COMPARATIVE STUDY OF HAEMODYNAMIC RESPONSE WITH LARYNGOSCOPIC ENDOTRACHEAL INTUBATION AND LARYNGEAL MASKAIRWAY INSERTION IN ADULT HYPERTENSIVE PATIENTS

INTRODUCTION: Laryngoscopy and endotracheal intubation has been the mainstay in providing adequate airway management, delivering general anaesthesia but are associated with hypertension, tachycardia and arrhythmias. These haemodynamic responses may be more hazardous in hypertensive patients. OBJECTIVE: In this study, we aimed to compare the haemodynamic response elicited by laryngoscopic endotracheal intubation with laryngeal mask airway insertion, in ASA II of adult hypertensive patients. METHODS: The study conducted on 100 hypertensive patients of either sex aged between 20 and 60 years belonging to ASA II grade and scheduled for elective surgery. The patients were randomly divided into two groups of 50 patients each. In one group (Group I) laryngoscopic endotracheal intubation was done and in another group (Group II) laryngeal mask airway was inserted. Baseline vitals of the patients (SBP, DBP, MAP, HR, SpO2) were documented. Patients were given inj. Midazolam 2mg IM and Phenargan 25 mg IM as premedication before the elective surgery. General anaesthesia was administered. Haemodynamics including heart rate, blood pressure and SpO2 were recorded every minute till intubation or insertion and at 1,3,5 minutes after intubation or insertion and then every 5 minutes till 20 minutes. RESULTS: All the haemodynamic responses (SBP,DBP,MAP,HR) in Laryngoscopy + Endotracheal Intubation Group compared to the Laryngeal Mask Airway Insertion Group was statistically signi?cant as the p value is <0.05. CONCLUSION: The laryngeal mask airway may be used for airway management during anaesthesia in hypertensive patients on treatment in whom the pressor response would be deleterious.

Comparative Study of IV Esmolol, IV Diltiazem, and IV Lignocaine Hydrochloride in Attenuating Pressure Response to Laryngoscopy and Intubation.

Not many studies have compared more than two drugs in attenuating pressor responses to laryngoscopy and intubation. This study compares four groups of considerable size. The present study compared intravenous esmolol, diltiazem, and lignocaine, for their efficacy to abate pressure response to laryngoscopy and intubation. METHODSThis is a prospective, randomized, double-blinded, controlled clinical study conducted among 220 patients of ASA grade I/II (age 18–60 years), undergoing elective surgical procedure requiring general anaesthesia with endotracheal intubation over a period of 15 months at a tertiary hospital setup. Study subjects were categorised as Groups D, E, L, and N that received diltiazem (0.2 mg/Kg IV), esmolol (2 mg/Kg IV), lignocaine (1.5 mg/Kg IV), and normal saline, respectively; each group had 55 patients. Haemodynamic parameters were recorded at baseline, after drug administration, immediately after intubation, and at 1-, 3-, and 5-minutes after intubation. Data entry and analysis were performed using MS Excel and SPSS-PC-17 version, respectively. One-way ANOVA and the chi-square test were used to evaluate the difference. P < 0.05 was considered significant. RESULTSA maximum increase in haemodynamic parameters occurred immediately after intubation. The increase in heart rate and rate pressure product were significantly lower in Group E (+2.93% & +15.31%), whereas the increase in blood pressure was lower in Group D (8.51%). CONCLUSIONSHaemodynamic stability during laryngoscopy and endotracheal intubation is an integral and essential goal of any anaesthetic management plan and was more effectively maintained with esmolol and diltiazem than with lignocaine.

A Comparative Study of Oral Clonidine and Oral Midazolam as Premedicants for General Anaesthesia

