Yamashita Soichiro, Yamaguchi Hiroshi, Hisajima Yu, Ijima Kazuhiro, Saito Kaori, Chiba Ai, Yasunaga Toru
Departments of *Anesthesia and Critical Care Medicine and ‡Orthopedics, Iwaki Kyoritsu General Hospital, Iwaki, Fukushima, Japan; and †Department of Anesthesia, Ryugasaki Saiseikai Hospital, Ryugasaki, Ibaraki, Japan.
Anesth Analg. 2004 Apr;98(4):994-998. doi: 10.1213/01.ANE.0000104610.99716.37.
The precise mechanism of tourniquet-induced arterial blood pressure increase is unknown. We determined the effect of preoperative oral dextromethorphan (DM) on arterial blood pressure and heart rate changes during tourniquet inflation in knee cruciate ligament reconstruction patients under general anesthesia. Patients in the DM group (n = 38) received oral DM 30 mg, and patients in the control group (n = 38) received oral placebo 2 h before the induction of anesthesia. Anesthesia was maintained with sevoflurane 2.0% and N(2)O in 33% oxygen, and the trachea was intubated until the end of surgery. Arterial blood pressure and heart rate were measured at 0, 30, and 60 min after the start of tourniquet inflation. Systolic arterial blood pressure and heart rate at 60 min in the control group were significantly more than those in the DM group (131.1 +/- 15.8 mm Hg versus 123.6 +/- 15.9 mm Hg [P < 0.05] and 74.1 +/- 11.3 bpm versus 67.8 +/- 8.5 bpm [P < 0.01], respectively). The percentage increase in systolic arterial blood pressure and heart rate in the DM group was also attenuated when compared with that in the control group (P < 0.05). In conclusion, preoperative oral DM 30 mg significantly attenuated arterial blood pressure and heart rate increases during tourniquet inflation under general anesthesia.
We demonstrated that preoperative oral dextromethorphan 30 mg significantly attenuated arterial blood pressure and heart rate increases at 60 min during tourniquet inflation in patients undergoing knee cruciate ligament reconstruction under general anesthesia.
止血带引起动脉血压升高的确切机制尚不清楚。我们确定了术前口服右美沙芬（DM）对全身麻醉下膝关节交叉韧带重建患者止血带充气期间动脉血压和心率变化的影响。DM组（n = 38）患者在麻醉诱导前2小时口服30 mg DM，对照组（n = 38）患者口服安慰剂。用2.0%七氟醚和33%氧气中的N₂O维持麻醉，气管插管直至手术结束。在止血带充气开始后0、30和60分钟测量动脉血压和心率。对照组60分钟时的收缩压和心率显著高于DM组（分别为131.1±15.8 mmHg对123.6±15.9 mmHg [P < 0.05]和74.1±11.3次/分对67.8±8.5次/分[P < 0.01]）。与对照组相比，DM组收缩压和心率的升高百分比也有所减弱（P < 0.05）。总之，术前口服30 mg DM可显著减弱全身麻醉下止血带充气期间动脉血压和心率的升高。
我们证明，术前口服30 mg右美沙芬可显著减弱全身麻醉下膝关节交叉韧带重建患者止血带充气60分钟时动脉血压和心率的升高。
