Afferent baroreflex failure with hyponatremia:A case report / 北京大学学报(医学版)

Afferent baroreflex failure(ABF)is a rare disease.It refers to the clinical syndrome caused by the impairment of the afferent limb of the baroreflex or its central connections at the level of the medul-la.The recognized causes include trauma,surgery in related areas(radical neck tumor surgery,carotid endarterectomy),neck radiotherapy,brain stem stroke,tumor growth paraganglioma and hereditary diseases,among which the most common cause is extensive neck surgery or radiotherapy for neck cancer.The main manifestations are fluctuating hypertension,orthostatic hypotension,paroxysmal tachycardia and bradycardia.This case is a young man,whose main feature is blood pressure fluctuation,accom-panied by neurogenic orthostatic hypotension(nOH).After examination,the common causes of hyper-tension and nOH were ruled out.Combined with the previous neck radiotherapy and neck lymph node dissection,it was considered that the blood pressure regulation was abnormal due to the damage of carotid sinus baroreceptor after radiotherapy for nasopharyngeal carcinoma and neck lymph node dissection,which was called ABF.At the same time,the patient was complicated with chronic hyponatremia.Com-bined with clinical and laboratory examination,the final consideration was caused by syndrome of in-appropriate antidiuretic hormone(SIADH).Baroreceptors controlled the secretion of heart rate,blood pres-sure and antidiuretic hormone through the mandatory"inhibition"signal.We speculate that the carotid sinus baroreceptor was damaged after neck radiotherapy and surgery,which leads to abnormal blood pres-sure regulation and nOH,while the function of inhibiting ADH secretion was weakened,resulting in higher ADH than normal level and mild hyponatremia.The goal of treating ABF patients was to reduce the frequency and amplitude of sudden changes in blood pressure and heart rate,and to alleviate the on-set of symptomatic hypotension.At present,drug treatment is still controversial,and non-drug treatment may alleviate some patients'symptoms,but long-term effective treatment still needs further study.The incidence of ABF is not high,but it may lead to serious cardiovascular and cerebrovascular events,and the mechanism involved is extremely complicated,and there are few related studies.The reports of rele-vant medical records warn that patients undergoing neck radiotherapy or surgery should minimize the da-mage to the baroreceptor in the carotid sinus in order to reduce the adverse prognosis caused by complica-tions.

Application of ciprofol-alfentanil in short urological surgery / 重庆医学

Objective To evaluate the application effect of ciprofol-alfentanil in short urological surgery.Methods A total of 80 patients who were to undergo urological general anesthesia surgery in this hospital were divided into two groups by random number method:ciprofol-alfentanil group(group C)and propofol-alfentanil group(group P).Group C was injected with ciprofol 0.4 mg/kg,group P was injected with propofol 1.5-2.0 mg/kg,and when the bispectral index(BIS)was<60,the intravenous injection of alfen-tanil(10 μg/kg)and rocuronium bromide(0.6 mg/kg)was continued.When the modified alertness/sedation score(MOAA/S score)was 0,the laryngeal mask was placed and mechanical ventilation was used.During the maintenance period,ciprofol 0.8-1.2 mg·kg-1·h-1 was infused intravenously in group C,and propofol 4-6 mg·kg-1·h-1 was infused intravenously in group P.The heart rate(HR),blood pressure(BP),oxygen saturation(SpO2),end-tidal carbon dioxide(PetCO2),BIS and MOAA/S score were recorded at the begin-ning of anesthesia induction(T0),laryngeal mask insertion(T1),ureteroscopy entry(T2),10 min after sur-gery(T3)and the end of surgery(T4).The consciousness disappearance time,operation time,anesthesia re-covery time,drug dosage,injection pain during induction,hypotension,bradycardia and other adverse reactions during the operation were recorded.Results There was no significant difference in HR,SpO2,PetCO2,BIS value,MOAA/S score,operation time,consciousness disappearance time,and anesthesia recovery time be-tween the two groups at each time point(P>0.05).The dosage of sedative drugs in group C was less than that in group P(P<0.05).Compared with group P,systolic blood pressure and diastolic blood pressure at T1-T3 and diastolic blood pressure at T4 increased in group C(P<0.05).Compared with T0,systolic blood pressure at T1-T4 in group C and group P decreased,diastolic blood pressure at T2-T4 in group C de-creased,and diastolic blood pressure at T1-T4 in group P decreased(P<0.05).Compared with group P,the injection pain and the incidence of intraoperative hypotension were reduced in group C(P<0.05).Conclusion Cipro-fol-alfentanil is superior to propofol-alfentanil in short urological surgery.

