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The aim of the study was to investigate the pulmonary haemodynamic response to exercise in Central Asian high- and lowlanders. This was a cross-sectional study in Central Asian highlanders (living >2500 m) compared with lowlanders (living, Central Asian highlanders living between 2500 and 3600 m assessed by stress echocardiography showed that chronic exposure to hypoxia leads to a steeper pressure–flow curve during exercise and worse right ventricular–arterial coupling compared to lowlanders https://bit.ly/3qlvhOj

Background Several fMRI studies found hyperactivity in the hippocampus during pattern separation tasks in patients with Mild Cognitive Impairment (MCI; a prodromal stage of Alzheimer’s disease). This was associated with memory deficits, subsequent cognitive decline, and faster clinical progression. A reduction of hippocampal hyperactivity with an antiepileptic drug improved memory performance. Pharmacological interventions, however, entail the risk of side effects. An alternative approach may be real-time fMRI neurofeedback, during which individuals learn to control region-specific brain activity. In the current project we aim to test the potential of neurofeedback to reduce hippocampal hyperactivity and thereby improve memory performance. Methods In a single-blind parallel-group study, we will randomize n = 84 individuals (n = 42 patients with MCI, n = 42 healthy elderly volunteers) to one of two groups receiving feedback from either the hippocampus or a functionally independent region. Percent signal change of the hemodynamic response within the respective target region will be displayed to the participant with a thermometer icon. We hypothesize that only feedback from the hippocampus will decrease hippocampal hyperactivity during pattern separation and thereby improve memory performance. Discussion Results of this study will reveal whether real-time fMRI neurofeedback is able to reduce hippocampal hyperactivity and thereby improve memory performance. In addition, the results of this study may identify predictors of successful neurofeedback as well as the most successful regulation strategies. Trial registration The study has been registered with clinicaltrials.gov on the 16th of July 2019 (trial identifier: NCT04020744).

Background Vasodilatory shock refractory to catecholamine vasopressors and arginine vasopressin is highly morbid and responsible for significant mortality. Synthetic angiotensin II is a potent vasoconstrictor that may be suitable for use in these patients. Research Question What is the safety and effectiveness of angiotensin II and what variables are associated with a favorable hemodynamic response? Study Design and Methods We performed a multicenter, retrospective study at five tertiary medical centers in the United States. The primary end point of hemodynamic responsiveness to angiotensin II was defined as attainment of mean arterial pressure (MAP) of ≥ 65 mm Hg with a stable or reduced total vasopressor dosage 3 h after drug initiation. Results Of 270 included patients, 181 (67%) demonstrated hemodynamic responsiveness to angiotensin II. Responders showed a greater increase in MAP (+10.3 mm Hg vs +1.6 mm Hg, P Interpretation In postmarketing use for vasopressor-refractory shock, 67% of angiotensin II recipients demonstrated a favorable hemodynamic response. Patients with lower lactate concentrations and those receiving vasopressin were more likely to respond to angiotensin II. Patients who responded to angiotensin II experienced reduced mortality.

Background Exercise capacity is evaluated using the 6-minute walk test (6MWT) in various cardiovascular diseases. Bevacizumab (BEV) has been associated with significant risk of cardiovascular complications. The aim of this study was to investigate BEV-related influences on cardiac hemodynamic response to 6MWT. Methods We prospectively studied 24 patients with intestinal carcinoma to assess the hemodynamic response during 6MWT, of whom eight underwent BEV treatment. Obtained data was analyzed to identify hemodynamic differences between BEV and non-BEV treated patients. Results Twenty-four patients with stage IV intestinal carcinoma consented to assessment after the completion of three cycles of BEV-combined chemotherapy (age, 46.4±16.7 years) or standard chemotherapy alone (age, 56.4±13.7 years). In comparison with non-BEV treated patients, BEV-treated patients walked less (484.3±42.4 vs. 503.0±48.2, P=0.339). These two groups manifested similar hemodynamic response during the 6MWT. The change of hemodynamic parameters at 1 minute after completion of 6MWT was defined as hemodynamic parameter recovery. BEV-treated patients had significantly lower change of left cardiac work index (LCWi), cardiac index (CI), cardiac output (CO) and stroke volume (SV) after 6MWT. Interestingly, in BEV-treated patients CI change after 6MWT was predominantly related to the decrease in SV instead of heart rate (HR) as suggested by a higher standardized beta coefficient (0.883 vs. 0.657) and semi-partial correlations (0.821 vs. 0.677). Conclusions Estimation of hemodynamic response to 6MWT is feasible, and may provide useful information of myocardial damage in BEV-treated patients.

Firefighting is associated with an increased risk for a cardiovascular (CV) event, likely due to increased CV strain. The increase in CV strain during firefighting can be attributed to the interaction of several factors such as the strenuous physical demand, sympathetic nervous system activation, increased thermal burden, and the environmental exposure to smoke pollutants. Characterizing the impact of varying thermal burden and pollutant exposure on hemodynamics may help understand the CV burden experienced during firefighting. The purpose of this study was to examine the hemodynamic response of firefighters to training environments created by pallets and straw; oriented strand board (OSB); or simulated fire/smoke (fog). Twenty-three firefighters had brachial blood pressure measured and central blood pressure and hemodynamics estimated from the pressure waveform at baseline, and immediately and 30 minutes after each scenario. The training environment did not influence the hemodynamic response over time (interaction, p > 0.05); however, OSB scenarios resulted in higher pulse wave velocity and blood pressure (environment, p < 0.05). In conclusion, conducting OSB training scenarios appears to create the largest arterial burden in firefighters compared to other scenarios in this study. Environmental thermal burden in combination with the strenuous exercise, and psychological and environmental stress placed on firefighters should be considered when designing fire training scenarios and evaluating CV risk.