Preanaesthetic medication should be effective and pleasant to be taken orally, have analgesic and non-emetic properties, should not impair cardiovascular stability or depress respiration and produce adequate sedation and anxiolysis. We wanted to compare the effectiveness of oral clonidine and oral midazolam as preanaesthetic medicants.METHODSAfter obtaining the institutional ethical committee clearance and written informed consent, 60 patients, selected for surgery under general anaesthesia were divided by computer generated randomization in Group C (n=30): received Tablet clonidine 150 mcg (0.15 mg) and Group M (n=30): received Tablet midazolam 7.5 mg. Noninvasive blood pressure (systolic, diastolic & mean), respiratory rate, heart rate, degree of sedation, degree of anxiolysis, were recorded at, just before the administration of the any study drug which was 90 minutes before to the induction of anaesthesia, just before to induction of anaesthesia, three minutes after the orotracheal intubation, every 10 minutes for 3 such readings, and three minutes after the orotracheal extubation, and were statistically analysed.RESULTSOral clonidine produced significant attenuation of systolic, diastolic & mean arterial pressure, and reduced respiratory rate, than oral midazolam. Oral midazolam was able to attenuate the pulse rate in a better way than oral clonidine. Oral clonidine produced significant sedation and anxiolysis in comparison to patients who receiving oral midazolam.CONCLUSIONSOral clonidine is the better attenuator amongst the two drugs studied as premedicants to attenuate the cardiovascular responses to laryngoscopy and intubation.

A comparative study of various types of intravenous fluids on the changes during induction of general anaesthesia

Background: The induction and endotracheal intubation is the most risky and initial process of general anaesthesia. Without induction and endotracheal tube placement one cannot imagine the general anaesthesia. Propofol and fentanyl are the commonly used drugs for induction of general anaesthesia. These drugs produce hypotension and other cardiorespiratory disturbances. These hazardous and sometimes fatal effects can be reduced and eliminated by preloading the patients with colloid or crystalloid solutions.Methods: We selected 90 patients who visited our hospital in the last 2 years from June 2017 to May 2019. All the investigations and pre-anaesthetic check-up was done routinely. These patients had to undergo different surgical procedures under general anaesthesia. The induction of anaesthesia was done with propofol and fentanyl. These patients were divided in three groups A, B and C. Group A patients did not receive any preloading. Group B was given colloids (3.5% gelatins) and group C received crystalloids (Ringer’s lactate solution). The haemodynamic changes were noted and analysed statistically.Results: The study showed that IV fluids given before induction of general anaesthesia blunts the adverse cardiovascular response.Conclusions: We concluded that preload with fluids whether colloids or crystalloids are beneficial to counter the detrimental effects of propofol and fentanyl for induction of general anaesthesia. The preload fluids stabilise the patient haemodynamically. When compared the two, colloids were better to blunt the cardiovascular changes.

Comparison of haemodynamic parameters in two different geriatric age groups undergoing cemented bipolar hemiarthroplasty

Background: To conduct a prospective observational study to compare the haemodynamic changes in two age groups, group A: 60-75yrs and group B: >75yrs during cemented bipolar hemiarthroplasty for hip fractures under spinal anaesthesia.Methods: Patients of either sex belonging to above two groups, with no contra-indications for central neuraxial block received spinal anesthesia at lumbar level. Heart Rate (HR), Systolic Blood Pressure(SBP), Diastolic Blood Pressure(DBP) and Mean Arterial Pressure(MAP), pulse pressure variability(PPV), arterial oxygen saturation (SpO2), Electrocardiogram for any changes and nasal  end tidal CO2 (EtCO2) were recorded at the following time points:  baseline(on table), after giving spinal, after giving surgical position, at the start of surgery, at femoral canal reaming, immediately after cement insertion, every 2 minutes after cement insertion, femoral joint reduction and the end of the surgery. Hypotension, bradycardia, arrythmias, desaturation or unexpected loss of consciousness occurring in peri-cementation period suggestive of ‘Bone cement implantation syndrome’(BCIS) or any other adverse event was recognized and treated.Results: The SBP, HR, PPV, ETCO2, SPO2 and incidence of adverse events; were comparable in both the groups. The difference in the DBP and MAP was statistically significant.Conclusions: The difference in the occurrence of haemodynamic alterations was more in the older age group. Continuous vigilant monitoring during bipolar hemiarthroplasty is required.

