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Valsalva Maneuver

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1. Valsalva Maneuver for Termination of Supraventricular Tachycardia

Valsalva Maneuver for Termination of Supraventricular Tachycardia Systematic Review Snapshot TAKE-HOME MESSAGE The Valsalva maneuver appears to be a modestly effective intervention, with a low risk of adverse events, but is supported by only a small number of low-quality trials. Valsalva Maneuver for Termination of Supraventricular Tachycardia EBEM Commentators Anjli Pandya, MD Eddy Lang, MDCM CFPC(EM) University of Calgary Calgary, Alberta, Canada Results Study Valsalva Maneuver Technique (...) Valsalva maneuver, right carotid sinus massage, left carotid sinus massage, and face in water at separate times and had supraventricular tachycardia induced for each strategy. Only 32 of 35 patients underwent face in water for undisclosed reasons. † Each patient underwent Valsalva maneuver, carotid sinus massage, and ice to face at separate times and had supraventricular tachycardia induced for each strategy. METHODS DATA SOURCES The authors of the review performed electronic searches, without language

2015 Annals of Emergency Medicine Systematic Review Snapshots

2. Right-to-left shunt detection using contrast-enhanced transcranial Doppler: A comparison of provocation maneuvers between coughing and a modified Valsalva maneuver. Full Text available with Trip Pro

Right-to-left shunt detection using contrast-enhanced transcranial Doppler: A comparison of provocation maneuvers between coughing and a modified Valsalva maneuver. Contrast-enhanced transcranial Doppler (c-TCD) has been used to detect right-to-left shunts (RLS) because it is highly sensitive and cost-effective. The use of provocation maneuvers, such as physiologic maneuvers (e.g., coughing) and the Valsalva maneuver (VM) to transiently increase right atrial pressure and induce RLS increases (...) the two maneuvers was observed in terms of the degree of RLS seen. The m-VM should be widely used to detect RLS, because it is reliable, standardized, and cost-effective.

2017 PLoS ONE

3. The Modified Valsalva Maneuver for Reversion of Stable Supraventricular Tachycardia: Lessons Learned From the REVERT Trial. (Abstract)

The Modified Valsalva Maneuver for Reversion of Stable Supraventricular Tachycardia: Lessons Learned From the REVERT Trial. The REVERT trial was a randomized multicenter trial that investigated the efficacy of using a modified Valsalva maneuver for the reversion of stable supraventricular tachycardia back to a sinus rhythm. Although no improvement in discharge to home from the emergency department (ED) or ED length of stay was observed, the REVERT trial demonstrated that the modified Valsalva (...) maneuver was superior to the standard Valsalva maneuver. The modified Valsalva maneuver should be considered first-line treatment for patients who present with a stable supraventricular tachycardia. A case presentation illustrates the methodology for utilizing the modified Valsalva maneuver to treat supraventricular tachycardia in a hemodynamically stable patient who presents to the ED.

2019 Advanced emergency nursing journal Controlled trial quality: uncertain

4. A multicenter randomized controlled trial of a modified Valsalva maneuver for cardioversion of supraventricular tachycardias. (Abstract)

A multicenter randomized controlled trial of a modified Valsalva maneuver for cardioversion of supraventricular tachycardias. Valsalva maneuver is a recognized treatment for supraventricular tachycardia, but in clinical setting it has a low chance to achieve successful cardioversion. Studies suggested that the postural modification of valsalva maneuver may improve the rate of cardioversion. We further modified the maneuver and conduct a multicenter randomized controlled trial to test its (...) efficacy.Appelboam A, Reuben A, Mann C, et al. Postural modification of the standard Valsalva maneuver for emergency treatment for supraventricular tachycardias (REVERT): a randomized controlled trial. Lancet 2015; 386 (10005):1747-53 [1]. Allison Michaud, PhD, Eddy Lang. Leg lift Valsalva maneuver for treatment of supraventricular tachycardias. CJEM 2017; 19(3):235-237 [2].To verify the efficacy of the modified Valsalva maneuver in SVT in Chinese population and simplify the operation process further.Copyright ©