PurposePelvic and lower junctional hemorrhage result in a significant amount of trauma related deaths in military and rural civilian environments. The Abdominal Aortic and Junctional Tourniquet (AAJT) and infra-renal (zone 3) Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) are two options for resuscitation of patients with life threatening blood loss from and distal to the pelvis. Evidence suggest differences in the hemodynamic response between AAJT and zone 3 REBOA, but fluid management during resuscitation with the devices has not been fully elucidated. We compared crystalloid fluid requirements (Ringer’s acetate) between these devices to maintain a carotid mean arterial pressure (MAP) > 60 mmHg.Methods60 kg anesthetized and mechanically ventilated male pigs were subjected to a mean 1030 (range 900–1246) mL (25% of estimated total blood volume, class II) haemorrhage. AAJT (n = 6) or zone 3 REBOA (n = 6) were then applied for 240 min. Crystalloid fluids were administered to maintain carotid MAP. The animals were monitored for 30 min after reperfusion.ResultsCumulative resuscitative fluid requirements increased 7.2 times (mean difference 2079 mL; 95% CI 627–3530 mL) in zone 3 REBOA (mean 2412; range 800–4871 mL) compared to AAJT (mean 333; range 0–1000 mL) to maintain target carotid MAP. Release of the AAJT required vasopressor support with norepinephrine infusion for a mean 9.6 min (0.1 µg/kg/min), while REBOA release required no vasopressor support.ConclusionZone 3 REBOA required 7.2 times more crystalloids to maintain the targeted MAP. The AAJT may therefore be considered in a situation of hemorrhagic shock to limit the need for crystalloid infusions, although removal of the AAJT caused more severe hemodynamic and metabolic effects which required vasopressor support.

Objective: To compare the hemodynamic response between flexible fiber optic bronchoscope (FOB) and Macintosh laryngoscope during orotracheal intubation. The secondary objective was to calculate the time required for intubation between these two techniques Study Design: Quasi experimental study. Place and Duration of Study: Department of Anesthesia, Frontier Corps Hospital Quetta, from Oct 2016 to Apr 2017. Methodology: Eighty patients fulfilling the inclusion/exclusion criteria were included in this study and were divided randomly into two groups. Group L was intubated with Macintosh laryngoscope (control group) where-as group F was intubated with Fiber optic bronchoscope. Mean arterial pressure and heart rate was recorded as baseline, pre-intubation and then every 01 minute for 03 minutes. Changes in heart rate and mean arterial pressure were recorded in the proforma by another anesthetist who was blinded to the procedure performed. Results: The mean age in group L was 41.23 ± 8.37 years and in group F was 40.73 ± 9.77 years. The mean weight in group L was 69.63 ± 8.92 kg and in group F was 70.6 ± 9.20 kg. In group L, male to female ratio was 26:14 whereas in group F it was 28:12. Mean heart rate and mean arterial pressure did not show significant change over time between groups. Time required for intubation was significantly less (22.45 ± 4.12 secs) in laryngoscopy group versus Fiber-Optic Bronchoscope group (44.68 ± 5.88 secs). Conclusion: In conclusion we can say that our study demonstrated that using laryngoscope or Fiber-Optic Bronchoscope for orotracheal intubation exhibits no difference in hemodynamic parameters and serves no added advantage in attenuating the stress response to intubation.

Allocentric and egocentric are two types of spatial coding. Previous studies reported the dorsal attention network's involvement in both types. To eliminate possible paradigm-specific confounds in the results, this study employed fine-grained cue-to-target paradigm to dissociate allocentric (aSC) and egocentric (eSC) spatial coding. Twenty-two participants completed a custom visuospatial task, and changes in the concentration of oxygenated hemoglobin (O2-Hb) were recorded using functional near-infrared spectroscopy (fNIRS). The least absolute shrinkage and selection operator-regularized principal component (LASSO-RPC) algorithm was used to identify cortical sites that predicted the aSC and eSC conditions' reaction times. Significant changes in O2-Hb concentration in the right inferior parietal lobule (IPL) and post-central gyrus regions were common in both aSC and eSC. Results of inter-channel correlations further substantiate cortical activities in both conditions were predominantly over the right parieto-frontal areas. Together with right superior frontal gyrus areas be the reaction time neural correlates, the results suggest top-down attention and response-mapping processes are common to both spatial coding types. Changes unique to aSC were in clusters over the right intraparietal sulcus, right temporo-parietal junction, and left IPL. With the left pre-central gyrus region, be the reaction time neural correlate, aSC is likely to involve more orienting attention, updating of spatial information, and object-based response selection and inhibition than eSC. Future studies will use other visuospatial task designs for testing the robustness of the findings on spatial coding processes.

Objective: To compare intravenous lignocaine vs. intravenous nalbuphine in terms of mean change in heart rate and mean arterial pressures (MAP) during awake tracheal extubation. Study Design: Randomized control trial. Place and Duration of Study: Main Operation Theatre, Combined Military Hospital Rawalpindi, from May 2016to Dec 2016. Methodology: After approval of the study by the institution’s research ethics committee, the patients meetinginclusion criteria were assigned randomly to one of the two groups by lottery method. On return of spontaneous ventilation, patients in group L received intravenous lignocaine 1.5 mg/kg while group N patients received intravenous Nalbuphine 0.2mg/kg. Data recorded immediately (T1) and 5min after (T2) extubation. Results: After stratification of data in terms of age, gender, duration of surgery and ASA classification, evaluation of hemodynamic parameters (HR and MAP) between the two groups was done. The mean change in HR in group L was 6.66 ± 1.53 bpm and in group N was 4.43 ± 1.35. The mean change in MAP in group L was 4.90 ± 1.49 mm of Hg and in group N was 3.23 ± 1.33. p-value in both parameters was found to be less than 0.05 and thus declared significant.Conclusion: We concluded that intravenous nalbuphine, in the dose of 0.2mg/kg, is a better attenuator ofhemodynamic response to extubation as compared to intravenous lignocaine and provides better stability ofHeart rate and Mean arterial Pressure.

Introduction: LMA Supreme is a device which has recently been gaining popularly as an aid to airway management. During ETT intubation induces reflex sympathetic adrenal stimulation which is associated with raised levels of plasma catecholamines. This raised catecholamines induce hypertension and tachycardia. These effects should be avoided in patients with hypertension, ischemic heart disease, stenotic valvular heart disease, and raised intracranial tension, LMA Supreme can be used to over come the sympathetic response.Materials and Methods: 80 patients of either sex, aged 18 to 50 yrs posted for elective surgeries. Randomized to 2 groups N=40 each. We recorded HR, SBP, DBP, MAP, ETCO2, SPO2 at 0, 1, 5, 10 min and post extubation after LMA Supreme insertion, ET tube intubation and ease of insertion, no of attempts and post operative complications.Results: LMA Supreme airway is a safe and effective mean of maintaining airway. Ease and the simplicity makes the device well tolerated and the pressure response is less than endotracheal intubation. In our study we have observed the ETT intubation had increased haemodynamic responses when compared with LMA-S insertion.Conclusion: LMA Supreme can be suitable alternative to ETT intubation in elective adult surgeries. LMA-S with its unique design will help to expand Anaesthesiologist efficiency in the management of patients.

