Background：Dual sensor （DS） for rate adaption was supposed to be more physiological.To evaluate its superiority,the DS （accelerometer [ACC] and minute ventilation [MV]） and normal sinus rate response were compare...Background：Dual sensor （DS） for rate adaption was supposed to be more physiological.To evaluate its superiority,the DS （accelerometer [ACC] and minute ventilation [MV]） and normal sinus rate response were compared in a self-controlled way during exercise treadmill testing.Methods：This self-controlled study was performed in atrioventricular block patients with normal sinus function who met the indications of pacemaker implant.Twenty-one patients came to the 1-month follow-up visit.Patients performed a treadmill test 1-month post implant while programmed in DDDR and sensor passive mode.For these patients,sensor response factors were left at default settings （ACC =8,MV =3） and sensor indicated rates （SIRs） for DS,ACC and MV sensor were retrieved from the pacemaker memories,along with measured sinus node （SN） rates from the beginning to 1-minute after the end of the treadmill test,and compared among study groups.Repeated measures analysis of variance and profile analysis,as well as variance analysis of randomized block designs,were used for statistical analysis.Results：Fifteen patients （15/2 l） were determined to be chronotropically competent.The mean differences between DS SIRs and intrinsic sinus rates during treadmill testing were smaller than those for ACC and MV sensor （mean difference between SIR and SN rate：ACC vs.SN,MV vs.SN,DS vs.SN,respectively,34.84,17.60,16.15 beats/min）,though no sensors could mimic sinus rates under the default settings for sensor response factor （ACC vs.SN P-adjusted 〈 0.001; MV vs.SN P-adjusted =0.002; DS vs.SN P-adjusted =0.005）.However,both in the range of 1st minute and first 3 minutes of exercise,only the DS SIR profile did not differ from sinus rates （P-adjusted =0.09,0.90,respectively）.Conclusions：The DS under default settings provides more physiological rate response during physical activity than the corresponding single sensors （ACC or MV sensor）.Further study is needed to determine if individual optimization would further im展开更多
The systemic administration of morphine affects ventilation via a mixture of central and peripheral actions. The aims of this study were to characterize the ventilatory responses elicited by a low dose of morphine in ...The systemic administration of morphine affects ventilation via a mixture of central and peripheral actions. The aims of this study were to characterize the ventilatory responses elicited by a low dose of morphine in conscious rats;to determine whether tolerance develops to these responses;and to determine the potential roles of peripheral μ-opioid receptors (μ-ORs) in these responses. Ventilatory parameters were monitored via unrestrained whole-body plethysmography. Conscious male Sprague-Dawley rats received an intravenous injection of vehicle or the peripherally-restricted μ-OR antagonist, naloxone methiodide (NLXmi), and then three successive injections of morphine (1 mg/kg) given 30 min apart. The first injection of morphine in vehicle-treated rats elicited an array of ventilatory excitant (i.e., increases in frequency of breathing, minute volume, respiratory drive, peak inspiratory and expiratory flows, accompanied by decreases in inspiratory time and end inspiratory pause) and inhibitory (i.e., a decrease in tidal volume and an increase in expiratory time) responses. Subsequent injections of morphine elicited progressively and substantially smaller responses. The pattern of ventilatory responses elicited by the first injection of morphine was substantially affected by pretreatment with NLXmi whereas NLXmi minimally affected the development of tolerance to these responses. Low-dose morphine elicits an array of ventilatory excitant and depressant effects in conscious rats that are subject to the development of tolerance. Many of these initial actions of morphine appear to involve activation of peripheral μ-ORs whereas the development of tolerance to these responses does not.展开更多
