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PubMedDate not supplied

Significance of portal hemodynamic investigation in prediction of hepatic functional reserve in patients with hepatocellular carcinoma undergoing operative treatment.

BACKGROUND/AIMS: To evaluate clinical significance of portal hemodynamic investigation in prediction of hepatic functional reserve in patients with hepatocellular carcinoma undergoing operative treatment. METHODOLOGY: By using the color Doppler velocity profile technique, preoperative portal hemodynamic status was assessed in 29 patients with hepatocellular carcinoma treated surgically, including 15 segmentectomies, 6 hemihepatectomies and 8 transarterial chemoembolizations. Forty-six normal volunteers were taken as control. Comparison of preoperative portal hemodynamics between patients recovering from operation smoothly (tolerant subgroup) and those with major complications or death (intolerant subgroup) was done, and discriminant analysis was employed to identify the cut-off value for significant parameters that maximally separate the tolerant subgroup from the intolerant subgroup. RESULTS: In the portal trunk, CSVmax (maximum cross-sectional mean velocity) was significantly lower in the hepatocellular carcinoma group compared with the normal group (P < 0.01); flow volume was not obviously different between the two groups; congestion index was markedly higher in the hepatocellular carcinoma group than that of the normal group (P < 0.05). In the splenic vein, CSVmax and congestion index was not obviously different between the hepatocellular carcinoma and the normal groups; flow volume was significantly higher in the hepatocellular carcinoma group than that of the normal group (P < 0.05). In the hepatocellular carcinomas, twenty-three patients recovered smoothly from the operation and the remaining 6 had severe complications or death. Tolerant subgroup had a significantly higher preoperative CSVmax and flow volume and lower congestion index of the portal trunk compared with the intolerant subgroup (all P < 0.01). Discriminant analysis revealed that portal trunk CSVmax > 13.50 cm/s and flow volume > 12.13 mL/min/kg could predict tolerance for surgery, with an accuracy of 82.7% and 89.7%, respectively. CONCLUSIONS: The results suggest that preoperative portal hemodynamic status in hepatocellular carcinomas had a close correlation with hepatic functional reserve, and CSVmax and flow volume of portal trunk might become valuable predictive parameters.

Adult↗
PubMedDate not supplied

Laser oximetry: A novel noninvasive method to determine changes in penile hemodynamics in an anesthetized rabbit model.

This study was designed to determine the utility and validity of laser oximetry in measuring changes in penile hemodynamics. Anesthetized male New Zealand White Rabbits were divided into 2 groups, and penile hemodynamics were assessed by either laser oximetry (oxyhemoglobin, deoxyhemoglobin concentration, and oxygen saturation) or intracavernosal pressure (ICP) monitoring during penile erection induced by pelvic nerve stimulation (PNS) or intracavernosal administration of phentolamine, nitroprusside, papaverine, or sildenafil. PNS caused significant frequency-dependent increases in penile ICP. PNS also caused significant increases in penile tissue oxyhemoglobin concentrations and tissue oxygen saturation in a frequency-dependent manner. The changes in oxyhemoglobin concentrations and oxygen saturation correlated with frequency-dependent increases in ICP. Intracavernosal vasoactive drug administration produced significant increases in ICP, tissue oxyhemoglobin concentration, oxygen saturation, and duration of response as a function of increasing drug concentration. Laser oximetry permits reproducible and valid assessment of changes in penile hemodynamics comparable to conventional ICP measurements. Thus, we consider laser oximetry a reliable technique in evaluating penile hemodynamics. Its sensitivity in detecting small changes in oxyhemoglobin concentration and its noninvasive nature make it advantageous over invasive methods such as ICP monitoring and laser Doppler flowmetry.

Animals↗
PubMed2002

Hemodynamic monitoring.