Comparison of Glottic View and Haemodynamic Stress Response Associated with Laryngoscopy using the Macintosh, McCoy and Miller Blades in Adult Patients

Introduction: Laryngoscopy induces haemodynamic responsewhich has implications for patients with cardiovascularillnesses. We devised this study to compare the laryngoscopicview of the glottis obtained with the Macintosh, McCoy andMiller blades, and corresponding haemodynamic changes.Material and Methods: 105 ASA grade I and II patientsrandomly divided into three groups were intubated usingMacintosh, McCoy and Miller blade respectively. Cormackand Lehane grade of glottic view obtained, heart rate, systolicand diastolic blood pressure at baseline, immediately beforeinduction, following induction, and at 1, 3 and 10 minutesafter intubation were noted. Epi Info 7.2 was used forstatistical analysis. Chi square and ANOVA tests were appliedto compare haemodynamic parameters.Results: 18 patients (51.4%) were CL grade I and 17 (48.6%)were CL grade II in Macintosh, 24 (68.6%) were CL gradeI and 11 (31.4%) were CL II in McCoy and, 32 (91.4%)were CL I and 3 (8.6%) were CL II in Miller group. Risein heart rate following intubation was greatest with Millerblade, followed by Macintosh and least with McCoy, andwas statistically significant (P< 0.01). Rise in both, systolicand diastolic blood pressure following intubation was highestwith the Miller blade, followed by Macintosh and least withMcCoy, and the difference compared with baseline values wasstatistically significant (P<0.01).Conclusions: Miller blade provides best visualization of larynxbut McCoy blade produced least haemodynamic response,hence the latter is preferable when less haemodynamicresponse is desired.

Effects of Various Anaesthetic Techniques on Haemodynamic Stability and Inflammatory Cytokine (IL-6) Level in Patients Undergoing Breast Cancer Surgery

Introduction: Multimodal anaesthesia techniques includeregional anaesthesia in the form of paravertebral block andvarious anaesthetic drugs which acts on different sites of painpathway with different mechanism of action, results in goodquality of analgesia with minimal side effects. They improverecovery along with early mobilization and rehabilitationand early resumption. This technique lowers the level ofinflammatory cytokines. Due to this we aim to evaluate theeffects multimodal anaesthesia technique on level of IL-6inflammatory cytokines in breast carcinoma surgery.Material and Methods: Patients were randomized intofollowing three groups (n=30 in each group) using a computergenerated random number tables. Group I: paracetamol 10 mg/kg, Group II: paracetamol at 10 mg/kg and dexmedetomidine0.5μg/kg, Group III: paracetamol 10 mg/kg, dexmedetomidine0.5 μg/kg and paravertebral block with levobupivacaine.Fentany (2 μg/kg) with general anaesthesia were common inall three groups. Statistical Analysis: All the categorical datawas compared by using student “t” test, chi-square test andparametric data by analysis of variance (ANOVA).Results: Patients of group III was haemodynamically morestable as compared to group II and I. IL-6 level was 358.15, ingroup I, 354 in group II and 346.65 in group III preoperativelywhile 324.85 in group I, 320.95 in group II, 278.35 in group IIIafter 2 hour surgery. IL-6 level was significantly different ingroup III as compared to group II and group I postoperatively.Conclusion: Multimodal approach is a better anesthetictechnique in terms of hemodynamic stability with decreasedlevels of IL-6 inflammatory cytokines.

To Compare the Haemodynamic Characteristics of Sevoflurane and Desflurane Anaesthesia and Fast Track Criteria of Recovery after Ambulatory Surgery

Background: The number and variety of procedures done onday care basis has rapidly increased in recent past. For daycare anaesthesia, the use of anaesthetics that provide fast andsmooth induction, allow quick changes in depth whilemaintaining anaesthesia, early recovery and less postoperative nausea and vomiting are recommended. The aim ofthis study to compared the haemodynamic characteristics ofsevoflurane and desflurane anaesthesia and Fast track criteriaof recovery after ambulatory surgery.Materials & Methods: A double blind randomized study in theDepartment of Anaesthesiology and Intensive Care Unit atGovt. Medical College, Amritsar. 100 patients of AmericanSociety of Anaesthesiologist grade I or II in the age group of 20to 50 years undergoing short surgical procedure under generalanaesthesia were included. Continuous monitoring of vitalswas started after attaching Multipara monitor. In first 15minutes of intra-operative period monitoring of BP, HR, SPO2and ECG pattern were done every 5 minutes after that timeinterval was changed to 10 minutes till completion of surgery.After completion of surgery emergence time was noted. Inrecovery room assessment of variables required for fast trackscoring system were recorded after every 5 minutes. All theresults were be compiled, analyzed statistically and theappropriate test was applied and the blinding of the study wasopened at the end.Results: Our study showed that the mean age of patients inboth the groups was found to be statistically insignificant(p>0.05). The mean duration of surgery in both the groups wasfound to be statistically insignificant (p>0.05). The fast trackscore in group S and D at different time interval wasstatistically insignificant (p>0.05) and the maximum number ofpatients achieving PADDS score between 60-120 minutes.83% patients were ready to go home at 120 minutes.Conclusion: We concluded that both the inhalationalanaesthetics i.e. sevoflurane and desflurane provide similarhaemodynamic stability, but desflurane is associated withfaster emergence as compared to sevoflurane.

