Does the sphenopalatine ganglion have an effect on the cerebral hemodynamic that can be modulated by local anesthetics?

The sphenopalatine ganglion [SPG] is one of four parasympathetic ganglia in the head. The purpose of this pilot study was to assess the efficacy of blocking the SPG with local anesthetic and its effect on cerebral hemodynamics. Validation of the selected blocking technique and the data obtained in this study will then be used in future studies to understand how opioids may influence the effects of the SPG on the cerebral blood vessels. We hypothesize that blocking the SPG with local anesthetics would lead to a change in the tone of the cerebral vessels and may affect the cerebral blood flow. 1KB approval and informed consent was obtained. This is a double-blinded cross-over pilot study. Five out of ten healthy adult volunteers have been recruited. A cross over between the use of a placebo [normal saline N.S.] and a local anesthetic [Lidocaine, 0.2-0.5 mg/Kg in a liquid form] was administered on the same volunteer to determine changes in cerebral hemodynamics between treatment groups. The attempt to block the SPG was done by the application of a local anesthetic on the intranasal mucosa with continuous monitoring of the cerebral hemodynamics via Trans-cranial Doppler [TCD]. EKG, non-invasive arterial pressure, end-tidal carbon dioxide [PeCO[2]], and oxygen saturation [SpO[2]] were monitored. The ipsilateral middle cerebral artery [MCA] was located through the temporal acoustic window using a 2 MHz TCD. During normal breathing, the baseline values were recorded. Thereafter, pressure was applied for few seconds on the side of the neck to compress the carotid artery followed by sudden release. This maneuver elicits the Transient Hyperemic Response Test [THRT] of the MCA. After the application of one of the treatments via Q-tip on the site of the SPG, the first set of measurements for one hour were recorded, and a second set of measurements were taken for another hour after applying the second medicine. We could not find an effect on the cerebral hemodynaminc when lidocaine was applied on the SPG using a modified transnasal approach. Replication of the modified technique to the traditional transnasal block of the SPG with lidocaine has no effect on cerebral hemodynamic

Preoperative oraltriiodothyronine improves clinical parameters and prevents non-thyroid illness for patients undergoing valvular heart surgery

Non-thyroid illness [NTI] is a temporary condition that can affect patients undergoing open heart surgeries. Preoperative oral T3 for patients undergoing valvular heart surgeries has been studied in few trials with no beneficial clinical outcome. The aim of this study was to,test different doses of oral T3at different duration of administration on the clinical parameters and the prevention of NTI for patients undergoing valvular heart surgeries. A total of 45 patients undergoing valvular heart surgeries were randomly allocated into three groups: group I [n=15] received 50microg /day of oral T[3] for three successive doses before induction of anesthesia; group II [n=15] received 50microg of oral T[3] as a single dose three hours before induction of anesthesia; and group III [N=15] did not receive T[3] tablets. Systolic, diastolic and mean blood pressure and heart rate were recorded before the start of treatment 48 hours [TO] and 24 hours [Tl] prior to surgery, Pre induction of anesthesia [T2], post induction of anesthesia [T3] and at weaning from CPB [T4]. Systolic pulmonary artery pressure was measured at TO by TTE, T3 and T4 by TEE. Number of patients who needed inotropic support and pacemaker and doses of inotropic support needed were recorded at T4. TSH, freeT4 and freeT[3] were measured at TO, T2 and 24 hour after admission to the ICU [T5]. Blood pressure was significantly higher in group I [P<0.05] at T3 and T4.SPAP was significantly lower in group I compared with other groups at T4 [37.614.5 vs 41.313.9 vs 43.313.5 mm Hg respectively, P value<0.05]. The doses of adrenaline at T4 was lower in group I compared with groups II and III [.0110.02 vs0.0410.01 vs. 0.0710.01 ug/kg/min, respectively, P value <0.01]. At T2 free T[3] was significantly higher in group I compared with groups II and III [3.310.49 vs2.8 +/- 0.49vs2.3i0.37 pg/ml, respectively, P value<0.01]. At T5 free T[3] was significantly higher in group I compared to groups II and III [3.110.53 vs 2.3610.31 vs 1.931.027 pg/ml, respectively.P value <0.01] and TSH was significantly lower in group I compared to groups II and III [3.7210.35 vs 4.9410.63 vs 6.8110.48 ulU/ml, respectively. P value <0.01]. Three successive doses of 50 ng /day of oral triiodothyronine given 48 hours before induction of anesthesia, maintained blood pressure with lower inotropic support and lower systolic pulmonary artery pressure and prevented NTI in patients undergoing valvular heart surgeries

effect of tadalafil on right ventricular function in patient with pulmonary hypertension undergoing mitral valve surgery assessed by tissue doppler and TEI index

Pulmonary artery hypertension is a disorder with limited treatment options and poor prognosis. We studied the effect of tadalafil, a selective phosphodiesterase type 5 inhibitor, in patients with this disease. In fifty patients subjected to mitral valve surgery [26 males, 24 females] aged 19040 years, with pulmonary artery hypertension, 10 mg tadalafil single dose was given to 25 patients after induction of anesthesia, and its effect was compared to a placebo given to the other 25 patients, all fifty patients had a comprehensive Transoesophageal echo examination including tissue Doppler and Tie index. Tadalafil resulted in a marked improvement in right ventricular function as regards tissue Doppler and Tie index [0.3110.05] compared to [0.34 +/- 0.02] in control group [p value =0.01] and pulmonary artery pressure [52.6 +/- 12.17] compared to control group [59.60 +/- 11.31] [p value =0.04]. 10 mg Single dose tadalafil was well tolerated and had a beneficial effect in patients with pulmonary artery hypertension undergoing mitral valve surgery

Myocardial preconditioning using sevoflurane inon-pump coronary artery bypass grafting surgery

Anesthetic preconditioning may contribute to the cardio protective effects of sevofiurane in patients having coronary artery bypass surgery. We investigated effects of on- pump exposure to sevofiurane for 10 minutes prior to aortic cross clamping on the hemodynamics, intraoperative ischemia and postoperative biochemical markers for patients undergoing coronary artery bypass. In this pilot study, 40 patients were randomly allocated into 2 groups. Patients of sevofiurane group received sevoflurane4vol.% corresponding to 2 minimum alveolar concentrations for exactly 10 minutes through a vaporizer on the heart-lung machine prior to aortic cross clamping; whereas patients of control group had no further intervention. Myocardial Biomarkers [CK, CK-MB and Troponin I] were measured as markers of cardiac cellular damage. Secondary outcome variables were invasive [systolic blood pressure, diastolic blood pressure, mean arterial pressure, and central venous pressure] and non-mvasive measurements [heart rate], S-T segment changes, diastolic and systolic dysfunctions and wail motion abnormalities in mid-papillary short axis view as well as the four chamber view were assessed by TEE denoting ischemia and finally the need for inotropic support. Hemodynamic parameters showed significant post bypass stability in sevofiurane group [P Value <0.05] compared to the control group, however there were no statistical significant differences between the two groups regarding intraoprative ischemia and inotropic support The myocardial biomarkers 9 hours after discharge to the ICU were comparable between the two groups. Current data demonstrates that sevoflurane-induced preconditioning maintainedhemodynamic stability in the post bypass period; however the preconditioning was without significant effects on intraoperative ischemia or postoperative myocardial biomarkers