Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 623-8522, Japan.
J Anesth. 2010 Aug;24(4):503-10. doi: 10.1007/s00540-010-0931-4. Epub 2010 Mar 26.
Maintenance of systemic and cerebral hemodynamics and quick recovery from anesthesia are required for craniotomy. We conducted a prospective randomized study to investigate the effects of continuous infusion of landiolol on hemodynamic responses to various stimuli, changes in systemic and cerebral hemodynamics during anesthesia, and recovery from anesthesia in patients undergoing craniotomy.
Thirty patients undergoing elective craniotomy were randomly divided into two groups: a landiolol group and a control (saline) group. Landiolol was administered as an infusion rate of 0.125 mg/kg/min for 1 min, followed by an infusion at 0.01-0.04 mg/kg/min until 6 h after the end of anesthesia. Maximal values of heart rate (HR) and systolic blood pressure (SBP) in response to tracheal intubation, pin fixation, the beginning of operation, and extubation were compared between groups. Tissue oxygen index (TOI), mean arterial pressure (MAP), cardiac index (CI), and stroke volume index (SVI) before, during, and at the end of operation were compared between groups. Total doses of fentanyl, interval for the recovery from anesthesia, and incidence of postoperative nausea and vomiting (PONV) were also compared.
Maximal values of HR at intubation and pin fixation and of HR and SBP at extubation were significantly less in the landiolol group compared with those in the control group. TOI, MAP, CI, and SVI were similar between groups during anesthesia. Total doses of fentanyl were significantly less in the landiolol group than in the control group. Interval for recovery from anesthesia and incidence of PONV were similar between groups.
This study indicates that continuous infusion of landiolol suppressed hyperdynamic responses to stimuli during anesthesia while maintaining arterial blood pressure and cerebral oxygen balance during craniotomy. Although landiolol infusion did not affect recovery from anesthesia and incidence of PONV, it reduced intraoperative requirement of fentanyl.
开颅手术需要维持全身和脑部血液动力学稳定，并快速从麻醉中苏醒。我们进行了一项前瞻性随机研究，以调查拉地洛尔持续输注对各种刺激时的血液动力学反应、麻醉期间全身和脑部血液动力学变化以及开颅手术患者麻醉苏醒的影响。
选择 30 例行择期开颅手术的患者，随机分为两组：拉地洛尔组和对照组（生理盐水）。拉地洛尔以 0.125mg/kg/min 的速度输注 1 分钟，然后以 0.01-0.04mg/kg/min 的速度输注至麻醉结束后 6 小时。比较两组患者气管插管、针固定、手术开始和拔管时的心率（HR）和收缩压（SBP）最大值。比较两组患者手术前、手术中和手术结束时的组织氧指数（TOI）、平均动脉压（MAP）、心指数（CI）和每搏量指数（SVI）。还比较了两组患者的芬太尼总剂量、麻醉恢复间隔时间和术后恶心呕吐（PONV）的发生率。
拉地洛尔组患者在插管和针固定时的 HR 最大值以及拔管时的 HR 和 SBP 最大值均显著低于对照组。麻醉期间，两组患者的 TOI、MAP、CI 和 SVI 相似。拉地洛尔组患者的芬太尼总剂量明显少于对照组。麻醉恢复间隔时间和 PONV 发生率两组间相似。
本研究表明，拉地洛尔持续输注可抑制麻醉期间对刺激的高动力反应，同时维持开颅手术期间的动脉血压和脑氧平衡。虽然拉地洛尔输注不影响麻醉苏醒和 PONV 的发生率，但减少了术中芬太尼的需求。