To Evaluate the Effectiveness of Intravenous Dexmedetomidine Infusion During Laproscopic Cholecystectomy. A Prospective Randomised Placebo Control Study

Introduction: Laparoscopic cholecystectomy is one of thecommonest surgery performed under general anesthesiain our set up but maintaining the hemodynamic stability ischallenging in these patients .Due to its well-known advantageslike less post-operative pain, shorter hospitalization and fasterfunctional recovery, laparoscopic cholecystectomy is alsotermed as patient friendly surgery. The Dexmedetomidine isa relatively new potent and highly selective α2-adrenoceptoragonist that has been used to provide sympatholysis,analgesia and sedation in the perioperative period. Thepresent prospective, randomized study was designed toanalyse the effect of IV dexmedetomedine on intraoperativehemodynamics, and the incidence of side effects in patientsscheduled for laparoscopic cholecystectomy.Material and methods: After obtaining approval fromHospital Ethics Committee, Study was conducted on 80 adultpatients aged 18-60 years, of ASA grade I or II of either sex,scheduled for laparoscopic cholecystectomy under generalanesthesia. Patients were randomized into two groups of 40patients each. Patients of Group D received dexmedetomedineinfusion (loading: 0.7μg/kg and maintenance: 0.4μg/kg/hr)and Group C (control group) received normal saline infusionwith the same rate as group D. Patients were monitored forchanges in heart rate, ECG, systemic blood pressure andEtCO2, at baseline, at 5 min and 10 min after giving studydrug bolus, after induction, intubation, skin incision and CO2insufflation. Thereafter, these changes were recorded at 15min intervals till the end of surgeryResults: It was found that dexmedetomidine significantlyreduces heart rate, systolic, diastolic and mean arterialblood pressure .It was observed that perioperative use ofdexmedetomidine infusion maintained better hemodynamicstability as compared to the normal saline in control groupand has sparing effect on other anaesthetic drug mainly onproppfol and fentanyl.Conclusion: Dexmedetomidine infusion was a betteroption for maintaining hemodynamic stability duringlaparoscopic surgeries. Dexmedetomidine effectivelyattenuates haemodynamic stress response during laparoscopiccholecystectomy with reduction in requirement ofconcomitantly-administered anaesthesia maintaining drugs.

Assessment of Complications and Haemodynamic Stability with the Use of Dexmedetomidine with Bupivacaine: An Institutional Based Study

Background: Lesser doses of local anesthetic in addition withadditives provides the necessary sensory level with enoughanalgesia. Dexmedetomidine is the S enantiomer ofmedetomidine that carries a high degree of specificity foradrenoreceptor. The present study was conducted with the aimto assess the complications and haemodynamic stability withthe use of dexmedetomidine with bupivacaine.Materials and Methods: The present study was conducted ina prospective manner for a period of 1 year at Department ofAnaesthesiology, Lady Hardinge Medical College & Smt. S. K.Hospital, New Delhi, India. No anesthesiologist enrolled in thepresent study was conscious of the group assigned till theentire 30 subjects were enrolled and the study was completed.After verifying a clear and free flow of the CSF, the drugadministration was completed and the subjects were placed atthe supine position. For every patient, heart rate and meanarterial pressure monitoring was done every 2 min for the initial10 minutes after spinal anesthesia, then after every 5 minutestill 30 minutes and then every 30 minutes till complete motorand sensory recovery. All the data thus obtained was arrangedin a tabulated form and analyzed using SPSS software.Probability value of less than 0.05 was regarded as significant.Results: The present study enrolled 30 subjects with15 patients in each group. The mean age of the subjects was39.22+/-4.67 years. The preoperative BP in Group I was94.67+/-8.22 and in group II was 91.52+/-5.38. There was nosignificant difference between them. There was 1 subject eachin Group I and II with nausea and shivering respectively.Conclusion: The study showed no significant alterations in thehaemodynamic stability the side effects between subjects whoreceived bupivacaine alone or bupivacaine plusdexmedetomidine.