Background Hemodynamic response to supplemental oxygen in idiopathic pulmonary fibrosis (IPF) is still not well known. Objective To determine and compare the effect of low-flow acute supplemental oxygen on the hemodynamics of IPF patients and matched healthy subjects. Methods Descriptive and comparative study in 20 IPF-patients and 19 Control-subjects, (60-80 years old) breathing ambient air followed by acute nasal low-flow (3 L/min) supplemental oxygen. Non-invasive methods were used during the supine position to evaluate oxygen saturation, heart rate, stroke volume index, cardiac output index, total peripheral resistance and arterial blood pressure. Results Breathing ambient air, IPF (vs. Control) presented lower values in stroke volume index (38.7 [29.4–43.2] vs. 45.4 [38.4–50.9] mL•kg-1•m 2 ; p=0.009) and cardiac output index (2.484 [2.268 – 2.946] vs. 2.857 [2.628 – 3.054] L•min−1•m−2; p=0.028), with higher total peripheral resistance (1644 [1559–2076] vs. 1505 [1366–1784] dyne•s•cm−5; p=0.017). During supplemental oxygen (vs. ambient air), both groups increased oxygen saturation above 94% (p Conclusion Low-flow acute supplemental oxygen in IPF causes a meaningful decrement in cardiac output due to greater reduction in heart rate and increment in total peripheral resistance than matched healthy subjects. Knowing the hemodynamic profile of IPF patients may be helpful in determining their management with supplemental oxygen.

Background and Objectives: Clonidine is a common additive to local anesthetics for various regional and local nerve blocks. However, its effectiveness in dentistry has not yet been fully explored. Thus, this study was performed to evaluate the quality of anesthesia, vasoconstrictive effects, hemodynamic response, and pain control using a solution of 2% lignocaine hydrochloride with clonidine hydrochloride in comparison with the standard solution of 2% lignocaine hydrochloride and adrenaline bitartrate for pterygomandibular nerve blocks. Materials and Methods: A parallel arm, triple-blind randomized controlled study was conducted on 152 patients belonging to ASA-I (American Society of Anesthesiologists) category in the age group of 18-45 years, requiring surgical extraction of impacted mandibular third molars. The patients were divided equally into two groups randomly by computer-generated sequence; Group 1: 2% lignocaine hydrochloride with 1 ml of clonidine hydrochloride (150 μg/ml) and Group 2: 2% lignocaine hydrochloride with adrenaline bitartrate 1: 80,000 (12.5 μg/ml). The variables evaluated were systolic, diastolic, and mean arterial blood pressures, heart rate (HR), blood loss, onset, depth (pain), and duration of anesthesia. Results: There was a statistically nonsignificant difference seen between the two groups (P > 0.05) for the onset of anesthesia, pain assessed, and blood loss, whereas a statistically highly significant difference was seen for cardiovascular variables (systolic, diastolic and mean arterial blood pressures, and HR) at various intervals with higher values for Group 2 (P < 0.001) and for the duration of action of local anesthesia (LA), with higher values for Group 1 (P < 0.001). Conclusions: Clonidine as an additive to lignocaine has proved to have the onset of action, vasoconstrictive properties, and pain control, equivalent to adrenaline. However, with better stability of hemodynamic variables and prolonged duration of action of LA with clonidine, it can be considered as a better, safer, and more effective additive to lignocaine than adrenaline

Hypertension is often associated with metabolic changes. The sustained increase in sympathetic activity is related to increased blood pressure and metabolic changes. Environmental stimuli may be related to increased sympathetic activity, blood pressure, and metabolic changes, especially in genetically predisposed individuals. The aim of this study was to evaluate the response of fatty acids to physical and mental stress in healthy volunteers and the hemodynamic, hormonal, and metabolic implications of these stimuli. Fifteen healthy individuals with a mean age of 31 ± 7 years, of both sexes, were evaluated. They were assessed at baseline and after combined physical and mental stress (isometric exercise test, Stroop color test). Blood samples were collected at baseline and after stimulation for glucose, insulin, fatty acid, and catecholamine levels. Blood pressure, heart rate, cardiac output, systemic vascular resistance, and distensibility of the large and small arteries were analyzed. The data obtained at baseline and after stimuli were from the same individual, being the control itself. Compared to baseline, after physical and mental stress there was a statistically significant increase (p, Arterial hypertension is highly prevalent worldwide. The real mechanisms of pathophysiology are not well understood. Stress, the sympathetic nervous system, and the release of fatty acids seem to play an important role in the pathophysiology of hypertension.

Introduction: During the pharmacological stress test with dipyridamole, a normal hemodynamic response is slightly reduced blood pressure and raised heart rate (HR). However, sometimes the HR response is reduced. This study investigated the relationship between the HR response during the dipyridamole stress test and the severity of the perfusion defects using Thallium 201 myocardial perfusion imaging. Methods: We enrolled 50 patients undergoing dipyridamole stress at the nuclear cardiology Lab, Main University Hospital of Alexandria. Standard dipyridamole protocol (infusion over 4 min) and standard thallium 201 protocol (2 min after dipyridamole infusion) were followed. If the heart rate (HR) ratio (peak HR/rest HR) was 1.20 or less, it was considered a reduced response. Total perfusion defect (TPD), summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) for myocardial perfusion were calculated. Patients with reduced HR response and normal HR responses were compared and independent predictors of reduced HR response were determined. Results: About 56% of patients had reduced HR response; which included a high number of patients with a history of dyslipidemia and diabetes mellitus. The reduced HR response group showed lower SSS, SRS. The analysis showed that the independent predictors of reduced HR response were rest HR, SSS, and diabetes mellitus. Conclusions: Reduction in the HR response during the dipyridamole-induced stress test is related to the severity of perfusion defect, diabetes mellitus, and Dyslipidemia.

