scholarly journals Demam pada Penggunaan Analgesia Persalinan Epidural

2020 ◽  
Vol 1 (1) ◽  
pp. 72-9
Author(s):  
Alfan Mahdi Nugroho ◽  
Yusmein Uyun ◽  
Annemarie Chrysantia Melati
Keyword(s):  
Heart Rate ◽  
Cardiac Output ◽  
Oxygen Consumption ◽  
Epidural Analgesia ◽  
Neonatal Seizure ◽  
Increased Temperature ◽  
Fetal Infection ◽  
Labour Epidural Analgesia ◽  
Clinical Consequences ◽  
The Relationship

Analgesia epidural telah diperkenalkan secara rutin sebagai salah satu modalitas analgesia pada proses persalinan sejak lama. Hubungan antara analgesia epidural persalinan dengan demam intrapartum pada maternal sudah disebutkan pada beberapa literatur. Demam didefinisikan sebagai peningkatan suhu tubuh lebih dari 38 oC yang didapat dari dua kali pemeriksaan. Beberapa teori yang disebutkan antara lain perubahan termoregulasi, infeksi pada ibu-janin dan inflamasi non-infeksi yang dimediasi oleh sitokin proinflamasi. Namun demikian berbagai mekanisme analgesia epidural dapat menyebabkan demam masih terus diteliti. Identifikasi demam pada ibu saat persalinan merupakan hal yang penting untuk dilakukan karena memiliki konsekuensi klinis pada ibu dan neonatus. Pada ibu ditemukan suhu yang meningkat dikaitkan dengan peningkatan denyut jantung ibu, curah jantung, konsumsi oksigen, dan produksi katekolamin. Sedangkan pada janin demam intrapartum dapat menyebabkan sepsis, perubahan skor APGAR, peningkatan kebutuhan bantuan napas dan kejadian kejang. Efek demam pada ibu dan janin masih terus dipelajari, sehingga suatu saat didapatkan cara pencegahan yang paling baik yang pada akhirnya menghindarkan keraguan untuk melakukan analgesia persalinan.   Fever during labour epidural analgesia Abstract Epidural analgesia has been routinely introduced as one of the analgesia modalities during labour. Literature has mentioned the relationship between epidural analgesia and intrapartum fever among mothers. Fever is defined as increased temperature above 38 oC in more than two measurements. Several theories have been proposed, inculing thermoregulation changes, mother-fetal infection, and non-infectious inflammation mediated by proinflammatory cytokines. However, these mechanisms have been continued to evolve. Fever identification in pregnant women is essential to recognize clinical consequences to both mothers and neonates. Increased temperature in mothers is associated with increased heart rate, cardiac output, oxygen consumption, and catecholamines production. Meanwhile, in neonates intrapartum fever is related to sepsis, APGAR score changes, the need of respiratory support and incidence of neonatal seizure. Therefore, these consequences are extensively studied in order to determine the appropriate prevention.

scholarly journals Maternal haemodynamics during labour epidural analgesia with and without adrenaline

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Felix Haidl ◽  
Christian Tronstad ◽  
Leiv Arne Rosseland ◽  
Vegard Dahl
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiac Output ◽  
Epidural Analgesia ◽  
Systolic Blood Pressure ◽  
Circulatory System ◽  
Temporal Changes ◽  
Double Blind ◽  
Nulliparous Women ◽  
Labour Epidural Analgesia

Abstract Objectives Labour is one of the most painful experiences in a woman’s life. Epidural analgesia using low-concentration local anaesthetics and lipophilic opioids is the gold standard for pain relief during labour. Pregnancy in general, particularly labour, is associated with changes in maternal haemodynamic variables, such as cardiac output and heart rate, which increase and peak during uterine contractions. Adrenaline is added to labour epidural solutions to enhance efficacy by stimulating the α2-adrenoreceptor. The minimal effective concentration of adrenaline was found to be 2 μg mL−1 for postoperative analgesia. The addition of adrenaline may also produce vasoconstriction, limiting the absorption of fentanyl into the systemic circulation, thereby reducing foetal exposure. However, adrenaline may influence the haemodynamic fluctuations, possibly adding to the strain on the circulatory system. The aim of this study was to compare the haemodynamic changes after application of labour epidural analgesia with or without adrenaline 2 μg mL−1. Methods This was a secondary analysis of a single-centre, randomised double-blind trial. Forty-one nulliparous women in labour requesting epidural analgesia were randomised to receive epidural solution of bupivacaine 1 mg mL−1, fentanyl 2 μg mL−1 with or without adrenaline 2 μg mL−1. The participants were monitored using a Nexfin CC continuous non-invasive blood pressure and cardiac output monitor. The primary outcomes were changes in peak systolic blood pressure and cardiac output during uterine contraction within 30 min after epidural activation. The effect of adrenaline was tested statistically using a linear mixed-effects model of the outcome variables’ dependency on time, adrenaline, and their interaction. Results After excluding three patients due to poor data quality and two due to a malfunctioning epidural catheter, 36 patients (18 in each group) were analysed. The addition of adrenaline to the solution had no significant effect on the temporal changes in peak systolic blood pressure (p=0.26), peak cardiac output (0.84), or heart rate (p=0.91). Furthermore, no significant temporal changes in maternal haemodynamics (peak systolic blood pressure, p=0.54, peak cardiac output, p=0.59, or heart rate p=0.55) were associated with epidural analgesia during 30 min after epidural activation in both groups despite good analgesia. Conclusions The addition of 2 μg mL−1 adrenaline to the epidural solution is not likely to change maternal haemodynamics during labour.

