hemodynamic changes

There are contradictory results regarding the effects of the menstrual cycle on changes in blood pressure, heart rate, ventilation, and oxytocin hormone during anesthesia in patients who are candidates for laparoscopic cholecystectomy surgery. Therefore, the present study was performed with aim to investigate the effect of menstrual phases on the hemodynamic changes of patients during laparoscopic cholecystectomy.

This cross-sectional descriptive study was conducted in 2018 on 100 patients who were candidates for laparoscopic cholecystectomy referred to Imam Reza Hospital (affiliated to Tabriz University of Medical Sciences). Patients were divided into two groups: luteal phase and follicular phase. Hemodynamic parameters, including heart rate, blood pressure, arterial oxygen saturation, and end-expiratory CO2 were compared between these groups. Demographic information and hemodynamic status before and during anesthesia were recorded in a researcher-made checklist. Data analysis was performed using SPSS software (version 22) and t-test, chi-square, and repeated measures tests. P<0.05 was considered statistically significant.

According to the results of t-test, there was no statistically significant difference between the two groups at any time in the mean arterial pressure, end-expiratory CO2, and arterial oxygen saturation (P>0.05). However, according to the results of repeated measures tests, the mean arterial pressure changes during the study were significantly higher in the follicular phase group (P=0.031) than in the luteal phase group (P=0.059). Also, according to the results of t-test, the comparison of the heart rate status between the two groups did not show a significant statistical difference at any time (P˃0.05); However, according to the results of repeated measures tests, heart rate changes during the study were significantly higher in the follicular phase group (P=0.019) than in the luteal phase group (P=0.126).

Menstrual cycle significantly affects hemodynamic parameters during anesthesia in patients undergoing laparoscopic cholecystectomy. These changes are more pronounced during the follicular phase compared to the luteal phase.

Laryngeal Mask Airway (LMA) is commonly used in short-term surgical anesthesia. Intravenous lidocaine is used for better patient tolerance after LMA insertion. Regarding the side effects of intravenous lidocaine, the aim of this study is to compare the effect of lidocaine spray versus intravenous lidocaine on blood pressure, heart rate, sore throat, cough, laryngospasm, and other side effects including nausea, vomiting, and convulsions after LMA insertion.

This double-blind randomized clinical trial was conducted on 120 patients aged 18-65 years with indications for short-term elective eye surgery, in 2 equal groups of 60 people. The first group was given 1% intravenous lidocaine at the rate of 1.5 mg/kg, and the second group was administered with 5 puffs of 10% lidocaine spray in the throat. Then, blood pressure by a sphygmomanometer, heart rate by a heart rate monitoring system, sore throat intensity based on VAS criteria, and cough intensity based on mild, moderate and severe were measured and compared in the two groups.

79 men (65.8%) and 41 women (42.2%) participated in this study. Clinically, there was no significant change in blood pressure in the two groups. The mean intensity of sore throat two and three hours after waking up in lidocaine spray group (0.51±1.33 and 0.41±1.07) compared to intravenous lidocaine (1.15±2.02 and 1.9±1.08) showed a significant decrease (p<0.05). Also, there were no significant changes in heart rate, cough and laryngospasm between the two groups. In addition, no cases of nausea, vomiting and seizures were found in the two groups.

Based on the results of this study, lidocaine spray can be suggested to reduce the severity of sore throat caused by LMA insertion.

Rhinoplasty is one of the most challenging cosmetic surgeries. The nature of surgery itself and hemodynamic instability in patients causes bleeding during surgery, which affects the quality of the surgical field of view, complications during and after surgery, and the outcome of surgery. This double-blind randomized clinical trial study was conducted on 51 patients aged 18 to 44 years with anesthesia class І, II who were candidates for septorhinoplasty surgery. The patients were randomly divided into two groups of tranexamic acid and control. Hemodynamic parameters at times; before induction, after induction, 1 minute after induction, 5 minutes after induction, 30, 60, 90 and 120 minutes during the operation, entry into recovery and exit from recovery were measured. The amount of bleeding during the operation was estimated based on the amount of bleeding in the suction. The average trend of systolic and diastolic blood pressure from the time before induction to outside of recovery in the control and tranramic acid groups showed a significant difference (P<0.001). In the times before and after induction, 5 minutes, 15 minutes, 30 minutes, 60 minutes, 90 minutes, 120 minutes, a significant difference in the average heart rate between the two groups was observed (P<0.05). ). The results of the present study showed that the use of a dose of 250 mg of tranexamic acid had a decreasing trend in the average hemodynamic changes over time, and during these times, the decreasing changes in heart rate were significant.