The goal of hemodynamic monitoring is to maintain adequate tissue perfusion. Classical hemodynamic monitoring is based on the invasive measurement of systemic, pulmonary arterial and venous pressures, and of cardiac output. Since organ blood flow cannot be directly measured in clinical practice, arterial blood pressure is used, despite limitations, as estimate of adequacy of tissue perfusion. A mean arterial pressure (MAP) of 70 mm Hg may be considered a reasonable target, associated with sign of adequate organ perfusion, in most patients. In the approach to hypotension, which is the most common cause of hemodynamic instability in critical ill patients, increasing levels of monitoring may be used. Assuming that central venous pressure (CVP) and pulmonary artery occlusion pressure (PAOP) are adequate estimates of the volume of the systemic and pulmonary circulation respectively, the following decision tree is suggested: 1) make a working diagnosis based on the relationship between pressure (CVP and PAOP) and cardiac output or stroke volume (CO or SV); 2) consider conditions that may alter reliability of CVP and PAOP in estimate adequately circulating volumes such as abnormal pressure/volume relationship (compliance) of the RV or LV, increased intrathoracic pressure (PEEP, autoPEEP, intra-abdominal pressure), valvular heart disease (mitral stenosis); 3) look at the history; 4) separating RV and LV by reciprocal variations of CVP, PAOP and SV. CVP is often used as sole parameter to monitor hemodynamic. However CVP alone may not differentiate between changes in volume (different venous return curve) or changes in contractility (different starling curve). Finally, other techniques such as echocardiography, transesophageal Doppler and volume-based monitoring system are now available.

Blood Pressure↗
PubMed2001

No evidence for participation of non-adrenergic non-cholinergic subtances in brain death-related hemodynamic deterioration of the feline potential heart donor.

OBJECTIVE: To onset of brain death (BD) is associated with a hyperdynamic cardiovascular response caused by the acute sympathetic release of catecholamines. This is followed by progressive hemodynamic deterioration which may preclude heart donation for transplantation. The mechanism of the hemodynamic collapse is not fully understood. Changes in plasma concentrations of non-adrenergic non-cholinergic (NANC) substances, neuropeptide-Y (NP-Y, a vasoconstrictor) and the vasodilators calcitonin gene-related peptide (CGRP) and substance P (SP), were studied in relation to BD-related hemodynamic alterations. MATERIALS AND METHODS: Cats (6 BD and 6 controls (C)) were studied for 6 h. Heart rate (HR) and mean arterial pressure (MAP) were monitored. BD was induced at t = O min. At t = -5, 15, 60, 180 and 360 min, 5 ml arterial blood samples were taken. The plasma was collected and analyzed. The correlations between MAP and NANC levels were calculated. RESULTS: In the BD cats a maximal and significant increase in HR and MAP was observed at t = 2 min. HR returned to basal levels at t = 20 min and remained at that level. However, MAP deteriorated progressively to 53 +/- 8 mmHg (p 0.001 vs C) at/ = 360 min. NP-Y had increased from 59.7 +/- 2.5 to 110 +/- 20.2 pmol/l (p 0.05 vs C) at t = 15 min, had returned to basal value at t = 60 min and remained at that level. CGRP levels were lower and SP levels did not change vs C but both showed a trend towards higher levels at t = 360 min. The correlations between MAP and NP-Y, CGRP and SP appeared to be not significant. CONCLUSION: No evidence for participation of NANC substances could be demonstrated in brain death-related hemodynamic deterioration of the feline potential heart donor.

Animals↗
PubMed2002

[Hemodynamic and respiratory changes during hip and knee arthroplasty. An echocardiographic study].

BACKGROUND: The "bone cement implantation syndrome" is a rare but severe complication observed especially during the insertion of cemented prostheses in hip and knee replacement surgery. Several mechanisms are involved: effects of methylmethacrilate, embolism of fat, air and bone marrow, and release of tissue thromboplastin during acetabular and femoral reaming. Aim of this study was to detect embolic events, right heart impairment, hemodynamic and respiratory changes during hip and knee replacement surgery. METHODS DESIGN: Prospective study, between February-May 2001. ENVIRONMENT: Orthopedic Operative room. PATIENTS: Twenty-one patients who underwent total hip or knee arthroplasty under general anesthesia. Patients were divided in methylmethacrylate cemented prostheses groups (CEM, n=10) and totally uncemented prostheses (NON CEM, n=11). DATA COLLECTION: Standard anesthesia monitoring and omniplane TEE were performed. TEE probe was positioned in order to obtain "inflow-outflow" views of right heart. Measurements were obtained after anesthesia induction (T1), during femoral realing (T2) at prostheses insertion (T3), and at the end of surgery (T4). RESULTS: Hemodynamic and respiratory parameters measured in different phases of surgical procedures were not different within groups and between groups. Fourtheen patients had TEE evidence of emboli, and the phenomenon was more evident in CEM group (Z= -347; p<0.001). During prostheses insertion, a slight, not significant increase in right ventricular dimensions was observed in both groups, without any right ventricular wall kinetic abnormality. No difference was observed between groups. No adverse cardiac or cerebrovascular events in intra- and postoperatory period were observed. CONCLUSIONS: In normal patients total hip or knee arthroplasty is associated with embolic phenomena, without any significant change in systemic and right heart hemodynamics. Insertion of cemented prostheses does not modify hemodynamic profile. It remains to be elucidated if the occurrence of emboli has a critical role in patients with cardiorespiratory disease.