Introduction: Propofol use during endoscopic procedures has become increasingly popular and assessing and maintaining airway patency is a significant challenge. Anesthesiologists often use airway maneuvers to maintain...Introduction: Propofol use during endoscopic procedures has become increasingly popular and assessing and maintaining airway patency is a significant challenge. Anesthesiologists often use airway maneuvers to maintain airway patency and ventilation during procedural sedation. A novel, non-invasive, Respiratory Volume Monitor (RVM) that provided continuous, real-time measurements of minute ventilation (MV), tidal volume (TV) and respiratory rate (RR) was used to monitor respiratory performance before, during, and after endoscopic procedures, quantify MV changes before and after airway maneuvers, and to quantify propofol-induced respiratory depression. Methods: RVM traces were obtained from 25 patients undergoing sedation for endoscopic procedures. Airway maneuvers were performed in 19/25 patients. All 25 patients received propofol as the primary sedative. Results: Forty-five airway maneuvers were performed. During these maneuvers, all respiratory parameters increased relative to pre-maneuver levels. On average, MV increased by 24% ± 5% (mean ± SEM), TV 14% ± 5% and RR: 17% ± 6%. The cohort average MVBASELINE was 9.5 ± 0.7 L/min (TV = 670 ± 60 ml, RR = 15 ± 0.7). Following propofol MV decreased transiently, reaching nadir five minutes after the last dose of propofol at 82% ± 10% of baseline (MV = 7.5 ± 1.0 L/min). The reduction in MV was driven by reduction in TV, not RR. Conclusions: Data demonstrated that RVM was able to track changes in ventilation and was able to quantify respiratory changes following airway maneuvers. All patients had a significant reduction in ventilatory volumes after propofol. Five minutes after the last dose of propofol, MV and TV were significantly reduced while RR was not, suggesting that monitoring respiratory rate alone was not a sufficient indicator of respiratory status.展开更多
目的研究侧卧位腹膜后气腹对二氧化碳排出量的影响。方法选择28例择期侧卧位下行腹膜后腹腔镜手术的泌尿外科患者,ASA分级为I^II级。术中调整潮气量和呼吸频率维持气腹期间呼气末二氧化碳分压(PETCO2)在35~40 mm Hg。记录气腹前、气腹...目的研究侧卧位腹膜后气腹对二氧化碳排出量的影响。方法选择28例择期侧卧位下行腹膜后腹腔镜手术的泌尿外科患者,ASA分级为I^II级。术中调整潮气量和呼吸频率维持气腹期间呼气末二氧化碳分压(PETCO2)在35~40 mm Hg。记录气腹前、气腹后20、40、60、80和90 min以及气腹结束后10 min时的分钟通气量(MV)和二氧化碳排出量(VCO2)。结果气腹后和气腹结束后各时间点的MV和VCO2均显著高于气腹前(P<0.05),气腹后0~60 min期间MV和VCO2成梯度逐渐上升(P<0.05),60~90 min时处于相对稳定的峰值(P>0.05)。结论侧卧位腹膜后二氧化碳气腹导致二氧化碳排出量随时间逐渐上升至相对稳定高平台期,应加强呼吸的管理。展开更多
This study explored the concept that morphine has latent deleterious actions on the ventilatory control systems that respond to a hypoxic-hypercapnic challenge. In this study, we examined the ventilatory responses eli...This study explored the concept that morphine has latent deleterious actions on the ventilatory control systems that respond to a hypoxic-hypercapnic challenge. In this study, we examined the ventilatory responses elicited by hypoxic-hypercapnic challenge in conscious rats at a time when the effects of morphine (10 mg/kg) on arterial blood-gas chemistry and minute ventilation had subsided. Morphine induced pronounced changes in arterial blood-gas chemistry (e.g., an increase in pCO2, decreases in pO2 and sO2) and decreases in minute ventilation. Despite the complete resolution of the morphine-induced changes in arterial blood-gas chemistry and minute ventilation and almost complete resolution of the effects on peak inspiratory flow and peak expiratory flow, subsequent exposure to hypoxic-hypercapnic challenge elicited markedly blunted increases in minute ventilation and in peak inspiratory and expiratory flows. These findings demonstrate that 1) the changes in arterial blood-gas chemistry elicited by morphine parallel changes in minute ventilation rather than PIF and PEF, and 2) morphine has latent untoward effects on the ventilatory responses to hypoxic-hypercapnic challenge. These novel findings raise the possibility that patients deemed to have recovered from the acute ventilatory depresssant effects of morphine may still be susceptible to the latent effects of this opioid analgesic. The mechanisms underlying these latent effects remain to be elucidated.展开更多
