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Background: Laryngoscopy and intubation lead to unfavorable hemodynamic responses. Many studies have already compared direct laryngoscope (DL) and different types of video laryngoscopes (VLs). While some of those reported favorable response with use of VL, others have depicted an unfavorable response with VL. Aims and Objectives: Hence, the present study was carried out to compare the hemodynamic response to laryngoscopy between use of Macintosh DL and Tuoren VL in controlled hypertensive patients during elective surgery. Materials and Methods: A total of 122 patients were recruited for this interventional study. Patients were allocated into two groups to have their intubation with Tuoren VL (Group V, n=61) or Macintosh DL (Group D, n=61). The mean arterial pressure (MAP) at 1 min after intubation was the primary outcome. Other outcome measures were to compare heart rate (HR) at different time points, procedure time (glottis exposure time and intubation time), and number of attempts. Results: The use of DL led to considerably higher MAP at 1, 3, and 5 min after laryngoscopy and intubation compared with VL. However, comparable HRs were found between the two groups at such time points. Glottis visualization time and intubation time were considerably higher using VL compared with DL. The mean total procedure time was considerably lesser with DL over VL (mean, 29.5 vs. 38.5 s, respectively, <0.001). Conclusion: Tuoren video laryngoscope can be a better alternative to Macintosh direct laryngoscope in view of considerably lesser rise of mean arterial pressure and comparable heart rate during laryngoscopy and intubation in hypertensive patient. [ABSTRACT FROM AUTHOR]

Compensatory strategies used to treat dysphagia, like the chin-down and chin-up positions, are often employed by speech-language pathologists to enhance swallowing safety. However, their effects on cortical neural responses remain unclear. This study aimed to investigate the cortical hemodynamic responses to swallowing across three head positions —chin-down, chin-neutral, and chin-up — using functional near-infrared spectroscopy (fNIRS) in the bilateral precentral and postcentral gyrus regions of interest. Twenty-six healthy adults completed 32 swallows of 5 ml water in each head position. Results revealed short-term cortical activation increases for chin-up swallows compared to both chin-neutral (mean difference = 1.2, SE = 0.18, p =.048) and chin-down swallows (mean difference = 0.76, SE = 0.18, p =.009). These findings suggest that postural changes during swallowing induce immediate neural adaptations in people without swallowing difficulty. These modifications likely reflect the necessary sensory and neuromuscular adaptations required for safe swallowing in different head positions, with less hyolaryngeal movement needed for a chin-down swallow and more movement needed for a chin-up swallow. While challenging swallow conditions, like the chin-up, may offer promising therapeutic potential, caution is warranted considering the associated safety risk, and further investigation is needed. This study provides insights into the immediate effects of head positions on cortical activity during swallowing and highlights avenues for future research in dysphagia rehabilitation. [ABSTRACT FROM AUTHOR]

Objective: This study functional endoscopic sinus surgery (FESS) is a surgical procedure requiring minimal bleeding to optimize the surgical field. This study aimed to evaluate the effectiveness of magnesium sulfate, lignocaine, and propofol in attenuating hemodynamic response. The primary objective of this study was to compare the efficacy of these agents in reducing hemodynamic response. The secondary objectives included assessing the quality of the surgical field, recovery time, and total neuromuscular dose. Methods: We randomly allocated 105 patients scheduled for FESS into three groups: lignocaine, propofol, and magnesium sulfate. Heart rate and mean arterial pressure were recorded every 5 min for the first 30 min, followed by measurements every 10 min at the end of the procedure. Moreover, recovery time, total neuromuscular blocking dose, and surgical field score were noted upon completion of the procedure. Statistical analysis was conducted using the number cruncher statistical systems version 9.0.8 software. Results: All three groups showed comparable hemodynamic response and surgical field scores. The recovery time was notably longer in the magnesium sulfate group [10.94 min (2.45)] than in the lignocaine [4.37 min (1.03)] [95% confidence interval (CI) -7.32, -5.83; P=0.000] and propofol groups [4.60 min (0.60)] (95% CI 5.60, 7.095; P=0.000). Moreover, the total neuromuscular blocking agent used was significantly lower in the magnesium sulfate group [5.89 mg (0.47)] than in the lignocaine [6.26 mg (0.56)] (95% CI 0.66, 0.03; P=0.035). Conclusion: Propofol, magnesium sulfate, and lignocaine exerted equal efficacy in attenuating hemodynamic responses during surgery and ensuring a satisfactory surgical field. However, magnesium sulfate led to significantly longer recovery times compared with propofol and lignocaine. In addition, magnesium sulfate required a significantly lower total dose of neuromuscular blocking agents than lignocaine. [ABSTRACT FROM AUTHOR]

Introduction Extubation is associated with hemodynamic changes and emergence phenomena leading to cough, sore throat, dysphonia, and dysphagia in the postoperative period. The aim of our study was to compare intracuff 2% alkalinized lignocaine with 1% alkalinized lignocaine and saline in reducing endotracheal tube induced emergence phenomena and haemodynamic changes at extubation in neurosurgical patients. Materials and Methods In this randomized controlled study, 90 adult patients of either sex, scheduled to undergo neurosurgical procedures were randomly divided into three groups of 30 each to receive either 1% alkalinized lignocaine (AL1), 2% alkalinized lignocaine (AL2), or saline as cuff inflation media. Intracuff pressures and haemodynamic variables were noted intraoperatively and during emergence. The presence of postextubation cough, sore throat, dysphonia, and dysphagia were monitored until 24 hours postoperatively. Data were analyzed using Chi-square test and ANOVA. A p -value of less than 0.05 was considered significant. Results The intracuff pressures were significantly less with alkalinized lignocaine as compared to saline, after 3 hours of induction. Post extubation, hemodynamic parameters and incidence of coughing and bucking at extubation were significantly less in Groups AL1 (p = 0.024) and AL2 (p = 0.02) as compared to saline. On assessment of laryngotracheal morbidity, the incidence of coughing was found to be significantly less with 2% alkalinized lignocaine as compared to saline (p = 0.021) at 1 hour after extubation. Sore throat was significantly less in Groups AL1 and AL2 as compared with saline at 1 hour (p = 0.008, 0.002 respectively) and 8 hours (p = 0.01 in both groups), and in Group AL2 versus saline at 24 hours (p = 0.044) after extubation. The incidence of dysphonia was significantly less in Groups AL1 and AL2 as compared with saline at 1 hour (p = 0.016, p = 0.002) and 24 hours (p = 0.012 in both groups) and in Group AL2 versus saline at 8 hours (p = 0.03) postoperatively. No significant differences were noted between 1% alkalinized lignocaine and 2% alkalinized lignocaine. Conclusion Intracuff alkalinized lignocaine 1% and 2% were significantly better than saline in reducing coughing and bucking at extubation, post extubation haemodynamic changes and incidence of postoperative cough, sore throat, and dysphonia. [ABSTRACT FROM AUTHOR]

Background: Fentanyl and lidocaine are two drugs that are often suggested to lower the reaction of the blood flow to laryngoscopy and endotracheal intubation. Aims and Objectives: The main goal of our study is to find out how the heart and blood vessels react when laryngoscopy and intubation are used. A comparison was made between fentanyl 2 mcg/kg and fentanyl 2 mcg/kg plus 15 mg of paracetamol per kg of body weight. The goal was to find the best and safest ways for these options to reduce stress during laryngoscopy and intubation. Materials and Methods: The anesthesiology department and the general surgery department at the medical college and hospital that is connected to it worked together on the study. The study included a total of 120 patients, covering a wide age range from 20 to 70 years, and including both males and females. The patients had physical statuses I and II, indicating their overall health. In Group A, patients were given a pre-medication of 0.02 mg/kg of glycopyrrolate and then 2 mg/kg of fentanyl through an intravenous (IV) 90 s before they were intubated. Fentanyl at a dose of 2 mcg/kg was given to patients in Group B 90 s before they were intubated. A dose of 15 mg/kg of paracetamol was also given 10 min before the operation. As a starting point, the medical team wrote down the patient's heart rate (HR), systolic and diastolic blood pressures, and mean artery pressure before they started intubation. Results: Large rise in HR was seen in Group A, while Group B's HR stayed close to the baseline. There was a clear rise in mean blood pressure in both groups after intubation. Group A, on the other hand, saw a rise that was clear and lasted for 6 min, while Group B did not. When compared to IV fentanyl alone, IV fentanyl and paracetamol work better at lowering the changes in blood flow that happen during laryngoscopy and airway intubation. Conclusion: This finding highlights the potential benefits of combining these two medications for improved patient outcomes. Endotracheal intubation, fentanyl, paracetamol, and laryngoscopy are all important medical terms that are commonly used in health-care settings. These procedures and medications play a crucial role in various medical interventions and treatments. Understanding the significance and proper usage of these terms is essential for health-care professionals to provide effective care to their patients. [ABSTRACT FROM AUTHOR]