Energy expenditure by elite midget male ice hockey players in small-sided games

2017 ◽  
Vol 12 (4) ◽  
pp. 504-513 ◽  
Author(s):  
Charles-Mathieu Lachaume ◽  
François Trudeau ◽  
Jean Lemoyne
Keyword(s):  
Heart Rate ◽  
Oxygen Consumption ◽  
Energy Expenditure ◽  
Ice Hockey ◽  
Training Method ◽  
Hockey Players ◽  
Treadmill Testing ◽  
Effective Training ◽  
Relationship Of ◽  
The Relationship

The purpose of this study was to investigate the energy expenditure and heart rate responses elicited in elite male midget ice hockey players during small-sided games. Nine players (aged 15.89 ± 0.33 years) participated in the study. Maximal progressive treadmill testing in the laboratory measured the relationship of oxygen consumption ([Formula: see text]) to heart rate before on-ice assessments of heart rate during six different small-sided games: 1v1, 2v2, 2v2 with support player, 3v3 with support player, 3v3 with transitions, and 4v4 with two support players. Heart rate was recorded continuously in each game. 3v3 T small-sided game was the most intense for all four intensity markers. All six small-sided games reached 89% HRmax or more with heart rate peaks in active effort repetition. These findings demonstrate that such small-sided games are considered as high intensity games and are an effective training method for ice hockey players.

scholarly journals Comparison of Ropivacaine-Fentanyl with Bupivacaine-Fentanyl for Labour Epidural Analgesia

2020 ◽  
Vol 14 (1) ◽  
pp. 108-114
Author(s):  
Kalpana Kulkarni ◽  
Rahul Patil
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Epidural Analgesia ◽  
Diastolic Blood Pressure ◽  
Diastolic Pressure ◽  
Vas Score ◽  
Group I ◽  
Significant Difference ◽  
Labour Epidural Analgesia ◽  
Group Ii

Background: Bupivacaine with opioid is commonly used for labour epidural analgesia. Ropivacaine is considered as an alternative to bupivacaine due to its lower cardiovascular complications. However, there is a controversy regarding the efficacy of these drugs as some studies suggest equivalent action, whereas others report that ropivacaine produces less motor blockade. The study aimed to compare the effect of ropivacaine-fentanyl and bupivacaine-fentanyl for labour analgesia. Materials and Methods: The prospective randomized study was performed on 60 parturients, divided into two groups of 30 subjects each. Group I received 10ml of bupivacaine 0.1% + fentanyl 2µg/ml and Group II received 10ml of ropivacaine 0.1% + fentanyl 2µg/ml by epidural catheter. Pre-anaesthetic evaluation was performed on all the participants and all were administered metoclopramide 0.25mg/kg and ondansetron 0.08-0.1mg/kg intravenously as premedication. The baseline and post anaesthesia systolic, diastolic blood pressure, heart rate, VAS score, degree of motor block, sedation and APGAR score of the baby were recorded. The data were tabulated and statistically analyzed. Results: When compared, there was no significant difference in systolic/diastolic blood pressure in two groups except at 360 min where diastolic pressure was low in group II. Significantly higher heart rate at 30 min (P=0.0003), 120 min (0.006), and 300 min (P=0.001) was observed in group I subjects. VAS score was significantly less at 180 min (P=0.019) and 300 min (P=0.019) in group II. Adverse effects such as fetal bradycardia, nausea/vomiting and hypotension observed were clinically insignificance when compared in two groups. Conclusion: Bupivacaine and ropivacaine produce an equal degree of analgesia and hemodynamic stability in 0.1% of concentration when added with 2µg/ml fentanyl . However, heart rate was well maintained with lower VAS scores in group II receiving ropivacaine. No significant difference in the side effects between the two groups. Hence, Ropivacaine can be used as a safe alternative to bupivacaine for labour epidural analgesia.