2019 American Journal of Emergency Medicine Controlled trial quality: uncertain

5. Evaluation of efficacy of Valsalva maneuver for attenuating propofol injection pain: a prospective, randomized, single blind, placebo controlled study. Full Text available with Trip Pro

Evaluation of efficacy of Valsalva maneuver for attenuating propofol injection pain: a prospective, randomized, single blind, placebo controlled study. Pain on injection is a limitation with propofol use. The effect of the Valsalva maneuver on pain during propofol injection has not been studied. This maneuver reduces pain through the sinoaortic baroreceptor reflex arc and by distraction. We aimed to assess the efficacy of the Valsalva maneuver in reducing pain during propofol injection.Eighty (...) [6.25-8.00], P < 0.001).A prior Valsalva maneuver is effective in attenuating injection pain due to propofol; it is advantageous in being a non-pharmacological, safe, easy, and time-effective technique.

2018 Korean journal of anesthesiology Controlled trial quality: uncertain

6. Valsalva Maneuver and Peripapillary OCT Angiography Vessel Density. (Abstract)

Valsalva Maneuver and Peripapillary OCT Angiography Vessel Density. To investigate the potential influence of breath holding on the results of peripapillary vessel density (VD) measurement with optical coherence tomography angiography.Three peripapillary VD measurements were made at 2-minute intervals on the right eye of 12 healthy young volunteers using the Angiovue/RTvue-XR OCT (software version 2017.1, Phase 7 update) without changing the head and body positions. During the first 2 (...) measurements the volunteers were breathing normally. Four seconds before the third measurement the participants started to perform the Valsalva maneuver and continued until the completion of the ∼17-second image acquisition. The whole image area, the inside-disc area and the peripapillary area were investigated for capillary VD and all-vessels VD, separately.All volunteers had normal blood pressure and intraocular pressure, and all study eyes were normal with healthy optic nerve head and peripapillary area

2018 Journal of Glaucoma

7. Intraoperative Valsalva maneuver: a narrative review. Full Text available with Trip Pro

Intraoperative Valsalva maneuver: a narrative review. The Valsalva maneuver (VM) involves expiratory effort against a closed mouth and/or glottis in the sitting or supine position with the increased intraoral and intrathoracic pressure raised to 40 mmHg for 15-20 sec after which the pressure is suddenly released and the breathing restored to normal. Complex cardiovascular and other physiologic changes occur during the VM. The VM has been used for diagnostic and therapeutic reasons as well

2018 Canadian Journal Of Anaesthesia

8. Contraction of the levator ani muscle during Valsalva maneuver (co-activation) is associated with a longer active second stage of labor in nulliparous women undergoing induction of labor. Full Text available with Trip Pro

Contraction of the levator ani muscle during Valsalva maneuver (co-activation) is associated with a longer active second stage of labor in nulliparous women undergoing induction of labor. The Valsalva maneuver is normally accompanied by relaxation of the levator ani muscle, which stretches around the presenting part, but in some women the maneuver is accompanied by levator ani muscle contraction, which is referred to as levator ani muscle coactivation. The effect of such coactivation on labor (...) outcome in women undergoing induction of labor has not been previously assessed.The aim of the study was to assess the effect of levator ani muscle coactivation on labor outcome, in particular on the duration of the second and active second stage of labor, in nulliparous women undergoing induction of labor.Transperineal ultrasound was used to measure the anteroposterior diameter of the levator hiatus, both at rest and at maximum Valsalva maneuver, in a group of nulliparous women undergoing induction

2018 American Journal of Obstetrics and Gynecology

9. Usefulness of a Noninvasive Device to Identify Elevated Left Ventricular Filling Pressure Using Finger Photoplethysmography During a Valsalva Maneuver. (Abstract)

Usefulness of a Noninvasive Device to Identify Elevated Left Ventricular Filling Pressure Using Finger Photoplethysmography During a Valsalva Maneuver. The high rate of re-hospitalization for heart failure might be reduced by improving noninvasive techniques for identifying elevated left ventricular (LV) filling pressure. We previously showed that changes in a finger photoplethysmography (PPG) waveform during the Valsalva maneuver (VM) reflect invasively measured LV end-diastolic pressure