Background: Laryngoscopy and intubation lead to unfavorable hemodynamic responses. Many studies have already compared direct laryngoscope (DL) and different types of video laryngoscopes (VLs). While some of those reported favorable response with use of VL, others have depicted an unfavorable response with VL. Aims and Objectives: Hence, the present study was carried out to compare the hemodynamic response to laryngoscopy between use of Macintosh DL and Tuoren VL in controlled hypertensive patients during elective surgery. Materials and Methods: A total of 122 patients were recruited for this interventional study. Patients were allocated into two groups to have their intubation with Tuoren VL (Group V, n=61) or Macintosh DL (Group D, n=61). The mean arterial pressure (MAP) at 1 min after intubation was the primary outcome. Other outcome measures were to compare heart rate (HR) at different time points, procedure time (glottis exposure time and intubation time), and number of attempts. Results: The use of DL led to considerably higher MAP at 1, 3, and 5 min after laryngoscopy and intubation compared with VL. However, comparable HRs were found between the two groups at such time points. Glottis visualization time and intubation time were considerably higher using VL compared with DL. The mean total procedure time was considerably lesser with DL over VL (mean, 29.5 vs. 38.5 s, respectively,

Objective: This study functional endoscopic sinus surgery (FESS) is a surgical procedure requiring minimal bleeding to optimize the surgical field. This study aimed to evaluate the effectiveness of magnesium sulfate, lignocaine, and propofol in attenuating hemodynamic response. The primary objective of this study was to compare the efficacy of these agents in reducing hemodynamic response. The secondary objectives included assessing the quality of the surgical field, recovery time, and total neuromuscular dose. Methods: We randomly allocated 105 patients scheduled for FESS into three groups: lignocaine, propofol, and magnesium sulfate. Heart rate and mean arterial pressure were recorded every 5 min for the first 30 min, followed by measurements every 10 min at the end of the procedure. Moreover, recovery time, total neuromuscular blocking dose, and surgical field score were noted upon completion of the procedure. Statistical analysis was conducted using the number cruncher statistical systems version 9.0.8 software. Results: All three groups showed comparable hemodynamic response and surgical field scores. The recovery time was notably longer in the magnesium sulfate group [10.94 min (2.45)] than in the lignocaine [4.37 min (1.03)] [95% confidence interval (CI) -7.32, -5.83; P=0.000] and propofol groups [4.60 min (0.60)] (95% CI 5.60, 7.095; P=0.000). Moreover, the total neuromuscular blocking agent used was significantly lower in the magnesium sulfate group [5.89 mg (0.47)] than in the lignocaine [6.26 mg (0.56)] (95% CI 0.66, 0.03; P=0.035). Conclusion: Propofol, magnesium sulfate, and lignocaine exerted equal efficacy in attenuating hemodynamic responses during surgery and ensuring a satisfactory surgical field. However, magnesium sulfate led to significantly longer recovery timescompared withpropofol and lignocaine. In addition, magnesium sulfate required a significantly lower total dose of neuromuscular blocking agentsthan lignocaine.

Tactile and motor imagery are crucial components of sensorimotor functioning and cognitive neuroscience research, yet the neural mechanisms of tactile imagery remain underexplored compared to motor imagery. This study employs multichannel functional near-infrared spectroscopy (fNIRS) combined with image reconstruction techniques to investigate the neural hemodynamics associated with tactile (TI) and motor imagery (MI). In a study of 15 healthy participants, we found that MI elicited significantly greater hemodynamic responses (HRs) in the precentral area compared to TI, suggesting the involvement of different cortical areas involved in two different types of sensorimotor mental imagery. Concurrently, the HRs in S1 and parietal areas exhibited comparable patterns in both TI and MI. During MI, both motor and somatosensory areas demonstrated comparable HRs. However, in TI, somatosensory activation was observed to be more pronounced. Our results highlight the distinctive neural profiles of motor versus tactile imagery and indicate fNIRS technique to be sensitive for this. This distinction is significant for fundamental understanding of sensorimotor integration and for developing advanced neurotechnologies, including imagery-based brain-computer interfaces (BCIs) that can differentiate between different types of mental imagery.Key Points: ● Both tactile and motor imagery evoke contralateral hemodynamic responses. ● Tactile imagery predominantly activates the postcentral area. ● Motor imagery involves equal contributions from pre- and post-central areas. [ABSTRACT FROM AUTHOR]

Background: The hemodynamic response to the stress of laryngoscopy and endotracheal intubation does not present a problem for most patients, except in cardiovascular or cerebral disease. Various anesthetic techniques and drugs are available to control the hemodynamic response to laryngoscopy and intubation. However administration of an additional drug may adversely affect hemodynamics of the patient or unnecessarily increase the depth of anesthesia. Hence a non pharmacological measure to reduce response is preferred. The purpose of this study was to compare the hemodynamic response during laryngoscopy and intubation when choice of the moment of intubation is directed by either clinical assessment and neuromuscular monitoring with train of four. Methods: A total of 60 patients were randomised into two groups. In Group M endotracheal intubation was done after train of four count became zero in adductor pollicis muscle. In Group C timing of intubation was determined clinically by assessment of jaw muscle relaxation. Changes in heart rate (HR), systolic BP (SBP), diasolic BP (DBP), mean arterial pressure (MAP), time between the administration of neuromuscular blocking agent and endotracheal intubation was recorded. Results were analysed by the analysis of variance and chi square test. Results: Heart rate, SBP, DBP and mean arterial pressure were significantly higher in Group C as compared to Group M after laryngoscopy and endotracheal intubation (P

Background: Laryngoscopy and orotracheal intubation often trigger a hemodynamic response, increasing catecholamines and potentially leading to higher morbidity. Fentanyl, with a high safety margin and rapid onset, and Nalbuphine, a µ receptor antagonist and k receptor agonist with minimal respiratory depression and a “ceiling effect,” are commonly used to mitigate this response. Aim: This study compares the efficacy of Fentanyl and Nalbuphine in reducing the pressor response during laryngoscopy and intubation in patients under general anesthesia, monitored by Bispectral Index (BIS). It also evaluates total analgesic requirements, time to first rescue analgesic post-extubation (VAS score), and associated complications. Method: The study was a hospital-based, prospective, double-blind, randomized interventional trial registered under the Clinical Trials Registry - India (CTRI/2022/05/042731). The sample size of 70 patients (35 in each group) was calculated based on alpha error, study power, and the minimum clinically significant difference for MAP after induction. Patients aged 18-65 years with ASA grade I and II and body weight between 40-70 kg were included. Group A received Fentanyl, and Group B received Nalbuphine. Vital parameters were monitored during the surgery, and additional doses of the study drug were administered if the BIS score exceeded 60. Postoperative analgesic effect was evaluated by a blinded anesthesiologist. Results: The demographic characteristics of the study population were similar between the Fentanyl and Nalbuphine groups, as indicated by age, weight, sex, and ASA physical status, there was a statistically significant difference in systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rate post-intubation, with the Nalbuphine group demonstrating a greater increase compared to the Fentanyl group, which was significant at all time intervals.

Background and Aims: Both laryngoscopy and endotracheal intubation individually contribute to hemodynamic pressor response following endotracheal intubation. Parker Flex-Tip tracheal tube has a flexible, curved, smooth, centered, and tapered distal tip that is designed to facilitate rapid, easy, and nontraumatic intubation. The present study was conducted to compare Parker Flex-Tip and polyvinyl chloride (PVC) endotracheal tube (ETT) for hemodynamic response during intubation. Materials and Methods: Sixty patients of either sex of age 18–50 years, belonging to the American Society of Anesthesiologists (ASA) physical Status I or II scheduled for elective surgery under general anesthesia requiring endotracheal intubation were included. In Group I (n = 30), Parker Flex-Tip tube was used and in Group II (n = 30), PVC ETT was used. Heart rate (HR), systolic blood pressure, diastolic blood pressure (DBP), and mean arterial pressure were compared at various time intervals. Quantitative variables were compared using unpaired t-test and qualitative variables were compared using Chi-square test. P ≤0.05 was considered statistically significant. Results: The mean basal value of HR was 81.33 ± 13.78 beats/min in Group I and 87.36 ± 13.34 beats/min in Group II (P = 0.09). The difference between both the groups was found to be comparable at baseline, prelaryngoscopy, and just after laryngoscopy (AL) but this difference was found to be statistically significant just after intubation (AI) and at 1 min AI. In both groups, DBP started increasing just AL but the difference was not significant. This difference between the two groups was observed to be statistically significant at 1 min AI (81.73 ± 13.29 in Group I vs. 88.96 ± 10.27 in Group II, [P = 0.02]). Conclusion: Parker Flex-Tip tube is beneficial in controlling the hemodynamic response during laryngoscopy and intubation. This effect is significantly evident in HR and DBP.