Aged↗
PubMed2002

Severe accidental hypothermia with or without hemodynamic instability: rewarming without the use of extracorporeal circulation.

BACKGROUND: The optimal rewarming technique for patients in deep accidental hypothermia with core temperatures below 28 degrees C is not established. Several authors believe that extracorporeal rewarming is essential, especially for patients with hemodynamic instability. Others believe that invasive rewarming ought to be reserved for patients in cardiac arrest. We describe our experience with a strictly conservative technique without the use of invasive rewarming devices in patients with severe accidental hypothermia and a sustained perfusion rhythm. METHODS: A cohort study extending from 1991 to 2000, including all patients received at the emergency department of the University Hospital of Vienna with severe hypothermia, a core temperature of maximum 28 degrees C and no preclinical cardiac arrest. RESULTS: 36 patients with deep hypothermia were included in the study. Their core temperatures ranged from 20.2 degrees C to 28 degrees C; the median temperature was 25.75 degrees C (25th and 75th percentile, 24.2/27.3). Fourteen patients were intoxicated and their multimorbidity was high. All of 19 patients with stable hemodynamics and 14 of 17 patients with unstable hemodynamics were successfully rewarmed to normothermia with warmed infusions, inhalation rewarming and forced air rewarming. The rewarming process took 9.5 hours (8/10.5) and required a volume load of 4820 ml (2735/5770). The rewarming rate was 1.09 degrees C per hour (0.94/1.25). Although 92% of the patients were successfully rewarmed to normothermia, in-hospital mortality was 42%, but was largely related to comorbidity. DISCUSSION: A conservative approach is highly successful in achieving normothermia in patients with deep hypothermia with or without stable hemodynamics. In-hospital mortality of severe accidental hypothermia in urban conditions is high; comorbidity might play a major role. The influence of the rewarming strategy on late in-hospital mortality remains unclear.

Austria↗
PubMedDate not supplied

[Integrated hemodynamic response to hemofiltration and peritoneal dialysis in patients with acute renal failure].

Central hemodynamics was studied by integral polyrheography in 24 patients with acute renal failure (ARF) during hemofiltration (HF) and in 18 patients with ARF during peritoneal dialysis. All central hemodynamic parameters improved by the end of HF. However stroke volume decreased by 26.6%, stroke index by 24.4%, minute volume by 25.7%, and cardiac index by 24.8% as early as at the moment of extracorporeal contour filling. This was paralleled by an increase of total peripheral vascular resistance from 1321 +/- 124 to 1586 +/- 106 din/(cm*c-5) (by 16.7%). Hence, clear-cut signs of centralization of circulation were seen during the initial period of HF in patients with ARF. Peritoneal dialysis did not lead to centralization of circulation in patients with ARF; moreover, minute heart volume increased by 9% during some stages of the procedure, stroke volume increased significantly (p < 0.05), other parameters increased, but total peripheral vascular resistance was virtually unchanged. After removal of dialysis solution from the abdominal cavity all hemodynamic parameters returned to the initial values. Hence, both hemofiltration and peritoneal dialysis ameliorate the central hemodynamics. However peritoneal dialysis does not involve even temporary centralization of circulation, which has a positive impact on the course of acute tubular necrosis.

Acute Kidney Injury↗
PubMed2002

[Metamizol versus propacetamol: comparative study of the hemodynamic and antipyretic effects in critically ill patients].