Pregnancy has a significant effect on the thyroid gland and its function. Hypothyroidism in pregnancy is defined as an increase in serum TSH levels. The present study was conducted with aim to investigate the amount of hemodynamic changes and the level of spinal anesthesia in hypothyroid patients undergoing caesarean section with spinal anesthesia and comparing it with the control group.

In this case-control study, 83 patients aged 18-42 years who referred to Motahari Hospital in Jahrom city for caesarean section were studied in two hypothyroid (n=42) and control (n=41) groups. The level of spinal anesthesia, systolic, diastolic and mean arterial blood pressure and heart rate were measured and recorded before the administration of anesthetic, 1, 15, 30, 45 and 60 minutes after anesthesia and at the time of entry and exit from recovery. Data analysis was done by SPSS software (version 21) and repeated measurement, Cochran, analysis of variance and chi square tests. P<0.05 was considered statistically significant.

There was a significant difference in the frequency of spinal anesthesia between hypothyroid patients undergoing caesarean section with spinal anesthesia and the control group (p<0.001). There was no significant difference between the groups of patients with hypothyroidism and the control group in terms of mean systolic and diastolic blood pressure before and 1 minute after anesthesia, 15, 30, 45 and 60 minutes after anesthesia and at the time of entry and exit from recovery (P<0.05).

Although the use of spinal anesthesia in pregnant mothers with hypothyroidism reported a higher level of anesthesia during the operation compared to the control group, the difference in mean arterial pressure and heart rate was not clinically significant between the groups. Based on the present study, it seems that there is no need to change the spinal anesthesia protocol for patients with hypothyroidism.

Choosing an appropriate anesthetic agent for induction and maintenance of anesthesia is very important in hemodynamic stability and pain control. The aim of this study was to compare the effects of ketamine-remifentanil combination with ketamine-propofol combination on pain, agitation and hemodynamic changes during closed reduction of nasal fracture.

This single-blind clinical trial included 80 patients between 16 and 18 years of age with ASA1 physical status who had undergone closed reduction for nasal fracture. Patients in the group 1 received 0.75 mg/kg ketamine and 2µ/kg remifentanil and group 2 received 0.75 mg/kg ketamine and 1.5 mg/kg propofol to induce anesthesia. Hemodynamic changes (heart rate, systolic and diastolic blood pressure), pain intensity, agitation, as well as nausea and vomiting and changes in arterial hemoglobin oxygen saturation during surgery were evaluated immediately after induction of anesthesia and after surgery every 15 minutes for 2 hours.

Based on the statistical analysis of the patients' data, the mean heart rate and pain intensity scores in the ketamine-remifentanil group were significantly lower than those in the ketamine-propofol group (P <0.05). Mean systolic and diastolic blood pressure and RASS scores in the two groups did not show any statistically significant differences (P> 0.05). The incidence of nausea was higher in the ketamine-remifentanil group and the decrease in oxygen saturation was higher in the ketamine-propofol group (P <0.05). There was no statistically significant difference between the two groups in regard to incidence of vomiting (P> 0.05).

Based on the results of this study, it seems that use of ketamine-remifentanil combination in comparison to ketamine-propofol in closed reduction of nasal fracture is associated with greater hemodynamic stability, higher analgesic effect and fewer complications.

 With regards to the usage of local anesthetic drugs in hypertensive patients, this study is designed for comparing the effects of mepivacaine 3% and prilocaine 3% + felypressin in hemodynamic changes after inferior alveolar nerve block to help dental practitioner select anesthetic solutions for hypertensive patients considering their hemodynamic effects in order to provide patient safety.