The primary objective of this study was to determine whether or not hemodynamic parameters and laboratory values at the time of admission to the pediatric cardiac intensive care unit after the Norwood operation were associated with a composite outcome of either need for extracorporeal membrane oxygenation or inpatient mortality. This was a single-center retrospective study of infants with functionally univentricular hearts admitted to intensive care after the Norwood procedure from January 2011 to January 2020. Data were obtained at a single point (after a Norwood procedure) and then compared between two subsets of patients based on the presence or not of the composite outcome of interest. In univariate and multiple regression analyses, a series of receiver operator curves were generated to assess the relationship between the variables of interest and the composite outcome. Eight (7.6%) experienced the composite outcome out of a total of 104 patients. Those who experienced the composite endpoint had significantly higher oxygen extraction ratio (0.43 vs. 0.31, p = 0.01), lower systemic blood flow (2.5 L/min versus 3.1 L/min, p = 0.01), and higher systemic vascular resistance (20.2 indexed woods units versus 14.8 indexed woods units, p = 0.01). Those with systemic blood flow of less than 2.5 L/min/m2 had a 17% risk of experiencing the composite endpoint AUC = 0.79. Those with systemic vascular resistance of greater than 19 indexed woods units had a 22% risk of experiencing the composite endpoint AUC 0.80. Systemic blood flow and systemic vascular resistance are independently associated with this composite outcome. [ABSTRACT FROM AUTHOR]

Background: Laryngoscopy and intubation are almost always associated with an increased sympathetic activity. To attenuate the pressor response, various drugs have been tried. This study aimed at finding out the different doses of clonidine in attenuating the hemodynamic response to laryngoscopy and intubation in patients posted for any elective surgery under general anaesthesia. Material and methods: This was a prospective, comparative, observational study, which involved two groups of patients. Each group had 30 patients, Group A (n=30) received injection Clonidine 1µg/kg diluted to 10 ml of normal saline and group B (n=30) received injection Clonidine 2µg/kg diluted to 10 ml normal saline intravenously. Patients were observed for 10 minutes. Baseline data of heart rate, mean arterial blood pressure, rate pressure product, respiratory rate, and sedation score were noted. All the parameters were recorded at different intervals up to 10 minutes after intubation. Results were compiled and statistically analysed. Result: In group B, following laryngoscopy and intubation, there is more decrease in HR, MAP, RPP at 2 minutes and 3 minutes after intubation from baseline values compared to group A, which was statistically significant (p<0.01). So, there is more attenuation of hemodynamic response in group B as compare to group A. Conclusion: Clonidine 2 µg/kg was found to be marginally superior to Clonidine 1 µg/kg for attenuation of sympathetic response without any adverse effects. [ABSTRACT FROM AUTHOR]

Background: The introduction of deep sedation & tracheal intubation is demanding and causes severe hemodynamic alterations. Laryngoscopy & tracheal manoeuvres were unpleasant stimuli that cause a short-term rise in autonomic response, resulting in dysrhythmias, elevated arterial pressure, and pulse rate. Objective: To compare the difference in HR, SBP, DBP, and MAP at different intervals (before induction and after induction) in two groups during laryngoscopy and intubation under general anaesthesia. Methods: A randomized control trial was conducted and a total of 98 patients undergoing elective surgeries under General Anaesthesia were taken and were randomly divided in 2 groups: Group A (I.V Lignocaine) and Group B (Nebulized lignocaine) to 49 patients each. GROUP A: 49 patients were given IV Lignocaine (2%) 1.5mg/kg 3 minutes prior to laryngoscopy. GROUP B: 49 patients were given Nebulized Lignocaine (2%) 5ml 5 minutes prior to laryngoscopy. Results: Comparing the nebulized lignocaine group to the IV lignocaine group, we observed a statistically significant decrease of hemodynamic responses after intubation in our research. In our study statistically significant results were seen with heart rate, systolic blood pressure and mean arterial pressure with p value less than 0.05 and insignificant results with diastolic blood pressure and all other demographic variables. Conclusion: Hemodynamic variables were more stable in nebulized lignocaine group and it was seen that nebulized lignocaine attenuates the pressor responses much better than intravenous lignocaine with less hemodynamic instability. [ABSTRACT FROM AUTHOR]

Significance: Many techniques exist for screening retinal phenotypes in mouse models in vision research, but significant challenges remain for efficiently probing higher visual centers of the brain. Photoacoustic computed tomography (PACT), with optical sensitivity to hemodynamic response (HR) in brain and ultrasound resolution, provides unique advantages in comprehensively assessing higher visual function in the mouse brain. Aim: We aim to examine the reliability of PACT in the functional phenotyping of mouse models for vision research. Approach: A PACT-ultrasound (US) parallel imaging system was established with a one-dimensional (1D) US transducer array and a tunable laser. Imaging was performed at three coronal planes of the brain, covering the primary visual cortex and the four subcortical nuclei, including the superior colliculus, the dorsal lateral geniculate nucleus, the suprachiasmatic nucleus, and the olivary pretectal nucleus. The visual-evoked HR was isolated from background signals using an impulsebased data processing protocol. rd1 mice with rod/cone degeneration, melanopsinknockout (mel-KO) mice with photoreceptive ganglion cells that lack intrinsic photosensitivity, and wild-type mice as controls were imaged. The quantitative characteristics of the visual-evoked HR were compared. Results: Quantitative analysis of the HRs shows significant differences among the three mouse strains: (1) rd1 mice showed both smaller and slower responses compared with wild type (n = 10;10, p < 0.01) and (2) mel-KO mice had lower amplitude but not significantly delayed photoresponses than wild-type mice (n = 10;10, p < 0.01). These results agree with the known visual deficits of the mouse strains. Conclusions: PACT demonstrated sufficient sensitivity to detecting post-retinal functional deficits. [ABSTRACT FROM AUTHOR]

Background & objective: The anesthesiologists have been trying various strategies to lessen the adverse effects of endotracheal intubation on hemodynamic parameters. The aim of this study was to explore a better and safer drug to attenuate the pressor response to laryngoscopy and intubation by comparing dexmedetomidine (Precedex; Brookes Pharma), fentanyl (Fentra; Brookes Pharma), and lidocaine (Xylocaine; Barret Hodgson). Methodology: In this double-blind, randomized controlled trial, a total of 90 patients of ASA physical status I and II, undergoing laparoscopic cholecystectomy under general anesthesia were included. Sample size was calculated using OPEN EPI sample size calculator. Patients were randomized into three groups by sealed envelope method. Patients in Group D received intravenous dexmedetomidine 0.6 μg/kg, Group F received intravenous fentanyl 2 μg/kg and Group L received intravenous lidocaine 1.5 mg/kg over 10 min before induction. Hemodynamic variables were recorded at baseline, at laryngoscopy, 1, 3, 5 and 10 min after intubation. Perioperative complications and postoperative sedation and recovery were also noted at 0 and 10 min in Post Anesthesia Care Unit (PACU). Results: As compared to dexmedetomidine, there was no significant impact of lidocaine (P = 0.774) and fentanyl (P = 0.992) in managing the heart rate (HR) of patients, while time had a significant impact on the HR. There was no substantial effect of fentanyl (P = 0.123) or lidocaine (P = 0.616) in managing SBP and no effect of fentanyl (P = 0.580) or lidocaine (P = 0.752) in managing DBP, in contrast to dexmedetomidine. Although statistically significant reduction in HR, SBP and DBP was observed in Group D, soon after study drug infusion, but overall long-term stability was noticed. Ramsey sedation scores were significantly higher in the Group D at arrival in PACU, but after 10 min all three study groups showed almost similar results. Aldrete score was statistically significant in the fentanyl group compared to Group D and L in PACU, both at arrival and after 10 min (P = 0.001 and 0.010 respectively). Conclusion: We conclude that intravenous dexmedetomidine demonstrated better attenuation of hemodynamic response to laryngoscopy and intubation in patients undergoing laparoscopic cholecystectomy by controlling rise in heart rate and by providing long-term stability in systolic and diastolic blood pressure. Fentanyl and lidocaine showed inconsistencies in heart rate, systolic and diastolic blood pressure over time. Fentanyl showed better hemodynamic profile compared to lidocaine. Patients included in fentanyl group exhibited early recovery than dexmedetomidine and lidocaine. [ABSTRACT FROM AUTHOR]