2017 American Journal of Cardiology

10. Leg Lift Valsalva Maneuver for Treatment of Supraventricular Tachycardias. Full Text available with Trip Pro

Leg Lift Valsalva Maneuver for Treatment of Supraventricular Tachycardias. Clinical question Can conversion to sinus rhythm for a supraventricular tachycardia be enhanced by a postural modification to the Valsalva maneuver? Article chosen Appelboam A, Reuben A, Mann C, et al. Postural modification of the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial. Lancet 2015;386(10005):1747-53. 1 OBJECTIVE: To determine (...) effectiveness of a postural modification of the Valsalva involving leg elevation and supine positioning.

2017 CJEM Controlled trial quality: uncertain

11. Valsalva Maneuver-induced Changes in Anterior Lamina Cribrosa Surface Depth: A Comparison between Normal and Glaucomatous Eyes. (Abstract)

Valsalva Maneuver-induced Changes in Anterior Lamina Cribrosa Surface Depth: A Comparison between Normal and Glaucomatous Eyes. The purpose of this study is to investigate the influence of the Valsalva maneuver (VM) on anterior lamina cribrosa surface depth (ALCSD), and to compare normal with treated glaucomatous eyes in terms of this effect.Thirty-two patients (32 eyes) with early-to-moderate glaucoma under treatment and 30 normal healthy participants (30 eyes) were prospectively enrolled (...) . Study subjects performed the VM by blowing through a mouthpiece attached to a handheld manometer; expiratory pressure during the maneuver ranged from 35 to 40 mm Hg. Swept-source optical coherence tomography B-scans were performed during phase 2 of the VM (from 10 to 15 s).The ALCSD was significantly different in the normal eyes only, decreasing by 31.90±14.81 μm (-8.79%; 394.85±53.63 μm at baseline vs. 362.95±44.23 μm during the VM; P<0.001). In the glaucomatous eyes, the ALCSD decreased by only

2017 Journal of Glaucoma

12. Usefulness of Pulse Amplitude Changes During the Valsalva Maneuver Measured Using Finger Photoplethysmography to Identify Elevated Pulmonary Capillary Wedge Pressure in Patients With Heart Failure. (Abstract)

Usefulness of Pulse Amplitude Changes During the Valsalva Maneuver Measured Using Finger Photoplethysmography to Identify Elevated Pulmonary Capillary Wedge Pressure in Patients With Heart Failure. The pulse amplitude ratio, the ratio of pulse pressure at the end of a Valsalva maneuver to before the onset of Valsalva, correlates with filling pressure. This study aimed to noninvasively estimate cardiac filling pressure in patients with heart failure. We developed a noninvasive handheld device (...) to measure pulse amplitude ratio using finger photoplethysmography. In 69 patients who underwent right heart catheterization, photoplethysmography waveforms were recorded during a standardized Valsalva maneuver, and in 60 of these patients, pulse amplitude ratio was able to be calculated. Pulse amplitude ratio correlated with pulmonary capillary wedge pressure (PCWP) (r = 0.58, p <0.0001), particularly among those subjects with reduced ejection fraction (r = 0.60, p = 0.002, n = 25). A multivariable

2017 American Journal of Cardiology

13. Comparison of Valsalva Maneuver, Amyl Nitrite, and Exercise Echocardiography to Demonstrate Latent Left Ventricular Outflow Obstruction in Hypertrophic Cardiomyopathy. (Abstract)

