The safety of controlled hypotension induced with sodium nitroprusside versus nicardipine in patients undergoing elective hip operations
- VernacularTitle:髋部手术全麻患者硝普钠或尼卡地平控制性降压的安全性
- Author:
Yan ZHANG
;
Xing XU
;
Guimin YUAN
- Publication Type:Journal Article
- Keywords:
Nitroprusside;
Nicardipine;
Hypotension, controlled;
Hemodynamic phenomena
- From:
Chinese Journal of Anesthesiology
1994;0(03):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the effects of controlled hypotension induced with sodium nitroprusside (SNP) or nicardipine on hemodynamics during hip operation and postoperative hepatic and renal function.Methods Twenty ASA Ⅰ or Ⅱ patients aged 20-70 yrs weighing 50-80 kg scheduled for total hip replacement or open reduction and internal fixation of fracture of acetabulum were randomized to receive either SNP (group Ⅰ ) or nicardipine (group Ⅱ ) for induced hypotension during operation. Each group included 10 patients. Radial artery and right internal jugular vein were cannulated for BP and CVP monitoring. The probe of Hemo-Sonic ?100 esophageal supersonic hemodynamic monitor (Arrow U.S.A) was placed in the esophagus and fixed when best signal was obtained. ECG, hemodynamics including MAP, HR, CVP, CO and other parameters, SpO2 and PetCO2 were continuously monitored. Anesthesia was induced with propofol 2 mg?kg-1 , fentanyl 2-3 ?g? kg-1 and vecuronium 0.1 mg?kg-1 and maintained with 1.5% isoflurane and continuous infusion of propofol ( at 4-6 mg?kg-1 ?h-1 ) and intermittent i.v. boluses of vecuronium after tracheal intubation. MAP was reduced to 55-65 mm Hg with SNP (at a rate of 0.5-8.0 ?g?kg-1?min-1 ) or nicardipine (at 1.0-8.0 ?g?kg-1 ?min-1 ) . Intraoperative blood loss and blood transfusion and postoperative drainage from the wound were measured and recorded.Hemodynamic parameters were recorded before hypotension and 15, 30 and 60 min after start of induced hypotension and 15 and 30 min after recovery from hypotension. Hepatic and renal functions were measured before and after operation using total bilirubin, AST, ALT, BUN and creatinine. Results The two groups were comparable with respect to sex ratio (M/F) , age, height, body weight, duration of induced hypotension and operation. MAP and systemic vascular resistance (SVR) were significantly reduced and tachycardia developed during hypotension in both groups. The left ventricular ejection time was significantly prolonged and aortic blood flow (ABF) and cardiac output (CO) were significantly increased and CVP was lowered during hypotension as compared to the baseline values in SNP group. BUN was significantly reduced after operation ( P