Previous research has extensively explored cognitive and neural deficits in clinically diagnosed depression, but the early stages of depression, where symptoms do not meet clinical thresholds, are less explored. This study investigated neurocognitive markers in individuals with non-clinical depression. The study assessed working memory (WM) performance and hemodynamic responses of prefrontal cortex (PFC) in 30 individuals with non-clinical depression and 41 healthy controls using two-back tasks with four stimulus types: numbers, letters, shapes, and emotional facial expressions. Hemodynamic responses were measured via oxyhemoglobin (HbO) using functional near-infrared spectroscopy. Results showed that individuals with non-clinical depression have significantly lower WM performance compare to healthy controls, particularly for shape- and emotional facial expression-based tasks. No differences were observed for the number- and letter- based tasks. Additionally, individual with non-clinical depression exhibited elevated HbO levels, indicating increased PFC activation. Specifically, significant HbO differences observed in the bilateral ventrolateral PFC during shape-based tasks, and in the left medial, bilateral orbital, and bilateral ventrolateral PFCs during emotional facial expression-based tasks. In conclusion, individuals with non-clinical depression may experience WM deficits and PFC dysregulation, even without a clinical diagnosis. This study highlights the role of stimulus type in understanding WM performance and PFC activation in depression.

Focused ultrasound (FUS) stimulation is a promising neuromodulation technique with the merits of non-invasiveness, high spatial resolution, and deep penetration depth. However, simultaneous imaging of FUS-induced brain tissue displacement and the subsequent effect of FUS stimulation on brain hemodynamics has proven challenging thus far. In addition, earlier studies lack in situ confirmation of targeting except for the magnetic resonance imaging-guided FUS system-based studies. The purpose of this study is 1) to introduce a fully ultrasonic approach to in situ target, modulate neuronal activity, and monitor the resultant neuromodulation effect by respectively leveraging displacement imaging, FUS, and functional ultrasound (fUS) imaging, and 2) to investigate FUS-evoked cerebral blood volume (CBV) response and the relationship between CBV and displacement. We performed displacement imaging on craniotomized mice to confirm the in situ targeting for neuromodulation site. We recorded hemodynamic responses evoked by FUS while fUS imaging revealed an ipsilateral CBV increase that peaks at 4 s post-FUS. We report a stronger hemodynamic activation in the subcortical region than cortical, showing good agreement with a brain elasticity map that can also be obtained using a similar methodology. We observed dose-dependent CBV responses with peak CBV, activated area, and correlation coefficient increasing with the ultrasonic dose. Furthermore, by mapping displacement and hemodynamic activation, we found that displacement colocalized and linearly correlated with CBV increase. The findings presented herein demonstrated that FUS evokes ipsilateral hemodynamic activation in cortical and subcortical depths while the evoked hemodynamic responses colocalize and correlate with FUS-induced displacement. We anticipate that our findings will help consolidate accurate targeting as well as shedding light on one of the mechanisms behind FUS modulation, i.e., how FUS mechanically displaces brain tissue affecting cerebral hemodynamics and thereby its associated connectivity.

Abstract Background This study aimed to determine the median effective dose (ED50) and 95% effective dose (ED95) of nicardipine for treating pituitrin-induced hypertension during laparoscopic myomectomy, providing guidance for the management of intraoperative blood pressure in such patients. Methods Among the initial 40 participants assessed, 24 underwent elective laparoscopic myomectomy. A sequential up-and-down method was employed to ascertain the ED50 of nicardipine based on its antihypertensive efficacy. Nicardipine was initially administered at 6 µg/kg following the diagnosis of pituitrin-induced hypertension in the first patient. Dosing adjustments were made to achieve the desired antihypertensive effect, restoring systolic blood pressure and heart rate to within ± 20% of baseline within 120 s. The dosing increment or reduction was set at 0.5 µg/kg for effective or ineffective responses, respectively. The ED50 and ED95 of nicardipine were calculated using Probit regression by Maximum Likelihood Estimation (MLE) to establish dose-response curves and confidence intervals. Results 24 patients were included for analysis finally. The ED50 and ED95 of nicardipine for blood pressure control after pituitrin injection were determined. The study found that the ED50 of nicardipine for treating pituitrin-induced hypertension was 4.839 µg/kg (95% CI: 4.569–5.099 µg/kg), and the ED95 was estimated at 5.308 µg/kg (95% CI: 5.065–6.496 µg/kg). Nicardipine effectively mitigated the hypertensive response caused by pituitrin without inducing significant tachycardia or hypotension. Conclusions Nicardipine effectively controlled blood pressure after pituitrin injection during laparoscopic myomectomy, with ED50 and ED95 values established. This research highlights the potential utility of nicardipine in addressing hypertensive responses induced by pituitrin, particularly in clinical settings where pituitrin is routinely administered.

Background: Many studies have shown the beneficial effect of prophylactic lidocaine or esmolol on hemodynamic response during laryngoscopic intubation. Although many studies observed a better effect of esmolol over lidocaine, some studies have drawn an impression of equal efficacy or even no benefit with the use of either of the drugs. Aims and Objectives: The study aimed to compare the heart rate (HR) at 1 min after intubation between the patients receiving lidocaine and esmolol. Other outcome measures were to compare HR at 3 and 5 min post-intubation and to compare the mean arterial pressure at 1, 3, and 5 min after intubation. In addition, the adverse events, if any, were noted. Materials and Methods: Fifty patients, 30–45 years, either sex, Mallampati grade 1–2, of the American Society of Anesthesiologists physical status I-II, posted for elective abdominal surgery requiring direct laryngoscopic endotracheal intubation were included. Patients were randomly allocated into two groups to receive esmolol 2 mg/kg (Group E, n=25) or 2% lidocaine 2 mg/kg (Group L, n=25), intravenously. HR and mean arterial blood pressure (MAP) were recorded at 1-, 3-, and 5-min interval post-intubation. Results: The mean HR at 1-min post-intubation was considerably lower using esmolol in comparison with lidocaine (91.7±9.7 vs. 107.7±5.1, P≤0.0001). The mean HR and MAP at 3-min and 5-min post-intubation were considerably lower with the use of esmolol compared with lidocaine. Conclusion: Esmolol is better than lidocaine in attenuating the hemodynamic response of intubation.

Background Cardiac amyloidosis, characterized by the deposition of amyloid proteins in the heart tissue, presents in two main types: transthyretin (ATTR) and light-chain (AL) amyloidosis. The hemodynamic response to exercise and the relationship with pulmonary hypertension (PH) in these patients is not well understood. Methods This retrospective study analyzed 100 patients diagnosed with either ATTR or AL amyloidosis. We assessed the prevalence of PH at rest and its induction during exercise stress tests. Hemodynamic parameters were measured to identify differences in the cardiac response to exercise between the two subtypes. Results A higher prevalence of PH was noted in the ATTR group compared to the AL group. Exercise stress tests induced significant PH, particularly in the ATTR subgroup. Subtle yet clinically relevant hemodynamic differences were observed between the amyloidosis subtypes. Conclusions Our findings suggest that the amyloidosis subtype is an important factor in the management of PH. There is a need for tailored clinical approaches to address the distinct pathophysiological mechanisms in ATTR and AL amyloidosis. This study contributes to a better understanding of the hemodynamic changes during exercise in cardiac amyloidosis and underscores the importance of subtype-specific management strategies.

