reduction in Group II compared to Group I (P < .05). In the postoperative period, the total dose of glyceryl trinitrate administered was 40.8 ± 31.9 mg in Group I and 53 ± 17.2 mg in Group II, showing a statistically significant difference (P = .001). Additionally, blood pressure measurements during this period were significantly higher in Group II than in Group I (P < .05). While the application of a local anesthetic during CEA appears to provide better intraoperative heart rate and postoperative blood pressure control, attributing these results solely to local anesthesia may not be entirely accurate. Hemodynamic instability observed during and after CEA is influenced by various factors., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2025 the Author(s). Published by Wolters Kluwer Health, Inc.)

The initiation of sodium-glucose cotransporter 2 (SGLT2) inhibitor treatment was shown to reduce pulmonary artery pressure (PAP) in New York Heart Association (NYHA) class III heart failure (HF) patients with an implanted PAP sensor. We aimed to investigate the impact of SGLT2-I initiation on pulmonary vascular resistance (PVR), pulmonary capillary wedge pressure (PCWP), pulmonary arterial capacitance (PAC), and right ventricle (RV) to PA (RV-PA) coupling in a pilot cohort of HF with preserved/mildly reduced ejection fraction (HFpEF/HFmrEF) patients and whether PVR and PCWP can be serially calculated non-invasively using PAP sensor data during follow-up., Methods: Right heart catheterization parameters (PVR, PCWP, and PAC) were obtained at sensor implantation and echocardiographic assessments (E/E', RV-PA coupling, and RV cardiac output) were made at baseline and every 3 months. SGLT2 inhibition was initiated after 3 months of telemedical care. Three methods for calculating PVR and PCWP were compared using Bland-Altman plots and Spearman's correlation., Results: In 13 HF patients (mean age 77 ± 4 years), there were no significant changes in PAP, PVR, PCWP, RV-PA coupling, or PAC over 9 months (all p -values > 0.05), including after SGLT2-I initiation. PVR values were closely correlated across the three methods (PVR New and PVR New Tedford (r = 0.614, p < 0.001), PVR Echo and PVR New Tedford (r = 0.446, p = 0.006), and PVR Echo and PVR New (r = 0.394, p = 0.016)), but PCWP methods lacked reliable association (PCWP Echo and PCWP New (r = 0.180, p = 0.332)., Conclusions: No changes in cardiopulmonary hemodynamics were detected after hemodynamic telemonitoring either prior to or following SGLT2-I initiation. Different PVR assessment methods yielded comparable results, whereas PCWP methods were not associated with each other. Further investigations with larger cohorts including repeated right heart catheterization are planned.

Blood pressure (BP) is a dynamic measure that is frequently discussed in static terms. There exist many limitations in current documentation systems whereby documented BP values may not be reflective of the dynamic variability of BP. This study used an observational, prospective, non-randomized study design to examine the variability in BP response during intravenous vasoactive medication administration in an intensive care unit setting. Subjects admitted to a neuroscience intensive care unit were monitored continuously during a 12-hour period. The BP values include systolic BP, diastolic BP, and mean arterial pressure. Intermittent values from an intra-arterial figurecatheter (a-line) and continuously sampled values from an a-line obtained using continuous data acquisition (CDA) software, were compared to intermittently sampling of cuff-based BP measurements documented in the medical record. The 30 patients provided 1,220,511 BP observations from CDA, 944 from a-line documentation, and 416 from cuff-based BP documentation. The systolic BP was used as a goal parameter for 23 (77%) of the patients. Repeated measures models demonstrated that on average cuff-based differed from intermittent a-line and from CDA (p < .005) for all BP values. No differences between a-line and CDA were observed. Concordance correlation coefficients ranged from 0.56 to 0.72 for a-line, cuff-based BP, and CDA, indicating moderate agreement. Using intermittently documented BP values does not fully represent the dynamic nature of BP over time., Competing Interests: Competing interests: DaiWai Olson is the editor-in-chief of the Journal of Neuroscience Nursing. Amber Salter receives research funding from Multiple Sclerosis Society of Canada, National Multiple Sclerosis Society, CMSC and the Department of Defense Congressionally Directed Medical Research Program and is a member of editorial board for Neurology. She serves as a consultant for Gryphon Bio, LLC, Sora Neuroscience and Abata Therapeutics. She has equity in Owl Therapeutics. She is a member of the Data and Safety Monitoring Board for Premature Infants Receiving Milking or Delayed Cord Clamping (PREMOD2), Central Vein Sign: A Diagnostic Biomarker in Multiple Sclerosis (CAVS-MS), Video Telehealth Pulmonary Rehabilitation to Reduce Hospital Readmission in Chronic Obstructive Pulmonary Disease (Tele-COPD) and Methotrexate treatment of Arthritis caused by Chikungunya virus (MARCH). She holds the Kenney Marie Dixon‐Pickens Distinguished Professorship in Multiple Sclerosis Research. All other authors have no competing interests., (© 2025. The Author(s).)