Association between intraoperative hypotension and postoperative acute kidney injury in patients un-dergoing brain tumor resection / 临床麻醉学杂志

Objective To investigate the association between intraoperative hypotension and post-operative acute kidney injury(AKI)in patients undergoing brain tumor resections.Methods A total of 428 patients undergoing elective craniotomy for tumor resection were selected,276 males and 152 females,aged≥18 years,BMI 15-36 kg/m2,ASA physical statusⅡ orⅢ.Based on postoperative occurrence of AKI,the patients were divided into two groups:the AKI group and the control group.This study defined three thresholds for hypotension,including MAP during surgery below 65 mmHg,60 mmHg,and 55 mmHg.Multivariate logistic regression was used to analyze the correlation between intraoperative hypotension and postoperative AKI under three thresholds.Results A total of 107 patients had postoperative AKI.The re-sults of multivariable regression analysis indicated that intraoperative MAP＜65 mmHg(OR = 1.11,95%CI 1.03-1.20,P = 0.010)and intraoperative MAP＜60 mmHg(OR = 1.12,95%CI 1.02-1.23,P = 0.017)were associated with postoperative AKI.Conclusion Intraoperative MAP＜65 mmHg or 60 mmHg is associated with postoperative AKI in patients undergoing brain tumor resection.

Systematic review of risk prediction models for intradialytic hypotension in patients with maintenance hemodialysis / 中华护理杂志

Objective To systematically review the risk prediction models for intradialytic hypotension in maintenance hemodialysis patients,with a view to provide references for clinical practice.Methods PubMed,Embase,Web of Science,Cochrane Library,CINAHL,CNKI,VIP,Wanfang and CBM were searched from inception to May 29,2023.2 reviewers independently screened the literature,extracted information and assessed methodological quality using the Prediction Model Risk of Bias Assessment Tool.Results A total of 20 studies and 25 models were included with the sample size of 68～9 292 cases and the incidence of outcome events of 2.1～51％.Baseline systolic blood pressure,age,ultrafiltration rate,diabetes and dialysis duration were the top 5 predictors of repeated reporting of the models.20 models reported the area under the curve of ranging from 0.649 to 0.969,and 5 models reported calibration metrics.There were 9 internal validations and 4 combined internal and external validation models.The overall applicability of the 20 studies was good,but all had a high risk of bias,mainly in data analysis.Conclusion Research on risk prediction models for intradialytic hypotension in maintenance hemodialysis patients is still in the developmental stage.Future studies should improve the research design and reporting process,and validation studies of existing models should be carried out to further evaluate the effectiveness and feasibility in clinical practice.

Study on the similarities and differences of orthostatic hypotension in patients with Parkinson′s disease and multiple system atrophy / 中华神经科杂志

Objective:To summarize and compare the characteristics of orthostatic hypotension (OH)　in　patients　with　Parkinson′s disease and multiple system atrophy (MSA).Methods:The active standing test data of 210 Parkinson′s disease patients (Parkinson′s disease group) and 85 MSA patients (MSA group) admitted to the Department of Neurology, Xuanwu Hospital, Capital Medical University from January 2021 to March 2022 were retrospectively analyzed. Demographic information, clinical data, Hoehn-Yahr staging, and Unified Parkinson′s Disease Rating Scale (UPDRS), Non-Motor Symptoms Questionnaire (NMSQ), Montreal Cognitive Assessment Scale and Mini-Mental State Examination scores were collected. The comparative analysis of OH was conducted according to the changes of heart rate and blood pressure during the active standing test.Results:Among the 85 patients with MSA, 52 were found with MSA parkinsonism variant (MSA-P) and 33 with MSA cerebellar variant (MSA-C). The 210 Parkinson′s disease patients were aged (61.5±11.0) years, with 116 males (55.2%). The 85　MSA　patients　were aged (60.1±6.8) years, with 44 males (51.8%). Compared with the Parkinson′s disease group, the Hoehn-Yahr staging [2.0(2.0, 3.0) vs 3.0(2.0, 3.0), Z=-5.278, P<0.001], NMSQ[ 25.0(11.0,46.5) vs 45.0(24.0,70.0), Z=-3.632, P<0.001] and UPDRS scores [50.0(32.0,68.0) vs 65.5(44.5,78.5), Z=-3.073, P=0.003] in the MSA group were higher. The incidence of OH in the MSA group was higher than that in the Parkinson′s disease group [63.5% (54/85) vs 25.7%(54/210), χ 2= 37.284, P<0.001], but there was no statistically significant difference between the MSA-P and MSA-C groups . Compared with the Parkinson′s disease group, the MSA group had a higher incidence of classical OH [54.1%(46/85) vs 12.9%(27/210), χ 2=55.316, P<0.001] and neurogenic OH [36.5%(31/85) vs 9.0%(19/210), χ 2=32.326, P<0.001],but there was no statistically significant difference in the incidence of initial OH and delayed OH between the two groups. The incidence of severe OH in the MSA group was also higher than that in the Parkinson′s disease group [57.6%(49/85) vs 16.7%(35/210), χ 2=49.894, P<0.001], but there was no statistically significant difference in the incidence of pre-clinical OH and mild OH between the two groups. Conclusions:The incidence, time change, severity and pathophysiological basis of OH in Parkinson′s disease and MSA patients are different. Different types of OH may help to distinguish MSA from Parkinson′s disease.