Exogenous ketone supplements have been suggested to have potential cardiovascular benefits, but their overall effect on blood pressure is unclear. Our objective was to perform a systematic review and meta-analysis on the effects of exogenous ketone supplements on blood pressure (BP) and concomitant changes in resting heart rate (HR). Five databases were searched on January 27th, 2023, for randomized and non-randomized studies. A random-effects model meta-analysis was performed including all studies jointly and separately for acute and chronic ingestion of ketone supplements. Out of 4012 studies identified in the search, 4 acute and 6 chronic studies with n = 187 participants were included. Pooled results (n = 10) showed no change in systolic (SMD [95% CI]= −0.14 [−0.40; 0.11]; I2= 30%; p = 0.17) or diastolic BP (−0.12 [−0.30; 0.05]; I2= 0%; p = 0.69), with a potential tendency observed toward increased resting heart rate (0.17 [-0.14; 0.47]; I2= 40%; p = 0.10). Similar results for systolic and diastolic BP were observed when assessing separately the effect of acute and chronic ingestion of ketone supplements (p ≥ 0.33). Supplement dosage was found to modulate the increase in resting heart rate (0.019 ± 0.006; p = 0.013; R2=100%), suggesting that higher supplement doses lead to a higher resting heart rate. Based on currently available data, acute or prolonged ingestion of ketone supplements does not seem to modulate BP. However, a tendency for HR to increase after acute ingestion was observed, particularly with higher doses. Higher quality studies with appropriate standardized measurements are needed to confirm these results. [ABSTRACT FROM AUTHOR]

Background: This study aimed to determine the median effective dose (ED50) and 95% effective dose (ED95) of nicardipine for treating pituitrin-induced hypertension during laparoscopic myomectomy, providing guidance for the management of intraoperative blood pressure in such patients. Methods: Among the initial 40 participants assessed, 24 underwent elective laparoscopic myomectomy. A sequential up-and-down method was employed to ascertain the ED50 of nicardipine based on its antihypertensive efficacy. Nicardipine was initially administered at 6 µg/kg following the diagnosis of pituitrin-induced hypertension in the first patient. Dosing adjustments were made to achieve the desired antihypertensive effect, restoring systolic blood pressure and heart rate to within ± 20% of baseline within 120 s. The dosing increment or reduction was set at 0.5 µg/kg for effective or ineffective responses, respectively. The ED50 and ED95 of nicardipine were calculated using Probit regression by Maximum Likelihood Estimation (MLE) to establish dose-response curves and confidence intervals. Results: 24 patients were included for analysis finally. The ED50 and ED95 of nicardipine for blood pressure control after pituitrin injection were determined. The study found that the ED50 of nicardipine for treating pituitrin-induced hypertension was 4.839 µg/kg (95% CI: 4.569–5.099 µg/kg), and the ED95 was estimated at 5.308 µg/kg (95% CI: 5.065–6.496 µg/kg). Nicardipine effectively mitigated the hypertensive response caused by pituitrin without inducing significant tachycardia or hypotension. Conclusions: Nicardipine effectively controlled blood pressure after pituitrin injection during laparoscopic myomectomy, with ED50 and ED95 values established. This research highlights the potential utility of nicardipine in addressing hypertensive responses induced by pituitrin, particularly in clinical settings where pituitrin is routinely administered. [ABSTRACT FROM AUTHOR]

Background: Electroconvulsive therapy (ECT) is a critical treatment modality for certain psychiatric conditions, though it can induce transient cardiovascular changes. The choice of anesthetic agent can influence these hemodynamic responses, necessitating a careful selection process. Methods: This observational study compared the cardiovascular effects of intravenous etomidate, propofol, and thiopentone in 90 patients undergoing ECT. Heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were measured at baseline, 1 minute, 5 minutes, and 10 minutes post-ictal. Results: No significant inter-group differences were observed in heart rate, SBP, DBP, or MAP at any time point. All groups exhibited a significant increase in heart rate and blood pressure at 1 minute post -ictal, with values returning to near - baseline by 10 minutes. Specifically, the heart rate increased significantly from baseline at 1 minute postictal (Group E p < 0.001, Group P p = 0.00182, Group T p = 0.00011), with similar patterns observed for SBP and DBP. By the 10 -minute mark, changes from baseline were not statistically significant, indicating a transient cardiovascular response to ECT. Conclusion: Etomidate, propofol, and thiopentone are comparable in their cardiovascular safety profiles when used as anesthetic agents in ECT. These findings support the clinical flexibility in selecting an anesthetic based on factors other than cardiovascular effects. [ABSTRACT FROM AUTHOR]

Background: Dexmedetomidine is a highly selective, a2 adrenoreceptor agonist drug, which has sedative, analgesic and anxiolytic property without any respiratory depressive action. Dexmedetomidine causes post synaptic activation of a2 adrenoreceptors in the CNS resulting in hypotension and bradycardia through sympatholysis. Preoperative administration of dexmedetomidine can successfully attenuate the laryngoscopic stress response via intravenous, intramuscular or intranasal routes. Material and Methods: 80 adult patients of either sex between the age group of 18 to 60 years of ASA-I and ASA-II undergoing elective major surgeries were divided randomly into two groups of 40 patients each. Group - D(IV) received intravenous dexmedetomidine (0.50µg/kg) diluted in 50 ml syringe with normal saline through an infusion pump over 40 min before induction. Group - D(IN) received intranasal dexmedetomidine (1 µg/kg) in undiluted form which was prepared from parenteral preparation (100µg/ml). Intranasal drug dripped into both nostrils in equal volume using a 1 ml syringe in supine head down position about 40 min before induction. Result: The mean baseline heart rate in group D(IV) was (82.73 ± 5.95) per minute and it decreased to (80.33 ± 5.93) per min at 10 minutes time interval but was statistically insignificant. The p-value became statistically significant at 30minute (0.024) and 40-minute (0.011) time interval in pre induction period. During laryngoscopy and intubation time interval Mean heart rate was (87.18 ±5.54) beats/minute in group D(IV) and (90.95±6.02) beats/minute in group D(IN) and the p-value in intergroup comparison came out to be 0.004 which was statistically significant. Conclusion: Dexmedetomidine drug when given in group D(IN) through intranasal route at a dose of 1 µg/kg body weight forty minutes before induction of anesthesia produced similar haemodynamic changes as when given through intravenous route as infusion in group D(IV) at a dose of 0.5 µg/kg body weight in patients undergoing major surgeries under general anaesthesia. [ABSTRACT FROM AUTHOR]

Background: Many studies have shown the beneficial effect of prophylactic lidocaine or esmolol on hemodynamic response during laryngoscopic intubation. Although many studies observed a better effect of esmolol over lidocaine, some studies have drawn an impression of equal efficacy or even no benefit with the use of either of the drugs. Aims and Objectives: The study aimed to compare the heart rate (HR) at 1 min after intubation between the patients receiving lidocaine and esmolol. Other outcome measures were to compare HR at 3 and 5 min post-intubation and to compare the mean arterial pressure at 1, 3, and 5 min after intubation. In addition, the adverse events, if any, were noted. Materials and Methods: Fifty patients, 30-45 years, either sex, Mallampati grade 1-2, of the American Society of Anesthesiologists physical status I-II, posted for elective abdominal surgery requiring direct laryngoscopic endotracheal intubation were included. Patients were randomly allocated into two groups to receive esmolol 2 mg/kg (Group E, n=25) or 2% lidocaine 2 mg/kg (Group L, n=25), intravenously. HR and mean arterial blood pressure (MAP) were recorded at 1-, 3-, and 5-min interval post-intubation. Results: The mean HR at 1-min post-intubation was considerably lower using esmolol in comparison with lidocaine (91.7±9.7 vs. 107.7±5.1, P≤0.0001). The mean HR and MAP at 3-min and 5-min post-intubation were considerably lower with the use of esmolol compared with lidocaine. Conclusion: Esmolol is better than lidocaine in attenuating the hemodynamic response of intubation. [ABSTRACT FROM AUTHOR]

Transcranial electrical stimulation has demonstrated the potential to enhance cognitive functions such as working memory, learning capacity, and attentional allocation. Recently, it was shown that periodic stimulation within a specific duration could augment the human brain’s neuroplasticity. This study investigates the effects of repetitive transcranial alternating current stimulation (tACS; 1 mA, 5 Hz, 2 min duration) on cognitive function, functional connectivity, and topographic changes using both electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS). Fifteen healthy subjects were recruited to measure brain activity in the pre-, during-, and post-stimulation sessions under tACS and sham stimulation conditions. Fourteen trials of working memory tasks and eight repetitions of tACS/sham stimulation with a 1-minute intersession interval were applied to the frontal cortex of the participants. The working memory score, EEG band-wise powers, EEG topography, concentration changes of oxygenated hemoglobin, and functional connectivity (FC) were individually analyzed to quantify the behavioral and neurophysiological effects of tACS. Our results indicate that tACS increases: i) behavioral scores (i.e., 15.08, ${p} < 0.001$ ) and EEG band-wise powers (i.e., theta and beta bands) compared to the sham stimulation condition, ii) FC of both EEG-fNIRS signals, especially in the large-scale brain network communication and interhemispheric connections, and iii) the hemodynamic response in comparison to the pre-stimulation session and the sham condition. Conclusively, the repetitive theta-band tACS stimulation improves the working memory capacity regarding behavioral and neuroplasticity perspectives. Additionally, the proposed fNIRS biomarkers (mean, slope), EEG band-wise powers, and FC can be used as neuro-feedback indices for closed-loop brain stimulation.