Context: Relative hypoglycemia (RH) is linked to sympathetic responses that can alter vascular function in individuals with type 2 diabetes. However, less is known about the role of RH on hemodynamics or metabolic insulin sensitivity in prediabetes., Objective: Determine if RH alters peripheral endothelial function or central hemodynamics to a greater extent in those with prediabetes vs normoglycemia., Methods: Seventy adults with obesity were classified using ADA criteria as prediabetes (n = 34 (28 F); HbA1c = 6.02% ± 0.1%) or normoglycemia (n = 36 (30 F); HbA1c = 5.4% ± 0.0%). Brachial artery endothelial function, skeletal muscle capillary perfusion, and aortic waveforms were assessed at 0 and 120 minutes of a euglycemic clamp (40 mU/m2/min, 90 mg/dL). Plasma nitrate/nitrite and endothelin-1 were measured as surrogates of nitric oxide-mediated vasodilation and vasoconstriction, respectively. RH was defined as the drop in glucose (%) from fasting to clamp steady state., Results: There were no differences in age, weight, or VO2max between groups. The prediabetes group had higher HbA1c (P < .01) and a greater drop in glucose in response to insulin (14% vs 8%; P = .03). Further, heart rate increased in normoglycemia compared to prediabetes (P < .01), while forward wave (Pf) decreased in prediabetes (P = .04). Insulin also tended to reduce arterial stiffness in normoglycemia vs prediabetes (P = .07), despite similar increases in preocclusion diameter (P = .02), blood flow (P = .02), and lower augmentation index (P ≤ .05)., Conclusion: Compared with normoglycemia, insulin-induced RH corresponded with a blunted rise in heart rate and drop in Pf during insulin infusion in adults with prediabetes, independent of changes in peripheral endothelial function., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: To evaluate the safety and efficacy of different doses of ciprofol for the induction of general anesthesia in elderly patients with diabetes undergoing spinal surgery., Methods: Ninety elderly diabetic patients scheduled for elective single-level posterior lumbar interbody fusion (PLIF) under general anesthesia were enrolled and randomly assigned to three groups according to the induction dose of ciprofol: group A (0.2 mg/kg), Group B (0.3 mg/kg), and Group C (0.4 mg/kg). The safety and efficacy of anesthesia induction were compared among the three groups., Case Presentation: The incidence of hypotension in Group C (46.4%) was significantly higher than that in Groups A (7.4%) and B (14.8%) (P < 0.05). The area under the time-mean arterial pressure curve (AUT MAP ) was significantly greater in Group C (176.39 ± 33.83 mmHg·min) than in Group B (158.44 ± 26.55 mmHg·min) and Group A (143.59 ± 19.52 mmHg·min) (P < 0.05). The incidence of intubation response was highest in Group A (77.8%, P < 0.05). Significant differences in bispectral index (BIS) values were observed at 3, 4, and 5 min post-administration among the groups CONCLUSIONS: The induction regimen of 0.3 mg/kg ciprofol combined with 0.4 µg/kg sufentanil and 0.7 mg/kg rocuronium provided superior hemodynamic stability and reduced the need for vasoactive drugs in elderly diabetic patients. This regimen was found to be more favorable compared to the 0.2 mg/kg and 0.4 mg/kg ciprofol dosing groups, demonstrating an optimal balance of safety and efficacy during anesthesia induction in this high-risk population. This trial was registered in the Chinese Clinical Trial Registry on February 26, 2024 (Registration Number: ChiCTR2400081164)., Competing Interests: Declarations. Ethics approval and consent to participate: The study followed the Consolidated Standards of Reporting Trials statement and the Declaration of Helsinki. This study was approved by the Ethics Committee of the Second Hospital of Shanxi Medical University (review board number: [2024] YX 021). Written informed consent was obtained from all patients before participation. The report was prepared following the CONSORT checklist. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Objective: The present study investigated the impact of continuous infusion therapy with low-dose terlipressin (TP) combined with norepinephrine on hemodynamics, inflammatory markers, and prognosis in patients with severe septic shock., Materials and Methods: Seventy-four patients with severe septic shock were randomly assigned to either a control group (n = 37) or an observation group (n = 37). Patients in the control group received norepinephrine alone, while those in the observation group received a continuous infusion of low-dose TP in addition to norepinephrine. To assess the effect of treatment, a set of clinical parameters was evaluated in both groups before and after treatment. These parameters included hemodynamic indicators (heart rate [HR], mean arterial pressure [MAP], central venous pressure [CVP], cardiac index [CI], and systemic vascular resistance index [SVRI]), levels of serum inflammatory markers (interleukin-8 [IL-8], tumor necrosis factor-α [TNF-α], and hypersensitivity C-reactive protein [hs-CRP]), renal function indicators (blood urea nitrogen [BUN], serum creatinine [SCr], and cystatin C [Cys-C]), serum procalcitonin (PCT), and lactate, as well as lactate clearance rate (LCR). Additionally, the acute physiology and chronic health evaluation II (APACHE II) score, 28-day mortality rate, multiple organ dysfunction syndrome (MODS) incidence rate, and adverse reaction incidence were also determined., Results: Compared to baseline values, MAP, CVP, CI, SVRI, and LCR increased in both groups after treatment, while HR, levels of IL-8, TNF-α, hs-CRP, BUN, SCr, PCT, and lactate all decreased. Additionally, APACHE II scores also decreased. Furthermore, the observation group exhibited higher MAP, CVP, CI, SVRI, and LCR, along with lower HR, levels of IL-8, TNF-α, hs-CRP, BUN, SCr, PCT, and lactate than the control group after treatment. The observation group also had lower APACHE II score, 28-day mortality rate, MODS incidence rate, and adverse reaction incidence than the control group after treatment (P < .05)., Conclusion: Continuous infusion therapy with low-dose TP combined with norepinephrine was effective in treating patients with severe septic shock, improving hemodynamic parameters, reducing the levels of inflammatory markers, promoting renal function recovery, and reducing the mortality rate., (© The Association of Military Surgeons of the United States 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site–for further information please contact journals.permissions@oup.com.)

The current study investigated the effect of a single administration of human chorionic gonadotropin hormone (hCG) and its nanoparticles (NPs) on testicular hemodynamics using Doppler ultrasonography, testicular volume, testicular echotexture (PIX), and circulating testosterone and nitric oxide (NO) in pubescent goat bucks during summer months. Fifteen Baladi goats were divided into three groups (5 in each) and subjected to a single intramuscular administration of one ml of physiological saline ( control group), one ml containing 500 IU of hCG (hCG group) or one ml containing 125 IU of hCG NPs (hCG NPs group). Testicular hemodynamics assessment was done just before administration (0 h), and at 2, 4, 6, 24, and daily till 7 days after administration. Testicular volume and PIX were measured and analyzed by B-mode ultrasonography and computer analysis software. Testosterone and NO concentrations were measured using commercial kits. Results revealed significant decreases (P ˂0.05) in Doppler indices values (resistance index and pulsatility index) especially at 24 h in the hCG group (0.314 ± 0.01, 0.382 ± 0.01, respectively) compared with the hCG NPs group (0.428 ± 0.01, 0.567 ± 0.02, respectively), and the control group (0.464 ± 0.006, 0.64 ± 0.01, respectively). There were significant increases (P < 0.001) in testicular volume, PIX, testosterone, and NO concentrations in hCG NPs and hCG groups compared to the control group. There were no significant differences between the hCG NPs and hCG groups (P ˃ 0.05) in testicular volume and PIX, while testosterone significantly increased in the hCG group compared to the hCG NPs group and NO was significantly increased in the hCG NPs group compared to the hCG group. In conclusion, a single administration of hCG or its NPs improved testicular vascularization, testicular volume, and circulating testosterone and NO in pubescent goat bucks. So, hCG NPs could be recommended for improving the reproductive performance of goat bucks under heat-stress conditions., Competing Interests: Declarations. Animal ethics and consent to participate declarations: All methods in this study were performed following the rules and regulations of the Ethics Committee for Animal Use at the Faculty of Veterinary Medicine, Cairo University, Egypt (approval number: Vet CU 25122023889). All authors participate in the final version of the manuscript. Consent to publish: The manuscript is not under consideration in other journals. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Lidocaine, a widely used local anaesthetic, also serves as an adjuvant in pain management. However, its use in children is off-label. This study aimed to determine if intravenous lidocaine alleviates the haemodynamic, metabolic, and hormonal responses to intubation and laparoscopic surgery in children., Methods: A single-centre, parallel, double-masked, randomised, placebo-controlled trial. 132 patients, aged 18 months to 18 years, with no contraindications to lidocaine administration and qualified for laparoscopic appendectomy were enrolled. The intervention studied was a lidocaine bolus of 1.5 mg⋅kg - 1 over 5 min given before induction of anaesthesia, followed by intraoperative lidocaine infusion at 1.5 mg⋅kg - 1 ⋅h - 1 intraoperatively. Patients in the control group were administered a placebo. Mean arterial pressure, glucose, cortisol, lidocaine blood levels, lidocaine-related side effects, and intraoperative opioid requirements were analysed., Results: 132 participants completed the trial. The number of patients who experienced an excessive cardiovascular response to induction of anaesthesia or intubation was 23 (37%) in the control group and 21 (34%) in the lidocaine group (p = 0.707). No statistically significant difference was found between the control and lidocaine groups in the hormonal and metabolic responses, as well as intraoperative fentanyl requirements. Serum lidocaine levels remained below the toxic threshold in all patients., Conclusions: Although the studied intervention appears to be safe, with no clinical side effects observed and serum lidocaine levels remaining below the toxic threshold, its intraoperative administration is not recommended, as it does not demonstrate any significant benefit during the anaesthesia period when compared to placebo., Trial Registration Number: NCT05238506. The date of first registration: 14/02/2022., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the Ethics Committee of the Medical University of Warsaw (KB/204/2021). The trial was registered with the US National Institutes of Health (ClinicalTrials.gov): NCT05238506. The date of first registration: 14/02/2022. Written informed consent for participation in the trial was obtained from the parents or legal guardians of the patients, as well as from all patients aged 16 years or older. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