Changes In The Haemodynamic Response Following Endotracheal Intubation And Laryngeal Mask Airway Insertion In Hypertensive Patients– A Comparative Study

Endotracheal intubation with the help of a laryngoscope has become a routine part of delivering a general anaesthetic. In general, intubation is indicated for patients who are at risk of aspiration and for those undergoing surgical procedures (1,2).Tracheal intubation causes a reflex increase in sympathetic activity that may result in rise in blood pressure, heart rate, and arrhythmia (3). Achange in plasma catecholamine concentrations also has been demonstrated to be a part of the stress response to tracheal intubation. Various supraglottic devices have provided conflicting evidence of an attenuated haemodynamic response. Materials and Methods:100 Patients divided into two groups (n=50)of 25-60 years of age of either sex with hypertension stage-1 of ASAgrade II on oral anti-hypertensives drugs were selected for the study and endotracheal tube inserted in ETgroup where as LMAinserted in group LMA.Results:Haemodynamics (heart rate, blood pressure, rate pressure product) changes is more in group ETafter induction compared to group LMA.Conclusion:Pressor response and duration of the pressor response to laryngeal mask airway insertion is much less than that of laryngoscopy and endotracheal intubation which establishes the usefulness of LMAin hypertensive patients.

Pre-emptive Use of Oral Pregabalin Attenuates the Pressor Response of Laryngoscopy and Endotracheal Intubation: A Double Blind Randomized Placebo Controlled Study.

Background: Laryngoscopy and intubation may cause undesirable increase in blood pressure and heart rate. The aim of the present study was to investigate the effect of Pregabalin premedication on hemodynamic responses to laryngoscopy and intubation. Methods: Sixty ASA physical status I or II patients undergoing elective surgery under general anesthesia were randomly allocated into two equal groups who received either oral Pregabalin 150 mg (Group PB)or placebo (Group PL)1 hour prior to surgery. Heart rate, Systolic, Diastolic and Mean arterial blood pressures were recorded preoperative, at laryngoscopy and 0,1,3,5 and 10 minutes after tracheal intubation. Results: Demographic data and base-line values for Heart rate, Systolic, Diastolic and Mean arterial blood pressures were comparable between groups. During laryngoscopy and intubation there was significant attenuation of SBP, DBP and MBP in PB group as compared to PL group. Although increase in heart rate was less in pregabalin group during laryngoscopy and intubation but it was not statistically significant. Conclusion: In the present study design, oral Pregabalin premedication at a dose of 150 mg one hour prior to surgery attenuates pressor response associated with laryngoscopy and endotracheal intubation but not the tachycardia significantly.

A randomised comparative study of the effect of Airtraq optical laryngoscope vs. Macintosh laryngoscope on intraocular pressure in non-ophthalmic surgery / Estudo comparativo randomizado do efeito do laringoscópio óptico Airtraq vs. laringoscópio Macintosh sobre a pressão intraocular em cirurgia não oftálmica

BACKGROUND: We compared intraocular pressure changes following laryngoscopy and intubation with conventional Macintosh blade and Airtraq optical laryngoscope. METHODS: Ninety adult patients were randomly assigned to study group or control group. Study group (n = 45) - Airtraq laryngoscope was used for laryngoscopy. Control group (n = 45) - conventional Macintosh laryngoscope was used for laryngoscopy. Preoperative baseline intraocular pressure was measured with Schiotz tonometer. Laryngoscopy was done as per group protocol. Intraocular pressure and haemodynamic parameters were recorded just before insertion of the device and subsequently three times at an interval of one minute after insertion of the device. RESULTS: Patient characteristics, baseline haemodynamic parameters and baseline intraocular pressure were comparable in the two groups. Following insertion of the endotracheal tube with Macintosh laryngoscope, there was statistically significant rise in heart rate and intraocular pressure compared to Airtraq group. There was no significant change in MAP. Eight patients in Macintosh group had tongue-lip-dental trauma during intubation, while only 2 patients received upper airway trauma in Airtraq group. CONCLUSION: We conclude that Airtraq laryngoscope in comparison to Macintosh laryngoscope results in significantly fewer rises in intraocular pressure and clinically less marked increase in haemodynamic response to laryngoscopy and intubation.