Clinical research progress of orthostatic hypotension in patients with hypertension / 公共卫生与预防医学

Hypertension and orthostatic hypotension (OH) often coexist in the range of cardiovascular autonomic dysfunction, especially in the elderly population, where antihypertensive therapy may be more likely to cause OH. The incidence rate of hypertension combined with OH is increasing year by year, which brings clinicians a clinical dilemma as to what measures to provide to hypertensive patients to prevent the occurrence of OH in the future. However, current clinical studies have shown that the management strategies based on pathophysiology are effective for most patients. This paper mainly elaborates on the complex relationship between OH and hypertension, and discusses the risk factors and prevention strategies of hypertension with OH, in order to provide theoretical support for the prevention of OH in patients with hypertension.

Research progress of IDO1-mediated tryptophan metabolism in sepsis / 药学学报

Sepsis is a condition characterized by organ dysfunction resulting from the systemic inflammatory response triggered by an infection. Excessive inflammation and immunosuppression are intertwined, and severe cases may even develop into multiple organ failure. Studies have shown that indoleamine 2,3-dioxygenase 1-mediated tryptophan metabolism is involved in the occurrence and development of sepsis, and elevated plasma kynurenine levels and Kyn/Trp ratios are early indicators of sepsis development. In this paper, we provide a comprehensive summary of the role of IDO1 in the acute inflammatory phase of sepsis, late immunosuppression, and organ damage. This includes its regulation of inflammatory state, immune cell function, blood pressure, and other aspects. Additionally, we analyze preclinical studies on targeted IDO1 drugs. An in-depth understanding and study of IDO may help to understand the pathogenesis and clinical significance of sepsis and multiple organ damage from a new perspective and provide new research ideas for exploring its prevention and treatment methods.

Clinical characteristics and risk factors for hypotension in children with multisystem inflammatory syndrome related to SARS-CoV-2 / 中国小儿急救医学

Objective:To summarize the clinical characteristics of multisystem inflammatory syndrome in children（MIS-C）related to SARS-CoV-2 and analyze the risk factors for hypotension.Methods:The clinical data of children with MIS-C who visited Beijing Children's Hospital from January 2023 to March 2023 were retrospectively collected,and the clinical characteristics and risk factors for hypotension were analyzed.Results:Thirty-six patients were included,the median age was 3.1 (2.3,5.8) years; 61.1% were boys.All cases had a history of SARS-CoV-2 infection between 1 and 9 weeks before onset.Clinical symptoms included fever (100.0%); rash (94.4%); bilateral conjunctival congestion (88.8%); lips/oral cavity changes (100.0%); swollen hands and foot (61.1%); cervical lymphadenopathy (88.8%); acute gastrointestinal symptoms (61.1%) of diarrhea,abdominal pain and vomiting; neurologic manifestations (33.3%) of lethargy,headache,and convulsions; respiratory symptoms(41.6%) of cough,sore throat and shortness of breath.Nineteen (52.8%) cases developed hypotension and needed vasoactive drugs support to maintain blood pressure.Mechanical ventilation was required in four(11.1%) cases,and one patient was intubated and treated with continuous renal replacement therapy.The level of ferritin in hypotension group was significantly higher than those in normal blood pressure group( P＜0.05),while the levels of platelet count,serum sodium and potassium in hypotension group were significantly lower than those in normal blood pressure group( P＜0.05).Logistic regression multivariable analysis found the elevated serum ferritin ( OR=20.000,95% CI:2.750-145.481, P=0.003) was an independent risk factor for hypotension. Conclusions:MIS-C may be observed following SARS-CoV-2 infection.Various symptoms and signs,including fever,multiple organ dysfunction,and hypotension,may occur in children with MIS-C.Elevated ferritin is a risk factor for hypotension.

