Aerobic exercise such as cycling is known to elicit a post-exercise hypotensive (PEH) response. However, it is not known if swim exercise produces a similar effect in normotensive individuals. We tested the hypothesis that an acute bout of swimming would elicit a PEH response that is less compared to an equivalent bout of cycling. 10 trained and 11 untrained normotensive (SBP/DBP < 120/80 mmHg) individuals (23±1 years) underwent 30 min intensity-matched cycling and swimming sessions to assess changes in BP and cardiovascular responses. While PEH was similar between modalities within groups, the magnitude and temporality of change in BP following swimming was significantly different (p < 0.01) between groups, with untrained participants showing a significant PEH response. Attenuation of PEH in trained individuals was reflective of a significant increase in sympathetic outflow and slower vagal reactivation, suggesting training in an aquatic environment leads to alterations in post-exercise BP regulatory mechanisms.

名古屋大学博士学位論文 学位の種類 : 博士(医学)(論文) 学位授与年月日:平成5年1月28日 平山正昭氏の博士論文として提出された

Hemodinamikos pokyčiai kepenų operacijų metu yra svarbūs perioperacinėms išeitims. Tyrimo tikslas: išsiaiškinus hemodinaminių pokyčių pobūdį bei priežastis parinkti optimalią pacientų monitoravimo metodiką darant kepenų rezekci¬nes operacijas. Tikslui pasiekti iškelti šie uždaviniai: palyginti širdies minutinio tūrio monitoravimo neinvaziniu impe¬dan¬so kardiografijos būdu vertę su invaziniu intermituojančios termodiliucijos būdu pacientams, kuriems daromos kepenų rezek¬cijos, nustatyti dažniausiai kintančius hemodinaminius parametrus kepe¬nų operacijų metu, nustatyti hemodinaminių rodiklių pokyčių priežastis, rasti hemodinaminius veiksnius, įtakojančius didesnį kraujo nete¬kimą operacijos metu. Remiantis tyrimo rezultatais, daromos šios išvados: siekiant sumažinti perioperacinį sergamumą ir mirštamumą darant kepenų rezekcijas būtina monitoruoti centrinės hemodinamikos ro¬dik¬lius. Širdies minutinio tūrio monitoravimui tinka saugus, nebrangus ir tikslus neinvazinis impedanso kardiografijos metodas. Kepenų rezekcinių operacijų metu stebimi hemodinaminiai pokyčiai yra vidurinio arterinio kraujo spaudimo sumažėjimas (hipotenzija), susijęs su širdies indekso su¬ma¬žėjimu, ir slėgio apatinėje tuščiojoje venoje padidėjimas. Hipotenzijos bei širdies indekso sumažėjimo priežastis dažniau yra apatinės tuščiosios venos perspaudimas, pasireiškiantis didėjančiu slėgiu šlaunies venoje, kurį sąlygoja chirurginės manipuliacijos. Hipotenzijos priežastį kepenų rezekcinių operacijų metu galima... [toliau žr. visą tekstą] / Aim of the study: select optimal methods for patient’s monitoring du¬ring hepatic resection after evaluation the character, causes and rate of hemodynamic changes. Main goals: to compare the value of non-invasive impedance cardiography for moni¬toring of cardiac output to invasive intermittent thermodilution method in patients undergoing hepatic resection, to determine mostly changing hemodynamic parameters during the hepatic surgery, to determine the causes of hemodynamic changes, to determine hemodynamic factors, influencing increase in blood loss during the surgery. Conclusions: non-invasive ICG method may be used to monitor cardiac output during the hepatic resection surgery, most common hemodynamic changes during hepatic resection surgery include the reduction in mean arterial blood pressure (hypotension), decreased cardiac index, and elevated pressure in the inferior vena cava, more common cause of hypotension is clamping of the inferior vena cava, which is caused by surgical manipulations; less common – blood loss. Cause of hypotension during hepatic resection surgery may be determined by pressure monitoring in the superior and inferior vena cava, blood loss is related to the number of clamping of the inferior vena cava and increasing pressure in the superior vena cava. Practical recommendations: in order to reduce the number of hemodynamic changes during the surgery, it is essential to monitor arterial blood pressure, cardiac output and pressures in the superior and... [to full text]

Thesis (Ph. D.)--University of Wisconsin--Madison, 1940. / Typescript. Includes abstract and vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves [27]-[28]).

Academisch Proefschrift--Universiteit van Amsterdam, 2007. / Description based on print version record. Includes bibliographical references (p. 91-108).