OBJECTIVE: To compare the antipyretic and hemodynamic effects of metamizol and propacetamol in critically ill patients with fever. PATIENTS AND METHODS: A prospective randomized trial enrolling 60 patients admitted to our postoperative intensive care unit with fever > 38 degrees C. Patients were assigned to group M to receive intravenous doses of 2 g of metamizol or group P to receive 2 g of propacetamol. Measures were central temperature (Ta), systolic (SBP), diastolic (DBP) and mean (MBP) blood pressures, mean pulmonary artery pressure, central venous pressure, pulmonary capillary pressure, pulmonary and systemic vascular resistance index, and mixed venous saturation. All measures were taken at four times: baseline and 30, 60 and 120 minutes after infusion of the medication. Patients whose SBP fell below 90 mm Hg were withdrawn from the study. RESULTS: Patient characteristics and baseline hemodynamics and Ta were similar in the two groups. We observed a significant decrease in temperature in both groups, the maximum decrease occurring 120 minutes after administration of the antipyretic (0.5 degree C and 0.6 degree in the metamizol and propacetamol groups, respectively). SBP, DBP, MBP, and the vascular resistance index decreased from baseline values in both groups 30, 60 and 120 minutes after dosing. Thirteen percent of the patients in group M and 6.67% in group P were withdrawn from the study because of hypotension. We observed no statistically significant differences between the groups in Ta or hemodynamic variables at any of the four moments of measurement. CONCLUSION: Both metamizol and propacetamol are effective antipyretics at the doses tested. However, both have adverse hemodynamic side effects that may be poorly tolerated by critically patients.

Acetaminophen↗
PubMed2002

[Study on a test of screening to predict stroke-using cerebral vascular hemodynamic indexes].

OBJECTIVE: To evaluate efficacy and optimal cut-off-point through cerebral vascular hemodynamic indexes (CVHI) examination to predict stroke. METHODS: A number of 20,333 people at 35 years old and over were checked by CVHI and accumulative score was calculated according to the value of detected indexes. Risk factors of stroke were investigated simultaneously. One hundred and sixty-eight patients with stroke occurred during 4-year following up. Typical syndromes and signs stroke were used as golden standard to evaluate screening efficacy of CVHI. RESULTS: Score of optimal cut-off-point of cerebral vascular hemodynamic indexes was under 75 in ROC curve analyses. Sensitivity, specificity, accuracy, positive and negative predictive values, positive and negative likelihood ratios as well as Youden's index for predicting stroke within 4 years after examination were found to be 87.50%, 67.70%, 67.86%, 2.21%, 99.85%, 2.71, 0.18 and 0.55 respectively. Sensitivity and positive predict values for predicting cerebral vascular thrombosis were superior to predicting cerebral hemorrhage. Positive predicting value in risk exposure population was higher than that of overall population. Coefficiency of variation of cerebral vascular hemodynamic examination was 4.03%. The agreement rate of examination between two physicians was 97.62% and Kappa value was 0.94. CONCLUSION: The score of optimal cut-off-point of cerebral vascular hemodynamic indexes examination was 75. Both Efficacy and reliability for predicting stroke seemed to be good, especially for predicting cerebral vascular thrombosis.

Adult↗
PubMed2002

Effects of extra-corporeal shock waves on penile hemodynamics and histopathology in rats.

AIM: To study the effect of extra-corporeal shock wave (ESW) on the penile hemodynamics and histopathology in rats. METHODS: Adult male Sprague-Dawley rats were divided at random into 3 groups. ESW application was performed with a Siemens Lithostar with the rats under anesthesia lying prone on the balloon probe. Rats in Group I received a total of 1000 shocks at 18 kV and immediately underwent hemodynamic evaluation performed by direct electrostimulation of the cavernous nerve and measurement of intracavernous pressure (ICP). Rats in Group II received 3 times 1000 shocks at 18 kV at weekly intervals and hemodynamic evaluation was performed 1 month after the last ESW application. Group III served as the control. Histopathological examinations of penile tissues were done on Masson's trichrome and hematoxylin and eosin stained sections. RESULTS: Penile hemodynamic evaluation showed a trend toward a diminished mean maximal ICP, duration of erection, ICP during the plateau phase and maximal ICP/ blood pressure ratio in Group I, although there was no significant significance. The mean latency period in Groups I and II was prolonged. Petechial bleeding within tunical layers and small foci of hemorrhage within the corpora cavernosa were observed in Group I. However, histopathological examination failed to reveal any significant differences between the groups in terms of smooth muscle content, tunical thickness, organization of collagen bundles and elastic fiber-lattice framework. CONCLUSION: ESW has certain damaging effects on the penis.