On Respiration in the Dragonet Callionymus Lyra L

1968 ◽  
Vol 49 (3) ◽  
pp. 565-582
Author(s):  
G. M. HUGHES ◽  
SHUN-ICHI UMEZAWA
Keyword(s):  
Heart Rate ◽  
Oxygen Consumption ◽  
Time Course ◽  
Water Pressure ◽  
Minute Volume ◽  
Individual Variations ◽  
Wide Range ◽  
The Relationship ◽  
Respiratory Rhythms ◽  
Normal Ventilation

1. The usefulness of a bottom-living fish, the dragonet (Callionymus lyra), in experiments on fish respiration is described. The position and nature of its opercular opening made it possible to determine directly the volume of water pumped over the gills and the PO2 of the mixed expired water. The normal ventilation volume for a 100 g. fish was about 30 c.c./min. 2. The relationship between cardiac and respiratory rhythms was investigated and showed a variety of ratios. The heart usually beats more than once during each respiratory cycle. Individual variations in the coupling between these rhythms was common and close couplings were observed in the absence of anaesthetic and at normal PO2s. 3. Changes in minute volume produced by altering the hydrostatic pressure across the respiratory system did not affect the heart rate. Percentage utilization fell at higher flow rates. Changes in flow per cm. of water pressure gradient was less with negative gradients than when the static pressure on the mouth side exceeded that in the opercular collecting chamber. 4. Oxygen consumption of the fish is directly related to the ambient PO2 over a wide range (30-120 mm. Hg). Sudden lowering of the PO2 in the inspired water leads to compensatory responses in which the minute volume is maintained or increased as a result of a rise in stroke volume and lowered respiratory frequency: there is also a marked bradycardia. During recovery the increased oxygen consumption of the fish resulted from a rise in utilization rather than a change in the respiratory rate or ventilation volume. 5. Analysis of the time course of the changes in heart rate and ventilation volume in experiments in which PO2 was changed supports the view that the receptors mediating bradycardia occur on the gills and respond directly to the change in PO2 rather than to the secondary increase in flow produced by the hypoxia.

Cardiovascular changes in the exercising emu

1983 ◽  
Vol 104 (1) ◽  
pp. 193-201 ◽  
Author(s):  
B. Grubb ◽  
D. D. Jorgensen ◽  
M. Conner
Keyword(s):  
Heart Rate ◽  
Cardiac Output ◽  
Oxygen Consumption ◽  
Stroke Volume ◽  
Oxygen Content ◽  
Body Mass ◽  
Fold Increase ◽  
Exercise Heart Rate ◽  
Rate Of Oxygen Consumption ◽  
Cardiovascular Variables

Cardiovascular variables were studied as a function of oxygen consumption in the emu, a large, flightless ratite bird well suited to treadmill exercise. At the highest level of exercise, the birds' rate of oxygen consumption (VO2) was approximately 11.4 times the resting level (4.2 ml kg-1 min-1). Cardiac output was linearly related to VO2, increasing 9.5 ml for each 1 ml increase in oxygen consumption. The increase in cardiac output is similar to that in other birds, but appears to be larger than in mammals. The venous oxygen content dropped during exercise, thus increasing the arteriovenous oxygen content difference. At the highest levels of exercise, heart rate showed a 3.9-fold increase over the resting rate (45.8 beats min-1). The mean resting specific stroke volume was 1.5 ml per kg body mass, which is larger than shown by most mammals. However, birds have larger hearts relative to body mass than do mammals, and stroke volume expressed per gram of heart (0.18 ml g-1) is similar to that for mammals. Stroke volume showed a 1.8-fold increase as a result of exercise in the emus, but a change in heart rate plays a greater role in increasing cardiac output during exercise.

Cardiopulmonary effects of continuous pressure breathing in hypothermic dogs

1965 ◽  
Vol 20 (4) ◽  
pp. 669-674 ◽  
Author(s):  
J. Salzano ◽  
F. G. Hall
Keyword(s):  
Heart Rate ◽  
Cardiac Output ◽  
Oxygen Consumption ◽  
Stroke Volume ◽  
Negative Pressure ◽  
Alveolar Ventilation ◽  
Positive Pressure ◽  
Negative Pressure Breathing ◽  
Continuous Positive Pressure ◽  
Respiratory Dead Space