Comparison of Valsalva Maneuver, Amyl Nitrite, and Exercise Echocardiography to Demonstrate Latent Left Ventricular Outflow Obstruction in Hypertrophic Cardiomyopathy. Guidelines recommend exercise stress echocardiogram (ESE) for patients with hypertrophic cardiomyopathy (HC) if a 50 mm Hg gradient is not present at rest or provoked with Valsalva or amyl nitrite, to direct medical and surgical management. However, no study has directly compared all 3 methods. We sought to evaluate efficacy (...) and degree of provocation of left ventricular outflow gradients by ESE, and compare with Valsalva and amyl nitrite. In patients with HC between 2002 and 2015, resting echocardiograms and ESEs within 1 year were retrospectively reviewed. Gradients elicited by each provocation method were compared. Rest and ESE were available in 97 patients (mean age 54 ± 18 years, 57% male); 78 underwent Valsalva maneuver and 41 amyl nitrite provocation. Median gradients (interquartile range) were 10 mm Hg (7,19) at rest

2017 American Journal of Cardiology

14. Is cardiac autonomic modulation during upper limb isometric contraction and Valsalva maneuver impaired in COPD patients? Full Text available with Trip Pro

Is cardiac autonomic modulation during upper limb isometric contraction and Valsalva maneuver impaired in COPD patients? To evaluate the heart rate variability (HRV) indices and heart rate (HR) responses during isometric contraction (IC) and Valsalva maneuver (VM) in COPD patients.Twenty-two stable moderate to severe COPD patients were evaluated. R-R intervals were recorded (monitor Polar® S810i) during dominant upper limb IC (2 minutes). Stable signals were analyzed by Kubios HRV® software (...) . Indices of HRV were computed in the time domain (mean HR; square root of the mean squared differences of successive RR intervals [RMSSD] and HRV triangular index [RR tri index]) and in the frequency domain (high frequency [HF]; low frequency [LF] and LF/HF ratio). The HR responses were evaluated at rest, at the peak and at the nadir of the VM (15 seconds). The Valsalva index was also calculated.During IC: time domain indices (mean HR increased [P=0.001], RMSSD, and RR tri index decreased [P=0.005

2017 International journal of chronic obstructive pulmonary disease Controlled trial quality: uncertain

15. Influence of the Valsalva maneuver on cardiac hemodynamics and right to left shunt in patients with patent foramen ovale Full Text available with Trip Pro

Influence of the Valsalva maneuver on cardiac hemodynamics and right to left shunt in patients with patent foramen ovale The purpose of this study was to investigate the influence of the Valsalva maneuver (VM) on cardiac hemodynamics in patients with patent foramen ovale (PFO). Sixty-five patients who were highly suspected to have PFO were included. The changes in E, A, E/A ratio of mitral valve blood flow, E, A, E/A ratio of tricuspid valve blood flow, left ventricular end-diastolic volume (...) , area and right atrial area during the resting state and the strain phase of the Valsalva maneuver were observed by transthoracic echocardiography (TTE). Statistical analyses were performed using SPSS Version18.0. Compared to the resting state, mitral valve diastolic velocity E and A peaks at the strain phase of the Valsalva maneuver significantly decreased (P < 0.05), left ventricular end diastolic volume(LVEDV) and area(LVEDA) decreased significantly (P < 0.05), while E/A ratio of mitral valve

2017 Scientific reports

16. Valsalva maneuver using a Handmade Device in Supraventricular Tachycardia Reversion; a Quasi Experimental Study Full Text available with Trip Pro

Valsalva maneuver using a Handmade Device in Supraventricular Tachycardia Reversion; a Quasi Experimental Study The use of vagal nerve stimulation is identified as a proper treatment option in patients with stable supraventricular tachycardia (SVT). This study aimed to assess the success of Valsalva maneuver via a handmade device in reversion of SVT.In this quasi experimental study, using a handmade device, vagus nerve stimulation was performed for SVT patients presenting to emergency (...) maneuver had history of SVT (p = 0.031). There was not any significant association between success rate and sex (p = 0.084), age (p = 0.744), or other medical histories (p ≥ 0.05).Based on the results of the present study, the success rate of Valsalva maneuver with the mentioned handmade device was calculated to be 14.8%. The only independent related factor of successful reversion was SVT history.

