Quality of life and perceived health status in adults with congenitally corrected transposition of the great arteries

ObjectiveThe purpose of this study is to assess perceived health status and quality of life in adults with congenitally corrected transposition of the great arteries who have not undergone anatomic repair.MethodsQuality of life as measured by the satisfaction with life scale and linear analog scales and perceived health status as measured by the Short Form 36 Health Survey (version 1) were evaluated in 25 adults with congenitally corrected transposition and compared with a control group of 25 adults with mild, hemodynamically insignificant defects.ResultsInstruments were returned by 83% of patients (25/30; 11 male; mean age, 44.6 ± 16 years). Health status by the linear analog scale was significantly lower (P = .03) in subjects (median, 80; range, 15–100) than in controls (median, 85; range, 65–100). Quality of life by the satisfaction with life scale was also lower (P = .009) in subjects (mean, 24 ± 8) compared with controls. Age was negatively correlated with the Short Form 36 Health Survey physical functioning (r = −0.41, P = .04), bodily pain (r = −0.5, P = .01), and physical component (r = −0.56, P = .004) summary scores in adults with congenitally corrected transposition but not in controls.ConclusionsAdults with congenitally corrected transposition have lower reported health status and satisfaction with life than a control population, with perceived health status declining with advancing age

Continuous Positive Airway Pressure Mitigates Opioid-induced Worsening of Sleep-disordered Breathing Early after Bariatric Surgery

INTRODUCTION: Bariatric surgery patients are vulnerable to sleep-disordered breathing (SDB) early after recovery from surgery and anesthesia. We hypothesized that continuous positive airway pressure (CPAP) improves postoperative oxygenation and SDB and mitigates opioid-induced respiratory depression. METHODS: In a randomized crossover trial, patients following bariatric surgery received 30% oxygen in the Post Anesthesia Care Unit (PACU) under two conditions: atmospheric pressure (AP) and CPAP (8–10 cmH(2)O). During one hour of each treatment, breathing across cortical arousal states was analyzed using polysomnography and spirometry. Arousal state and respiratory events were scored in accordance with American Academy of Sleep Medicine guidelines. Data on opioid boluses in the PACU were collected. The primary and secondary outcomes were the apnea hypopnea index (AHI) and apnea following self-administration of opioids in the PACU. Linear mixed model analysis was used to compare physiologic measures of breathing. RESULTS: 64% of the 33 patients with complete postoperative polysomnography data, demonstrated SDB (AHI>5/h) early after recovery from anesthesia. CPAP treatment decreased AHI (8±2/h vs. 25±5/h, p<0.001), decreased oxygen desaturations (5±10/h vs. 16±20/h, p<0.001), and increased the mean oxygen saturation by 3% (p=0.003). CPAP significantly decreased the respiratory depressant effects observed during sleep-wake transitions without affecting hemodynamics. The interaction effects between CPAP treatment and opioid dose for the dependent variables AHI (p<0.001), inspiratory flow (p=0.002), and minute ventilation (p=0.015) were significant. CONCLUSIONS: This pharmaco-physiological interaction trial shows that supervised CPAP treatment early after surgery improves SDB and ameliorates the respiratory depressant effects of opioids without undue hemodynamic effects

The effect of HIV related proteins on hippocampal inflammation was measured in adolescent WT and HIV-1 tg rats.

<p><i>A</i>) Analysis of hippocampal gene expression of inflammatory markers showed increased expression of the potent chemokine, <i>Mcp-1</i>, in non-drug treated HIV-1 tg rats compared to WT controls (*<i>p</i><0.05). <i>B</i>) In contrast, once daily meloxicam administration attenuated <i>Mcp-1</i> expression in HIV-1 tg rats, normalizing inflammatory gene expression to WT levels (<i>p</i>>0.05). Data are presented as mean ± SEM.</p

Depressive- and anxiety-like behaviors were measured in WT and HIV-1 tg rats receiving daily oral dosing of meloxicam.