The aim of this study was to determine whether morphine depresses the ventilatory responses elicited by a hypoxic challenge (10% O2, 90% N2) in conscious rats at a time when the effects of morphine on arterial blood g...The aim of this study was to determine whether morphine depresses the ventilatory responses elicited by a hypoxic challenge (10% O2, 90% N2) in conscious rats at a time when the effects of morphine on arterial blood gas (ABG) chemistry, Alveolar-arterial (A-a) gradient and minute ventilation (Vm) had completely subsided. In vehicle-treated rats, each episode of hypoxia stimulated ventilatory function and the responses generally subsided during each normoxic period. Morphine (5 mg/kg, i.v.) induced an array of depressant effects on ABG chemistry, A-a gradient and Vm (via decreases in tidal volume). Despite resolution of these morphine-induced effects, the first episode of hypoxia elicited substantially smaller increases in Vm than in vehicle-treated rats, due mainly to smaller increases in frequency of breathing. The pattern of ventilatory responses during subsequent episodes of hypoxia and normoxia changed substantially in morphine-treated rats. It is evident that morphine haslatent deleterious effects on ventilatory responses elicited by hypoxic challenge.展开更多
文摘Background：Dual sensor （DS） for rate adaption was supposed to be more physiological.To evaluate its superiority,the DS （accelerometer [ACC] and minute ventilation [MV]） and normal sinus rate response were compared in a self-controlled way during exercise treadmill testing.Methods：This self-controlled study was performed in atrioventricular block patients with normal sinus function who met the indications of pacemaker implant.Twenty-one patients came to the 1-month follow-up visit.Patients performed a treadmill test 1-month post implant while programmed in DDDR and sensor passive mode.For these patients,sensor response factors were left at default settings （ACC =8,MV =3） and sensor indicated rates （SIRs） for DS,ACC and MV sensor were retrieved from the pacemaker memories,along with measured sinus node （SN） rates from the beginning to 1-minute after the end of the treadmill test,and compared among study groups.Repeated measures analysis of variance and profile analysis,as well as variance analysis of randomized block designs,were used for statistical analysis.Results：Fifteen patients （15/2 l） were determined to be chronotropically competent.The mean differences between DS SIRs and intrinsic sinus rates during treadmill testing were smaller than those for ACC and MV sensor （mean difference between SIR and SN rate：ACC vs.SN,MV vs.SN,DS vs.SN,respectively,34.84,17.60,16.15 beats/min）,though no sensors could mimic sinus rates under the default settings for sensor response factor （ACC vs.SN P-adjusted 〈 0.001; MV vs.SN P-adjusted =0.002; DS vs.SN P-adjusted =0.005）.However,both in the range of 1st minute and first 3 minutes of exercise,only the DS SIR profile did not differ from sinus rates （P-adjusted =0.09,0.90,respectively）.Conclusions：The DS under default settings provides more physiological rate response during physical activity than the corresponding single sensors （ACC or MV sensor）.Further study is needed to determine if individual optimization would further im
文摘The systemic administration of morphine affects ventilation via a mixture of central and peripheral actions. The aims of this study were to characterize the ventilatory responses elicited by a low dose of morphine in conscious rats;to determine whether tolerance develops to these responses;and to determine the potential roles of peripheral μ-opioid receptors (μ-ORs) in these responses. Ventilatory parameters were monitored via unrestrained whole-body plethysmography. Conscious male Sprague-Dawley rats received an intravenous injection of vehicle or the peripherally-restricted μ-OR antagonist, naloxone methiodide (NLXmi), and then three successive injections of morphine (1 mg/kg) given 30 min apart. The first injection of morphine in vehicle-treated rats elicited an array of ventilatory excitant (i.e., increases in frequency of breathing, minute volume, respiratory drive, peak inspiratory and expiratory flows, accompanied by decreases in inspiratory time and end inspiratory pause) and inhibitory (i.e., a decrease in tidal volume and an increase in expiratory time) responses. Subsequent injections of morphine elicited progressively and substantially smaller responses. The pattern of ventilatory responses elicited by the first injection of morphine was substantially affected by pretreatment with NLXmi whereas NLXmi minimally affected the development of tolerance to these responses. Low-dose morphine elicits an array of ventilatory excitant and depressant effects in conscious rats that are subject to the development of tolerance. Many of these initial actions of morphine appear to involve activation of peripheral μ-ORs whereas the development of tolerance to these responses does not.
