To Evaluate the Effectiveness of Magnesium Sulphate as an Agent to induce Hypotensive Anaesthesia in Lumbar Spine Surgery. A Prospective Randomized, Placebo-Control Study

Introduction: This randomized placebo controlled study wasdesigned to evaluate the effectiveness of magnesium sulphateas an agent to induce hypotensive anaesthesia in lumbar spinesurgery.Material and Methods: The study included 100 patients ofboth sexes who were equally distributed in two groups, theGroup Mg(Magnesium sulphate group) and Group C (controlgroup). The Magnesium group received magnesium sulphate40mg/kg administered as a slow IV bolus over a period of 10minutes before induction and 15mg/kg/hr by continuous IVinfusion during surgery. The same volume of isotonic salinewas administered to the control group. Surgical time, heartrate and mean arterial blood pressure was measured.Results: In the magnesium group there was reduction insurgical time (103.54 mins vs 117.34 mins), although theanaesthestic time was 9 minutes longer in the Magnesiumgroup denoting a longer emergence time. The mean arterialpressure and heart rate were significantly reduced inMagnesium group(p<0.005). Postoperative shivering was alsoless in Magnesium group.Conclusion: Magnesium infusion resulted in a steady andsmooth reduction in mean blood pressure and reduced heartrate, with no episodes of severe hypotension. Furthermoremagnesium causes reduction in duration of surgical time andpostoperative shivering

Acute hypotensive and diuretic activities of Berberis vulgaris root bark aqueous extract in normal rats

The aim of this study is to investigate the effectiveness of intravenous administration of Berberis vulgaris root bark aqueous extract (BRBD) on the cardiovascular and renal functions of healthy normotensive rats. The different doses of BRBD 1, 10 and 20 mg/kg were administered intravenously (i.v) in normal rats. Blood pressure, diuretic activity and serum renal profile were analyzed. Intravenous injection of BRBD at the different doses of 1, 10 and 20 mg/kg showed a dose-dependent reduction in mean arterial blood pressure (P<0.001). At different doses of 1, 10 and 20 mg/kg, the hypotensive effect remained for more than one hour. Single dose administration of BRBD at doses of 10 and 20 mg/kg caused a significant increase in urine output (P<0.001) as compared to the control rats. Serum renal profile test (albumin, Urea, Uric Acid, creatinine and BUN) did not show any significant alteration. The authors conclude that the BRBD is a potent hypotensive and possesses diuretic potential

Evaluation of mechanism for antihypertensive and vasorelaxant effects of hexanic and hydroalcoholic extracts of celery seed in normotensive and hypertensive rats

ABSTRACT Celery (Apium graveolens L., Apiaceae) is one of the popular aromatic vegetables and part of the daily diet around the world. In this study, aqueous-ethanolic and hexane extracts of celery seed were prepared and the amount of n-butylphthalide, as an active component, was determined in each extract. Then the effects of hexanic extract on systolic, diastolic, mean arterial blood pressure and heart rate were evaluated in an invasive rat model. The vasodilatory effect and possible mechanisms of above mentioned extracts on aorta ring were also measured. High performance liquid chromatography analysis revealed that hexanic extract contains significantly higher amounts of n-butylphthalide, compared to aqueous-ethanolic extract. The results indicated that hexanic extract significantly decreased the systolic, diastolic, mean arterial blood pressure and heart rate in normotensive and hypertensive rats. Our data revealed that celery seed extract exerts its hypotensive effects through its bradycardic and vasodilatory properties. Moreover, the active components in celery seed extracts could induce their vasodilatory properties through Ca2+ channel blocking activity in endothelial and non-endothelial pathways and particularly by interference with the extra or intracellular calcium.