2017 Emergency

17. What adds Valsalva maneuver to hemostasis after Trendelenburg’s positioning during thyroid surgery? Full Text available with Trip Pro

What adds Valsalva maneuver to hemostasis after Trendelenburg’s positioning during thyroid surgery? Bleeding after thyroidectomy is life-threatening. The aim of the study was to evaluate whether controlling of further bleeding with Valsalva maneuver following Trendelenburg's positioning has an impact on hemostasis.This prospective study included 68 consecutive patients undergoing thyroidectomy. Study protocol consisted of performing manual intra-abdominal pressure increase and Valsalva (...) maneuver to check hemostasis and treating any bleeding point identified, after Trendelenburg's positioning. All identified bleeding points and treatments were recorded.Total number of bleeding points identified in Trendelenburg's tilt was 49, while it was 41 when using Valsalva maneuver. Abdominal pressure increase, carried out before Valsalva maneuver, identified 14 bleeding points, which was less than bleeding after Trendelenburg's positioning and Valsalva maneuver (P<0.05). All bleeding points

2017 Gland surgery

18. Retinal Vascular Autoregulation during Phase IV of the Valsalva Maneuver: An Optical Coherence Tomography Angiography Study in Healthy Chinese Adults Full Text available with Trip Pro

Retinal Vascular Autoregulation during Phase IV of the Valsalva Maneuver: An Optical Coherence Tomography Angiography Study in Healthy Chinese Adults The impairment of retinal vascular autoregulation can be an early manifestation of many systemic and ocular diseases. Therefore, quantifying retinal vascular autoregulation in a non-invasive manner is very important. This study evaluated the effects of a Valsalva maneuver (VM)-induced blood pressure increases on retinal vascular autoregulation

2017 Frontiers in physiology

19. The Effect of Warm Compress Bistage Intervention on the Rate of Episiotomy, Perineal Trauma, and Postpartum Pain Intensity in Primiparous Women with Delayed Valsalva Maneuver Referring to the Selected Hospitals of Shiraz University of Medical Sciences in Full Text available with Trip Pro

The Effect of Warm Compress Bistage Intervention on the Rate of Episiotomy, Perineal Trauma, and Postpartum Pain Intensity in Primiparous Women with Delayed Valsalva Maneuver Referring to the Selected Hospitals of Shiraz University of Medical Sciences in Genital trauma during vaginal delivery may result from episiotomy, spontaneous perineal tears (perineum, vagina), or both. In 2012, this study aimed to investigate the effect of warm compress bistage intervention on the rate of episiotomy (...) , perineal trauma, and postpartum pain intensity in the primiparous woman with delayed Valsalva maneuver.In this randomized clinical trial, which was performed in hospitals in Shiraz, Iran, in 2012-2013, 150 women were randomly divided into 2 groups: 1 intervention and 1 control. The intervention group received warm compress bistage intervention at 7-cm and 10-cm dilatation and zero position during the first and second stages of labor for 15 to 20 minutes, whereas the control group received the hospitals

2017 Advances in skin & wound care Controlled trial quality: uncertain

20. Comparison of Treatment of Supraventricular Tachycardia by Valsalva Maneuver and Carotid Sinus Massage. (Abstract)

Comparison of Treatment of Supraventricular Tachycardia by Valsalva Maneuver and Carotid Sinus Massage. To compare the efficacy of the Valsalva maneuver with that of carotid sinus massage (CSM) in terminating paroxysmal supraventricular tachycardia (SVT) in the ED.This prospective, randomized case study was performed in the ED of a tertiary care institution. Patients were at least 10 years of age with regular narrow complex tachycardia and had an ECG diagnosis of SVT. Patients with regular (...) narrow complex tachycardia were randomly assigned to undergo either the Valsalva maneuver or CSM. If the tachycardia was not terminated by the method chosen by randomization, then the alternative method of vagal maneuver was used. If the tachycardia was not converted by both methods of vagal stimulation, patients would undergo either synchronized electrical cardioversion or a pharmacologic method of conversion at the discretion of the treating physician, depending on the patient's hemodynamic

2017 Annals of Emergency Medicine Controlled trial quality: uncertain

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