Made available in DSpace on 2015-07-22T20:49:57Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-05-26 / A redução da massa de anestésico local é utilizada para minimizar os efeitos da hipotensão arterial, relacionados com raquianestesia para cesariana, diminuindo a incidência de eventos adversos maternos e preservando o bem-estar fetal. Esta estratégia tem o risco de resultar em anestesia insuficiente. Por outro lado, a hipotensão associada às maiores massas de anestésico local no espaço subaracnóideo pode ser controlada com infusão contínua profilática de fenilefrina.! Objetivo: Avaliar os efeitos da infusão contínua e profilática de fenilefrina para controle pressórico sobre os eventos adversos maternos e conceptuais em cesarianas com diferentes doses de bupivacaína na raquianestesia. Métodos: Foi realizado um estudo clínico prospectivo, não-aleatório, com 60 gestantes a termo, admitidas para cesariana eletiva. Todas as pacientes receberam raquianestesia com bupivacaína hiperbárica, acrescida de 5 mcg de sufentanil e 100 mcg de morfina. Foram alocadas em dois grupos, G12 e G8, na dependência da dose de bupivacaína hiperbárica administrada, 12 ou 8 mg, respectivamente. Foi realizada hidratação com 10 ml/Kg de solução de Ringer Lactato, 10 a 15 minutos antes da realização do bloqueio. Logo após, iniciou-se infusão contínua de 100 mcg/min de fenilefrina, com o objetivo de manter a pressão arterial dentro de limites estritos. Foram avaliados níveis sensitivos de bloqueio anestésico, consumo de vasopressores, incidência de eventos adversos maternos e condições do recém-nascido. Resultados: Os dados maternos mostraram que os dois grupos foram semelhantes, quanto ao nível de bloqueio anestésico, consumo de fenilefrina por unidade de tempo e incidências de hipotensão e hipertensão arterial, bradicardia, náuseas, vômitos, dispnéia, dor e tremores. Os dados conceptuais evidenciaram que os grupos foram semelhantes quanto à gasometria de artéria e veia umbilicais e lactato arterial e venoso. Todos os RN apresentaram pH > 7,2 e apenas 1 obteve pontuação < 7 no Apgar do primeiro minuto. Conclusões: Quando a pressão arterial é mantida dentro de controle rígido, por meio da infusão profilática contínua de fenilefrina, a incidência de eventos adversos maternos e conceptuais não difere quando a raquianestesia é realizada com 12 mg ou 8 mg de bupivacaína hiperbárica. / Background: Reduced local anesthetic dose is used for minimizing hypotension changes related with spinal anesthesia for cesarean section, optimizing both maternal and fetal outcomes. This strategy can result in neuroaxial block failure. On the other hand, the higher doses associated with hypotension can be controlled with continuous prophylactic infusion of phenylephrine. The present study assessed the effects of continuous infusion of phenylephrine under strict blood pressure control and the maternal-fetal outcomes in patients under spinal anesthesia for elective cesarean section with two anesthetic solution. Methods: The number of 60 patients, scheduled for elective cesarean section, was allocated into 2 non-randomized groups (30 individuals each) for this prospective clinical study identified as Group 12 (G12), who were administered 12 mg hyperbaric bupivacaine and; Group 8 (G8), who were injected with 8 mg hyperbaric bupivacaine. In both groups, the anesthetic solution was added to sufentanyl 5 !g and morphine 100 !g. Pre-hydration with Ringer Lactate solution – 10 ml/Kg. Continuous phenylephrine infusion started at the end of the spinal block, with a infusion rate of 100 !g/min under strict blood pressure control. Comparatively, sensitive anesthetic block level, vasopressor consumption, adverse maternal and neonate outcomes were evaluated. Results: The incidence of maternal adverse effects such as nausea, vomiting, dispnea, pain, tremor, and bradicardy, necessity of atropine, hypotension and hypertension showed no significant difference between groups. In addition, other parameters were evaluated in neonates, pH, pCO2, BE and lactate of umbilical vases and the consumption of phenylephrine per time unit. All neonates showed pH higher than 7.20, as well as the Apgar score higher than 7 at 5`; only one neonate of G12 showed the Apgar score lower than 7 at 1`. Conclusion: Strict arterial blood pressure performed with prophylactic continuous infusion of phenylephrine, doesn’t change the maternal and fetal outcomes in patients scheduled for elective cesarean section under spinal anesthesia. / TEDE / BV UNIFESP: Teses e dissertações