Intraoperative anesthetic management in breast cancer patients undergoing free flap breast reconstruction / 中国癌症杂志

Background and purpose:Perioperative anesthetic management is thought to be critical to the success of free flap breast reconstruction. The purpose of this study was to discuss intraoperative fluid, hemodynamic and temperature management in patients undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction.Methods:From Jun. 2011 to Dec. 2015, 126 patients underwent DIEP lfap breast reconstruction. Postoperative complications were reviewed. Intraoperative fluid infusion rate was analyzed. Mean arterial blood pressure (MAP) and core temperature were measured before induction (T0), after lfap elevation but before lfap transfer (T1), 15 min after flap revascularization (T2), and at the end of surgery (T3).Results:Nine patients developed flap compromised: 7 were salvaged and 2 failed. The mean intraoperative lfuid infusion rate was (5.44±1.66) (mL?kg-1)/h. MAP at T0, T1, T2 and T3 were (87.45±8.90), (74.19±8.63), (74.60±8.71) and (79.62±7.88) mmHg, respectively. Core temperature at T0, T1, T2 and T3 were (36.69±0.14), (36.36±0.18), (36.27±0.14) and (36.21±0.15)℃, respectively. Conclusion:Standard practice focusing on intraoperative lfuid management, hemodynamic adjustment and temperature control in microsurgical reconstruction of the breast should be established to further improve free lfap outcome.

Effect of different degrees of tilt on heart rate, pulse pressure and mean arterial blood pressure in young male and female Nigerians

It is well documented that changes in cardiac output are lower in the upright than supine positions. This study investigates the effect of different angles of tilt on the heart rate, pulse pressure and mean arterial pressure (MAP) of healthy male and female subjects in the 18 to 24 years age group and heights between 150 -180cm. All subjects were students in the University of Ilorin. Each participant was studied and the parameters were determined at the supine position and head up tilts at 15º, 30º, 45º and, 60º for 15 minutes interval. Additionally the supine position variables were taken as the resting value against each of the head up tilt angle degree. The result shows that there was progressive and significant increase in heart rate from supine 59.5±1.3beat/min to 62.2 ± 1.4beat/min (p<0.05) at 15º; 59.5±1.3beat/min to 63.8 ± 1.4beat/min at 30⁰ tilt (p<0.05); 59.5 ± 1.3beat/min to 65.9 ± 1.4beat/min at 45⁰ tilt (p<0.05); 59.5 ± 1.3beat/min and 68.2 ± 1.6beat/min at 60⁰ tilt (p<0.05). The results also showed that there were significant (p<0.05) increases in pulse pressure at all angles which peaked at 30⁰ tilt. Furthermore, it was observed that MAP significantly (p<0.05) increased with corresponding increase in the angle of tilt from supine to 60º (76.5±2.2 mmHg (supine) to 80.6±2.1 mmHg (15 º) to 83.8±2.1 mmHg (30 º) to 85.4±2.1 mmHg (45 º) to 85.4±2.2 mmHg (60 º). Our results demonstrated that the heart rate, pulse pressure and MAP were significantly (p<0.05) increased in males and females for all the variables.

Effects of vagus nerve stimulation on endotoxic shock in rabbits / 中华急诊医学杂志

Objective To study the effects of electrical stimulation of efferent vagus nerve on the endotoxic shock in rabbits. Method Sixteen Newzealand rabbits were randomly divided into 2 groups, namely group S as the stimulation group and group C as the control group). Rabbits were subjected to bilateral cervical vagotomy and had challenge with intravenous injection of lipopolysaccharide (LPS) (E. COLI O111: B4 , DIFCO, USA) in a dose of 600 μg/kg. The distal end of the left vagus nerve trunk was connected to an electric stimulator with bipolar electrode and controlled by an acquisition system. Stimuli with stable voltage (10 V,5 Hz,5 ms) were applied twice to the nerve for 10 minutes just before and after the administration of LPS in group S. At the time before and after the infusion of LPS 30 min,60 min, 120 min, 180 min,240 min and 300 min respectively, the heart rate(HR)and the mean arterial blood pressure (MABP) in each animal were recorded, and blood samples were taken for measuring serum tumor necrosis factor-αa(TNF-α) and interleukin-10 (IL-10). Results Compared with group C,the electrical stimulation of efferent vagus nerve could significantly attenuated the LPS-induced hypotension and de-creased the contents of TNF-α[(38.12±7.85) pg/mL vs. (55.12±7.89) pg/mL, P <0.01], but increased the contents of IL-10[(55.12±9.37)pg/mL vs. (40.15±5.44) pg/mL, P <0.01]afar LPS challenge. Conclusions The stimulation of the efferent vagus nerve can down-regulate systemic TNF-α, production and attenu-ate the development of shock after LPS challenge.