 In this double blind clinical trial 32 patients were referred to oral and maxillofacial surgery department of Shiraz dentistry school in 2021 were divided into 2 groups with 16 patients in each group. In first group, inferior alveolar nerve block was accomplished by mepivacaine 3% and in the other group, prilocaine 3% and felypressin. Then systolic and diastolic blood pressure, heart rate and oxygen saturation were measured at 4 different time points consisting of before injection, immediately after injection, 10 minutes after injection and 30 minutes after tooth extraction. The data were analyzed by ANOVA and T-test (p value < 0.05).

There were no statistically significant differences in systolic blood pressure, diastolic blood pressure, heart rate and oxygen saturation changes between mepivacaine and prilocaine groups during all four sampling time points. But in each group, individually there were significant differences in systolic and diastolic blood pressure, heart rate and oxygen saturation in different times. In addition mepivacaine causes a significant increase in systolic blood pressure immediately after injection but in contrast prilocaine + felypressin didn’t do so.

  We recommend prilocaine + felypressin in comparison with mepivacaine for local anesthesia in hypertensive patients.

Cataract surgery is a common surgery, especially among the elderly, and the choice of anesthesia medications is critical in such patients. In this study, the effects of midazolam, propofol, and dexmedetomidine were investigated for sedation in patients undergoing cataract surgery under local anesthesia.

Ninety patients were included in this study and underwent cataract surgery using class II and III anesthesia (according to the ASA criteria). They were also randomly assigned to three groups. The first group received midazolam, the second group received propofol, and the third group received dexmedetomidine. During the surgery and recovery phase, blood pressure, arterial blood oxygen saturation, heart rate, and the occurrence of complications were recorded. Data were analyzed using the SPSS software (version 23) at a significance level of 0.05.

Alterations in arterial blood oxygen saturation (SpO2) levels were not significantly different among the three groups (P>0.05); however, there were fewer changes in SpO2 levels at recovery in the propofol group (P<0.05). Moreover, alterations in blood pressure did not differ significantly across the three groups during the surgery (P>0.05), whereas during the recovery, they were lower in the group receiving dexmedetomidine (P>0.05). Finally, Heart rates were not significantly different among the three groups during surgery and recovery (P>0.05).

The results demonstrated that in patients with hypertension and tachycardia, dexmedetomidine may be a better choice for sedation.

The injection site in spinal anesthesia is one of the factors that can affect the height of the sensory block. This clinical trial study aimed to compare the effect of spinal anesthesia at L3-L4 and L4-L5 on the level of sensory-motor block and hemodynamic status in cesarean section.

Seventy patients undergoing elective cesarean section and receiving spinal anesthesia (10 mg of 0.5% bupivacaine plus 2.5 μg of sufentanil) were randomly divided into two groups of 35 with spinal anesthesia at L3-L4 (group 1) or L4-L5 (group 2). The two groups were compared concerning demographic data, hemodynamic status, level of sensory block, degree of motor block, time to return the sensory level to T10, complications of spinal anesthesia, and neonate Apgar score.

There was no significant difference between the two groups in the mean age (P=0.329). In the first group, 22.9%, and in the second group, 40% of the patients had the level of anesthesia at the eighth thoracic vertebra (T8). None of the patients had zero or one score in both groups. Hypotension (82.9% vs. 8.6%), bradycardia (34.3% vs. 8.6%), and intraoperative nausea and vomiting (65.7% vs. 11.4%) were higher in the first group than in the second group (P<0.001).

Performing spinal anesthesia in L4-L5 lumbar space, compared to L3-L4 space, in addition to creating a sufficient level of anesthesia, is associated with fewer complications, such as hypotension, bradycardia, as well as nausea and vomiting, in cesarean section.

Pain is the most common and unpleasant symptom of diseases, which causes hemodynamic changes if left untreated. Considering the importance of pain, we decided to determine the effect of ketamine infusion on the post-operative pain and hemodynamic status in addict patients undergoing cardiac surgery.