Animals↗
PubMed2002

[Effects of biventricular support with Luo-Ye pump on hemodynamics during ischemic biventricular dysfunction].

To compare the effects on hemodynamics of univentricular support with that of biventricular support on experimental ischemic biventricular dysfunction so as to provide experimental basis for clinical usage of the Luo-Ye pump. Eight canines were placed with a left ventricular assist device (LVAD; left atrial-aorta bypass) and a right ventricular assist device (RVAD; right atrial-pulmonary artery bypass). Left anterior descending coronary artery(LAD) was ligated, three minutes later, the proximal of right coronary artery (RCA) was ligated to establish animal madel of acute ischemic biventricular dysfunction. First start the LVAD, and then RVAD was started five minutes later. The hemodynamic data were recorded including central venous pressure(CVP), cardiac output (CO), mean artery pressure(MAP), and pulmonary artery pressure(PAP) and pulmonary capillary wedge pressure (PCWP). During biventricular assist devices (BVAD) the hemodynamics were improved remarkably, MAP increased from 37.4 +/- 8.8 mmHg to 84.2 +/- 9.7 mmHg (P < 0.01) (the normal level), CO increased from 0.82 +/- 0.1 L/min to 1.33 +/- 0.12 L/min (P < 0.01), CVP decreased from 14.6 +/- 2.3 cmH2O to 4.2 +/- 1.5 cmH2O (P < 0.01), PCWP decreased significantly from 14 +/- 3.9 mmHg to 1.6 +/- 0.9 mmHg. These data suggest that LVAD during biventricular dysfunction could not improve the hemodynamics to normal level. Howere BVAD could increase CO and MAP to normal level and decrease heart work and myocardial oxygen consumption, which could help to improve myocardial metabolism and myocardial function. Therefore, BVAD is the first choice in treating severe biventricular dysfunction which was not respond to drug therapy and intra-aortic balloon pump (IABP).

Animals↗
PubMed2003

The effects of handgrip stress test on hemodynamic parameters before and after cilazapril treatment in patients with heart failure.

OBJECTIVE: To assess the effect of cilazapril treatment on several hemodynamic parameters during handgrip maneuvers in patients with congestive heart failure. Cilazapril, an ACE inhibitor with high affinity, has been shown to be highly effective against a variety of vascular disorders. The effectiveness of isometric handgrip exercise on changes of cardiovascular hemodynamic parameters before and after cilazapril treatment in patients with congestive heart failure is unknown. METHODS: The study population included 30 patients (16 male, 14 female) with mean age of 65+/-18 years. The effects of handgrip maneuver on hemodynamic parameters were studied by right heart catheterization and Doppler echocardiography. RESULTS: Heart rate (HR) and mean arterial pressures (MAP) increased significantly after handgrip maneuver (from 95+/-6 beats/min to 101+/-12 beats/min; from 109+/-15 mm Hg to 118+/-19 mm Hg, p<0.05 respectively). Pulmonary capillary wedge pressure (PCWP), pulmonary artery systolic (s) and diastolic (d) pressures (PAP), cardiac index (CI), right ventricular systolic and diastolic pressures (RVPs and RVPd), left ventricular ejection fraction (LVEF), right ventricular ejection fraction (RVEF) did not change after handgrip maneuvers (p>0.05). On the other hand, PAPs and PAPd, RVPs and RVPd, MAP and HR (p<0.05) decreased significantly during handgrip maneuvers after cilazapril treatment. However PCWP and CI, LVEF, RVEF did not change after treatment (p>0.05). CONCLUSION: Cardiovascular response to handgrip maneuver may be a marker of failure to respond to compensatory mechanisms. Cilazapril treatment was associated with significant improvement in hemodynamic parameters during handgrip stress test, the mechanisms of which are increased sympathetic and renin-angiotensin system activation, and altered vascular tonus.