Difference in 24-Hour Ambulatory Blood Pressure in Normal Tension Glaucoma and Primary Open-Angle Glaucoma

PURPOSE: To evaluate the variation of 24-hours blood pressure in patients with normal tension glaucoma (NTG) and primary open-angle glaucoma (POAG). METHODS: Thirty patients with NTG, 30 patients with POAG, and 30 normal controls were enrolled in this study. Each subjects underwent 24-hours ambulatory blood pressure monitoring. The variation of each parameter and difference among NTG, POAG, and control groups were compared. RESULTS: The lowest diastolic blood pressure (DBP) and the lowest mean arterial blood pressure (MAP) were significantly lower in the NTG group(51.9+/-11.3 mmHg and 66.9+/-13.1 mmHg) than in the POAG group(60.0+/-11.4 mmHg and 77.8+/-16.8 mmHg, p=0.048 and 0.024) and the control group(60.1+/-10.5 mmHg and 77.4+/-13.3 mmHg, p=0.047 and 0.031) during nighttime. More patients showed a lowest MAP less than 60 mmHg in the NTG group(8 patients, 27%) than in the POAG group(2 patients, 7%) and the control group(2 subjects, 7%, p=0.038 each). In addition, a decrease of more than 15% in DBP was more frequent in NTG group(17 patients, 57%) than in the POAG group(9 patients, 30%) and the control group(9 subjects, 30%, p=0.037 each). CONCLUSIONS: Nocturnal reduction in blood pressure may play an important role in the pathogenesis of NTG in some patients. Therefore, nighttime blood pressure should be considered as an important reference factor in diagnosis and treatment of NTG.

Study on prediction of pre-eclampsia by measuring ?-HCG, blood calcium, hematocrit and mean arterial pressure / 中国医师进修杂志

Objective To investigate the clinical viability of pre-eclampsia by measuring the level of ?-HCG in blood,blood calcium,hematocrit(HCT)and the mean arterial blood pressure(mABP).The preventive value of calcium supplement was also evaluated. Methods 356 volunteers'(16th～20th gestational weeks)were measured ?-HCG in blood,blood calcium,HCT,meanwhile mABP from the same patients.If blood ?-HCG≥50 632 IU/L,blood calcium≤2.18 mmol/L,HCT≥0.35 and mABP≥85 mm Hg(1 mm Hg=0.133 kPa),a positive conclusion was made.Women with positive results were randomly divided into test group and control group. Results 71 cases turned out to be positive in this serial test.The positive predictive value was 81.82%,negative predictive value was(97.30%),the sensitivity and specificity were 84.38% and 96.77% respectively.In the study group,the incidence of pre-eclampsia was significantly decreased as compared with the control group(P

Correlations between Mean Arterial Blood Pressure, Cardiac Index, and Systemic Vascular Resistance Index in Laparoscopically-assisted Vaginal Hysterectomy (LAVH) / 대한마취과학회지