The effect of epidural infusion of dexmedetomidine on haemodynamics is unclear. This study aimed to explore the effects of epidural or intravenous infusion of dexmedetomidine on haemodynamics during lower extremity varicose veins surgery (saphenectomy) under epidural anaesthesia. Ninety patients were randomly allocated to three groups: ED group (epidural: 0.59% ropivacaine plus 0.5 µg/kg dexmedetomidine, intravenous: normal saline), VD group (epidural: 0.59% ropivacaine plus normal saline, intravenous: 0.5 µg/kg dexmedetomidine), or NS group (epidural: 0.59% ropivacaine plus normal saline, intravenous: normal saline). The primary outcome was the systolic blood pressure (SBP) at before anaesthesia (T 0 ) and at 5 (T 1 ), 15 (T 2 ), and 30 min (T 3 ) and 1 (T 4 ), 2 (T 5 ), 4 (T 6 ), 6 (T 7 ), and 8 h (T 8 ) after dexmedetomidine infusion. The secondary outcomes were diastolic blood pressure (DBP) and heart rate (HR) at T 0 - 8 , plasma norepinephrine (NE), myocardial oxygen consumption (MVO 2 ) and anesthesia efficacy. Adverse reactions and other general data were also recorded. Compared with those in the NS group, the SBP at T 3 - 7 and DBP at T 4 - 5,7 were significantly lower in the ED group (P = 0.008, 0.001, 0.001, 0.001, 0.038 and P = 0.017, 0.006, 0.044, respectively), and the SBP and DBP at T 1 - 8 were lower in the VD group (P < 0.001, 0.001, 0.001, 0.001, 0.004 and P < 0.001, 0.001, 0.001, 0.002, 0.001, 0.001, 0.001, 0.036, respectively). The SBP and DBP at T 1 - 2 in the ED group were greater than those in the VD group (P = 0.021, 0.01 and P = 0.001, 0.011, respectively). The HR at T 3 - 4,6-7 was lower in the ED group than in the NS group (P < 0.001, 0.021, 0.002, 0.004, respectively). Compared with that in the VD group, the HR in the ED group at T 7 was significantly lower (P < 0.001). Anaesthesia efficiency was improved in the ED group compared with VD and NS groups. The incidence of hypotension was lower in the ED group than in the VD group (P = 0.003). The combination of 0.5 µg/kg dexmedetomidine and 0.59% ropivacaine for epidural anaesthesia provides more stable haemodynamics with a lower incidence of hypotension and improved efficiency of epidural anaesthesia in patients undergoing saphenectomy., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethics approval and informed consent: All procedures performed on the patients were in accordance with the tenets of the 1964 Declaration of Helsinki and its later amendments. This protocol was reviewed and approved by the Medical Ethics Committee of the Affiliated Hospital of North Sichuan Medical College (Ref. 2022ER073-1). Written informed consent was obtained from the patient for publication and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request., (© 2025. The Author(s).)

Objective: To investigate the therapeutic effect of levosimendan on hemodynamics in patients undergoing major cardiac surgery and presenting with acute postoperative heart failure., Methods: The subjects of the study were 160 patients with severe cardiac conditions who underwent surgery and had acute heart failure. Eighty cases each were assigned to the research and control groups using a random number table. Document the general patient data for each of the two groups; compare the clinical outcomes of the two groups. The hemodynamic states of the two groups were compared both before and after therapy. 48 h after surgery, echocardiography was performed in both groups to determine cardiac function. 48 h after surgery, N-terminal pro-brain B-type natriuretic peptide (NT-Pro-BNP) levels were compared between the two groups., Results: The overall effective rate was significantly higher in the research group (92.5%) compared to the control group (76.25%, P < 0.05). Post-treatment, the research group demonstrated a significant reduction in CVP (9.25 ± 2.11 cmH2O vs. 11.36 ± 3.08 cmH2O, P < 0.001), heart rate (100.30 ± 8.69 bpm vs. 105.74 ± 7.69 bpm, P < 0.001), and lactic acid levels (1.68 ± 0.59 mmol/L vs. 2.69 ± 0.55 mmol/L, P < 0.001). The research group also showed improvements in SBP (117.23 ± 8.74 mmHg vs. 113.25 ± 7.55 mmHg, P = 0.002) and urine output (4.21 ± 1.76 mL/kg/h vs. 3.65 ± 1.23 mL/kg/h, P = 0.021). Cardiac function indicators 48 h after surgery indicated a higher LVEF (55.21 ± 8.04% vs. 47.18 ± 6.60%, P < 0.001) and lower LVEDVi and LVESVi in the research group (P < 0.001 for both). NT-Pro-BNP levels were significantly lower in the research group (6010.19 ± 1208.52 pg/mL vs. 9663.21 ± 2391.34 pg/mL, P < 0.001). The incidence of complications was lower in the research group (5% vs. 22.5%, P = 0.001)., Conclusion: Cardiac surgery patients are prone to complications with acute heart failure after surgery. Treatment with levosimendan can significantly improve clinical efficacy and reduce complications. It can also effectively improve patients' cardiac function and promote hemodynamic stability., Competing Interests: Declarations. Ethics approval: This study is approved by the Ethics Committee of Zibo Central Hospital. Signed informed consent was also obtained from all participants. Consent for publication: Not Applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

We report a case of a parturient with severe cardiac disease requiring elective termination of pregnancy. The patient underwent successfully monitored anesthesia care using remimazolam for dilation and curettage. The patient remained hemodynamically stable and appropriately sedated while achieving optimal procedural conditions. Remimazolam is an ultrashort acting benzodiazepine that is being used with increasing frequency in short procedures requiring sedation. Patients with complex cardiac comorbidities undergoing surgical procedures may receive maximum benefit from this novel medication due to its stable hemodynamic profile and rapid metabolism., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2025 International Anesthesia Research Society.)