Tindakan laringoskopi dan intubasi endotrakeal dapat menyebabkan hipertensi dan takikardia yang berbahaya bagi penderita dengan faktor risiko kelainan serebrovaskular, kardiovaskular, dan tirotoksikosis. Tujuan penelitian ini membandingkan efektivitas dosis bolus deksmedetomidin dan fentanil dalam melemahkan hemodinamik respons stres setelah laringoskopi dan intubasi. Penelitian ini merupakan penelitian eksperimental dengan rancangan double blind randomized controlled trial yang dilakukan di RSUP Dr. Hasan Sadikin Bandung (RSHS) sejak tanggal 1 April 2023 hingga 31 Mei 2023. Penelitian ini melibatkan 42 pasien yang menjalani operasi elektif dengan anestesi umum yang dibagi menjadi dua kelompok, yaitu kelompok D menerima 0,5 µg/kgBB deksmedetomidin dan kelompok F menerima fentanil 2 µg/kgBB sebelum tindakan laringoskopi dan intubasi endotrakeal. Pengamatan dilakukan pada tekanan darah sistole, tekanan darah diastole, mean arterial pressure, dan laju nadi sesaat setelah tindakan intubasi dilanjutkan tiap menit hingga 5 menit setelah tindakan intubasi. Hasil menunjukkan bahwa perubahan tekanan darah sistole, diastole, MAP, dan laju nadi antara kelompol deksmedetomidin dan kelompok fentanil tidak terdapat perbedaan bermakna (p

Abstract Background Sympathetic stimulation associated with laryngoscopy and endotracheal intubation (ETI) may lead to adverse cardio-/cerebro-vascular events in susceptible patients. Nebulization is a novel route for dexmedetomidine administration providing a large surface area for absorption while avoiding bradycardia and hypotension associated with intravenous route. We aimed to evaluate the efficacy and safety of dexmedetomidine nebulization for attenuating hemodynamic response to ETI in adult patients undergoing surgery under general anaesthesia. Methods This systematic review was registered prospectively in the International Prospective Register of Systematic Reviews (CRD42023403624). PubMed, Embase (OvidSP), Cochrane library, Scopus (Elsevier), Web of Science (Clarivate) and Google Scholar were systematically searched from database inception until March 31, 2023. Two reviewers independently screened titles, abstracts and then full text against pre-specified eligibility criteria. Randomized controlled trials (RCTs) assessing effect of dexmedetomidine nebulization on hemodynamic response to ETI in adult patients undergoing surgeries under general anaesthesia were included. All studies reporting heart rate and systolic blood pressure at baseline and various time points after ETI were included. A pre-piloted data extraction form, Cochrane revised risk-of-bias tool (ROB 2) tool, GRADE approach and RevMan 5.4.1 (Cochrane Collaboration, Copenhagen, Denmark) were used for data extraction, risk of bias assessment, rating certainty of evidence and data synthesis respectively. Mean difference and relative risk with 95% Confidence Interval (CI) were used for continuous and dichotomous variables respectively. Results Six RCTs randomized 480 patients with ASA I/II patients aged

This study compared the effects of clonidine and pregabalin as oral premedication for patients undergoing laparoscopic cholecystectomy under general anesthesia. The results showed that both drugs effectively stabilized the patients' blood pressure and heart rate during the procedure. However, pregabalin provided longer-lasting pain relief after the surgery and required less additional pain medication. Both drugs were well-tolerated with minimal side effects. The study suggests that both clonidine and pregabalin can be used as effective premedication options for these procedures. [Extracted from the article]

Introduction: There is a need to better understand the neurophysiological changes associated with early brain dysfunction in Type 2 diabetes mellitus (T2DM) before vascular or structural lesions. Our aim was to use a novel unbiased data-driven approach to detect and characterize hemodynamic response function (HRF) alterations in T2DM patients, focusing on their potential as biomarkers. Methods: We meshed task-based event-related (visual speed discrimination) functional magnetic resonance imaging with DL to show, from an unbiased perspective, that T2DM patients' blood-oxygen-level dependent response is altered. Relevance analysis determined which brain regions were more important for discrimination. We combined explainability with deconvolution generalized linear model to provide a more accurate picture of the nature of the neural changes. Results: The proposed approach to discriminate T2DM patients achieved up to 95% accuracy. Higher performance was achieved at higher stimulus (speed) contrast, showing a direct relationship with stimulus properties, and in the hemispherically dominant left visual hemifield, demonstrating biological interpretability. Differences are explained by physiological asymmetries in cortical spatial processing (right hemisphere dominance) and larger neural signal-to-noise ratios related to stimulus contrast. Relevance analysis revealed the most important regions for discrimination, such as extrastriate visual cortex, parietal cortex, and insula. These are disease/task related, providing additional evidence for pathophysiological significance. Our data-driven design allowed us to compute the unbiased HRF without assumptions. Conclusion: We can accurately differentiate T2DM patients using a datadriven classification of the HRF. HRF differences hold promise as biomarkers and could contribute to a deeper understanding of neurophysiological changes associated with T2DM. [ABSTRACT FROM AUTHOR]

Background and Aims: Both laryngoscopy and endotracheal intubation individually contribute to hemodynamic pressor response following endotracheal intubation. Parker Flex-Tip tracheal tube has a flexible, curved, smooth, centered, and tapered distal tip that is designed to facilitate rapid, easy, and nontraumatic intubation. The present study was conducted to compare Parker Flex-Tip and polyvinyl chloride (PVC) endotracheal tube (ETT) for hemodynamic response during intubation. Materials and Methods: Sixty patients of either sex of age 18-50 years, belonging to the American Society of Anesthesiologists (ASA) physical Status I or II scheduled for elective surgery under general anesthesia requiring endotracheal intubation were included. In Group I (n = 30), Parker Flex-Tip tube was used and in Group II (n = 30), PVC ETT was used. Heart rate (HR), systolic blood pressure, diastolic blood pressure (DBP), and mean arterial pressure were compared at various time intervals. Quantitative variables were compared using unpaired t-test and qualitative variables were compared using Chi-square test. P ≤0.05 was considered statistically significant. Results: The mean basal value of HR was 81.33 ± 13.78 beats/min in Group I and 87.36 ± 13.34 beats/min in Group II (P = 0.09). The difference between both the groups was found to be comparable at baseline, prelaryngoscopy, and just after laryngoscopy (AL) but this difference was found to be statistically significant just after intubation (AI) and at 1 min AI. In both groups, DBP started increasing just AL but the difference was not significant. This difference between the two groups was observed to be statistically significant at 1 min AI (81.73 ± 13.29 in Group I vs. 88.96 ± 10.27 in Group II, [P = 0.02]). Conclusion: Parker Flex-Tip tube is beneficial in controlling the hemodynamic response during laryngoscopy and intubation. This effect is significantly evident in HR and DBP. [ABSTRACT FROM AUTHOR]

Background: Laryngoscopy and orotracheal intubation often trigger a hemodynamic response, increasing catecholamines and potentially leading to higher morbidity. Fentanyl, with a high safety margin and rapid onset, and Nalbuphine, a μ receptor antagonist and k receptor agonist with minimal respiratory depression and a "ceiling effect," are commonly used to mitigate this response. Aim: This study compares the efficacy of Fentanyl and Nalbuphine in reducing the pressor response during laryngoscopy and intubation in patients under general anesthesia, monitored by Bispectral Index (BIS). It also evaluates total analgesic requirements, time to first rescue analgesic post-extubation (VAS score), and associated complications. Method: The study was a hospital-based, prospective, double-blind, randomized interventional trial registered under the Clinical Trials Registry - India (CTRI/2022/05/042731). The sample size of 70 patients (35 in each group) was calculated based on alpha error, study power, and the minimum clinically significant difference for MAP after induction. Patients aged 18-65 years with ASA grade I and II and body weight between 40-70 kg were included. Group A received Fentanyl, and Group B received Nalbuphine. Vital parameters were monitored during the surgery, and additional doses of the study drug were administered if the BIS score exceeded 60. Postoperative analgesic effect was evaluated by a blinded anesthesiologist. Results: The demographic characteristics of the study population were similar between the Fentanyl and Nalbuphine groups, as indicated by age, weight, sex, and ASA physical status, there was a statistically significant difference in systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rate post-intubation, with the Nalbuphine group demonstrating a greater increase compared to the Fentanyl group, which was significant at all time intervals. [ABSTRACT FROM AUTHOR]