JUSTIFICATIVA: Comparar as alterações de pressão intraocular após laringoscopia e intubação com lâmina Macintosh convencional e laringoscópio óptico Airtraq. MÉTODOS: Noventa pacientes adultos foram randomicamente designados para os grupos estudo ou controle. No grupo estudo (n = 45) o laringoscópio Airtraq foi usado para laringoscopia e no grupo controle (n = 45) o laringoscópio Macintosh convencional foi usado para laringoscopia. A pressão intraocular foi mensurada no pré-operatório com tonômetro Schiotz. A laringoscopia foi feita de acordo com o protocolo de cada grupo. Pressão intraocular e parâmetros hemodinâmicos foram registrados logo antes da inserção do dispositivo e três vezes após a inserção do dispositivo, com intervalo de um minuto. RESULTADOS: As características dos pacientes, os parâmetros hemodinâmicos basais e a PIO basal foram comparáveis nos dois grupos. Após a inserção do tubo endotraqueal com o laringoscópio Macintosh, houve um aumento estatisticamente significativo da frequência cardíaca e da pressão intraocular em comparação com o grupo Airtraq. Não houve alteração significativa da PAM. Oito pacientes do grupo Macintosh sofreram trauma de língua-lábio-dental durante a intubação, enquanto apenas dois pacientes sofreram trauma das vias aéreas superiores no grupo Airtraq. CONCLUSÃO: Concluímos que o laringoscópio Airtraq, em comparação com o laringoscópio Macintosh, resultou em elevações significativamente menores da PIO e em aumentos clinicamente menos acentuados da resposta hemodinâmica à laringoscopia e intubação.

Assessment of Changes in the Haemodynamic Parameters after Laryngeal Mask Airway Insertion.

Background: Significant increase in heart rate and arterial blood pressure due to laryngoscopy and tracheal intubation have been associated with acute left ventricular failure, ruptured cerebral aneurysm, cardiac dysarrythmia and ischemia electrocardiographic changes. Objective: To assess changes in the haemodynamic parameters after laryngeal mask airway insertion. Methods: In this study, 80 patients of ASA grade I and II were randomly divided into two Groups A and B. All the patients of both the Groups were posted for elective surgery. Informed and written consent was obtained from the patients. Group A patients received Inj Lignocaine (Xylocard) 1.5 mg/kg intravenously 90 seconds before LMA insertion. Group B patients received inj. placebo (0.9% normal saline). Heart rate, blood pressure and SpO2 were recorded at various periods. Results: There were significant changes in all the haemodynamic variables except DABP after LMA insertion. Intergroup comparison at ten minutes after LMA insertion shows significant changes in the heart rate and MAP only and the changes in the SABP and DABP were not significant. Conclusion: LMA insertion improves the conditions for LMA insertion. Although it does not abolish the pain of injection of Propofol completely, it does decrease the intensity of the pain in majority of patients.

Ultrasound Examination of Cardiovascular Profiles of Runners Participating in High Altitude Race and their Possible Influence on Performance: A Randomized Cross-sectional Study.

Objectives: This work was aimed at investigating, by means of ultrasonography, the impact of cardiovascular parameters on the physical endurance of runners participating in high altitude race. Experimental Design: This was a cross-sectional study. Place and Duration of the Study: The study was carried out in Cameroon. Anthropometric and cardiovascular parameters were recorded at the Regional Hospital annex of Buea (Cameroon) on the 12th and 13th February while race times were recorded at Molyko Stadium of Buea, on the 15th February 2014. Methodology: Out of 241 runners who finished the senior Mount Cameroon Race of Hope, 69 who were at least at their second participation, had voluntarily participated in the study. Haemodynamic parameters were collected through 2D transthoracic ultrasonography. Mann-Withney or Kruskal-Wallis tests and linear regression were used for statistical analysis. The significance level was set at p-value<0.05. Results: The mean LVEDD, LVDV, LVSV, LVMMI, SF/EF and TAPSE were 2.7±0.3 cm/m2, 88.5±49.3 mL/m2, 53.4±30.7 mL/m2, 131.1±28.6 g/m2, 69.3±9.4% and 1.7±0.3 cm/m2 respectively. In males and females, LVDV (mL/m2) was 98.6±55.3 vs. 64.2±12.6 (p=0.011) while LVSV (mL/m2) was 61.6±33.2 vs. 33.9±6.2 (p=0.0004), respectively. The linear regression model revealed that the lower the altitude, the greater the race time i.e. the weaker the performance (p=0.005; r2=0.12). In addition increase of LVDV related with increase of residential (p=0.025; r2=0.12) and training (p=0.021; r2=0.13) altitudes. Conclusion: Optimal values of haemodynamic parameters and/or high training altitude could be boosters of performance in endurance race at high altitude.