BACKGROUND: The purpose of this study was to evaluate the correlations between mean blood pressure (MBP), cardiac index (CI), and systemic vascular resistance index (SVRI) in patients undergoing laparoscopically-assisted vaginal hysterectomy (LAVH). METHODS: The authors enrolled 47-female patients prior to a LAVH. Hemodynamic parameters were measured before anesthetic induction, just after tracheal intubation, before skin incision, and 2, 5, 10, 20, and 30 min after pneumoperitoneum with CO2 by noninvasive cardiac output measurement using the partial carbon dioxide rebreathing method. RESULTS: CI was significantly reduced 2 and 5 min after pneumoperitoneum (2.6 +/- 0.7 L/min/m2, and 2.5 +/- 0.7 L/min/m2, respectively), and then returned to the pre-skin incision level. SVRI increased significantly after pneumoperitoneum and was then restored to that measured pre-skin incision at 20 min after pneumoperitoneum. MBP before anesthetic induction was found to be correlated with CI at 20 and 30 min after pneumoperitoneum (R = 0.37, P = 0.022, R = 0.37, P = 0.036, respectively). A moderate correlation was observed between MBP before anesthetic induction and SVRI at 2, 5, 10, 20, and 30 min after pneumoperitoneum (R = 0.39 0.60, P < 0.05). CONCLUSIONS: MBP before anesthetic induction correlated with CI at 20, and 30 min after pneumoperitoneum and with SVRI at 2, 5, 10, 20, and 30 min after pneumoperitoneum. Howerer, reduced CI at 2, 5, and 10 min after pneumoperitoneum was not correlated with MBP before anesthetic induction.

Effect of Alfentail on Cardiovascular Response to Bronchoscopic Endotracheal Intubation / 대한마취과학회지

BACKGROUND: Endotracheal fiberoptic bronchoscope intubation causes significant hemodynamic changes such as hypertension and tachycardia. The aim of this study was to evaluate the effects of alfentanil on cardiovascular response to endotracheal fiberoptic bronchoscope intubation in the patients anesthetized with N2O-O2-enflurane. METHODS: Forty seven healthy patients undergoing elective surgery requiring orotracheal intubation were randomly allocated to three groups and received either normal saline (control group), 8microgram/kg alfentanil (ALF8 group), or 4microgram/kg alfentanil (ALF4 group). Orotracheal intubation using a fiberoptic bronchoscope was carried out. Systolic, diastolic, and mean arterial blood pressures, and heart rates were monitored noninvasively and recorded at one-minute intervals. RESULTS: The percent change in mean arterial blood pressure from preanesthetic mean arterial blood pressure, was attenuated (P < 0.05 compared with the control group) in the ALF8 group 1 minute after intubation, but percent changes in mean arterial blood pressures from preanesthetic mean arterial blood pressure levels did not alter in the ALF4 or ALF8 groups between 1 and 5 minutes after intubation. Percent changes in heart rates from preanesthetic heart rates did not in either the ALF4 or ALF8 groups during the 5 minutes following intubation. CONCLUSIONS: These results show that alfentanil (8microgram/kg) attenuates blood pressure response to fiberoptic bronchoscopic intubation in patients anesthetized with N2O-O2-enflurane, but that it does not influence heart rate response.

Effect of Different Concentration of Fentanyl on Maintenance, Recovery and Postoperative Pain Relief in Propofol-Fentanyl-N2O Anesthesia / 대한마취과학회지