The present study has two objectives: 1) to verify the effect of Maitland mobilization, manual massage (MM), and static stretching (SS) on the acute range-of-motion (ROM) responses, over 30 min, in the elderly; 2) to verify the effect of Maitland's mobilization, MM, and SS on blood pressure (BP) responses, over 60 min, in the elderly. Sixteen inactive elderly men were recruited. After familiarization, all subjects performed the experimental conditions throughout four remaining sessions. Each session included two baselines ROM measures in randomized order. After baseline, participants completed the control group, Maitland, MM, and SS conditions and retesting immediately (Post-0) e again throughout 30-min following intervention. All conditions increased ankle, hip, and shoulder ROM for at least 10-min post-intervention. Systolic BP hypotensive effects were found for all experimental protocols when compared to baseline values. In conclusion, it was observed that Maitland, MM, and SS conditions enhance ROM and promote hypotensive effect post-intervention. These results have a practical prescription and rehabilitation implications and may be used in the elderly population, since a movement limitation can be treated by global interventions in a non-limited, as well as promoting cardiovascular protection through the hypotensive effects in the same experimental session. [ABSTRACT FROM AUTHOR]

Aims and objective-The purpose of this open comparative trial was to compare the efficacy of two different doses of fentanyl, 2ug/kg and 4µg/kg, to attenuate the haemodynamic response to laryngoscopy and intubation. Mateterial and methods. One hundred and fifty ASA-I patients 18-50 years of either sex were divided into three equal groups (Control group, F2 group and F4 group). All patients had standard protocol for premedication and induction. Pulse, systolic blood pressure, diastolic blood pressure, mean arterial pressure and rate pressure product were recorded at different time intervals and values were expressed as mean ± standard deviation. conclusion. Our study confirms previous reports that laryngoscopy and intubation are accompanied by a considerable increase in arterial blood pressure significantly attenuated by intravenous administration of fentanyl. [ABSTRACT FROM AUTHOR]

Background: Sympathetic stimulation associated with laryngoscopy and endotracheal intubation (ETI) may lead to adverse cardio-/cerebro-vascular events in susceptible patients. Nebulization is a novel route for dexmedetomidine administration providing a large surface area for absorption while avoiding bradycardia and hypotension associated with intravenous route. We aimed to evaluate the efficacy and safety of dexmedetomidine nebulization for attenuating hemodynamic response to ETI in adult patients undergoing surgery under general anaesthesia. Methods: This systematic review was registered prospectively in the International Prospective Register of Systematic Reviews (CRD42023403624). PubMed, Embase (OvidSP), Cochrane library, Scopus (Elsevier), Web of Science (Clarivate) and Google Scholar were systematically searched from database inception until March 31, 2023. Two reviewers independently screened titles, abstracts and then full text against pre-specified eligibility criteria. Randomized controlled trials (RCTs) assessing effect of dexmedetomidine nebulization on hemodynamic response to ETI in adult patients undergoing surgeries under general anaesthesia were included. All studies reporting heart rate and systolic blood pressure at baseline and various time points after ETI were included. A pre-piloted data extraction form, Cochrane revised risk-of-bias tool (ROB 2) tool, GRADE approach and RevMan 5.4.1 (Cochrane Collaboration, Copenhagen, Denmark) were used for data extraction, risk of bias assessment, rating certainty of evidence and data synthesis respectively. Mean difference and relative risk with 95% Confidence Interval (CI) were used for continuous and dichotomous variables respectively. Results: Six RCTs randomized 480 patients with ASA I/II patients aged < 60 years of age and undergoing elective surgeries to receive either dexmedetomidine (n = 240) or saline nebulization (n = 240). Except for one RCT which used 2 μg/kg, all other RCTs used dexmedetomidine dose of 1 μg /kg. Heart rate, systolic, diastolic and mean blood pressure were significantly lower in the dexmedetomidine group at all the measured time points after laryngoscopy and ETI with the only exception being systolic blood pressure at 3 min [mean difference -13.86 (95% CI -30.01 to 2.99), p = 0.09]. Bradycardia and hypotension as adverse effects were absent across the included studies. However, only one-third of the included studies had a low risk of bias and strength of evidence was very low according to the GRADE assessment. Conclusions: Compared to placebo, premedication with dexmedetomidine nebulization was associated with lower HR and BP following ETI without any risk of bradycardia and hypotension. However, the strength of evidence was very poor and came from just one country. Future well designed and conducted studies in different populations are warranted. Trial registration: PROSPERO Registration number: CRD42023403624 [ABSTRACT FROM AUTHOR]

Blood oxygenation level‐dependent (BOLD) functional magnetic resonance imaging (fMRI) is one of the most used imaging techniques to map brain activity or to obtain clinical information about human cortical vasculature, in both healthy and disease conditions. Nevertheless, BOLD fMRI is an indirect measurement of brain functioning triggered by neurovascular coupling. The origin of the BOLD signal is quite complex, and the signal formation thus depends, among other factors, on the topology of the cortical vasculature and the associated hemodynamic changes. To understand the hemodynamic evolution of the BOLD signal response in humans, it is beneficial to have a computational framework available that virtually resembles the human cortical vasculature, and simulates hemodynamic changes and corresponding MRI signal changes via interactions of intrinsic biophysical and magnetic properties of the tissues. To this end, we have developed a mechanistic computational framework that simulates the hemodynamic fingerprint of the BOLD signal based on a statistically defined, three‐dimensional, vascular model that approaches the human cortical vascular architecture. The microvasculature is approximated through a Voronoi tessellation method and the macrovasculature is adapted from two‐photon microscopy mice data. Using this computational framework, we simulated hemodynamic changes—cerebral blood flow, cerebral blood volume, and blood oxygen saturation—induced by virtual arterial dilation. Then we computed local magnetic field disturbances generated by the vascular topology and the corresponding blood oxygen saturation changes. This mechanistic computational framework also considers the intrinsic biophysical and magnetic properties of nearby tissue, such as water diffusion and relaxation properties, resulting in a dynamic BOLD signal response. The proposed mechanistic computational framework provides an integrated biophysical model that can offer better insights regarding the spatial and temporal properties of the BOLD signal changes. [ABSTRACT FROM AUTHOR]

Background: Laryngoscopy and tracheal intubation can cause a significant hemodynamic response, leading to adverse events. Pregabalin is a relatively new drug used to attenuate this response. Aims and Objectives: The aim of this study is to compare the efficacy and safety of two different doses, 75 mg and 150 mg, of orally administered Pregabalin given 1 h before the induction of general endotracheal anesthesia in adult patients scheduled for elective surgical procedures. Materials and Methods: This was a randomized, double-blind, placebo-controlled study conducted at a tertiary care hospital in Telangana, India. Adult patients were divided into three groups receiving 75 mg, 150 mg of oral pregabalin or placebo, 1 h before induction of anesthesia. Hemodynamic parameters were recorded before and after laryngoscopy and tracheal intubation. Results: A total of 90 patients were enrolled in the study, with 30 in each group. Both doses of pregabalin significantly attenuated the hemodynamic response compared to the placebo group. The maximum attenuation was observed in the 150 mg pregabalin group. No significant adverse effects were reported in any of the groups. Conclusion: Both 75 mg and 150 mg of oral pregabalin attenuated the hemodynamic response to laryngoscopy and tracheal intubation in adult patients, with a higher dose providing greater attenuation. Pregabalin may be considered an option for attenuating the hemodynamic response during anesthesia induction. Further studies are warranted to establish the optimal dose and duration of pregabalin administration.