Continuous pressure breathing was studied in hypothermic anesthetized dogs. Alveolar ventilation decreased during continuous positive-pressure breathing and increased during continuous negative-pressure breathing. The changes in alveolar ventilation were due to changes in respiratory rate as well as in respiratory dead space. Cardiac output fell significantly during continuous positive-pressure breathing due to a reduction in heart rate and stroke volume. During continuous negative-pressure breathing cardiac output was only slightly greater than during control as a result of a fall in heart rate and an increase in stroke volume. Oxygen consumption was reduced to 60% of control during continuous positive-pressure breathing of 16 cm H2O but was 25% greater than control during continuous negative-pressure breathing. Qualitatively, CO2 production changed as did O2 consumption but was different quantitatively during continuous negative-pressure breathing indicating hyperventilation due to increased respiratory rate. Mean pulmonary artery pressures and pulmonary resistance varied directly with the applied intratracheal pressure. The results indicate that the hypothermic animal can tolerate an imposed stress such as continuous pressure breathing and can increase its oxygen consumption during continuous negative-pressure breathing as does the normothermic animal. hypothermia; respiratory dead space; metabolic rate; cardiac output Submitted on December 8, 1964

Heart rate as an indicator of oxygen consumption: influence of body condition in the king penguin

2001 ◽  
Vol 204 (12) ◽  
pp. 2133-2144 ◽  
Author(s):  
G. Froget ◽  
P. J. Butler ◽  
Y. Handrich ◽  
A. J. Woakes
Keyword(s):  
Heart Rate ◽  
Oxygen Consumption ◽  
Body Condition ◽  
Active Oxygen ◽  
The Body ◽  
Regression Equations ◽  
Oxygen Pulse ◽  
Rate Of Oxygen Consumption ◽  
The Impact ◽  
The Relationship

SUMMARY The use of heart rate to estimate field metabolic rate has become a more widely used technique. However, this method also has some limitations, among which is the possible impact that several variables such as sex, body condition (i.e. body fat stores) and/or inactivity might have on the relationship between heart rate and rate of oxygen consumption. In the present study, we investigate the extent to which body condition can affect the use of heart rate as an indicator of the rate of oxygen consumption. Twenty-two breeding king penguins (Aptenodytes patagonicus) were exercised on a variable-speed treadmill. These birds were allocated to four groups according to their sex and whether or not they had been fasting. Linear regression equations were used to describe the relationship between heart rate and the rate of oxygen consumption for each group. There were significant differences between the regression equations for the four groups. Good relationships were obtained between resting and active oxygen pulses and an index of the body condition of the birds. Validation experiments on six courting king penguins showed that the use of a combination of resting oxygen pulse and active oxygen pulse gave the best estimate of the rate of oxygen consumption V̇O2. The mean percentage error between predicted and measured V̇O2 was only +0.81% for the six birds. We conclude that heart rate can be used to estimate rate of oxygen consumption in free-ranging king penguins even over a small time scale (30min). However, (i) the type of activity of the bird must be known and (ii) the body condition of the bird must be accurately determined. More investigations on the impact of fasting and/or inactivity on this relationship are required to refine these estimates further.

Maternal hemodynamics during labor epidural analgesia with and without adrenaline: a secondary analysis of a randomized trial

2020 ◽  
Author(s):  
Felix Haidl ◽  
Christian Tronstad ◽  
Leiv Arne Rosseland ◽  
Vegard Dahl
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiac Output ◽  
Epidural Analgesia ◽  
Systolic Blood Pressure ◽  
Secondary Analysis ◽  
Uterine Contractions ◽  
Non Invasive ◽  
Enhance Efficiency ◽  
Labor Epidural

Abstract Background: Pregnancy in general and labor in particular is associated with changes in maternal hemodynamic parameters such as increased cardiac output and heart rate, with peaks during uterine contractions. Adrenaline may be added to labor epidural solutions to enhance efficiency, but the hemodynamic fluctuations may increase. The aim of this study was to compare the hemodynamic changes of epidural drug solution with or without adrenaline 2 µg.ml -1 and to provide pilot data for a larger study. Methods: Forty-one nulliparous laboring women requesting epidural analgesia were randomized to epidural solution of bupivacaine 1mg.ml -1 , fentanyl 2 µg.ml -1 with or without adrenaline 2 µg.ml -1 . The participants were monitored with the Nexfin CC continuous non-invasive blood pressure and cardiac output monitor. The primary outcomes were changes in peak systolic blood pressure and cardiac output at uterine contraction within 30 minutes after epidural activation. The effect of adrenaline was tested statistically by a linear mixed effects model of the outcome variables’ dependency on time, adrenaline and their interaction. Results: The addition of adrenaline to the solution had no statistically significant effect on the temporal changes in peak systolic blood pressure (mean change 0.23 mmHg.min -1 95% CI [-0.17; 0.64] p=0.26), peak cardiac output (mean change 0.0029 l.min -1 .min -1 95 % CI [-0.026; 0.032] 0.84), or heart rate (mean change 0.015 beats.min -1 .min -1 95 % CI [-0.25; 0.28] p=0.91).

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