Platypnea-orthodeoxia syndrome: an intriguing perioperative hypoxemia case report

Abstract Platypnea-orthodeoxia syndrome (POS) is a rare condition of positional hypoxemia and dyspnea. The following is a case of hypoxemia for no obvious reason in the perioperative scenario. A 70-year-old male patient was submitted to a radical prostatectomy. On several occasions after anesthetic induction, peripheral oxygen saturation decreased without any understandable cause. In the postanesthesia care unit, severe hypoxemia occurred in the upright position, oddly correcting with recumbency. An echocardiography showed a right-to-left intracardiac shunt through a patent foramen ovale with no pulmonary hypertension, establishing POS. Achieving this diagnosis required a broad workup with a high degree of suspicion.

Comparison of labetalol and lidocaine in induction of controlled hypotension in tympanoplasty: a randomized clinical trial

Abstract Objectives This study aimed to compare the efficacy of labetalol and lidocaine in tympanoplasty surgery, specifically evaluating their impact on hemodynamic changes and perioperative outcomes. Methods A randomized controlled trial was conducted with 64 patients scheduled for tympanoplasty. Patients were randomly assigned to receive either 0.5-2 mg/min labetalol or 1.5 mg/kg/h lidocaine 1% to achieve controlled hypotension during surgery. The efficacy of the drugs was assessed by comparing the Mean Arterial Pressure (MAP), surgeon's satisfaction, time to target MAP, bleeding volume, postoperative pain scores, the need for analgesic medication in recovery, sedation, and other additional parameters. Results The hemodynamic parameters showed a similar trend over time in both the labetalol and lidocaine groups. The median bleeding volume in the labetalol group (10 cc) was lower than that in the lidocaine group (30 cc), although this difference was not statistically significant (p= 0.11). Similarly, surgeon's satisfaction level, pain intensity, and sedation level in the recovery room did not show statistically significant differences between the two groups (p> 0.05). The duration of surgery, recovery stay, and extubation time also did not significantly differ between the groups. Both medications took approximately the same time (20 min) to reach the target MAP and exhibited comparable hemodynamic responses (p> 0.05). Conclusion Both labetalol and lidocaine effectively achieved controlled hypotension during tympanoplasty surgery, thereby improving surgical conditions. The choice of medication should be based on individual patient characteristics and the anesthesiologist's judgment. Level of evidence: II.

Hipotensión intracraneal espontánea. Una puesta al día

Introducción: La hipotensión intracraneal espontánea es un síndrome causado por la disminución del volumen de líquido cefalorraquídeo consecuencia de su fuga al espacio extradural. Aunque la ICHD-3 proporciona un alto nivel de especificidad diagnóstica, esta enfermedad puede manifestarse de forma atípica. Hasta en un 30% no es posible establecer el punto de escape, pero con el refinamiento de los exámenes de imágenes este porcentaje se ha reducido a un 15%-20%. Actualmente, su manejo no se encuentra estandarizado y las recomendaciones se basan en evidencia de limitada calidad metodológica, además de la variabilidad de protocolos entre distintos centros. Desarrollo En esta revisión actualizamos los procedimientos diagnósticos y terapéuticos. Por un lado, analizamos el rol de la resonancia nuclear magnética de encéfalo y médula espinal completa como primer paso diagnóstico y, por otro lado, señalamos los exámenes destinados a determinar la fuga de líquido cefalorraquídeo. Tal es el caso de la mielo-resonancia, la mielo-tomografía computarizada, tanto estándar, dinámica y por sustracción digital, además de la cisternografía con 111-Indium-DPTA. Sin embargo, determinar cuál de estos exámenes es el óptimo es objeto de debate. Lo mismo ocurre con el tratamiento: reposo; parche sanguíneo epidural a ciegas, parche guiado por fluoroscopia o tomografía computarizada, parche de fibrina; o cirugía. Conclusiones Se requiere de una mayor investigación, especialmente con trabajos multicéntricos controlados, para una mejor comprensión de la fisiopatología, el diagnóstico por imágenes, los enfoques terapéuticos y evaluación objetiva de los resultados clínicos. Solo así se establecerán pautas diagnósticas y de tratamiento validadas.