BACKGROUND: Skin incision has been used as a standard stimulus in most concentration versus response relationship studies for anesthetics. However, skin incision is not the most intense stimulation and inconvenient method during operation. Mean arterial blood pressure, but not heart rate, is convenient and predicts surgical stress as well as propofol blood concentration. We evaluated the effects of different fentanyl concentration on propofol-fentanyl-N20 anesthesia using mean arterial blood pressure as an indicator of surgical stress during operation. METHODS: Eighty ASA I or II patients (age: 20~55 yrs) scheduled for spine fusion were randomly allocated to four groups according to expected fentanyl blood concentration (Group 1, 2, 3, 4: 0, 1.5, 3.0, 4.5 ng/ml respectively, n=20 for each group). Fentanyl was infused according to isoconcentration nomogram, and propofol infusion rate was titrated by changes of mean arterial blood pressure (0~12 mg/kg/hr). Fifteen minutes before expected end of surgery, propofol and fentanyl infusion were discontinued. Thereafter IV-PCA using fentanyl was applied for postoperative pain relief. Average propofol flow rate, recovery of orientation, verbal rating scale were cheked. RESULTS: Group 2, 3, 4 showed decreased average propofol flow rate, delayed recovery and decreased postoperative 24 hr fentanyl requirement for pain relief gradually compared with group 1. Group 4 showed ceiling effect in terms of average propofol flow rate, recovery of orientation and 24 hr fentanyl requirement for postoprerative pain relief compared with group 1~3. CONCLUSIONS: Keep the fentanyl concentration below 3.0~4.5 ng/ml and titrate propofol flow rate was reasonable method for adequate control of drug infusion during a propofol-fentanyl-N20 anesthesia.

A COMPARATIVE STUDY ON THE EFFECT OF ESMOLOL AND NITROGLYCERIN AS DRUGS FOR HYPOTENSIVE ANESTHESIA IN OREHOGNATHIC SURGERY

Induced hypotension is used to help control bleeding during procedures where surgical hemostasis is technically difficult to achieve. A mean arterial blood pressure(MABP) as low as 50-60 mmHg appears to be well tolerable in healthy patients. The present study was designed to compare the efficacy of Esmolol and Nitroglycerin as primary drug for hypotensive anesthesia during 22 cases of orthognathic surgery, and compare their effects on blood loss, duration of surgery, quality of the surgical gical field, hormonal response, and patient outcome. The results obtained are as follows. 1. During the induced hypotension, mean arterial blood pressure was similarly reduced in esmolol group and nitroglycein group. And any significant difference was not seen in the time of inducing hypotension from starting the drug administration, preoperative mean blood pressure and mean blood pressure during the period of postoperative recovery. 2. Difficulty of the operation, quality of the surgical field and total operation time in 2 groups show no difference but the time during hypotension was significantly reduced in esmolol group. 3. Urine output, administered fluid volume, transfusion volume of autologous blood, preoperative and postoperative base excess, preoperative and postoperative hematocrit had no difference between 2 groups. 4. The change of the plasma renin activity was more lowered in esmolol group than in nitroglycerin group. Based on th above results, esmolol can replace the nitroglycerin as an new primary drug for hypostensive anesthesia. Especially, esmolol is more recommendable tham nitroglycerin on the effect of stability in renin-angiotensin system and prevent rebound hypertension in posthypotensive period.

The Effect of Increased Infratentorial Intracranial Pressure and the Elevation of Blood Pressure on Frontal Cortical, Pontine Cerebral Blood Flow and Auditory Evoked Potentials

Patients with extra-axial mass lesions of the posterior fossa frequently demonstrate signs of brainstem dysfunction. These dysfunctions may be induced by the change of regional cerebral blood flow and electrophysiological status as well as mechanical compression and distortion of the brainstem. Frontal cortical regional cerebral blood flow(rCBF), pontine rCBF, brainstem autidory evoked potentials(AEPs), infratentorial intracranial pressure(infratentorial ICP) and mean arterial blood pressure(MABP) were recorded before and after expansion of an infratentorial epidural ballon in anesthetized experimental cat models. After the elevation of MABP during the increased infratentorial ICP, frontal cortical and potine rCBF, AEPs were recorded every 30 minutes. The results suggest that the elevating the MABP to improve cerebral perfusion pressure before irreversible change occurs in the brain may preserve cerebral function. We conclude that if the volume of the space in the posterior fossa that is occupied by the mass can be estimated, brain damage from low rCBF and brain compression due to intracranial hypertension can be prevented by the elevation of MABP before irreversible damage of the brain occurs.