This study aimed to investigate the effects of chronic sympathoinhibition on glucose uptake by the myocardium and by the skeletal muscle in an animal model of obesity associated with leptin signaling deficiency. 6 obese Zucker rats (OZR) and 6 control Lean Zucker rats (LZR) were studied during basal conditions, chronic clonidine administration (30 days, 300 µg/kg), and washout recovery period. Glucose uptake in the myocardium and in the skeletal muscle was measured using positron emission tomography (PET) and 2-[18F] fluoro-2-deoxy-D-glucose ([18F]FDG). The standardized uptake value (SUV) corrected for blood glucose was used for the semi-quantitative analysis. Body weight, food and water intake, blood glucose concentration, blood pressure variability as an index of sympathetic activity and hemodynamic parameters such as mean arterial blood pressure (MAP), systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were analyzed. Myocardial glucose uptake was significantly lower during basal conditions in OZR versus LZR. In both OZR and LZR, chronic clonidine significantly reduced myocardial glucose uptake and hemodynamic variables (such as MAP, SBP, DBP, HR), and sympathetic activity (SA). [18F]FDG skeletal muscle uptake did not significantly differ in OZR versus LZR. Our findings indicate that cardiac glucose metabolism is reduced in obesity presumably in relation with the level of sympathetic activation., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Institutional review board statement: The animal study protocol was approved by Ethics Committee of “Grigore T. Popa” University of Medicine and Pharmacy. Conflict of interest: The authors declare no conflict of interest., (© 2024. The Author(s).)

Background: Antihypertensives (AHD) can influence cerebral autoregulation (CA) and attenuate hypertrophic concentric remodelling of arterioles. The aim of this study was to examine the associations between AHD, CA and structural and functional properties of cerebral arteries., Methods: In this observational, cross-sectional study 115 volunteers were divided in group 1 (non-hypertensive) [n = 30]; group 2 (hypertensive with systolic blood pressure [SBP] < 140 and diastolic blood pressure [DBP] < 90 mmHg) [n = 54]; group 3 (hypertensive with SBP ≥ 140 or DBP ≥ 90 mmHg) [n = 31] and simultaneous measurements of systemic blood pressure (BP) and middle cerebral artery blood flow velocity (CBFV) were obtained from digital plethysmography and transcranial Doppler. Beat-to-beat, critical closing pressure (CrCP), resistance-area product (RAP) and autoregulation index (ARI) values were extracted by linear regression analysis of instantaneous BP and CBFV waveforms using computerised analysis. Pulsatility index (PI) was calculated and CO 2 reactivity was assessed by the breath-holding test., Results: Despite their higher RAP (1.7 [±0.7], p < 0.001) compared to groups 1 and 2, uncontrolled hypertensive using diuretics (p = 0.047) and α2-agonists (p = 0.009) had significantly lower PI. Impaired CO 2 reactivity was common between the two hypertensive groups (p = 0.008), however ARI, CrCP and CBFV did not differ between them and non-hypertensive individuals and also did not correlate with any AHD used., Conclusions: Unlike the RAP, PI does not seem to reflect the real cerebrovascular resistence resulting from chronic arterial remodelling. Despite impaired CO 2 reactivity, hypertensive have arterial tonus and CA comparable to non-hypertensive. Experimental studies involving an untreated hypertensive control group are required to robustly make definitive conclusions about these questions., (© 2024 Scandinavian Society of Clinical Physiology and Nuclear Medicine.)

Objective: To evaluate the effect of a constant rate infusion of ketamine on left ventricular systolic and diastolic function in dogs anesthetized with propofol., Study Design: Prospective randomized, blinded clinical study., Animals: Sixteen healthy dogs., Methods: Dogs were randomized into two groups, the propofol-ketamine group (GPK) and propofol group (GP), with eight animals each. Anesthesia was induced with propofol and maintained with a constant rate infusion (CRI) of propofol at a rate of 0.8 mg/kg/min. All dogs were mechanically ventilated throughout the study. Thirty-five minutes after anesthesia started, the GPK received a bolus of ketamine (0.5 mg/kg IV, over 2 minutes) followed by the CRI of ketamine at 30 μg/kg/min, while the GP received the same volume of 0.9% NaCl over 2 minutes followed by the CRI of 0.9% NaCl at the same rate. Hemodynamic and echocardiographic variables were recorded 15 min after initiating CRI of propofol (M0), immediately after each treatment bolus (M1), and 20 (M2) and 40 min (M3) after initiating CRI of ketamine or 0.9% NaCl solution in both groups., Results: Cardiac index, stroke index, and peripheral vascular resistance index were not significantly different between treatments. No significant differences in left ventricular systolic and diastolic functions derived from echocardiographic variables were observed between groups., Conclusions and Clinical Relevance: During treatment with CRI of ketamine at the proposed rate, hemodynamic parameters and echocardiographic variables, used to measure left ventricular systolic and diastolic function, were maintained stable in healthy dogs anesthetized with propofol., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Guilherme Andraus Bispo reports financial support was provided by Coordination of Higher Education Personnel Improvement. Thais Cabral de Oliveira reports financial support was provided by Coordination of Higher Education Personnel Improvement. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Despite the increasing use of drugs to facilitate feline management in veterinary care, there is still a lack of information on the anxiolytic and sedative effects and their specific physiological impacts. We aimed to compare the sedative, hematological, biochemical and cardiovascular effects of oral single-dose trazodone and gabapentin, alone or in combination, in 8 healthy adult mixed-breed domestic cats on a prospective, randomized, cross-over, and placebo-controlled study. Cats were assigned to receive an oral single dose of trazodone (50 mg) (TG), gabapentin (100 mg) (GG), trazodone (50 mg) and gabapentin (100 mg) (GTG), or placebo (PG). Sedation score, physiological, hematological, biochemical, and cardiovascular variables were assessed at baseline and 120 minutes after drug administration. The mean dose of trazodone was 12.1± 1.1 mg/kg and gabapentin 24.2± 2.3 mg/kg. All data were normally distributed. Blood tests remained within the reference range, but plasma protein increased by 3.78 % in TG. Trazodone alone and associated with gabapentin significantly reduced respiratory rate and systolic blood pressure compared to baseline and placebo. GTG showed a reduction in heart rate and the highest sedation scores. Short-duration excitatory reactions were observed in 37.5 % of the cats in GTG and 12.5 % in TG. Isovolumetric relaxation time (IVRT) increased in GTG and differed statistically from GG. On ECG, no clinically relevant changes were observed. The association of trazodone (50 mg/cat) and gabapentin (100 mg/cat) increases sedation scores compared to gabapentin alone, with a mild impact on HR, RR, BP, and IVRT in cats., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Dexmedetomidine is increasingly used for its ability to stabilise haemodynamic status during general anaesthesia. However, there is currently no data on paediatric kidney transplant recipients (pKTR). This study investigates the haemodynamic impact of dexmedetomidine administered perioperatively in pKTR., Methods: From 2019 to 2023, a retrospective study was conducted at Nantes University Hospital involving all pKTR under 18 years of age. The study compared intraoperative haemodynamic parameters between patients administered dexmedetomidine during kidney transplantation (DEX group) and those who did not receive it (no-DEX group). Mean arterial pressure (MAP) and heart rate (HR) were monitored throughout the duration of anaesthesia and compared. Graft function was assessed based on creatinine levels and glomerular filtration rate (GFR) at specific intervals. The perioperative use of fluids and vasoactive drugs, as well as their administration within 24 h post-surgery, were analysed., Results: Thirty-eight patients were enrolled, 10 in the DEX group and 28 in the no-DEX group. Intraoperative HR was similar between the groups; however, MAP was higher in the DEX group (mean difference 9, standard deviation (SD, 1-11) mmHg, p = 0.039). No differences were found regarding the use of fluid and vasoactive drug therapy between groups. GFR at 1 month post-transplantation was significantly elevated in the DEX group (p = 0.009)., Conclusions: pKTR receiving intraoperative dexmedetomidine exhibited higher perioperative MAP compared to those not administered dexmedetomidine. Additionally, the DEX group demonstrated superior graft function at 1 month. The direct impact of dexmedetomidine on immediate postoperative graft function in pTKR warrants further investigation in a prospective multicentre randomised study., Competing Interests: Declarations. Conflict of interest: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to International Pediatric Nephrology Association.)