Background: Laryngoscopy and endotracheal intubation has led to provision of safer anaesthesia due to better control of airway and ventilation. It is associated with reflex sympathetic stimulation resulting in an increase in heart-rate and blood-pressure, which is known as pressor response to laryngoscopy and intubation.Various drugs have been used to avoid this pressor response. This study was aimed to assess the effects of IV Fentanyl and IV Clonidine on pressor responses occurring due to laryngoscopy and intubation in normotensive patients posted for a planned surgical procedure under general anaesthesia.Methods: Approval from the institutional ethical committee was taken for the study. We conducted this study in 60 patients belonging to ASA grade I and II, of 18 to 65 years of age, of either sex, scheduled for planned surgical procedures under general anaesthesia.Patients were randomly allocated into 2 groups; the study drug was injected IV slowly 10 mins before induction.Group-F: received Inj Fentanyl 2mcg/kgGroup-C: received Inj. Clonidine 2mcg/kgObservations were noted in terms of heart-rate, systolic-BP, diastolic-BP, mean-BP and spO2.Results: We observed that Clonidine pre-treatment provided better blunting of stress response duringlaryngoscopy and intubation without causing clinically significant sedation, respiratory depression, bradycardiaor hypotension compare to Fentanyl.Conclusion:We came to a conclusion that Clonidine provided better response compare to Fenatanyl in obliterating the rise in heart-rate and blood pressure on laryngoscopy and intubation.

BACKGROUND: Fractional myocardial blood volume (fMBV) estimated using ferumoxytol-enhanced MRI (FE-MRI) has the potential to capture a hemodynamic response to myocardial hypoperfusion during contrast steady state without reliance on gadolinium chelates. Ferumoxytol has a long intravascular half-life and its use for steady-state MRI is off-label. PURPOSE: To optimize and evaluate a two-compartment model for estimation of fMBV based on FE-MRI. STUDY TYPE: Prospective ANIMAL MODEL: Nine healthy swine; one swine with artificially-induced single-vessel coronary stenosis. FIELD STRENGTH/SEQUENCE: 3.0T clinical magnet using the 5(3)3(3)3 Modified Look-Locker Inversion Recovery (MOLLI) sequence. ASSESSMENT: Myocardial longitudinal spin-lattice relaxation rate (R1) was measured using the MOLLI sequence before and at contrast steady state following seven ferumoxytol infusions (0.125 – 4.0 mg/kg). fMBV and water exchange were estimated using a two-compartment model. Model-fitted fMBV was compared to simple fast-exchange fMBV approximation and percent change in pre and post-ferumoxytol R1. Dose under-sampling schemes were investigated to reduce acquisition duration. STATISTICAL TESTS: Variation in fMBV was assessed with a one-way analysis of variance (ANOVA). Fast-exchange fMBV and ferumoxytol dose under-sampling were evaluated using Bland-Altman analysis. RESULTS: Healthy normal swine showed a mean mid-ventricular fMBV of 7.2 ± 1.4% and water exchange rate of 11.3 ± 5.1 s(−1). There was inter-subject variation in fMBV (p

Background: The present study was conducted to compare dexmedetomidine and clonidine for attenuation of hemodynamic response during laryngoscopy and intubation. Subjects and Methods: Group I patients received 0.9% normal saline (placebo), group II patients received 0.5 µg/kg of dexmedetomidine and group III patients received 3 µg/kg of or clonidine. Each group had 15 patients. Results: The mean age in group I was 28.2 years, in group II was 32.1 years and in group III was 33.2 years, mean weight was 61.2 years, in group II was 60.4 years and in group III was 62.1 years, height was 156.2 cm, in group II was 157.1 cm and in group III was 152.8 cm. There were 8 males and 7 females in group I, 6 males and 9 females in group II and 7 males and 8 females in group III. The mean SBP (mm Hg) in group I was 121.4 and in group II was 122.6, and in group III was 127.4, DBP (mm Hg) was 76.2 in group I, 78.4 in group II and 78.2 in group III. MAP (mm Hg) was 86.7 in group I, 93.2 in group II and 92.5 in group III. HR (bpm) was 74.2 in group I, 78.4 in group II and 77.3 in group III. % oxygen saturation was 98.2in group I, 98.5 in group II and 97.9 in group III. The difference was non- significant (P> 0.05). Conclusion: Authors found that both groups were equally effective in causing attenuation of hemodynamic response to endotracheal intubation.

Background: Throughout the present medical age, laparoscopic surgery is the most effective diagnostic and therapeutic methods. But it is associated with potentially harmful neuroendocrine response. Subjects and Methods: In our study we used dexmedetomidine infusion in group D and normal saline at a rate of 0.4mcg / kg / hr as placebo in group N beginning from 10 minutes before induction before pneumoperitoneum release. Patients in both groups were alike in age, gender, BMI, grade of ASA and anaesthesia. Results: After 10 min infusion of dexmedetomidine and normal saline in group D and group N respectively, fall in HR, DBP and Mean arterial pressure was significantly increased in group D compared to group N. Difference found in both the groups was statistically significant. Group N showed significant increase in HR, SBP, DBP and MAP during laryngoscopy, intubation and at 2 min , 5 min and 10 min after creation of pneumoperitoneum. Difference found was statistically significant in both groups. Thus attenuation in HR, SBP, DBP and MAP was seen in group D as compared to group N during laryngoscopy, tracheal intubation and pneumoperitoneum which were statistically significant. Group N showed statically significant increase in HR, DBP and MAP during extubation compared to group D. Difference found in both the groups was statistically significant. Thus attenuation in HR, DBP and MAP was seen in group D as compared to group N during extubation which was statistically significant. Postoperative sedation score was more in group D compared to group N which was statistically significant. Post-extubation, rescue analgesia was required early in group N compared to group D. Adverse effect in form of bradycardia was seen in 2 patients in group D which did not require atropine administration. Conclusion: Dexmedetomidine infusion at a rate of 0.4 mcg / kg / hr apparently started 10 minutes before the induction of anesthesia before release of pneumoperitoneum without any bolus dose. Useful adjuvant anesthesia to diminish the response of haemodynamic stress to intubation, Pneumoperitoneum, and extubation in laparoscopic surgical patients.

