Influence of the controlled hypotension induced by nicardipine combined with low dose esmolol on blood catecholamine, beta2-microglobulin and lactate
- VernacularTitle:尼卡地平与低剂量艾司洛尔联合控制性降压对血液儿茶酚胺、?_2-微球蛋白和血乳酸的影响
- Author:
Tianlong WANG
;
Yan JIANG
;
Baxian YANG
- Publication Type:Journal Article
- Keywords:
Nicardipine;
Propanolamines;
Hypotention, Controlled;
Catecholamines;
Beta 2- microglobulin;
Lactic acid
- From:
Chinese Journal of Anesthesiology
1996;0(09):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the feasibility of inducing controlled hypotension (CH) with nicardipine and low dose esmolol and its influence on blood catecholamine, blood beta 2-microlobulin (?2-mG) and tissue aerobic metabolism. Methods Thirty patients undergoing elective surgery for bone tumor were randomly divided into 3 groups: control group (C, n = 10); nicardipine group (N, n = 10) and nicardipine + esmolol group (N + E, n= 10). Controlled hypotension (CH) was started 15 min after incision. In group N nicardipine was infused at 2.5?g?kg-1?min-1 initially and in group N + E nicardipine (2.5?g?kg-1?min-1 ) and esmolol (12. 5?g?kg-1?min-1) were infused initially. When MAP was reduced to 60-70mm Hg nicardipine infusion rate was adjusted to maintain MAP at this level in both groups. In control group no CH was induced. The patients were premedicated with pethidine 25-50mg and scopolamine 0.3?g im. Anesthesia was induced with fentanyl 3?g?kg-1, propofol 1.2-2.5mg?kg-1 and vecuronium 0. 12mg?kg-1 iv and maintained with isoflurane inhalation (end-tidal concentration 1.0%-2.0%) and intermittent iv boluses of vecuronium . Radial artery was cannulated for continuous BP monitoring and internal jugular vein was cannulated for CVP monitoring. ECG , SpO2 and end-tidal CO2 concentration were continuously monitored . Blood samples were taken before CH (T0) , when MAP was reduced to 60-70mm Hg (T1), 30 min after CH had been maintained for 30min(T2 ), at the end of CH (T3) and at the end of operation (T4 ) for determination of concentrations of catecholamine ,?2-mG , lactate and Hb. Results The demographic data including age, body weight and height were comparable among the three groups. There was no significant difference in preoperative Hb and ALT, AST, Cr andBUN levels. There was also no significant difference in the duration of CH between group N and group N + E . In group C and N norepinephrine (NE) level gradually increased during CH whereas in group N + E NE level increased only slightly during CH as compared with the baseline value (T0) , and was maintained at this low level.?2-mG level was not significantly elevated during CH but lactate level increased significantly during CH in all three groups . There was no significant difference in urine output during CH among the three groups. Conclusion Hypotension with nicardipine does not result in tissue anaerobic metabolism and renal damage. Its combination with low dose esmolol has stress-inhibiting effect.