A comparative study of overall efficacy and hemodynamic effects following blind oro-tracheal intubation with ILMA vs. conventional direct laryngoscopy guided intubation with Macintosh laryngoscope.

Intubating Laryngeal Mask Airway (ILMA) is a new device to guide blind oro-tracheal intubation thus offering a new approach for endotracheal intubation and is expected to produce less sympathetically driven haemodynamic stress response. The purpose of this study was to assess overall efficacy, haemodynamic advantage and complication rate with use of ILMA compared to conventional method of endotracheal intubation with use of Macintosh Laryngoscope (ML). Methods: This randomized controlled study was conducted on 60 adult patients comparable in age, sex, weight, MPC and ASA status scheduled for elective surgeries. Patients were randomly allocated into two groups of 30 each. Both the groups received similar balanced anaesthesia technique (Inj. fentanyl 2 μg/kg, propofol 2-2.5 mg/kg, rocuronium 1 mg/kg). Tracheal intubation was done using either ILMA or Macintosh laryngoscope. The intubation time, number of attempts required for successful intubation, haemodynamic changes and oro-pharyngo-laryngeal complications encountered during both the methods were recorded. Results: Time to intubation was comparatively longer in the ILMA group than laryngoscopy group (P <0.05). The success rate of intubation was 100% in both the groups. Overall haemodynamic changes in both the groups were statistically comparable (P >0.05) and ILMA appears to be offering no haemodynamic advantage over ML. The incidence of complications was rare and comparable amongst both the groups (P >0.05). Conclusions: Therefore in patients with normal airway blind intubation with ILMA is a successful and equally efficacious method without significant oro-pharyngo-laryngeal morbidity but offers no added haemodynamic advantage compared to conventional direct laryngoscopy with ML. Thus ILMA may act as a suitable alternative to ML for patients with normal airway.

Comparative study of the effect of esmolol, fentanyl and their combination for attenuating haemodynamic responses of laryngoscopy and intubation.

Background&Objectives: Laryngeal, tracheal and bronchial receptors are stimulated by mechanical and chemical irritants during laryngoscopy, intubation and extubation. The reflex increases in sympathoadrenergic activity caused by these manipulations leads to an increase in catecholamine release, arterial blood pressure and heart rate. The aim of present study was to evaluate the efficacy of Fentanyl (2 mcg/kg), Esmolol (1mg/kg) and their combination in half the dose(fentanyl 1 mcg/kg +esmolol 0.5mg/kg) in attenuating the pressure response during laryngoscopy and tracheal intubation. Methods: This is a prospective double blind study comprising ninety patients between 21-60 yrs and ASA grade I and II scheduled for elective surgery under general anesthesia. Patients were randomly divided into group E (injection Esmolol 1mg/kg iv), group F (inj.Fentanyl 2mcg/kg iv) and group C (inj.Esmolol 0.5mg/kg and inj.Fentanyl 1mcg/kg). The study drug was given 2 minutes before induction of anaesthesia. All the vital parameters of patients were observed during intra operative and postoperative period .Values of heart rate and mean blood pressure were recorded at pre-induction, after giving study drug, after induction, immediately after intubation and at 1 min, 3 min, 5 min, 7 min and 10 min. after intubation. Results: Inter group comparison of groups E, F & C showed greater attenuation of heart rate in group F as compared to group C and group E. Inter group comparison of groups E, F & C in attenuating increase in MAP showed greater attenuation of MAP in group F as compared to group E ( p=0.880) and group C (p=0.0005). Conclusion: Among the fentanyl (2 mcg/kg), esmolol (1 mg/kg) and their combination drug in half doses, injection fentanyl is best in attenuating haemodynamic responses to laryngoscopy and tracheal intubation.