<p><i>A,B</i>) In the Porsolt forced swim test, meloxicam treated WT and HIV-1 tg rats showed similar latencies to first float (<i>p</i>>0.05); however, HIV-1 tg rats spent more time immobile compared to WT controls (*<i>p</i><0.05). <i>C,D</i>) Similarly, in the social interaction test, meloxicam treated WT and HIV-1 tg rats showed no differences in their time to approach a stimulus rat (<i>p</i>>0.05); however, overall, meloxicam-treated HIV-1 tg rats spend less time interacting (*<i>p</i><0.05). <i>E,F</i>) In the open field test, meloxicam treated HIV-1 tg rats showed no differences in overall locomotion (<i>p</i>>0.05), but did show a significant decrease in distance traveled in the center of the open field, as compared to WT rats (*<i>p</i><0.05). Data are presented as mean ± SEM.</p

Rats were assessed in a battery of behavioral tests of depressive- and anxiety-like behaviors.

<p><i>A,B</i>) In the forced swim test, latency to first immobile bout was not different between WT and HIV-1 tg rats (<i>p</i>>0.05); but HIV-1 tg rats spent significantly more time immobile in the test relative to WT controls. To measure social interaction, WT and HIV-1 tg rats were presented with an age-matched stimulus conspecific and allowed to interact for 10 minutes. <i>C,D</i>) HIV-1 tg rats had a greater latency to approach the stimulus animal (*<i>p</i><0.05) and spent less total time interacting, relative to WT controls. The open field paradigm was used to assess anxiety-like behaviors over a 10 minute period. Total distance traveled as well as distance traveled in the center was recorded. <i>E</i>) Total activity was unchanged between WT and HIV-1 tg rats as measured in 75 cm×75 cm arena during the open field test (<i>p</i>>0.05). <i>F</i>) Compared to WT controls, HIV-1 tg rats showed decreased activity in the center of the open field suggestive of increased anxiety-like behavior. For all, *<i>p</i><0.05 and data are presented as mean ± SEM.</p

WT and HIV-1 tg brains were sectioned and stained for Ki-67 reactivity as a measure of cell proliferation.

<p>(A) HIV-1 tg brains had significantly decreased levels of cell proliferation in the dentate gyrus of the hippocampus as compared to WT brains (*<i>p</i><0.05). Data are presented as mean ± SEM. (B) Photomicrograph of hemisection containing Ki-67 stained cells in the dentate gyrus of a WT rat. Inset highlights dense region of Ki-67 positive cells, marked with arrows. (C) Photomicrograph of Ki-67 stained cells in a HIV-1 tg rat. Again, insert highlights region of Ki-67 stained cells marked with arrows. Images captured at 20x, scale bar equals 50 µM.</p

Summary and mean scores of primary behaviors.

<p>Wild-type (WT) and HIV-1 transgenic (HIV-1 tg) rats were assessed using an extensive behavioral phenotyping schedule of primary, secondary, and tertiary behaviors. Mean body mass and food consumption are shown for adolescent WT and HIV-1 tg rats. Mean scores of neurologic tests, muscular strength, and sensory function are shown. Compared to WT controls, HIV-1 tg rats had decreased body mass at post-natal day 48, or the first day of behavioral testing (*<i>p</i><0.05). Despite this, no differences were detected in any other measure.</p><p>Summary and mean scores of primary behaviors.</p

Continuous Positive Airway Pressure Mitigates Opioid-induced Worsening of Sleep-disordered Breathing Early after Bariatric Surgery.

BackgroundBariatric surgery patients are vulnerable to sleep-disordered breathing (SDB) early after recovery from surgery and anesthesia. The authors hypothesized that continuous positive airway pressure (CPAP) improves postoperative oxygenation and SDB and mitigates opioid-induced respiratory depression.MethodsIn a randomized crossover trial, patients after bariatric surgery received 30% oxygen in the postanesthesia care unit (PACU) under two conditions: atmospheric pressure and CPAP (8 to 10 cm H2O). During 1 h of each treatment, breathing across cortical arousal states was analyzed using polysomnography and spirometry. Arousal state and respiratory events were scored in accordance with American Academy of Sleep Medicine guidelines. Data on opioid boluses in the PACU were collected. The primary and secondary outcomes were the apnea hypopnea index (AHI) and apnea after self-administration of opioids in the PACU. Linear mixed model analysis was used to compare physiologic measures of breathing.ResultsSixty-four percent of the 33 patients with complete postoperative polysomnography data demonstrated SDB (AHI greater than 5/h) early after recovery from anesthesia. CPAP treatment decreased AHI (8 ± 2/h vs. 25 ± 5/h, P &lt; 0.001), decreased oxygen desaturations (5 ± 10/h vs. 16 ± 20/h, P &lt; 0.001), and increased the mean oxygen saturation by 3% (P = 0.003). CPAP significantly decreased the respiratory-depressant effects observed during wakefulness-sleep transitions without affecting hemodynamics. The interaction effects between CPAP treatment and opioid dose for the dependent variables AHI (P &lt; 0.001), inspiratory flow (P = 0.002), and minute ventilation (P = 0.015) were significant.ConclusionsThis pharmacophysiologic interaction trial shows that supervised CPAP treatment early after surgery improves SDB and ameliorates the respiratory-depressant effects of opioids without undue hemodynamic effects