Adult↗
PubMed2002

[Renal hemodynamics in patients with systemic lupus erythematosus as shown by renal scintigraphy].

Dynamic scintigraphy (DS) provides qualitative and quantitative assessment of renal circulation in patients with different diseases. Few data are still available on application of DS of the kidneys in patients with systemic lupus erythematosus (SLE). Renal hemodynamics studies with DS are not described in SLE patients with disturbances of renal metabolism and/or antiphospholipid syndrome (APS). We examined renal hemodynamics in SLE patients with renal disease, arterial hypertension, impaired lipid metabolism, APS. We examined 65 patients with confirmed diagnosis of SLE with 99mTc DS and estimated effective renal blood flow. The latter was damaged more in SLE patients with symptoms of renal disorders. Arterial hypertension deteriorated renal hemodynamics. In hypertensive patients with affected kidneys angionephroscintigraphic parameters changed most significantly. Renal hemodynamics in disturbed lipid metabolism was worse than in normal one but the difference was not significant. Angionephroscintigraphy findings were worse in patients with APS than in those with renal lesion and arterial hypertension but free of APS.

Adult↗
PubMed2003

[Comparison of the hemodynamic response in subarachnoid anesthesia with bupivacaine versus bupivacaine with fentanyl in traumatology surgery in elderly patients].

OBJECTIVES: To compare the intraoperative hemodynamic effects and ephedrine requirements in elderly patients undergoing orthopedic surgery under subarachnoid anesthesia with hyperbaric bupivacaine with or without fentanyl. MATERIAL AND METHODS: Sixty patients over 75 years of age and scheduled for semi-urgent surgical repair of a fractured femur were randomized to two groups. Group F received subarachnoid surgery with 5 mg of bupivacaine and 15 micrograms of fentanyl. Group B received 7.5 mg bupivacaine. We recorded blood pressure, heart rate and oxygen saturation every 5 minutes and extension of anesthesia. Hemodynamic changes and ephedrine required by each patient were analyzed, along with side effects. RESULTS: Group F patients were more hemodynamically stable 10 and 20 minutes after infusion of the anesthetic, and more hypotensive episodes occurred in group B. Group B consumed significantly more ephedrine (p < 0.05), administered to 22 patients in group B and 6 in group F. The total dose of ephedrine administered was greater in group B (190 mg) than in group F (40 mg). The extension of anesthetic block was sufficient for surgery in all cases. No side effects from fentanyl administration were observed. CONCLUSION: Adding fentanyl to the local anesthetic used for subarachnoid anesthesia in elderly patients is effective for maintaining greater hemodynamic stability, allowing use of a lower dose of hyperbaric bupivacaine and reducing the need for intravenous ephedrine during surgery.

Aged↗
PubMed2003

Naturalistic decision making: a model to overcome methodological challenges in the study of critical care nurses' decision making about patients' hemodynamic status.

The quality of critical care nurses' decision making about patients' hemodynamic status in the immediate period after cardiac surgery is important for the patients' well-being and, at times, survival. The way nurses respond to hemodynamic cues varies according to the nurses' skills, experiences, and knowledge. Variability in decisions is also associated with the inherent complexity of hemodynamic monitoring. Previous methodological approaches to the study of hemodynamic assessment and treatment decisions have ignored the important interplay between nurses, the task, and the environment in which these decisions are made. The advantages of naturalistic decision making as a framework for studying the manner in which nurses make decisions are presented.

Critical Care↗
PubMed2003

Hemodynamic indices versus gastric tonometric measurements for prognosis of hemorrhagic shock: a porcine model.