BACKGROUND- Laryngoscopy and endotracheal intubation is known to cause hemodynamic changes which are usually increase in heart rate and blood pressure.Various drugslike beta blockers,opioids and alpha 2 agonists have been tried to attenuate these hemodynamic responses. AIMS-To compare the effects of Fentanyl and Nalbuphine in attenuating the stress response to directlaryngoscopy and endotracheal intubation. METHODS- After informed consent we studied 90patients,all posted for surgery under general anaesthesia between the age group of 15 to 60. We conducted the study over a period of 6months. Data was collected and analysed. Three groups of patients were made Group A – Inj. Fentanyl 2µg/kg ivGroup B– Inj. Nalbuphine 0.2mg/kg ivGroup C- Inj Normal Saline 10cc. Only ASA I and II patients were included in the study.Haemodynamic changes were noted by meticulous monitoring and analyzed. RESULTS-The hemodynamic stress response to laryngoscopy and endotracheal intubation in the form of increased heart rate,systolic blood pressure,diastolic blood pressure and mean blood pressure were less with Fentanyl as compared to Nalbuphine and Normal Saline.CONCLUSION-Fentanyl is more effective than Nalbuphine in attenuating hemodynamic stress response tolaryngoscopy and endotracheal intubation.

Introduction: As is well described laryngoscopy and intubation produce significant hemodynamic response. It is shown in previous studies that type of laryngoscope blade used affects the degree of hemodynamic response to endotracheal intubation. In our study we have attempted to compare hemodynamic response to laryngoscopy and intubation using Macintosh and McCoy blade. Aim: Our aim was to perform comparative study of hemodynamic response to laryngoscopy and intubation using Macintosh versus McCoy blade. Materials and Methods: A prospective randomized controlled study comparing hemodynamic response to laryngoscopy and intubation using Macintosh and McCoy blade was conducted. A total no. of Sixty patients, either male or female, between age group of 20 -50yrs, belonging to American Society of Anaesthesiology physical status I and II requiring General anaesthesia were randomly allocated to either group A (Macintosh group) or group B (McCoy group) In both the groups, standard methods were used. Comparison of hemodynamic parameters i.e. Heart rate (HR), systolic (SBP) diastolic (DBP) and mean blood pressure (MAP) was done at induction, during laryngoscopy and intubation, till 5 mins after intubation. Statistical Analysis: Hemodynamic changes in between the two groups were compared statistically using Unpaired “t” tests. Results: Significant rise in all HR, SBP, DBP, MAP was seen in both the groups after laryngoscopy and intubation. In group A the rise was found to be statistically significant as compared to group B. Conclusion: This study helped us to conclude that McCoy blade produces reduced hemodynamic response to laryngoscopy and intubation as compared to Macintosh blade. Keywords: Hemodynamic response, Intubation, Laryngoscopy, Macintosh and McCoy blade.

Background This prospective randomised double-blind study was carried out on forty patients American Society of Anesthesiologists (ASA) physical status I–II , aged 40–60 years, scheduled for elective abdominal gynecological surgeries under general anesthesia after obtaining the approval of the local institutional ethical committee and oral consent of the patients. This study was conducted to evaluate the effects of perioperative intravenous clonidine versus lidocaine on hemodynamic stress response to laryngoscopic intubation, immune function, pain intensity, time to the first request for analgesia, and total dose of analgesic requirement in the first 24 h postoperatively in gynecological surgeries. Results Throughout the study, heart rate and mean arterial blood pressure were significantly lower in clonidine group (group C) compared to lidocaine group (group L). Postoperatively, the levels of IL-6 were significantly higher in (group L) compared to (group C). VAS pain scores were lower in the clonidine group in comparison to the lidocaine group. There was a higher total dose of analgesia in the lidocaine group when compared to the clonidine group. Conclusions Both clonidine and lidocaine can be used to attenuate the hemodynamic response; however, clonidine was better in the reduction of postoperative pain scores and the decrease in the production of pro-inflammatory cytokines.

Objective Pain is prevalent and functionally impactful in older adults. The prefrontal cortex is involved in pain perception, attentional control, and cortical control of locomotion. Although pain is a known moderator of attentional capacity, its moderating effect on cortical control of locomotion has not been assessed. This study aimed to examine the effects of subjective pain on changes in functional near-infrared spectroscopy–derived measurements of oxygenated hemoglobin (HbO2), gait velocity, and cognitive accuracy from single- to dual-task walking conditions among older adults. Subjects The sample consisted of 383 healthy older adults (55% female). Methods Participants completed two single tasks (Single-Task-Walk [STW] and Cognitive Interference [Alpha]) and the Dual-Task-Walk (DTW), during which participants performed the two single tasks simultaneously. The Medical Outcomes Study Pain Severity Scale and Pain Effects Scale were used to assess pain severity and interference. ProtoKinetics Movement Analysis Software was used to assess gait velocity and rate of correct letter generation to assess cognitive accuracy. Functional Near-Infrared Spectroscopy (fNIRS) was used to assess HbO2 during active walking. Results Linear mixed-effects models revealed that HbO2 increased from single- to dual-task conditions. Perceived pain presence was associated with an attenuated increase in HbO2 from Alpha to DTW. Among those with pain, worse pain severity was associated with an attenuated increase in HbO2 from STW to DTW. Pain interference did not moderate the increase in HbO2 from single to dual tasks. Pain did not have a moderating effect on behavioral outcomes. Conclusions Task-related changes in the hemodynamic response in the prefrontal cortex during walking may be a sensitive marker of the effects of subjective pain on brain function in healthy older adults.

Online hemodiafiltration (HDF) is an established renal replacement modality for patients with end stage chronic kidney disease that is now gaining rapid clinical acceptance worldwide. Currently, there is a growing body of evidence indicating that treatment with HDF is associated with better outcomes and reduced cardiovascular mortality for dialysis patients. In this comprehensive review, we provide an update on the potential mechanisms which may improve survival in HDF treated patients. The strongest evidence is for better hemodynamic stability and reduced endothelial dysfunction associated with HDF treatments. Clinically, this is marked by a reduced incidence of intradialytic hypotensive episodes, with a better hemodynamic response to ultrafiltration, mediated by an increase in total peripheral vascular resistance and extra-vascular fluid recruitment, most likely driven by the negative thermal balance associated with online HDF therapy. In addition, endothelial function appears to be improved due to a combination of a reduction of the inflammatory and oxidative stress complex syndrome and exposure to circulating cardiovascular uremic toxins. Reports of reversed cardiovascular remodeling effects with HDF may be confounded by volume and blood pressure management, which are strongly linked to center clinical practices. Currently, treatment with HDF appears to improve the survival of dialysis patients predominantly due to a reduction in their cardiovascular burden, and this reduction is linked to the sessional convection volume exchanged.

