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Background: Laryngoscopy is associated with a sympathetic response that results in a rapid increase in blood pressure and heart rate in these patients. The mechanisms underlying these hemodynamic changes are incompletely understood. They may be caused by a reflex sympathetic discharge due to stimulation of the upper respiratory tract. It has been observed that hemodynamic responses to tracheal intubation are associated with an increase in plasma catecholamine concentrations and are attenuated by β-adrenergic blockade. These hemodynamic changes may be undesirable particularly in neurosurgical patients. Aim of the study is the present study was prospective, randomized, double-blind conducted to evaluate the efficacy of dexmdetomidine and fentanyl in attenuation of pressor responses to laryngoscopy and intubation in neurosurgical patients undergoing lumbar spine surgeries.Methods: A total of 60 patients of 18–65 years, American Society of Anaesthesiologists Class I/II of undergoing elective neurosurgical procedures were included in the study. The patients were divided into two groups of 30 patients each. Group D received dexmedetomidine and Group F received Fentanyl. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial blood pressure (MAP) were recorded preoperatively (baseline), at 5 and 8 minutes after infusion of study drug, before induction, 1 minute after induction, 2 minute after intubation, 5 minute after intubation, 10 minute after intubation and 15 minute after intubation.Results: There was a better control of Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure in Group D when compared to Group F during laryngoscopy and after intubation.Conclusions: The present study shows that dexmedetomidine suppresses hemodynamic responses effectively than fentanyl.
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@#Objective To analyze the neuroelectrophysiological characteristics of peripheral neuropathy after chronic obstructive pulmonary disease. Methods From January to December, 2016, a total of 60 patients of chronic obstructive pulmonary disease with peripheral neuropathy were reviewed the motor conduction velocity and compound muscle action potential amplitude of median, ulnar, tibial, peroneal nerves; the sensory conduction velocity and sensory nerve action potential amplitude of median, ulnar, tibial, superficial peroneal nerves; and the skin sympathetic response of limbs. Results The incidence of abnormalities was higher in amplitude than in conduction velocity of motor nerve and sensory nerves (χ2=190.026, P<0.001). The incidence of abnormal conduction velocity was similar in motor nerve and sensory nerves (χ2=1.538, P>0.05), as well as the abnormal action potential amplitude (χ2=2.839, P>0.05). The incidence of abnormal conduction was similar with abnormal skin sympathetic response (χ2=0.001, P>0.05). The incidence of abnormalities of nerve conduction study (χ2=81.114, P<0.001) and abnormal skin sympathetic response (χ2=5.689, P<0.05) was more in lower limbs than in upper limbs. Conclusion The peripheral neuropathy after chronic obstructive pulmonary disease characters mainly as motor-sensory multiple neuropathy, involving motor, sensory and autonomic nerve. The axonal damage is significant, with the similar severity between motor and sensory nerves, as well as between the large and small nerves.
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Objective To investigate the value of nerve conduction studies (NCSs),F wave analysis,somatosensory evoked potential (SEP) and skin sympathetic response (SSR) in the early diagnosis of diabetic peripheral neuropathy (DPN).Methods A total of 110 patients with diabetes mellitus were recruited as the diabetic group and another 50 well-matched healthy volunteers as the normal controls.Sensory and motor NCSs of the median,ulnar,posterior tibial and common peroneal nerves were performed.F waves were recorded from the median and posterior tibial nerves.SEPs elicited by stimulation to nerves of both the upper and lower limbs as well as SSRs were measured,all in both the diabetic group and the normal controls.Results The total rate of nerve conduction abnormality was 74.5％ in the diabetic group,with sensory nerve conduction abnormalities more frequent and more severe among motor nerves in the extremities.The total rate of F wave abnormalities was 57.3％ in the diabetic group.The rate in patients with normal distal motor conduction in their median and posterior tibial nerves was 50.7％.The total SEP abnormality rate was 70.0％ with regard to the proximal peripheral nerve potentials in the diabetic group,but there was no obvious abnormality of the supraclavicular electrical potential in the upper limbs for those with normal sensory nerve conduction in the median nerve.The rate of occurrence of abnormality in the gluteus point potential in the lower limbs of those with normal posterior tibial sensory conduction was 62.5％.The total rate of SSR abnormalities was 80.0％ in the diabetic group but 72％ among those with normal nerve conduction in their extremities.Combining the NCS,SSR,SEP and F wave results,the total abnormality rate was 90.9％ in the diabetic group,which was much higher than with any single test used alone.Conclusion NCS is essential for diagnosing DPN.Early diagnosis of subclinical diabetic neuropathy will be significantly enhanced when nerve conduction,SSRs,SEPs and F waves are tested together.
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Stress is inevitable in today’s world however people are different in the way they cope with stress. This study investigated the variable response to stress by the 1ST M.B.B.S. students during their 1ST credit examination. Thirty three male students participated in the study. They were divided into 2 groups, Group I- having less than 6 hours sleep, Group II-having more than 6 hours sleep before exam. Pulse rate was significantly higher in both the groups pre- examination (88±8.4 vs.78±4.47/min and 83.26± 9.96 vs 75.26±9.21/ min) Pre examination Systolic (118±7.27 vs 110±7.37mmHg) as well as Diastolic Blood Pressure (77.89±5.47 vs 72.1±5.05 mmHg) was significantly higher in group II. However the same was not significantly different in group I. On comparing the two groups pre exam none of parameters were significantly different while post exam only systolic BP was significantly higher in group I. Marks obtained in 3 subjects by two groups were not significantly different. Students vary in their response to stress as reflected in the sleep hours, reading habits & cardiac responses. Students having an abnormal sympathetic nerve activity at rest & in response to stressor, may be more susceptible to hypertension in future. The students should be screened and those showing sustained BP response should be followed up periodically.
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Objective To explore the potential connection between sympathetic response, heart rate and blood pressure modulation after caloric irrigation in order to study the role of vestibular stimuli in cardiovascular control. Method Efferent splanchnic nerve firing rates, ECG and blood pressure were recorded simultaneously during caloric stimuli on intact anesthetized(CON) rats(n=5), sinoaortic denervated (SAD)rats(n=5) and bilateral vestibular destroyed (VD) rats(n=5). Result It was found that after caloric stimulation with ice water mean blood pressure CON rats with intact reflex became lower and the mean heart rates became slower, splanchnic sympathetic nerve activities increased for a moment and then dropped significantly. SAD rats had significant stronger splanchnic sympathetic nerve activities VD rats after caloric stimulation, and their blood pressures changed to apposite directions. The coupled respiratory component on splanhnic sympathetic nerve activities were strongly affected by the caloric stimulation. Conclusion It is suggested that semicircular canal stimulation participate at least in the short-term blood pressure control mechanism and the role of central nervous system on respiratory drive may also be involved. Baro-reflex and vestibular afferent may play different role in the control of blood pressure they may work synergically in some physiological control processed.