The aim of the study reported here was to assess the prognostic value of gastric tonometry and its implications in the initial phases of hemorrhagic shock. Hemorrhagic shock was induced by use of femoral arterial bleeding in 12 hybrid swine under general anesthesia. Approximately 30% of the circulating blood volume was removed, until mean arterial pressure of 45 mmHg was reached. The shock conditions were observed over a limited period (90 min) by comparing traditional hemodynamic parameters with gastric tonometric measurements and tissue oxygenation. After a shock period of 90 min without pharmacologic treatment, blood was collected in acid-citrate dextrose-treated bags and was reinfused via the right femoral vein. At the end of the experiment, seven animals had good hemodynamic recovery on reinfusion (group A), whereas values in five animals deceased in the same phase (group B). Hemodynamic and gastric tonometric results were compared between survivors and nonsurvivors. Intravascular volume restoration and reduction of systemic vascular resistance (SVR) enabled the animals of group A to maintain standard ventricular kinetics and recover in terms of splanchnic regional flow. In addition, increase in intramucosal gastric pH (pHi), decrease in the pH-gap (pHa-Hi), and progressive restoration in gastric wall tissue oxygenation (PtO2) also were observed. These results suggest that useful diagnostic and therapeutic indications can be obtained by acquisition of simple hemodynamic measurements at the beginning of the shock period. On the basis of results of statistical analysis, only mean arterial pressure and SVR were good indicators of shock development, whereas pHi was not a significant factor in this experimental model.

Animals↗
PubMed2003

A tyrosine hydroxylase microsatellite and hemodynamic response to stress in a multi-ethnic sample of youth.

OBJECTIVE: Behavioral stress is believed to have an impact on cardiovascular health. As the rate-limiting enzyme in the pathway for catecholamine synthesis, tyrosine hydroxylase is a candidate gene for variability in cardiovascular function. The aim of this study was to determine whether a relationship exists between a tyrosine hydroxylase microsatellite and resting hemodynamic function, and/or hemodynamic responsivity to laboratory stress. DESIGN: Subjects underwent 2 laboratory stressors: a video game challenge and a social competence interview. SETTING: The stressors were administered in a laboratory setting. PARTICIPANTS: Subjects were 292 10- to 20-year-old normotensive African-American and European-American twin pairs. MAIN OUTCOME MEASURES: Blood pressure (BP) and heart rate (HR) were measured at rest and in response to the stressors. RESULTS: Chi-square analyses using re-sampling to account for the twin design indicated that allele and genotype frequencies were significantly different between European Americans and African Americans (P < or = .0001). Analyses of variance indicated that the 184 and 199 bp alleles were associated with an attenuation of the hemodynamic response to stress with increasing age (P < or = .003, P < or = .002, respectively), while the 188 bp allele was associated with a higher resting systolic blood pressure (SBP) (P < or = .02), and greater hemodynamic response to stress with increasing BMI (P < or = .02). CONCLUSIONS: This study showed that in a multi-ethnic sample of normotensive adolescents, specific alleles of this tyrosine hydroxylase microsatellite were associated with protective or deleterious cardiovascular effects with subjects at rest and responding to stress.

Adolescent↗
PubMed2003

[Effects of esmolol and fentanyl on the hemodynamic and catecholamine response to tracheal intubation in hypertensive patients].

OBJECTIVE: To compare effects of esmolol and fentanyl on the hemodynamic and catecholamine response to tracheal intubation in hypertensive patients. METHODS: Sixty hypertensive patients were randomly allocated into one of four groups: the patients received 0.9% saline in group A, 2 mg/kg esmolol in group B, 2 microg/kg fentanyl in group C and 2 mg/kg esmolol combined with 2 microg/kg fentanyl in group D before intubation. Tracheal intubation was performed with 0.1 mg/kg midazolam, 0.6 mg/kg atracurium and 2 mg/kg propofol. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), heart rate (HR), rate-pressure product (RPP), plasma noradrenaline (NA) and adrenaline (A) concentrations were measured before and after intubation. RESULTS: SAP, DAP, HR, RPP, NA and A levels in group A at 1 and 3 minutes after intubation were significantly higher than the baseline values (all P<0.01). NA levels in group B and SAP in group C increased significantly after intubation (both P<0.05). The hemodynamics and catecholamine in group D after intubation were not significantly different from the baselines (all P>0.05). CONCLUSION: 2 mg/kg esmolol or 2 microg/kg fentanyl can partly reduce hemodynamic response to intubation and 2 mg/kg esmolol combined with 2 microg/kg fentanyl can completely attenuate the hemodynamic and catecholamine response in hypertensive patients.

Adult↗