Introduction: Laryngoscopy and endotracheal intubation are the two essential procedures when general anaesthesia is administered to a patient. Adverse responses in the cardiovascular, respiratory, and other physiological systems can be provoked due to the noxious stimuli produced by laryngoscopy and intubation.1 During general anaesthesia maintenance of airway and ventilation can be done in various ways. Aims & Objectives: To assess the superiority of video laryngoscopy over direct laryngoscopy using baseline parameters like heart rate, systolic blood pressure, diastolic blood pressure and mean blood pressure. Materials And Methods: Interventional, Randomized study. Operation theatre of Durgapur Steel Plant Hospital, Durgapur, West Bengal. Adult males and females, ASA physical Grade 1 and 2 patients, scheduled for elective surgeries, under General Anesthesia, requiring or tracheal intubation. 1 year. From February 2018 to February 2019. Result And Analysis:In Group-A (MDL), 28(56.0%) patients had MPG 1 and 22(44.0%) patients had MPG 2. In Group-B (KVVL), 29(58.0%) patients had MPG 1 and 21(42.0%) patients had MPG 2. Association of MPG vs. group was not statistically signicant (p=0.8399). In Group-A (MDL), the mean time taken for intubation (mean±s.d.) of patients was 34.5600 ± 2.3661. In Group-B (KVVL), the mean time taken for intubation (mean±s.d.) of patients was 20.4000 ± 1.7728. Distribution of mean time taken for intubation vs. group was statistically signicant (p

Background: Arginine vasopressin (AVP) is suggested as an adjunct to norepinephrine in patients with septic shock. Guidelines recommend an AVP dosage up to 0.03 units/min, but 0.04 units/min is commonly used in practice based on initial studies. This study was designed to compare the incidence of hemodynamic response between initial fixed-dosage AVP 0.03 units/min and AVP 0.04 units/min. Methods: This retrospective, multi-hospital health system, cohort study included adult patients with septic shock receiving AVP as an adjunct to catecholamine vasopressors. Patients were excluded if they received an initial dosage other than 0.03 units/min or 0.04 units/min, or AVP was titrated within the first 6 hours of therapy. The primary outcome was hemodynamic response, defined as a mean arterial pressure ≥65 mm Hg and a decrease in catecholamine dosage at 6 hours after AVP initiation. Inverse probability of treatment weighting (IPTW) based on the propensity score for initial AVP dosage receipt was utilized to estimate adjusted exposure effects. Results: Of the 1536 patients included in the observed data, there was a nearly even split between initial AVP dosage of 0.03 units/min (n = 842 [54.8%]) and 0.04 units/min (n = 694 [45.2%]). Observed patients receiving AVP 0.03 units/min were more frequently treated at the main campus academic medical center (96.3% vs. 52.2%, p < 0.01) and in a medical intensive care unit (87.4% vs. 39.8%, p < 0.01). The IPTW analysis included 1379 patients with achievement of baseline covariate balance. There was no evidence for a difference between groups in the incidence of hemodynamic response (0.03 units/min 50.0% vs. 0.04 units/min 53.1%, adjusted relative risk 1.06 [95% CI 0.94, 1.20]). Conclusions: Initial AVP dosing varied by hospital and unit type. Although commonly used, an initial AVP dosage of 0.04 units/min was not associated with a higher incidence of early hemodynamic response to AVP in patients with septic shock.

Chemotherapy treatment can lead to cardiovascular toxicity and physical impairment prior to autologous hematopoietic stem cell transplantation (auto-HSCT). Cardiovascular adjustments during exercise and the exercise capacity remain unknown in patients prior to auto-HSCT. Thus, the hemodynamic responses during exercise and exercise capacity were evaluated using a novel effort test in patients prior to auto-HSCT. Thirty patients prior to auto-HSCT (BMT group: 44.6 ± 14.1 years) and 23 control participants (CON group: 43.9 ± 16.6 years) performed the 6-Minute Step Test (6MST) to assess their exercise capacity and the hemodynamic responses during exercise. Systolic and diastolic blood pressure (SBP and DBP), heart rate (HR), and oxygen saturation (SpO2) were measured during the test. Rate-pressure product (RPP) was calculated multiplying SBP by HR. The highest HR value recorded during the test was compared with the maximum HR predicted by age and was used as % of maximum HR (%HRmax). The number of steps up and down performed by the BMT group was lower than CON (108.8 ± 25.3 vs. 127.5 ± 34.4 steps, P = 0.02). The BMT group showed a higher magnitude of increase in SBP and RPP during the 6MST when compared to CON (ΔSBP: 18.5 ± 11.45 vs. 8.30 ± 18.46 mmHg, P = 0.01; and ΔRPP: 8197.3 ± 3829.1 vs. 6170.9 ± 3568.9 mmHg beats min−1, P = 0.05). The BMT group exhibited higher SpO2 and HR values throughout the protocol (P

Background and objectivesChronic pulmonic regurgitation (PR) following repair of congenital heart disease (CHD) impairs right ventricular function that impacts peak exercise cardiac index (pCI). We aimed to estimate in a non-invasive way pCI and peak oxygen consumption (pVO2) and to evaluate predictors of low pCI in patients with significant residual pulmonic regurgitation after CHD repair.MethodWe included 82 patients (median age 19 years (range 10–54 years)) with residual pulmonic regurgitation fraction >40%. All underwent cardiac MRI and cardiopulmonary testing with measurement of pCI by thoracic impedancemetry. Low pCI was defined 2.ResultsLow pCI was found in 18/82 patients. Peak indexed stroke volume (pSVi) tended to compensate chronotropic insufficiency only in patients with normal pCI (r=−0.31, p=0.01). Below 20 years of age, only 5/45 patients had low pCI but near-normal (≥6.5 L/min/m2). pVO2 (mL/kg/min) was correlated with pCI (r=0.58, p=0.0002) only in patients aged >20 years. Left ventricular stroke volume in MRI correlated with pSVi only in the group of patients with low pCI (r=0.54, p=0.02). No MRI measurements predicted low pCI. In multivariable analysis, only age predicted a low pCI (OR=1.082, 95% CI 1.035 to 1.131, p=0.001) with continuous increase of risk with age.ConclusionsIn patients with severe PR, pVO2 is a partial reflection of pCI. Risk of low pCI increases with age. No resting MRI measurement predicts low haemodynamic response to exercise. Probably more suitable to detect ventricular dysfunction, pCI measurement could be an additional parameter to take into account when considering pulmonic valve replacement.