Introducction: Spontaneous intracranial hypotension is a syndrome caused by decreased CSF volume secondary to its leakage into the extradural space Although ICHD-3 provides a high level of diagnostic specificity, manifestations may be atypical, making diagnosis challenging. The site of leakage may be undetermined in point Up to 30% of cases, although with recent refinement of imaging, this percentage has been reduced to 15-20%. Currently, management is not standardized and recommendations are based on inconclusive evidence, with variability of protocols between centres. Development. In this review, we update diagnostic and therapeutic procedures. We analyse the role of whole brain and spinal cord MRI as a first investigation and review tests aimed at determining cerebrospinal fluid leakage, such as MRI myelography, conventional CT myelography, dynamic CT myelography, and digital subtraction CT myelography, as well as 111-Indium-DPTA cisternography. Determining optimal use of these investigations remains a matter of debate. The same is true for treatment: rest, blind epidural blood patch, fluoroscopy or CT-guided epidural blood patch, fibrin patch and surgery are discussed. Conclusión: Further research, especially multicentre controlled studies, is required to improve understanding of pathophysiology, diagnostic imaging, therapeutic approaches and to objectively assess clinical outcomes. Only then will diagnostic and treatment guidelines be evidence-based.

Relationship between prehospital clinical status intracranial pressure and outcomes in pediatric patients with severe head trauma

Introduction: The prehospital phase of the management of pediatric severe traumatic brain injury may have a direct influence on the results. Objective: To evaluate the influence of prehospital variables on intracranial pressure and the results in pediatric patients with severe TBI. Method: A descriptive study of 41 pediatric patients who were admitted to the medical emergency department and later admitted to the pediatric intensive care unit due to severe head trauma was carried out between January 2003 and December 2018. Results: children aged 5-17 years predominate, and the highest number of cases were received between 0-3h at the neurotrauma center. Of the 41 cases, 27 arrived with a non-expedited airway and hypoxia was verified upon arrival by pulse oximetry. A correlation was observed between arterial hypotension on admission and elevated intracranial pressure in 9 of 15 children (60%) and in the deceased (40%). Discussion: Clinical conditions, oxygenation, arterial hypotension, and treatment in the prehospital phase may influence the state of intracranial pressure and other intracranial variables in pediatric patients with severe head injury.

Introducción: La fase prehospitalaria del manejo del traumatismo craneoencefálico grave pediátrico puede tener una influencia directa en los resultados. Objetivo: Evaluar la influencia de variables prehospitalarias sobre la presión intracraneal y los resultados en pacientes pediátricos con TCE grave. Metodología: Se realizó un estudio descriptivo de 41 pacientes pediátricos que ingresaron al servicio de urgencias médicas y posteriormente ingresaron a la unidad de cuidados intensivos pediátricos por traumatismo craneoencefálico severo entre enero de 2003 y diciembre de 2018. Resultados: predominan los niños de 5 a 17 años, y el mayor número de casos se recibieron entre las 0-3h en el centro de neurotrauma. De los 41 casos, 27 llegaron con vía aérea no acelerada y se verificó hipoxia al llegar mediante oximetría de pulso. Se observó correlación entre hipotensión arterial al ingreso y presión intracraneal elevada en 9 de 15 niños (60%) y en los fallecidos (40%). Discusión: Las condiciones clínicas, la oxigenación, la hipotensión arterial y el tratamiento en la fase prehospitalaria pueden influir en el estado de la presión intracraneal y otras variables intracraneales en pacientes pediátricos con traumatismo craneoencefálico grave.

Competencia clínica del personal de enfermería para el manejo de la hipotensión arterial intradialítica en el servicio de hemodiálisis del Centro Médico Naval / Clinical competence of nursing staff for the management of intradialytic hypotension in the hemodialysis service of the Naval Medical Center

Introducción: el correcto manejo de la hipotensión arterial durante la hemodiálisis es fundamental en la formación y trabajo del personal de enfermería nefrológica del Centro Médico Naval. El personal debe tener conocimientos suficientes sobre la hipotensión y sus factores asociados que le ayuden a predecirla y actuar de manera preventiva, así como con habilidades instrumentales para llevar a cabo medidas en la práctica. Objetivo: analizar la competencia clínica del personal de enfermería en el servicio de hemodiálisis del Centro Médico Naval con respecto a su formación académica y experiencia profesional en el manejo de la hipotensión arterial intradialítica. Metodología: estudio prospectivo, descriptivo y observacional. Se emplearon dos instrumentos: una adaptación del Cuestionario de conocimientos para el manejo de hemodiálisis de Miller y la Guía de observación de habilidades instrumentales en el personal de enfermería de Murillo. Resultados: se contó con una muestra de doce enfermeros pertenecientes al servicio de hemodiálisis. El 33.3% mostró un nivel regular de competencia clínica y 66.7% un nivel bueno. En promedio, la competencia clínica se ubicó en 78%. Discusión: los resultados obtenidos difieren de los reportados en otras investigaciones, tanto por el año de aplicación como de los sujetos evaluados. Limitaciones: se contó con una muestra baja debido a que el personal del servicio no es numeroso. Conclusiones: es necesario reforzar los conocimientos del personal sobre el tema. Sin embargo, se observó que las habilidades instrumentales fueron excelentes en todos los casos. No se observa relación con el nivel de estudios o la experiencia profesional.