In this clinical trial which was performed in Baqiyatallah Hospital in 2020, 72 patients who were candidates for open heart surgery by using cardiopulmonary pump were randomly assigned to two groups. One group received ketamine and the other one received normal saline. Hemodynamic parameters including heart rate, systolic and diastolic pressures were measured before, during and after surgery. We also assessed postoperative pain by visual analogue scale (VAS). Using two sample t-test and repeated measures analysis of variance, we compared the groups with each other in regard to the hemodynamic parameters.

The results showed a significant difference in the intensity of postoperative pain between the control and ketamine groups, which was lower in the ketamine group (P = 0.001). Systolic and diastolic blood pressures were more stable in the ketamine group but the heart rate was higher at most times in ketamine group (P = 0.001).

Continuous infusion of ketamine during heart surgery until 48 hours after surgery seems to reduce postoperative pain significantly and results in decreased use of narcotic drugs after surgery. It also stabilizes and improves hemodynamics and minimizes changes in hemodynamic status.

Anxiety is a common problem that can negatively affect outcomes of an operation. The main propose of the present study was to investigate the effects of anxiety on hemodynamic parameters in pregnant women, candidate for elective cesarean section under spinal anesthesia.

Totally, 300 pregnant candidates for elective cesarean section participated in our study. To assess the severity of anxiety, patients were asked to complete DASS questionnaires before surgery and the hemodynamic parameters were recorded before spinal anesthesia, skin incision, uterus incision, and delivery time, at the end of the surgery and in the recovery room.For normal distributed data, t –test was used and to determine whether there is a significant difference between the means of the two groups. Also, repeated measures Analysis of Variance (rANOVA) was run to see how level of blood pressure changes in the different levels of anxiety score.

In the present cross-sectional study, the prevalence percentages of mild, moderate, and extremely severe anxiety in the participants was 8.7 (n= 26), 38.79 (n=115), and 52.5 (n=157), respectively. There was a statistically significant correlation between severity of anxiety and the average of systolic, mean arterial blood pressure, and heart rate.Systolic blood pressure values in the moderate, severe, and extremely severe anxiety levels were found to be 131.3±5.9, 132.2±5.7, and 136±7.4, respectively (P≤0.001) Also, the mean arterial blood pressure values in the moderate, severe, and extremely severe anxiety levels were 99.4±5.8, 99.2±5.9, and 101.6±6.8 (P≤0.01). Futhermore, heart rate increased in these three levels from 82.1±6.3 to 85.5±8.7 and then 91.3±8.9 (P≤0.001).Patients with higher anxiety scores showed higher levels of systolic, mean arterial blood pressure, and heart rate. But it did not seem to have clinical importance.

According to our findings, anxiety results in higher levels of hemodynamic parameters. Also, in parallel with the increase in the severity of anxiety, more hemodynamic changes may be observed in surgery, which had statistical difference although not clinically important.

The study addressed the comparative hemodynamic and analgesic effects of subcutaneous dexmedetomidine versus marcaine 0.5% on herniorrhaphy scheduled patients, as well as postoperative pain management.

This double-blind trial enrolled three groups of patients (N=120) scheduled for herniorrhaphy at Valiasr Hospital (Arak, Iran): (i) MAR-DEX group, receiving marcaine 0.5% (5 mg) + dexmedetomidine (1 mcg/kg), (ii) MAR group, marcaine 0.5% (5 mg), and (iii) PBO group, placebo, subcutaneously. We measured vital signs (BP/HR/SaO2), as well as pain scores (using the visual analog scale) at recovery and certain time points (1, 2, 4, 6, 12, 24 hrs post-op), and the overall opioid administered postoperatively and side effects. This was afterward followed by an SPSS (20) analysis.

Lower pain was revealed in the MAR-DEX group and higher one in the PBO group (p = 0.0001), whereas the lowest opioid use was observed in the MAR-DEX group (p = 0.0001).

Adding dexmedetomidine had benefits of relieving pain and reducing opioid use without any side effects.