Background: Tracheal extubation process evokes stress response which causes autonomic variations such as tachycardia, rise in systolic arterial blood pressure and diastolic arterial blood pressure which is potentially lethal in high risk patients. Thus this study is conducted to compare the efficacy between 0.15mg/kg and 0.25mg/kg of iv Labetalol in the suppression of haemodynamic response to Extubation. Materials and Methods: 60 participants aged between 18-55 yrs belonging to ASA 1 or 2 were randomly allocated into 2 groups. Group Lb received injection Labetalol 0.15mg/kg and Group Lt received injection Labetalol 0.25mg/kg. Heart rate, systolic arterial blood pressure and diastolic arterial blood pressure were recorded at basal, two, five, eight minutes after drug infusion, at extubation and one, three, five, eight, ten and fifteen minutes post extubation. Results: Group Lt showed a better lowering values in heart rate, systolic arterial blood pressure and diastolic arterial blood pressure after drug infusion, at Extubation, and fifteen minutes post Extubation compared to Group Lb. Conclusion: Injection Labetalol 0.25mg/kg showed a effective suppression of haemodynamic response to Extubation compared to injection Labetalol 0.15mg/kg. Keywords: Labetalol. Haemodynamic response, Extubation.

One of the most common procedures performed by the anaesthisiologists is the Endotracheal Intubation. During this procedure, hemodynamic changes, which may be rapid and dramatic and adverse to the patient may occur. Lignocaine is an excellent drug for the attenuation of pressor events and Labetalol is a potent antihypertensive drug. 50 patients between the ages 18 to 60 years who were scheduled for various procedures under general anaesthesia with ASA Grade I status were included into the study and divided into 2 groups of 25 each. One group was given intravenous Labetalol 0.75mg/kg 10 minutes before intubation and the other group received intravenous injection of Lignocaine hydrochloride (without preservative) 2% in a dose of 1.5 mg/kg over a period of 10 seconds, before 90 seconds of laryngoscopy and intubation. The parameters were lower in Labetalol group (PLabetalol given intravenous was more advantageous compared to other methods for attenution of hemodynamic changes after laryngoscopy and intubation as it has a good attenuation of pressor response and heart rate and provides a good intra operative profession against haemodynamics response to surgical stimuli.

Passive stretching reduces stiffness in the lower limb arteries of the stretched limb. To address this physiological mechanism, we measured the change in shear rate in the posterior tibial artery during a single bout of one-legged passive calf stretching compared with that in the non-stretched leg. The diameter, mean blood velocity, blood flow, and shear rate in the posterior tibial artery were measured using Doppler ultrasound before (baseline), during, and after a one-legged passive intermittent calf stretching procedure (six repetitions of 30-s static stretch with 10-s relaxation) in nine healthy young men. In the posterior tibial artery of the stretched leg, the arterial diameter significantly decreased from baseline during the stretching period (baseline vs. stretching period of the 6th set, 0.19 ± 0.01 vs. 0.18 ± 0.01 cm, P

Hypertension is associated with impaired haemodynamic control mechanisms and autonomic dysfunction. Isometric exercise (IE) interventions have been shown to improve autonomic modulation and reduce blood pressure (BP) predominantly in male participants. The physiological responses to IE are unexplored in female populations; therefore, this study investigated the continous cardiac autonomic and haemodynamic response to a single bout of IE in a large female population. Forty physically inactive females performed a single, individually prescribed isometric wall squat training session. Total power spectral density of heart rate variability (HRV) and associated low-frequency (LF) and high-frequency (HF) power spectral components were recorded in absolute (ms2) and normalised units (nu) pre, during and post an IE session. Heart rate (HR) was recorded via electrocardiography and baroreceptor reflex sensitivity (BRS) via the sequence method. Continuous blood pressure was recorded via the vascular unloading technique and stroke volume via impedance cardiography. Total peripheral resistance (TPR) was calculated according to Ohm’s law. During IE, there were significant reductions in HRV (p

Objective/background This study aimed to clarify the relationship between migraine-like headache and ventriculo-arterial coupling after transcatheter closure of the atrial septal defect in children. We hypothesized that migraine headache after defect closure would be related to an abnormal hemodynamic response against an increased left ventricular filling. Design A retrospective cohort study. Methods We calculated the end-ventricular systolic elastance (Ees), effective arterial elastance (Ea), and ventricular energy efficiency approximated based on echocardiography before and after defect closure, and compared these parameters between the subjects with and without headache after defect closure. Results A total of 167 subjects were studied. Age at the procedure, defect diameter, and pulmonary to systemic blood flow ratio were 11 (9-17) years, 12.8 (9.2-16.0) mm, and 1.8 (1.6-2.3), respectively. We identified 47 (28%) subjects with migraine headache after defect closure. Although there was no significant difference in the Ees, Ea, and ventricular energy efficiency before defect closure between the groups, the Ees (4.0 [3.4-4.9] vs 4.8 [3.7-6.1], P = .014) and ventricular energy efficiency (0.79 [0.76-0.82] vs 0.83 [0.79-0.85], P = .001) after defect closure in subjects with headache were significantly lower than those in subjects without headache. Migraine headache after defect closure was significantly associated with age (odds ratio: 0.97, 95% confidential interval: 0.94-1.00, P = .036) and a decrease in the ventricular energy efficiency after defect closure (odds ratio: 6.42, 95% confidential interval: 2.76-14.90, P Conclusion A loss of ventricular energy efficiency was common in pediatric subjects with migraine-like headache after transcatheter closure of the atrial septal defect, which suggested that the left ventricular function maladaptation was related to headache development after defect closure. We advocate that an impaired ventriculo-arterial coupling may be one of the mechanisms for developing attacks in not only this population but also in other patients with migraine.