In vitro simulation on haemodynamics of mural coronary artery / 医用生物力学

Objective To study the effect of myocardial bridge oppression on blood flow, positive pressure, circumferential stress and shear stress of the coronary artery. Methods The original myocardial bridge simulative device was greatly improved to be able to measure multi-hemodynamic parameters, such as normal stress, circumferential stress and shear stress, so as to exactly simulate real blood dynamics environment with the common effect of several stresses, and comprehensively investigate the relationship between hemodynamics and atherosclerosis of mural coronary artery under the combined effects of several stresses. Results The results from the myocardial bridge simulative device indicated that the hemodynamic abnormalities were mainly located in the proximal end of mural coronary artery, and the mean and oscillation values of normal stress at the proximal end were increased by 27.8% and 139%, respectively, showing a significant increase with the intensification of myocardial bridge oppression. Conclusions It is myocardial oppression that causes the hemodynamic abnormity of proximal coronary artery, which is quite important for understanding the hemodynamic mechanism of coronary atherosclerotic diseases and valuable for studying pathological effects and treatments of the myocardial bridge in clinic.

Hypovolemia shock resuscitated with 3％ and 7.5％ hypertonic saline in emergency department / 中华急诊医学杂志

Objective To investigate the effects of 3％ and 7.5％ hypertonic saline (HS) on hemorrhagic shock patients in Emergency Department.Methods From December 2008 to February 2012,patients older than 15 years with severe trauma and systolic blood pressure (SBP) ≤70 mmHg or 70 to 90 mmHg with heart rate≥ 108 per minute were divided into three groups randomly (random number).Group A:patients treated with 3％ hypertonic saline (HS) 300 mL + lactated Ringer' s solutions (LRS).Group B:patients treated with 7.5％ HS 300 mL + LRS.Group C:patients treated with LRS.The mean arterial pressure (MAP),blood pressure (BP),heart rate (HR) were recorded before infusion and at 10,30,45,60 minutes successively after infusion.Incidence of complications and mortality rates were compared between groups.Results Atotal of 148 patients were enrolled in this study.Compared with LRS grouop,MAP was restored more promptly and maintained persistently in 3％ HS group and 7.5％ HS group,and the total volume of fluid infused was decreased to almost 50％ of LRS in the first 1 hour.No significant differences in MAP levels were observed between group A and B except 30 minutes after infusion.Single bolus of 7.5％ HS infusion resulted in increased of HR to mean 127 beats per minute at 10 minutesafter fluid resuscitation.Higher incidence of arrhythmia and transient hypotension occurred in 7.5％ HS group.There were no statistical differences of changes of electrolytic indices,mortality rates,incidences of ARDS and MODS among three groups.Conclusions Resuscitation with 3％ HS provide similar benefits and lower risk of complications compared with 7.5％ HS and LRS.This study demonstrates the practicability and safety of 3％ HS for fluid resuscitation of patients with hypovolemic shock.

Haemodynamic effects of intrathecal dexmedetomidine added to ropivacaine intraoperatively and for postoperative analgesia.

Background: For lower abdomen and lower limb surgery, spinal anaesthesia is most common modality used in routine. This study was conducted on 50 ASA 1 and 2 planned for lower limb and lower abdomen surgery. Methods: 50 patients of ASA 1 and 2 scheduled for lower limb and lower abdominal surgery were selected. Each patient received 4 milliliter volume of 0.75% isobaric ropivacaine + 5 microgram dexmedetomidine. At the intervals of 1 minute, 2 minute, 5 minute, 10 minute, 20 minute, 30 minute and 1 hour, 2 hour and 3 hour reading of pulse rate and blood pressure were recorded. Postoperatively, pain scores were recorded by using Visual Analogue Scale. Results: There were no significant changes in systolic and diastolic blood pressure after induction. The combination of ropivacaine and dexmedetomidine provided better postoperative analgesia and reduced requirement of diclofenac injection in first 24 hour. Conclusions: The patients showed excellent hemodynamic stability and postoperative analgesia to ropivacaine + dexmedetomidine. Thus it is a safe modality for lower limb and lower abdomen surgery as far as haemodynamic effects and postoperative analgesia is concerned.