Continuous Positive Airway Pressure Mitigates Opioid-induced Worsening of Sleep-disordered Breathing Early after Bariatric Surgery.

BackgroundBariatric surgery patients are vulnerable to sleep-disordered breathing (SDB) early after recovery from surgery and anesthesia. The authors hypothesized that continuous positive airway pressure (CPAP) improves postoperative oxygenation and SDB and mitigates opioid-induced respiratory depression.MethodsIn a randomized crossover trial, patients after bariatric surgery received 30% oxygen in the postanesthesia care unit (PACU) under two conditions: atmospheric pressure and CPAP (8 to 10 cm H2O). During 1 h of each treatment, breathing across cortical arousal states was analyzed using polysomnography and spirometry. Arousal state and respiratory events were scored in accordance with American Academy of Sleep Medicine guidelines. Data on opioid boluses in the PACU were collected. The primary and secondary outcomes were the apnea hypopnea index (AHI) and apnea after self-administration of opioids in the PACU. Linear mixed model analysis was used to compare physiologic measures of breathing.ResultsSixty-four percent of the 33 patients with complete postoperative polysomnography data demonstrated SDB (AHI greater than 5/h) early after recovery from anesthesia. CPAP treatment decreased AHI (8 ± 2/h vs. 25 ± 5/h, P &lt; 0.001), decreased oxygen desaturations (5 ± 10/h vs. 16 ± 20/h, P &lt; 0.001), and increased the mean oxygen saturation by 3% (P = 0.003). CPAP significantly decreased the respiratory-depressant effects observed during wakefulness-sleep transitions without affecting hemodynamics. The interaction effects between CPAP treatment and opioid dose for the dependent variables AHI (P &lt; 0.001), inspiratory flow (P = 0.002), and minute ventilation (P = 0.015) were significant.ConclusionsThis pharmacophysiologic interaction trial shows that supervised CPAP treatment early after surgery improves SDB and ameliorates the respiratory-depressant effects of opioids without undue hemodynamic effects

Effects of Depth of Propofol and Sevoflurane Anesthesia on Upper Airway Collapsibility, Respiratory Genioglossus Activation, and Breathing in Healthy Volunteers

Background: Volatile anesthetics and propofol impair upper airway stability and possibly respiratory upper airway dilator muscle activity. The magnitudes of these effects have not been compared at equivalent anesthetic doses. We hypothesized that upper airway closing pressure is less negative and genioglossus activity is lower during deep compared with shallow anesthesia. Methods: In a randomized controlled crossover study of 12 volunteers, anesthesia with propofol or sevoflurane was titrated using a pain stimulus to identify the threshold for suppression of motor response to electrical stimulation. Measurements included bispectral index, genioglossus electromyography, ventilation, hypopharyngeal pressure, upper airway closing pressure, and change in end-expiratory lung volume during mask pressure drops. Results: A total of 393 attempted breaths during occlusion maneuvers were analyzed. Upper airway closing pressure was significantly less negative at deep versus shallow anesthesia (-10.8 +/- 4.5 vs. -11.3 +/- 4.4 cm H2O, respectively [mean +/- SD]) and correlated with the bispectral index (P < 0.001), indicating a more collapsible airway at deep anesthesia. Respiratory genioglossus activity during airway occlusion was significantly lower at deep compared with light anesthesia (26 +/- 21 vs. 35 +/- 24% of maximal genioglossus activation, respectively; P < 0.001) and correlated with bispectral index (P < 0.001). Upper airway closing pressure and genioglossus activity during airway occlusion did not differ between sevoflurane and propofol anesthesia. Conclusions: Propofol and sevoflurane anesthesia increased upper airway collapsibility in a dose-dependent fashion with no difference at equivalent anesthetic concentrations. These effects can in part be explained by a dose-dependent inhibiting effect of anesthetics on respiratory genioglossus activity