Acute psychological stressors such as anger can precipitate ventricular arrhythmias, but the mechanism is incompletely understood. Quantification of regional myocardial sympathetic activity with 123I-metaiodobenzylguanidine (123I-mIBG) SPECT imaging in conjunction with perfusion imaging during mental stress may identify a mismatch between perfusion and sympathetic activity that may exacerbate a mismatch between perfusion and sympathetic activity that could create a milieu of increased vulnerability to ventricular arrhythmia. Five men with ischemic cardiomyopathy (ICM), and five age-matched healthy male controls underwent serial 123I-mIBG and 99mTc-Tetrofosmin SPECT/CT imaging during an anger recall mental stress task and dual isotope imaging was repeated approximately 1 week later during rest. Images were reconstructed using an iterative reconstruction algorithm with CT-based attenuation correction. The mismatch of left ventricular myocardial 123I-mIBG and 99mTc-Tetrofosmin was assessed along with radiotracer heterogeneity and the 123I-mIBG heart-to-mediastinal ratios (HMR) were calculated using custom software developed at Yale. The hemodynamic response to mental stress was similar in both groups. The resting-HMR was greater in healthy control subjects (3.67 ± 0.95) than those with ICM (3.18 ± 0.68, P = .04). Anger recall significantly decreased the HMR in ICM patients (2.62 ± 0.3, P = .04), but not in normal subjects. The heterogeneity of 123I-mIBG uptake in the myocardium was significantly increased in ICM patients during mental stress (26% ± 8.23% vs. rest: 19.62% ± 9.56%; P = .01), whereas the 99mTc-Tetrofosmin uptake pattern was unchanged. Mental stress decreased the 123I-mIBG HMR, increased mismatch between sympathetic activity and myocardial perfusion, and increased the heterogeneity of 123I-mIBG uptake in ICM patients, while there was no significant change in myocardial defect size or the heterogeneity of 99mTc-Tetrofosmin perfusion. The changes observed in this proof-of-concept study may provide valuable information about the trigger–substrate interaction and the potential vulnerability for ventricular arrhythmias.

Clinical perfectionism is associated with various cognitive processes including performance monitoring and emotion regulation. This exploratory study analyzed neurological data from a randomized controlled trial for clinical perfectionism that compared acceptance and commitment therapy (ACT) to a waitlist control. The objective was to assess the effect of ACT on neural activation. Twenty-nine participants underwent a functional near-infrared spectroscopy assessment during which they completed behavioral tasks designed to elicit error detection and error generation at pre- and posttreatment. The hemodynamic response function (HRF) in the dorsolateral prefrontal cortex, dorsomedial prefrontal cortex, and right inferior parietal lobe was analyzed using mixed effects models. In all areas, we found reductions or smaller increases in the total HRF for experimental tasks from pre-to posttreatment in the ACT condition compared to the waitlist condition. Decreases in total oxygenated hemoglobin are consistent with diminished recruitment of neurons in response to previously emotionally salient stimuli, possibly representing greater cognitive processing efficiency. Our preliminary findings tentatively support the processes of change posited by the theory underlying ACT and highlight the need for more precise methodology in neurological assessment to adequately evaluate how treatment affects neurological function. Limitations include lack of an active comparison condition and behavioral data.

Introduction: Laryngoscopy and endotracheal intubation is associated with significant hemodynamic changes. Though these changes are well tolerated in healthy patients, they are undesirable in patients with comorbidities like coronary artery disease, systemic hypertension, myocardial insufficiency and intracranial hypertension. Various drugs have been tried in an effort to attenuate adverse hemodynamic responses to intubation, but so far none is ideal. Objectives: To find efficacy of low dose oral carvedilol in attenuating the hemodynamic responses to direct laryngoscopy and endotracheal intubation. Methodology: In this randomized, prospective, double-blind placebocontrolled study 80 patients of either sex aged between 18 and 60 years of age, belonging to the American Society of Anesthesiologists (ASA) health status Classes I and II, undergoing elective surgery requiring general anesthesia with endotracheal intubation were included. Patients were randomly divided into two groups. Group A: given 3.125 mg of Carvedilol orally and Group B: given a placebo (Vitamin B capsule) orally one hour before intubation with sips of water. Hemodynamic parameters were noted before and then 1, 2, 5, 10, 15 min after intubation. Any adverse effects associated with drugs were noted. Results: Both groups were well matched for their demographic data. There was a statistically significant difference (P< 0.05) between carvedilol and placebo in heart rate at all points of measurement after tracheal intubation. The systolic blood pressure was significantly lower in carvedilol group only at 5min after intubation. Diastolic and mean blood pressures were comparable in every points of measurement. None of the patients had any adverse effects. Conclusion: Low dose carvedilol has statistically significant effect in attenuating the heart rate response to direct laryngoscopy and endotracheal intubation.

In this study, we have evaluated the hemodynamic effect of clonidine, administered as a premedication in patients undergoing laparoscopic cholecystectomy. This study reveals that clonidine is an excellent premedication that can suppress the hemodynamic changes associated with induction of anesthesia, during pneumoperitoneum for laparoscopic procedure and in the immediate period after release of the pneumoperitoneum. Clonidine 3 tg/kg, was compared to a placebo 60-90 minutes before surgery, there were no side effects like bradycardia and hypotension with the use of clonidine. We conclude that clonidine may be an excellent drug to use as a premedication in patients undergoing laparoscopic cholecystectomy.

Simultaneous [18 F]-fluorodeoxyglucose positron emission tomography and functional magnetic resonance imaging (FDG-PET/fMRI) provides the capability to image two sources of energetic dynamics in the brain – cerebral glucose uptake and the cerebrovascular haemodynamic response. Resting-state fMRI connectivity has been enormously useful for characterising interactions between distributed brain regions in humans. Metabolic connectivity has recently emerged as a complementary measure to investigate brain network dynamics. Functional PET (fPET) is a new approach for measuring FDG uptake with high temporal resolution and has recently shown promise for assessing the dynamics of neural metabolism. Simultaneous fMRI/fPET is a relatively new hybrid imaging modality, with only a few biomedical imaging research facilities able to acquire FDG PET and BOLD fMRI data simultaneously. We present data for n = 27 healthy young adults (18–20 yrs) who underwent a 95-min simultaneous fMRI/fPET scan while resting with their eyes open. This dataset provides significant re-use value to understand the neural dynamics of glucose metabolism and the haemodynamic response, the synchrony, and interaction between these measures, and the development of new single- and multi-modality image preparation and analysis procedures., Measurement(s) glucose import • haemodynamic response • functional brain measurement Technology Type(s) FDG-Positron Emission Tomography • Blood Oxygen Level-Dependent Functional MRI Factor Type(s) resting human brain Sample Characteristic - Organism Homo sapiens Machine-accessible metadata file describing the reported data: 10.6084/m9.figshare.12994508