Introduction: the correct management of arterial hypotension during hemodialysis is fundamental in the training and work of the nephrological nursing staff at the Naval Medical Center. The staff must have sufficient knowledge about hypotension and its associated factors to help them predict it and act preventively, as well as instrumental skills to carry out measures in practice. Objective: to analyze the clinical competence of the nursing staff in the hemodialysis service of the Naval Medical Center concerning their academic training and profesional experience in the management of intradialytic arterial hypotension. Methodology: a prospective, descriptive, and observational study. Two instruments were used: an adaptation of Miller's Hemodialysis Management Knowledge Questionnaire and Murillo's Guide to Observation of Instrumental Skills in Nursing Personnel. Results: There was a sample of twelve nurses belonging to the hemodialysis service. 33.3% percent showed a fair level of clinical competence and 66.7% a good level. On average, clinical competence was 78%. Discussion: the results obtained differ from those reported in other studies, in terms of both the year of application and the subjects evaluated. Limitations: there was a low sample size due to the small number of service personnel. Conclusions: it is necessary to reinforce the knowledge of the personnel on the subject. However, it was observed that instrumental skills were excellent in all cases. No relationship was observed with the level of studies or professional experience.

Intensive care management of Gitelman syndrome: A rare case

Gitelman syndrome (GS) is an autosomal-recessive disorder distinguished by hypokalemia, hypomagnesemia, and hypocalciuria. Elderly people and women of childbearing age are highly affected by GC. Not much evidence is known about its effects on maternal and fetal outcomes. GS is caused by mutations in the thiazide-sensitive Na-Cl cotransporter gene. Due to its rarity and lack of knowledge, it is susceptible to misdiagnosis or being overlooked. In our case, the patient suffered from recurrent hypokalemia, hypomagnesemia, hypochloraemia, and hypocalciuria with hypotension. After taking proper medication, the patient recovered slowly, and during counseling, the patient was provided a diet chart by nutritionists to avoid recurrent electrolyte imbalances.

Correlation of Serum Lactate Levels, Perfusion Index and Plethysmography Variability Index With Invasive Blood Pressure in Late Preterm and Term Infants With Shock

Objective: To study the correlation of objective parameters for diagnosing shock viz., perfusion index (PI), plethysmography variability index (PVI) and serum lactate (SL) with invasive blood pressure in late preterm and term infants with shock. Methods: Prospective observational study (diagnostic test) conducted at the neonatal intensive care unit of Kanchi Kamakoti CHILDS Trust Hospital, Chennai between June, 2018 and May, 2020. Term and late preterm neonates with shock were included in the study. PI, PVI, SL, SpO2 and heart rate were monitored. PI, PVI and SLL were recorded at 0,12, 24 and 72 hours of onset of shock. All the babies were followed up till discharge or death. Results: Total 78 neonates were enrolled in the study. At 0 hour, SL and PVI had negative correlation (P =0.002 and P=0.003) while PI had a weak-to-moderate positive correlation (P=0.002) with invasive blood pressure. SL ?4.65 had a sensitivity of 75% and specificity of 75.8%, and PI <0.455 had a sensitivity of 65%, and specificity of 58.6% for predicting invasive hypotension. PVI ?23.5 had a sensitivity of 90% and specificity of 63.8% in predicting invasive hypotension. Conclusion: PI has moderate positive correlation while SL and PVI have moderate negative correlation with invasive blood pressure. The cutoff values of SL ?4.65, PI <0.45 and PVI ?23.5 can predict invasive hypotension with good sensitivity and negative predictive value.

