RESUMEN
Purpose Hypotension during the early intraoperative phase is common and can lead to adverse perioperative outcomes. Fluid preloading is one of the methods to limit its occurrence. Patients with chronic compressive cervical myelopathy may have autonomic dysfunction, which can aggravate hemodynamic alterations during anesthesia. This study compared the occurrence of postinduction hypotension and changes in cardiac dynamic indices in patients with and without crystalloid preloading undergoing decompressive cervical spine surgery. Methods This randomized controlled trial was conducted over 15 months after obtaining patient consent, approval of the institute ethics committee, and trial registration. We compared preanesthetic fluid loading with Ringer's lactate (20 mL/kg over 30 minutes) with no preloading (2 mL/kg/h maintenance) in 60 consecutive patients undergoing cervical spine surgery. The ANSiscope was used to determine baseline cardiac autonomic function. Noninvasive cardiac output monitor was used to assess changes in heart rate, mean arterial pressure, cardiac index (CI), stroke volume variation (SVV), and total peripheral resistance index during study intervention, anesthetic induction, tracheal intubation, and change in position from supine to prone. Results The incidences of postinduction hypotension were 26.7% (8/30) and 86.7% (26/30) and the median doses of mephentermine used were 0 and 6 mg, respectively, in patients with and without fluid preloading (both p < 0.001). Preloading resulted in improvement in CI, reduction in SVV, and lesser vasopressor use. Conclusion Preloading reduced the occurrence of postinduction hypotension and vasopressor use, improved CI, and reduced SVV during the early intraoperative period. Registration number of Clinical Trial The trial was registered with Clinical Trial Registry of India (CTRI/2018/07/014970 on 19/07/2018).
RESUMEN
South Asians, one of the fastest growing ethnic groups in the USA today, trace their roots to countries in the Indian subcontinent (e.g., Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, Sri Lanka) and its global diaspora. With a wide range of cultural, religious, and linguistic diversity, as well as immigration experiences and inequality, South Asians have experienced racialized violence and discrimination since first arriving in the USA in the 1700s. Following September 11, 2001, South Asians and other groups racialized as "Brown," including Muslim, Sikh, Middle Eastern, and Arab Americans, have experienced a marked increase in state violence, including racist laws, policies, and immigration enforcement. Despite abundant evidence of the adverse effects of violence on mental and physical health, there is limited research examining the impact of this racialized state violence on the health of South Asians in the USA. We summarize and synthesize existing peer-reviewed and gray literature on the prevalence and types of violence experienced by South Asians in the USA and enumerate their potential detrimental health impacts. We highlight the paucity of public health data and propose a conceptual framework describing how racialized violence and hate have significant implications for health among South Asians in the USA. Ultimately, these findings illuminate the need for change at the highest levels of governance to mitigate and resist hate violence, including through political participation and inclusion and equitable allocation of social and economic resources, to improve the health of South Asians in the USA.