Background: Microcirculation health is critical to human health, and aging is an important factor affecting microcirculation health. Although D-Galactose has been widely used in aging research models, there is a lack of relevant studies on D-Galactose simulating microcirculatory aging. Here, we explored microcirculatory endothelial function in D-Galactose-induced aging mice., Methods: Intraperitoneal injection of 150 mg/(kg·d) of D-Galactose was given to cause senescence in mice. Aging was evaluated by SA-β-gal (senescence-associated β-galactosidase) staining. The auricular skin and hepatic microcirculation of mice were observed and detected by enzyme-linked immunosorbent assay (ELISA), immunohistochemistry (IHC) and microcirculation apparatus. The aging of microcirculation was analyzed from oxidative stress, endothelial impairment, inflammation, microvascular morphology and hemodynamics., Results: In aging mice, percentage of SA-β-gal positive area, oxidative stress products reactive oxygen species (ROS) and nitric oxide (NO), endothelial impairment marker syndecan-1 (SDC-1), stromal cell derived factor-1 (SDF-1), intercellular cell adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) in the senescence-associated secretory phenotype (SASP) were all up-regulated. The tortuosity of microvessels increased in aging mice, the linear density did not change significantly, but the total length of narrow microvessels (TLNMV) increased and wide microvessels (TLWMV) decreased, speculate that vasomotor dysfunction may be present. Hemodynamically, both perfusion and velocity of blood flow were reduced in senescent mice, presumably due to endothelial dysfunction., Conclusion: Microcirculatory endothelial dysfunction is induced by D-Galactose, leading to microcirculatory aging. In vivo, this is manifested by elevated levels of oxidative stress, impaired endothelial glycocalyx (eGC), and a greater production of chemokines and adhesive molecules. These changes cause vasomotor dysfunction and remodeling, ultimately leading to hemodynamic impairment., Competing Interests: Declaration of competing interest The authors declare no conflict of interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: To determine protamine administration increases pulmonary artery pressures (PAPs) in patients undergoing unifocalization or pulmonary artery reconstruction surgeries., Design: Retrospective database study., Setting: A large pediatric heart center within an academic quaternary care facility., Participants: All patients undergoing pulmonary artery reconstruction or a unifocalization procedure identifiable within the data warehouse., Interventions: We collected data from Stanford University's data repository, formatted it, and analyzed it using RStudio (v 2023.06.1+524)., Measurements and Main Results: Our primary outcome is the change in PAP after the administration of protamine. Secondary outcomes include changes in the mean arterial pressure, the ratio of systolic pulmonary artery to systemic artery pressure, right-sided filling pressure, and left atrial pressure. After a protamine bolus, we found a difference in PAP (Friedman χ 2 = 49.46; p < 0.001). When compared with 2 minutes before its administration, the PAP was higher at 2 minutes (29.00 mmHg versus 25.00 mmHg; p < 0.001), 5 minutes (30.00 mmHg versus 25.00 mmHg; p < 0.001) and 10 minutes (31 mmHg versus 25 mmHg; p < 0.001). When coadministered with calcium, there was also a significant increase in PAP (Friedman χ 2 = 28.11; p < 0.001), with a higher PAP 10 minutes after calcium administration when compared with 2 minutes before (32 mmHg versus 26 mmHg; p < 0.001)., Conclusions: Protamine administration led to a small increase in PAP after separation from cardiopulmonary bypass in patients undergoing pulmonary artery reconstruction or unifocalization surgeries. Calcium coadministration did not lead to a greater increase in PAP., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background and Aims: Herbal plants may contribute to reducing the incidence of cardiovascular disease. Yerba mate (YM) emerges as a candidate to improve endothelial function, hemodynamics, and heart rate variability (HRV) due to its antioxidant and anti-inflammatory properties, potentially decreasing cardiovascular risk. Therefore, studies are needed to assess the effect of YM ingestion on these parameters. This study aimed to evaluate the impact of acute ingestion of YM infusion (hot or cold) on endothelial function, hemodynamics, and HRV., Methods and Results: In this crossover randomized clinical trial, 13 participants (18-40 years old) of both genders were evaluated under three conditions: control (water), cold YM infusion, and hot YM infusion. The primary outcome was endothelial function assessed through flow-mediated dilation (FMD), with the secondary outcomes including blood pressure (BP), heart rate (HR) and HRV. Parameters were evaluated before and after intervention (40' and 80'). Analysis of variance (ANOVA) showed an intervention effect on FMD (%) (p < 0.05), with both cold and hot YM associated to higher FMD% compared to control, although no time or time*intervention effects were found. ANOVA also showed a time effect on BP, HR, and HRV time and frequency domains variables (p < 0.05), though no time*intervention or intervention effect was observed., Conclusion: We did not find acute effects of YM infusion on endothelial function, central hemodynamic, or autonomic parameters in healthy adults. These results were not impacted by the temperature of YM. Further studies should assess the dose-response of acute and chronic YM ingestion on endothelial function., Trial Registration: U1111-1289-9324, retrospectively registered in May 2023., Competing Interests: Declarations. Consent to Participate: All participants signed the Free and Informed Consent Form before the start of the study. Competing Interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: This study aimed to ascertain the efficacy and safety of remimazolam besylate and ciprofol in elderly patients undergoing painless gastrointestinal endoscopy., Methods: Patients in the control group (n = 31) were anesthetized with ciprofol, and those in the observation group (n = 31) were anesthetized with remimazolam besylate. The anesthetic effect, analgesic effect, hemodynamics, cognitive function, and adverse reactions between the two groups were compared., Results: The observation group had shorter anesthesia onset time, recovery time, as well as anesthesia recovery room stay time and a higher effective rate of analgesia. At T1, T2, and T3, the mean arterial pressure and heart rate of the observation group were higher versus the control group; at T1 and T2, SpO2 in the observation group was higher versus the control group. The simple mental state scale score of the observation group was higher than that of the control group (all p 0.05). The total incidence of adverse reactions exhibited no difference between the two groups (p> 0.05)., Conclusion: Versus ciprofol, remimazolam besylate has better anesthetic and analgesic effects, more stable hemodynamics, less impact on patients' cognitive function, and good safety in elderly patients undergoing painless gastrointestinal endoscopy.