Nivel de conocimiento de los estudiantes del tercer curso en Odontología de la UNAN-León, sobre trastornos de presión arterial y manejo odontológico / Level of knowledge third year dentistry students UNAN-León about blood pressure disorders and dental management

Las patologías cardiovasculares constituyen la causa más frecuente de muerte en el mundo, las más comunes son hipertensión e hipotensión. En la consulta odontológica, los pacientes con trastornos de presión arterial requieren diferentes protocolos de atención. En el tercer curso de odontología se tiene el primer contacto con pacientes, al haber estudiado y aprobado la parte teórica del manejo odontológico. Según los antecedentes encontrados, no existen investigaciones que abarquen ambos trastornos de la presión arterial, por lo que se realizó un estudio descriptivo de corte transversal para determinar el nivel de conocimiento en estudiantes del tercer curso Odontología UNAN-León, sobre trastornos de la presión arterial y su manejo odontológico en el segundo semestre del año 2021, por una encuesta tipo examen a estudiantes inscritos en cirugía bucal I, 55 estudiantes fueron encuestados. Se determinó que 50.9% tienen un nivel de conocimiento regular, seguido por 27.3% con nivel bueno, 12.7% deficiente y 9.1% obtuvo nivel de conocimiento excelente sobre los trastornos de presión arterial. Según investigaciones previas en odontología, la mayoría de los estudiantes presentaba un nivel de conocimiento deficiente sobre hipertensión arterial. Por lo que es importante evaluar periódicamente los niveles de conocimiento sobre éstos y otros trastornos que pueden presentarse en la consulta dental (AU)

Cardiovascular diseases are the most common cause of death world, hypertension and hypotension are very common nowadays. In the dental office, patients with blood pressure disorders require different care protocols. Students of the third year of dentistry have their first contact with patients, having studied and approved the theoretical part of dental management. According to antecedents researched, there are no investigations that cover both blood pressure disorders. So a descriptive cross-sectional study was made to determine the knowledge of third-year dentistry students UNAN-León, about blood pressure disorders and their dental management in the second semester of the year 2021, by an exam-type survey of students registered in oral surgery I, with 55 students surveyed. It determined that 50.9% have a regular level of knowledge, followed by 27.3% with a good level, 12.7% poor and 9.1% has an excellent level of knowledge about blood pressure disorders. According to previous research in dentistry faculty, the majority of students have a poor level of knowledge about high blood pressure. Therefore, it's important to evaluate periodically the levels of knowledge about these and other disorders that may occur in the dental office (AU)

Efficacy and safety of ciprofol in combined intravenous and inhalation anesthesia in elderly patients undergoing thoracoscopic surgery / 临床麻醉学杂志

Objective To research the efficacy and safety of ciprofol in combined intravenous and inhalation anesthesia in elderly patients undergoing thoracoscopic surgery.Methods A retrospective analysis was conducted on 806 elderly patients who underwent thoracoscopic surgery from January 2021 to July 2022,416 males and 390 females,aged 65-85 years,BMI 16-30 kg/m2,ASA physical status Ⅰ-Ⅲ.Patients were divided into two groups according to different intravenous anesthesia drugs during the sur-gery:ciprofol group(group C,n=229)and propofol group(group P,n=577).The preoperative and intraoperative indexes of the two groups were balanced by 1∶1 propensity score matching(PSM).Multiva-riate logistic regression was used to analyze the correlation between intravenous anesthetics and the incidence of adverse reactions(hypotension,bradycardia,hypoxemia during recovery,and postoperative nausea and vomiting).Multivariate linear regression was used to analyze the correlation between intravenous anesthetics and short-term recovery indicators after anesthesia(extubation time,postanesthesia care unit residence time,and length of postoperative hospitalization).Results Compared with group P,the total dosage of va-soactive drugs in group C were significantly reduced(P＜0.05),extubation time and PACU residence time were significantly shortened(P＜0.05).Multivariate logistic regression analysis showed that the use of cip-rofol was associated with a reduced incidence of intraoperative hypotension(OR=0.378,95％CI 0.236-0.603,P＜0.001)and hypoxemia during recovery(OR=0.542,95％CI 0.336-0.874,P=0.012).Multivariate linear regression analysis showed that the use of ciprofol was associated with the reduction of ex-tubation time and PACU residence time(P＜0.001).Conclusion Compared with propofol,combined in-travenous and inhalation anesthesia with ciprofol can significantly reduce the incidence of anesthetic adverse reactions in elderly patients,and is conducive to short-term recovery after anesthesia.