Background: Endotracheal intubation (ETI), which is the gold standard in coronary artery bypass grafting (CABG), may cause myocardial ischaemia by disturbing the balance between haemodynamic changes and oxygen supply and consumption of the myocardium as a result of sympathetic stimulation. In this study, we aimed to compare two different videolaryngoscopes (C-MAC and Airtraq) in the hemodynamic response to ETI. Methods: Fifty ASA II...III CABG surgery patients were randomly assigned to C-MAC or Airtraq. The hemodynamic data included arterial blood pressure [systolic (SAP), diastolic (DAP) and mean (MAP)] and heart rate (HR) and were recorded at six different points in time: before laryngoscopy-T1, during laryngoscopy-T2, immediately after intubation-T3, and 3 (T4), 5 (T5) and 10 (T6) minutes after intubation. Intraoperative complications were recorded. Patients were questioned about postoperative complications 2 and 24...hours following extubation. Results: The hemodynamic response to ETI was significantly greater with C-MAC. The increase in HR started with the laryngoscopy procedure, whereas increases in SAP, DAP, and MAP started immediately after ETI (p...=...0.024; p...=...0.012; p...=...0.030; p...=...0.009, respectively). In group analyses, T1...T2, T2...T3 and T1...T3 comparisons did not show any significant differences in HR with Airtraq. However, with C-MAC, HR after intubation increased significantly compared to the pre-laryngoscopy values (T1...T3) (p...=...0.004). The duration of laryngoscopy was significantly reduced with C-MAC (p...

IntroductionThere is a need to better understand the neurophysiological changes associated with early brain dysfunction in Type 2 diabetes mellitus (T2DM) before vascular or structural lesions. Our aim was to use a novel unbiased data-driven approach to detect and characterize hemodynamic response function (HRF) alterations in T2DM patients, focusing on their potential as biomarkers.MethodsWe meshed task-based event-related (visual speed discrimination) functional magnetic resonance imaging with DL to show, from an unbiased perspective, that T2DM patients’ blood-oxygen-level dependent response is altered. Relevance analysis determined which brain regions were more important for discrimination. We combined explainability with deconvolution generalized linear model to provide a more accurate picture of the nature of the neural changes.ResultsThe proposed approach to discriminate T2DM patients achieved up to 95% accuracy. Higher performance was achieved at higher stimulus (speed) contrast, showing a direct relationship with stimulus properties, and in the hemispherically dominant left visual hemifield, demonstrating biological interpretability. Differences are explained by physiological asymmetries in cortical spatial processing (right hemisphere dominance) and larger neural signal-to-noise ratios related to stimulus contrast. Relevance analysis revealed the most important regions for discrimination, such as extrastriate visual cortex, parietal cortex, and insula. These are disease/task related, providing additional evidence for pathophysiological significance. Our data-driven design allowed us to compute the unbiased HRF without assumptions.ConclusionWe can accurately differentiate T2DM patients using a data-driven classification of the HRF. HRF differences hold promise as biomarkers and could contribute to a deeper understanding of neurophysiological changes associated with T2DM.

Increasing the temporal resolution of the blood‑oxygen level-dependent (BOLD) response is usually accompanied by a decrease in repetition time and therefore also a reduction of the magnetic resonance (MR) signal due to incomplete T1 relaxation and thus a loss of signal-to-noise ratio (SNR). A previous data reordering method can achieve higher temporal sampling rate without the loss of SNR but at the cost of increased scan time. In this proof-of-principle work, we show that combining HiHi reshuffling with multiband acceleration allows us to measure the in vivo BOLD response with a 75-ms sampling rate that is decoupled from the acquisition repetition time (here 1.5 s and hence higher SNR) while covering the entire forebrain with 60 2-mm slices in a ~ 35-min scan. We provide single-voxel time-courses of the BOLD responses in the primary visual and primary motor cortices in three fMRI experiments on a 7 T scanner - 1 male (scanned twice on different days for test-retest reproducibility) and 1 female participant. [ABSTRACT FROM AUTHOR]

Background: Laryngoscopy and tracheal intubation can cause a significant hemodynamic response, leading to adverse events. Pregabalin is a relatively new drug used to attenuate this response. Aims and Objectives: The aim of this study is to compare the efficacy and safety of two different doses, 75 mg and 150 mg, of orally administered Pregabalin given 1 h before the induction of general endotracheal anesthesia in adult patients scheduled for elective surgical procedures. Materials and Methods: This was a randomized, double-blind, placebo-controlled study conducted at a tertiary care hospital in Telangana, India. Adult patients were divided into three groups receiving 75 mg, 150 mg of oral pregabalin or placebo, 1 h before induction of anesthesia. Hemodynamic parameters were recorded before and after laryngoscopy and tracheal intubation. Results: A total of 90 patients were enrolled in the study, with 30 in each group. Both doses of pregabalin significantly attenuated the hemodynamic response compared to the placebo group. The maximum attenuation was observed in the 150 mg pregabalin group. No significant adverse effects were reported in any of the groups. Conclusion: Both 75 mg and 150 mg of oral pregabalin attenuated the hemodynamic response to laryngoscopy and tracheal intubation in adult patients, with a higher dose providing greater attenuation. Pregabalin may be considered an option for attenuating the hemodynamic response during anesthesia induction. Further studies are warranted to establish the optimal dose and duration of pregabalin administration. [ABSTRACT FROM AUTHOR]

Background: Evolution of laparoscopic surgery has been enormous help to both patient and surgeon, although incidence of pneumoperitoneum as consequence of laparoscopic surgery would cause hemodynamic instability. In this study, effect of dexmedetomidine and magnesium sulfate on hemodynamic status during laparoscopic cholecystectomy has been assessed. Materials and Methods: This study was a double-blind randomized clinical trial that was conducted on 61 patients. Patients were randomly assigned to 3 groups. Control group (C) saline infusion, dexmedetomidine group (D) 1 μg/kg and then 0.5 μg/kg/h of dexmedetomidine and magnesium sulfate group (M) 2 g and then 0.9 mg/kg/h of magnesium sulfate they received. Heart rate, systolic and diastolic blood pressure and mean arterial pressure were recorded at different times before and after taking the drug. Independent T-test, ANOVA, and chi-square were used for univariate analysis and ANOVA with repeated measures for multivariate analysis. Results: The distribution of patients in terms of demographic factors and surgery were the same in the three groups of the study (P

ObjectiveThe benefits of long-term consumption of green tea on the brain are well known. However, among many ingredients of green tea, the acute effects of (–)-gallocatechin gallate-rich green tea extract (GCG-GTE), have received comparatively less attention. Herein, we investigated the acute effects of oral ingestion of green tea with GCG-GTE, which contains close replicas of the ingredients of hot green tea, on task-dependent hemodynamics in the prefrontal cortex of healthy adult human brains.MethodsIn this randomized, double-blind, placebo-controlled, parallel group trial, 35 healthy adults completed computerized cognitive tasks that demand activation of the prefrontal cortex at baseline and 1 h after consumption of placebo and 900 mg of GCG-GTE extract supplement. During cognitive testing, hemodynamic responses (change in HbO2 concentration) in the prefrontal cortex were assessed using functional near-infrared spectroscopy (fNIRS).ResultsIn fNIRS data, significant group x session interactions were found in the left (p = 0.035) and right (p = 0.036) dorsolateral prefrontal cortex (DLPFC). In behavioral data, despite the numerical increase in the GCG-GTE group and the numerical decrease in the Placebo group, no significant differences were observed in the cognitive performance measure between the groups.ConclusionThe result suggests a single dose of orally administered GCG-GTE can reduce DLPFC activation in healthy humans even with increased task demand. GCG-GTE is a promising functional material that can affect neural efficiency to lower mental workload during cognitively demanding tasks. However, further studies are needed to verify this.

Reflex summation in the expression of left and right aortic baroreflex control of hemodynamic functions was investigated. In anesthetized Sprague–Dawley rats, mean arterial pressure (MAP), heart rate (HR), and mesenteric vascular resistance (MVR) were recorded following left, right, and bilateral stimulation of the aortic depressor nerve (ADN). Stimulation frequency was varied between low (1 Hz), moderate (5 Hz), and high (20 Hz). At 1 Hz, left and right ADN stimulation evoked similar depressor, bradycardic and MVR responses, whereas bilateral stimulation induced larger MAP, HR, and MVR reductions compared with stimulations of either side. The sum of the separate and combined stimulation effects on MAP, HR, and MVR was similar, indicating an additive summation. A similar additive summation was observed with HR responses at 5 and 20 Hz. Left-sided and bilateral stimulation produced greater depressor and MVR responses than right-sided stimulation, with responses of the bilateral stimulation mimicking those of the left side. The bilateral MAP or MVR response was smaller than the sum of the separate responses, suggesting an inhibitory summation. In conclusion, reflex summation of the left and right aortic baroreceptor afferent input is differentially expressed in relation to the frequency of the input signal. Summation of baroreflex control of HR is always additive and independent of stimulation frequency. Summation of baroreflex control of MAP is additive when the frequency input is small and inhibitory when the frequency input is moderate to high, with MAP changes mainly driven by parallel baroreflex-triggered changes in vascular resistance. [ABSTRACT FROM AUTHOR]