Background and Objectives : Vasopressin increases blood pressure through aquaporin-2-mediated water retention and is useful for managing hemodynamics after surgery. However, even after decades of study, clear clinical guidelines on doses and ideal use cases after cardiovascular surgery remain unclear. Here, the existing literature is synthesized on vasopressin use for cardiac surgeries and coupled with real-world clinical experience to outline a clearer clinical path for vasopressin use. Materials and Methods : Literature from 1966 to the present was searched, and information on surgical outcomes for cardiovascular surgery was extracted. Clinicians from the University of Tsukuba with extensive vasopressin experience in pediatric cardiovascular patients were consulted for general use guidelines. Results : Vasopressin response after cardiovascular surgery is multifaceted, and low-power trials, plus conflicting study reports, generally render it as a secondary choice behind norepinephrine. Clinical experience indicates that low doses of 0.2-0.3 mU/kg/min with constant blood pressure and oxygen monitoring for response are required. Although sole use is not recommended, vasopressin may aid in controlling hemodynamics when given with other volemic or osmolal drugs. Conclusions : Vasopressin may work in a select population of first-line non-responders, but relevant response factors remain unanalyzed and clear guidelines for use remain unestablished. Future, large-scale studies are needed to delineate temporal and demographic characteristics that affect response to vasopressin for the purpose of managing post-surgical capillary leakage and hemodynamics.

Patients with aortic stenosis (AS) and other significant cardiopulmonary comorbidities are vulnerable to hemodynamic instability during anesthesia. This case report compares the use of remimazolam and midazolam in a 71-year-old man with symptomatic AS, chronic kidney disease, and ischemic cardiomyopathy. The patient underwent multiple short ambulatory interventional radiology procedures. While moderate sedation with midazolam resulted in significant hypotension, use of remimazolam in subsequent procedures demonstrated a stable hemodynamic profile despite increased disease burden. This report highlights the potential advantages of remimazolam compared to midazolam in high-risk patients undergoing interventional radiology procedures., Competing Interests: Conflicts of Interest: None., (Copyright © 2024 International Anesthesia Research Society.)

Background: While the acute exposure to electronic cigarette (E-cig) vapor has been associated with an increase in blood pressure, the chronic effect of E-cig vapor on blood pressure compared to standard cigarette smoke has not been extensively studied. We determined the effect of E-cig exposure on blood pressure and other measures of cardiac function in both young and old rats., Methods: Young Sprague Dawley rats (6 weeks old, both sexes) were randomly exposed to air (n = 34), E-cig with nicotine (E-cig Nic+; n = 30), E-cig without nicotine (E-cig Nic-; n = 28) or standard cigarette smoke (n = 27). Old Fischer 344 rats (25 months old, both sexes) were randomized into 2 groups: (1) 26 rats in the purified air (negative control) group and (2) 17 rats in the electronic cigarette vapor plus nicotine group (E-cig Nic+). After 12 weeks of exposure, hemodynamics were determined by Millar catheter, echocardiography, and thermodilution catheter, a few days after their last exposure., Results: In young rats, cigarette smoke was associated with higher systolic, diastolic and mean blood pressures and peak LV systolic pressure, compared to air or E-cig Nic + or E-cig Nic- groups. Neither fractional shortening nor cardiac output differed among the groups. Absolute value for dp/dt min, a measure of diastolic LV function, was lowest in the E-cig Nic- group. Tau, a measure of LV relaxation was worse in this group as well. In old rats, E-cig vaping did not change heart rate, blood pressure, and cardiac function. However, E-cig Nic + exposure was associated with a greater heart weight/BW and LV weight/BW compared to air exposure in old rats., Conclusions: Chronic exposure to E-cig vaping did not cause an increase in blood pressure or heart rate, nor did it change cardiac function compared to air in young rats after 12 weeks of exposure, while standard cigarette smoking was associated with an increase in blood pressure. E-cig vaping was associated with a greater heart weight/BW and LV weight/BW compared to air exposure in old rats, suggested that older animals might be more vulnerable to E-cig stimulus than younger ones., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Conflict of interest: The authors claim to have no conflicts of interest., (© 2024. The Author(s).)

Objective: To evaluate whether the perfusion index response to semiorthostatic stress can be used to monitor the sympathetic-vascular response in sepsis patients., Methods: Three groups were studied: Group A (30 healthy patients), Group B (30 critically ill patients without sepsis), and Group C (92 septic patients). The patients underwent a semiorthostatic stress test (head elevation from 0 to 60 degrees), and hemodynamics, perfusion index values and cardiac ultrasound data were evaluated. SOFA scores were also evaluated in septic patients, comparing those with increased and decreased perfusion indices after the test., Results: After the test, Group A presented significant reductions in stroke volume (p < 0.01) and the cardiac index (p < 0.05), with increases in heart rate (p < 0.05) and mean arterial pressure (p < 0.001). These responses were not observed in Groups B and C. In the individual analysis of Group A, there was a decrease in the perfusion index (p < 0,001), whereas in Groups B and C, the response was heterogeneous. Additionally, septic patients who had a reduced perfusion index after the test had a significant decrease in the SOFA score at 72 hours compared with the group with an increased perfusion index (p < 0.05). However, the delta-SOFA score did not differ between the groups., Conclusion: The perfusion index response to semiorthostatic stress in sepsis patients is a simple and inexpensive method that can be used to detect the sympathetic-microvascular response at the bedside and appears to have prognostic value.

Objective: This study aimed to observe the safe use of intraspinal anesthesia in geriatric orthopedic surgery and its effect on coagulation factors., Methods: The anesthesia indices, cognitive functions, hemodynamic indicators, along with coagulation function indices were compared. The duration of anesthesia was compared between the two groups. Adverse reactions occurring in the two groups of patients were compared., Results: The time to awaken, time to open eyes, time to the verbal statement, the onset of anesthesia, duration of sensory blockade, and duration of motor nerve blockade were shorter while the duration of analgesia was longer in the observation group than in the control group. The observation group's postoperative Mini-Mental State Examination scores were higher than those of the control group. Heart rate and mean arterial pressure of the patients in the observation group at 10 min after anesthesia and at the end of surgery were lower versus those in the control group. The observation group had lower levels of von Willebrand factor (%) and fibrinogen at 10 min after anesthesia and at the end of surgery than the control group, and lower levels of the thrombin-antithrombin complex at the end of surgery than the control group. The observation group exhibited a lower incidence of adverse reactions in contrast to the control group., Conclusion: The application of intraspinal anesthesia in geriatric orthopedic surgery has a significant and remarkable effect, with less impact on patients' hemodynamics and postoperative cognitive function, and can improve patients' blood hypercoagulability.