文摘Introduction: Propofol use during endoscopic procedures has become increasingly popular and assessing and maintaining airway patency is a significant challenge. Anesthesiologists often use airway maneuvers to maintain airway patency and ventilation during procedural sedation. A novel, non-invasive, Respiratory Volume Monitor (RVM) that provided continuous, real-time measurements of minute ventilation (MV), tidal volume (TV) and respiratory rate (RR) was used to monitor respiratory performance before, during, and after endoscopic procedures, quantify MV changes before and after airway maneuvers, and to quantify propofol-induced respiratory depression. Methods: RVM traces were obtained from 25 patients undergoing sedation for endoscopic procedures. Airway maneuvers were performed in 19/25 patients. All 25 patients received propofol as the primary sedative. Results: Forty-five airway maneuvers were performed. During these maneuvers, all respiratory parameters increased relative to pre-maneuver levels. On average, MV increased by 24% ± 5% (mean ± SEM), TV 14% ± 5% and RR: 17% ± 6%. The cohort average MVBASELINE was 9.5 ± 0.7 L/min (TV = 670 ± 60 ml, RR = 15 ± 0.7). Following propofol MV decreased transiently, reaching nadir five minutes after the last dose of propofol at 82% ± 10% of baseline (MV = 7.5 ± 1.0 L/min). The reduction in MV was driven by reduction in TV, not RR. Conclusions: Data demonstrated that RVM was able to track changes in ventilation and was able to quantify respiratory changes following airway maneuvers. All patients had a significant reduction in ventilatory volumes after propofol. Five minutes after the last dose of propofol, MV and TV were significantly reduced while RR was not, suggesting that monitoring respiratory rate alone was not a sufficient indicator of respiratory status.
文摘This study explored the concept that morphine has latent deleterious actions on the ventilatory control systems that respond to a hypoxic-hypercapnic challenge. In this study, we examined the ventilatory responses elicited by hypoxic-hypercapnic challenge in conscious rats at a time when the effects of morphine (10 mg/kg) on arterial blood-gas chemistry and minute ventilation had subsided. Morphine induced pronounced changes in arterial blood-gas chemistry (e.g., an increase in pCO2, decreases in pO2 and sO2) and decreases in minute ventilation. Despite the complete resolution of the morphine-induced changes in arterial blood-gas chemistry and minute ventilation and almost complete resolution of the effects on peak inspiratory flow and peak expiratory flow, subsequent exposure to hypoxic-hypercapnic challenge elicited markedly blunted increases in minute ventilation and in peak inspiratory and expiratory flows. These findings demonstrate that 1) the changes in arterial blood-gas chemistry elicited by morphine parallel changes in minute ventilation rather than PIF and PEF, and 2) morphine has latent untoward effects on the ventilatory responses to hypoxic-hypercapnic challenge. These novel findings raise the possibility that patients deemed to have recovered from the acute ventilatory depresssant effects of morphine may still be susceptible to the latent effects of this opioid analgesic. The mechanisms underlying these latent effects remain to be elucidated.
文摘The aim of this study was to determine whether morphine depresses the ventilatory responses elicited by a hypoxic challenge (10% O2, 90% N2) in conscious rats at a time when the effects of morphine on arterial blood gas (ABG) chemistry, Alveolar-arterial (A-a) gradient and minute ventilation (Vm) had completely subsided. In vehicle-treated rats, each episode of hypoxia stimulated ventilatory function and the responses generally subsided during each normoxic period. Morphine (5 mg/kg, i.v.) induced an array of depressant effects on ABG chemistry, A-a gradient and Vm (via decreases in tidal volume). Despite resolution of these morphine-induced effects, the first episode of hypoxia elicited substantially smaller increases in Vm than in vehicle-treated rats, due mainly to smaller increases in frequency of breathing. The pattern of ventilatory responses during subsequent episodes of hypoxia and normoxia changed substantially in morphine-treated rats. It is evident that morphine haslatent deleterious effects on ventilatory responses elicited by hypoxic challenge.