abstract: PURPOSE: Lean hypertension (HTN) is characterized by a mechanistically different HTN when compared to obese HTN. The purpose of this study is to assess whether body phenotype influences blood pressure (BP) responses following both acute and chronic exercise. METHODS: Obese (body mass index (BMI) > 30 kg/m2) and lean (BMI < 25 kg/m2) men with pre-hypertension (PHTN) (systolic BP (SBP) 120 - 139 or diastolic BP (DBP) 80 - 89 mm Hg) were asked to participate in a two-phase trial. Phase 1 assessed differences in post-exercise hypotension between groups in response to an acute exercise bout. Phase 2 consisted of a two-week aerobic exercise intervention at 65-70% of heart rate (HR) max on a cycle ergometer. Primary outcome measures were: brachial BP, central (aortic) BP, cardiac output (CO), and systemic vascular resistance (SVR) measured acutely after one exercise session and following two weeks of training. RESULTS: There were no differences between groups for baseline resting brachial BP, central BP, age, or VO2 peak (all P > 0.05). At rest, obese PHTN had greater CO compared to lean PHTN (6.3 ± 1 vs 4.7 ± 1 L/min-1, P = 0.005) and decreased SVR compared to lean PHTN (1218 ± 263 vs 1606 ± 444 Dyn.s/cm5, P = 0.003). Average 60-minute post-exercise brachial and central SBP reduced by 3 mm Hg in Lean PHTN in response to acute exercise (P < 0.005), while significantly increasing 4 mm Hg for brachial and 3 mm Hg for central SBP (P < 0.05). SVR had a significantly greater reduction following acute exercise in lean PHTN (-223 Dyn·s/cm5) compared to obese PHTN (-75 Dyn·s/cm5, P < 0.001). In lean subjects chronic training reduced brachial BP by 4 mm Hg and central BP by 3 mm Hg but training had no effect on the BP’s in obese subjects. Resting BP reduction in response to training was accompanied by reductions in SVR within lean (-169 Dyn·s/cm5, P < 0.001), while obese experienced increased SVR following training (47 Dyn·s/cm5, P < 0.001). CONCLUSION: Hemodynamic response to both acute and chronic exercise training differ between obese and lean individuals. / Dissertation/Thesis / Doctoral Dissertation Exercise Science 2016

Abstract Parkinson’s disease (PD) is a chronic and progressive neurodegenerative disease which is characterized by resting tremor, rigidity, bradykinesia and postural instability. Advanced PD is often complicated by falls, immobilisation and progressive deterioration of overall physical capability that may jointly contribute to a reduced quality of life and even to increased mortality. The purpose of this study was to identify risk factors for falls and mortality in PD, to assess the clinical correlates of balance and mobility, and to evaluate the association between orthostatic hypotension (OH), balance and mobility. From a total population of approximately 205 000 inhabitants, 125 patients with idiopathic PD were included in the study. Baseline medical data including occurrence of recent falls were collected, and patients were clinically tested for balance, mobility and orthostatic blood pressure reactions. Falls were thereafter prospectively recorded for two years using fall diaries and follow-up calls. Mortality was documented by reviewing the hospital charts four years after the baseline examination. In the cross-sectional part of the study, one-third of the patients reported recent falling. Disease duration and severity, recent falling and use of a walking aid were predictors of increased postural sway in PD. Advanced age and severity of the disease were related to impaired balance and mobility in PD patients. Severity of the disease and increased postural sway were independent risk factors for recent falling in PD, whereas measures of mobility were less important in this manner. Fifty-three percent of the patients had OH in the orthostatic test. Patients with OH had significantly increased postural sway in standing compared to patients without OH. On the contrary, OH was not associated with mobility and walking speed. In the present data, OH was not associated with the risk of falling in PD. Sixty-three percent of the study patients experienced falls and almost half of the subjects fell recurrently during the two-year follow-up. History of falling and disease severity indicated increased risk of recurrent falls in PD, while patients with slow walking speed had an increased risk of mortality. The results show that balance impairment and falls are common features in PD. Slow walking speed may be associated with increased mortality in PD.

Hypertension is not consistently associated with postoperative cardiovascular morbidity and therefore not considered a major peri-operative risk factor. However, hypertension may predispose to peri-operative haemodynamic changes known to be associated with perioperative morbidity and mortality, such as intra-operative hypotension and tachycardia. The objective of this study was to determine whether pre-operative hypertension was independently associated with haemodynamic changes known to be associated with adverse peri-operative outcomes. We performed a five-day multicentre, prospective, observational cohort study which included all adult inpatients undergoing elective, noncardiac, non-obstetric surgery. We recruited 343 patients of whom 164 (47.8%) were hypertensive. An intra-operative mean arterial pressure of 100 beats per minute) occurred in 126 (38.9%) patients, of which 61 (48.4%) were hypertensive. Multivariable logistic regression did not show an independent association between the stage of hypertension and either clinically significant hypotension or tachycardia, when controlled for ASA physical status, functional status, major surgery, the duration of surgery or blood transfusion. There was no association between pre-operative hypertension and peri-operative haemodynamic changes known to be associated with major morbidity and mortality. These data therefore support the recommendation of the Joint Guidelines of the Association of Anaesthetists of Great Britain and Ireland (AAGBI) and the British Hypertension Society to proceed with elective surgery if a patient’s blood pressure is < 180/110 mmHg.

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第12970号 / 論医博第2103号 / 新制||医||1012(附属図書館) / 32408 / 新制||医||1012 / 京都大学大学院医学研究科医学専攻 / (主査)教授 小池 薫, 教授 三嶋 理晃, 教授 中山 健夫 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DGAM