Objective: Electrical impedance tomography (EIT) enables continuous image acquisition, facilitating real-time measurements of ventilation and perfusion at the clinical bedside. Experimental and clinical studies on controversial effects of thoracic epidural blockade (TEB) with local anesthetics on ventilation-perfusion(V/Q) matching and hypoxia during one lung ventilation (OLV) are rare. The aim of this study was to use EIT to investigate the effects of TEB combined with general anesthesia on pulmonary perfusion distribution and V/Q matching during one-lung ventilation., Design: Single-centered, prospective, unblinded, randomized, parallel-group clinical trial., Setting: Surgical suite of a university-affiliated teaching hospital., Patients: Thirty patients prepared for thoracic surgery were randomly assigned to either the control group or the TEB group, which received a combination of thoracic epidural blockade and general anesthesia., Measurements: EIT measurements and blood gas analysis were conducted in the lateral position during two-lung ventilation(T 0 ), 15 min after OLV(T 1 ), and 15 min after administration of 0.25 % ropivacaine or 0.9 % saline via epidural delivery during OLV(T 2 ). Hemodynamic and respiratory parameters were recorded, and Dead Space%, Shunt%, and V/Q Match% were calculated based on blood gas analysis and EIT images., Results: Mean arterial pressure (p < 0.05) significantly decreased 15 min after TEB, while there were no significant changes in heart rate among the 30 patients (p = 0.547). OLV resulted in a significant decrease in arterial oxygen partial pressure/inspired oxygen fraction (PaO 2 /FiO 2 ) from T 0 to T 1 in both groups. The PaO 2 /FiO 2 in the TEB group was significantly lower after epidural administration of the local anesthetic (p < 0.05). Shunt- ABG (%) was significantly higher in the TEB group compared to the control group at T 2 (p < 0.05). TEB increased non-ventilated perfusion distribution(p < 0.05), and Shunt-EIT % (p < 0.05) and reduced Matched Region % (p < 0.05), while Dead Space-EIT % remained (p = 0.499)., Conclusions: Based on the contrast-enhanced EIT evaluation of pulmonary perfusion and ventilation, TEB appears to induce a V/Q mismatch in patients undergoing OLV in the lateral position for thoracic surgery., Trial Registration: ClinicalTrials.gov, NCT04730089. Registration on January 25th, 2021., Competing Interests: Declaration of competing interest The authors declare no potential conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background and Objective: Pulmonary hypertension (PH) is a progressive hemodynamic condition associated with significant morbidity and mortality, especially in patients undergoing cardiac surgery. Therefore, the objective of this network meta-analysis (NMA) is to compare the efficacy of various pulmonary vasodilators in perioperative control of PH among patients undergoing mitral valve replacement surgery (MVRS), aiming to address the existing knowledge gap and improve perioperative outcomes., Methods: Electronic databases including PubMed, Cochrane Central Registry of Controlled Trials, Scopus, Embase, and Web of Science (WOS) from inception to 17 September 2024. Only randomized controlled trials (RCTs) evaluating vasodilators in PH patients undergoing MVRS were included. We used netmeta package in RStudio to analyze the outcome data with their corresponding mean difference (MD) and confidence intervals (CI)., Results: Seventeen RCTs including 862 patients were analyzed. Prostacyclin, nitric oxide (NO), and sodium nitroprusside (SN) significantly reduced mean pulmonary arterial pressure with effect sizes [MD, 95% confidence interval (CI)] of (11.77, - 18.78; - 4.76; - 8.3, - 15.9; - 0.6; - 11.02, - 20.1; - 3.8, respectively). While no treatment showed significant efficacy on pulmonary capillary wedge pressure, systolic pulmonary arterial pressure, or heart rate, nitroglycerin, NO, and prostacyclin, showed significant increases in cardiac index with effect sizes (MD, 95% CI) of (1, 0.3; 1.7; 1.2 0.8; 1.6; 1.2 0.8; 1.6, respectively). Additionally, NO, prostacyclin, SN, and nitroglycerin demonstrated significant reductions in systemic vascular resistance (SVR), with effect sizes of. (- 0.54, - 0.82; - 0.26, - 0.37, - 0.65; - 0.09; - 0.47, - 0.77; - 0.16; - 0.14, - 0.24; - 0.03, respectively)., Conclusions: This NMA highlights prostacyclin, nitroglycerin, NO, and SN as consistently effective in improving hemodynamics for patients with PH undergoing MVRS, and provides valuable insights for surgeons to choose the suitable vasodilator for these surgeries. However, limitations and the need for further RCTs are acknowledged., Competing Interests: Declarations. Competing interests: The authors declare that they have no competing interests. Ethics approval: Not applicable Consent to participate: Not applicable Consent for publication: Not applicable Availability of data and material: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Authors’ contribution: A.E. conceived and designed the study, interpreted data, drafted the manuscript, and supervised the entire project; A.M. contributed to the study design, data acquisition, statistical modeling and analysis, interpretation of results, and critically revised the manuscript; A.R. was involved in data extraction, interpretation, and critical revision of the manuscript; N.G.H. assisted with data extraction, statistical analysis, and manuscript drafting; M.S. contributed to literature search, screening, and drafting of the results; S.K.K. assisted in methodological design, quality assessment, and manuscript revisions; B.E.M. participated in statistical analysis, data interpretation, and manuscript revision; A.A.S. contributed to literature review and manuscript preparation; M.N.K. assisted with data collection, quality assessment, and manuscript revisions; A.A.A. was involved in data extraction and screening and contributed to manuscript drafting; L.A.H. contributed to data curation, literature search, and manuscript development; A.Z. assisted with literature search, data analysis, and manuscript feedback; M.A.Z. contributed to quality assessment and analysis refinement; W.A. participated in the writing and revision of the manuscript; S.N. provided critical input on study design and wrote and revised the manuscript. All authors approved the final version of the manuscript and agree to be accountable for all aspects of the work., (© 2024. The Author(s).)