Effect of transcutaneous electrical acupoint stimulation on circulation depression in patients undergo-ing thoracoscopic radical resection of lung cancer / 临床麻醉学杂志

Objective To observe the effect of transcutaneous electrical acupoint stimulation(TEAS)on circulation depression in patients underwent thoracoscopic radical resection of lung cancer under general anesthesia combined with thoracic paravertebral block(TPVB).Methods A total of 150 patients from Octomber 2021 to May 2022,58 males and 92 females,aged 19-64 years,BMI 18-30 kg/m2,ASA physical status Ⅰ or Ⅱ,underwent thoracoscopic radical resection of lung cancer under general anesthesia combined with TPVB were enrolled.According to random number table method,the patients were divided into two groups:the TEAS group and the control group,75 patients in each group.In the TEAS group,transcutaneous electrical acupoint stimulation was performed at Hegu,Neiguan,and Zusanli 30 minutes be-fore induction until the end of operation.In the control group,the electrodes were only connected at the same time point without electrical stimulation.HR,SBP,DBP,MAP,and BIS were recorded before stimu-lation(T0),10 minutes after TPVB(T1),the time of skin incision(T2),30 minutes after operation star-ted(T3),60 minutes after operation started(T4),the end of operation(T5),and 30 minutes after opera-tion(T6).The incidences of bradycardia,tachycardia,hypotension,and hypertension,and the usages of vasoactive drugs during operation were recorded.The dosages of propofol,sufentanil,and remifentanil in the operation were recorded.The VAS pain score 1,2,and 7 days after operation,the usages of analgesics used within 7 days after operation,postoperative adverse effects such as nausea and vomiting,dizziness,chest tightness,and shortness of breath,and the length of hospital stay were recorded.Results Compared with the control group,intraoperative infusion volume,incidence of hypotension,hypertension,and circulation depression,the usages of deoxyepinephrine,ephedrine,norepinephrine,and urapidil intraoperation,VAS pain scores 1 and 2 days after operation,and the usage of analgesics within 7 days after operation were sig-nificantly decreased(P＜0.05),length of hospital stay was significantly shortened(P＜0.05),SBP,DBP,and MAP were significantly increased at T1(P＜0.05),the dosagesof propofol,sufentanil,and remifentanil were significantly decreased in the TEAS group(P＜0.05).There were no significantly differ-ences of nausea and vomiting,dizziness,and shortness of breath between the two groups.Conclusion TEAS can improve the circulation depression,and reduce the incidences of intraoperative hypotension and hypertension,decrease the dosages of anesthetics and the rate of using vasoactive drugs during operation,improve early postoperative acute pain and shorten the length of hospital stay in patients undergoing thoraco-scopic radical resection of lung cancer under general anesthesia combined with TPVB.

Research progress on predictors of hypotension after induction of general anesthesia / 临床麻醉学杂志

Post-induction hypotension(PIH)is very common in clinical anesthesia after induction of general anesthesia.Intravenous anesthetic drugs could decrease cardiac output and systemic vascular re-sistance and then lead to PIH.PIH is associated with adverse postoperative outcomes such as myocardial in-jury,renal injury,stroke,prolonged hospital stays,and even death.Therefore,predicting PIH and taking corresponding preventive measures will improve the prognosis of patients.However,the effective way to pre-dict PIH is still controversial.This article reviews the research progress of PIH predictors in order to provide a reference for the clinical identification of high-risk patients,improvement of PIH,and reduction of adverse postoperative outcomes.

Risk factors for supine hypotension syndrome after cesarean section and development of a prediction model in parturients / 中华麻醉学杂志

Objective:To identify the risk factors for supine hypotension syndrome (SHS) after spinal anesthesia and establish a predictive model in parturients.Methods:The medical records from pregnant women undergoing elective cesarean section were retrospectively analyzed. According to the standard that SBP dropped by 30 mmHg or below 80 mmHg after spinal anesthesia, the parturients were divided into non-SHS group and SHS group. The general data from patients and difference of external iliac vein flow (ΔIVF) during postural changes before anesthesia were collected. The factors with statistically significant differences between groups were included in the logistic regression model, the risk factors were identified and the weighted score regression prediction model was established, and the receiver operating characteristic curve was drawn to evaluate the model.Results:There were 64 parturients developed SHS after spinal anesthesia, with an incidence of 54.7%. Logistic regression analysis showed that fetal abdominal circumference, amniotic fluid index, ΔIVF and consumption of norepinephrine were independent risk factors for SHS after spinal anesthesia. The area under the receiver operating characteristic curve was 0.983, 95% confidence interval was 0.968-0.999, the sensitivity was 90.6%, the specificity was 96.2%, and the Youden index was 0.868. The prediction model of the line chart was tested by Hosmer-Lemshow, P=0.984, and the C index visualized the line chart model was 0.983. Conclusions:Fetal abdominal circumference, amniotic fluid index, ΔIVF and consumption of norepinephrine are independent risk factors for SHS after spinal anesthesia in parturients, and the risk prediction model can effectively predict the occurrence of SHS after spinal anesthesia.