Objective: This study retrospectively investigated the effects of different doses of dexmedetomidine combined with propofol on postoperative delirium in older adults undergoing cardiac surgery., Methods: The medical records of 82 older adults undergoing cardiac surgery admitted to two hospitals between August 2019 and August 2022 were analyzed. The participants were divided into two groups based on the dexmedetomidine dose: group A (0.5 µg/kg dexmedetomidine + propofol) and group B (1.0 µg/kg dexmedetomidine + propofol). The mean arterial pressure (MAP), heart rate (HR), anesthesia depth index (NTI), and incidence of postoperative delirium (POD) at 7 days after surgery were compared., Results: MAP and HR were significantly higher in group A than in group B during extubation and 10 minutes after extubation and significantly higher than the values before anesthesia induction. At all time points post-anesthesia induction, NTI was higher in group B than in group A, and the incidence of POD within 7 days after surgery was significantly higher in group A. The Prince-Henry pain scores were higher in group A than in group B at 1, 4, 24, and 48 hours after surgery., Conclusions: Higher dexmedetomidine doses were associated with more stable hemodynamics and stronger effects on POD in older adults undergoing cardiac surgery., Competing Interests: Declaration of conflicting interestsThe authors declare that they have no competing interests.

Background: Despite the available treatments, pulmonary arterial hypertension (PAH) prognosis is poor., Objectives: We aimed to investigate the effects of the alamandine (ALA), melatonin (MEL), and ALA + MEL in PAH., Methods: The rats were randomly divided into Control (n = 10), monocrotaline (MCT) (n = 12), ALA (n = 12), MEL (n = 12), and ALA + MEL (n = 12) groups. PAH was induced by MCT. The ALA, MEL, and ALA + MEL groups received 50 μg/kg/day ALA, 10 mg/kg/day MEL, and ALA + MEL, respectively, for 35 days. Echocardiographic and hemodynamic measurements and tissue analyses (morphometric, histopathological, ELISA, and western blot) were performed., Results: Monotherapies, especially MEL, reduced the right ventricular (RV) systolic pressure. Only MEL increased the pulmonary artery acceleration time. MCT increased the RV/left ventricle (LV) + interventricular septum (IVS) ratio. While ALA and ALA + MEL slightly decreased the RV/(LV + IVS), MEL significantly restored it. MCT increased the tunica intima-media (TIM) thickness, PCNA and α-SMA of pulmonary arterioles, histopathological score (HS) (inflammatory infiltration etc.) of the lung, and RV. All treatments reduced the TIM thickness (especially MEL), PCNA, and α-SMA. All treatments significantly decreased the HS of the lung; however, MEL and ALA + MEL produced greater benefits. All treatments attenuated the HS of RV. MCT caused a significant increase in lung lysyl oxidase (LOX) activity. All treatments restored the LOX; however, MEL and ALA + MEL provided greater improvement. While lung Nrf-2 was increased in MCT-treated rats, MEL reduced it., Conclusion: ALA, MEL, and ALA + MEL attenuate PAH and protect RV via antiproliferative, anti-remodeling, antihypertrophic, anti-inflammatory, and free radical scavenging (only MEL) capabilities. Overall, MEL produced the best outcomes., (© 2024 Société Française de Pharmacologie et de Thérapeutique. Published by John Wiley & Sons Ltd.)

Background: Ketamine and fentanyl are commonly used for sedation and induction of anesthesia in critically ill patients. This study aimed to compare the hemodynamic effects of ketamine versus fentanyl bolus in patients with septic shock., Methods: This randomized controlled trial included mechanically ventilated adults with septic shock receiving sedation. Patients were randomized to receive either 1 mg/kg ketamine bolus or 1 mcg/kg fentanyl bolus. Cardiac output (CO), stroke volume (SV), heart rate (HR), and mean arterial pressure (MAP) were measured at the baseline, 3, 6, 10, and 15 min after the intervention. Delta CO was calculated as the change in CO at each time point in relation to baseline measurement. The primary outcome was delta CO 6 min after administration of the study drug. Other outcomes included CO, SV, HR, and MAP., Results: Eighty-six patients were analyzed. The median (quartiles) delta CO 6 min after drug injection was 71(37, 116)% in the ketamine group versus - 31(- 43, - 12)% in the fentanyl group, P value < 0.001. The CO, SV, HR, and MAP increased in the ketamine group and decreased in the fentanyl group in relation to the baseline reading; and all were higher in the ketamine group than the fentanyl group., Conclusion: In patients with septic shock, ketamine bolus was associated with higher CO and SV compared to fentanyl bolus., Clinical Trial Registration: Date of registration: 24/07/2023., Clinicaltrials: gov Identifier: NCT05957302. URL: https://clinicaltrials.gov/study/NCT05957302 ., Competing Interests: Declarations. Conflict of interest: The authors declare that they have no conflict of interest with this work., (© 2024. The Author(s).)

Endogenous multiple modified LDL (mLDL) and the renin-angiotensin system play a significant role in the development of atherosclerosis. It has been found that by behavioral and hemodynamic parameters the physiological activity of angiotensin II (Ang II) in combination with mLDL is considerably modified due to weakening of its diuretic effect and the inversion of hypertensive and tachyarrhythmic effects. Atherosclerosis is a long-term pathological process, so a single administration of artificially synthesized Ang I-mLDL complexes can be considered a model of the first contact of the body with pathogenic factors. We believe that angiotensin complexes with mLDL participate in adaptive and compensatory mechanisms at the initial stages of atherosclerosis and later contribute to its progression., (© 2025. Springer Science+Business Media, LLC, part of Springer Nature.)

Objectives: To compare seizure-related, hemodynamic, and recovery outcomes when using remimazolam for ECT with those of other anesthetics, specifically propofol and etomidate., Methods: A total of 49 patients who underwent 405 ECT treatment sessions under general anesthesia were retrospectively analyzed. Remimazolam, propofol, and etomidate were used for 93, 138, and 174 ECT sessions, respectively. The primary outcome was durations of motor and electroencephalogram (EEG) seizure activity, whereas secondary outcomes included hemodynamics (ie, mean arterial pressure [MAP] and heart rate [HR] at various time points from induction to postanesthesia care unit [PACU] discharge), antihypertensive drugs administration after electrical stimulus, and recovery profiles (ie, length of PACU stay and incidence of postictal confusion)., Results: Durations of motor and EEG seizures were shorter for remimazolam than etomidate (motor, P < 0.001; EEG, P = 0.003) but similar compared with propofol (motor, P = 0.191; EEG, P = 0.850). During seizure, remimazolam showed a comparable MAP and HR to etomidate (MAP: P = 0.806; HR: P = 0.116). The antihypertensive drug use was lowest for remimazolam (6.8%), followed by propofol (35.6%) and etomidate (65.6%), and the mean length of PACU stay was comparable for remimazolam (19.7 min), propofol (22.8 min), and etomidate (24.5 min). The occurrence of postictal confusion did not differ among the 3 agents ( P > 0.050)., Conclusions: Remimazolam is a promising anesthetic option for ECT because of its comparable seizure profiles, stable hemodynamics, and comparable PACU stay when compared with propofol and etomidate without additional adverse events., Competing Interests: Insun Park and Jung-Hee Ryu have received a grant from Seoul National University Bundang Hospital. The authors other have no conflicts of interest or financial disclosures to report., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)