Sezen Gulbin, Demiraran Yavuz, Seker Ilknur Suidiye, Karagoz Ibrahim, Iskender Abdulkadir, Ankarali Handan, Ersoy Ozlem, Ozlu Onur
Department of Anesthesiology and Reanimation, Duzce University Faculty of Medicine, Duzce, Turkey.
Department of Biostatistics, Duzce University Faculty of Medicine, Duzce, Turkey.
BMC Anesthesiol. 2014 Dec 10;14:113. doi: 10.1186/1471-2253-14-113. eCollection 2014.
Perioperative hemodynamic fluctuations are seen more often in hypertensive patients than in normotensive patients. The purpose of our study was to investigate the perioperative hemodynamic effects of dexmedetomidine and midazolam used for premedication in hypertensive patients relative to each other and in comparison to normotensive patients.
One-hundred-forty female, normotensive or hypertensive patients undergoing myomectomies or hysterectomies. They were randomly enrolled into the subgroups: Group ND (normotensive-dexmedetomidine); Group HD (hypertensive-dexmedetomine); Group NM (normotensive-midazolam); Group HM (hypertensive- midazolam). Dexmedetomidine was administered at a concentration of 0.5 μg.kg(-1), and midazolam was administered at a concentration of 0.025 μg.kg(-1) via intravenous (IV) infusion before the induction of anaesthesia. Haemodynamic parameters were recorded at several times (T(beginning), T(preop5 min), T(preop 10 min), T(induction), T(intubation), T(intubation 5 min), T(initial surgery), T(surgery 15 min), T(surgery 30 min), T(extubation), T(extubation 5 min)). Propofol amount for induction, time between induction and initial surgery, demand of antihypertensive therapy, rescue atropine were recorded. Quantitative clinical and demographic characteristics were compared using One Way ANOVA. The values were compared using One-way Analysis of Variance. Additionally periodic variations were examined by One way Repeated Measures Analysis of Variance for groups separately.
SBP was significantly different between normotensive and hypertensive groups at the following time points: T(preop 5 min), T(preop 10 min), T(induction), T(intubation), T(intubation 5 min) and T(initial surgery). MBP was significantly different in the hypertensive groups at T(induction), T(intubation), T(intubation 5 min), T(initial surgery), T(surgery 15 min), T(surgery 30 min), T(extubation) and T(extubation 5 min). The perioperative requirements for antihypertensive drugs were significantly higher in Group HM.
In the hypertensive patients, dexmedetomidine premedication provides better hemodynamic stability compared with midazolam, and because it decreases the antihypertensive requirements, its use might be beneficial.
Clinicaltrials.gov identifier: NCT02058485.
围手术期血流动力学波动在高血压患者中比在血压正常的患者中更常见。我们研究的目的是调查右美托咪定和咪达唑仑用于高血压患者术前用药时相对于彼此以及与血压正常患者相比的围手术期血流动力学效应。
140例接受子宫肌瘤切除术或子宫切除术的女性，血压正常或患有高血压。她们被随机分为以下亚组：ND组（血压正常-右美托咪定）；HD组（高血压-右美托咪定）；NM组（血压正常-咪达唑仑）；HM组（高血压-咪达唑仑）。在麻醉诱导前，通过静脉输注以0.5μg·kg⁻¹的浓度给予右美托咪定，以0.025μg·kg⁻¹的浓度给予咪达唑仑。在几个时间点记录血流动力学参数（T（开始）、T（术前5分钟）、T（术前10分钟）、T（诱导）、T（插管）、T（插管后5分钟）、T（手术开始）、T（手术15分钟）、T（手术30分钟）、T（拔管）、T（拔管后5分钟））。记录诱导时丙泊酚用量、诱导至手术开始的时间、降压治疗需求、抢救用阿托品。使用单因素方差分析比较定量临床和人口统计学特征。使用单因素方差分析比较这些值。此外，通过单因素重复测量方差分析分别检查各亚组的周期性变化。
在以下时间点，血压正常组和高血压组之间的收缩压有显著差异：T（术前5分钟）、T（术前10分钟）、T（诱导）、T（插管）、T（插管后5分钟）和T（手术开始）。在T（诱导）、T（插管）、T（插管后5分钟）、T（手术开始）、T（手术15分钟）、T（手术30分钟）、T（拔管）和T（拔管后5分钟）时，高血压组的平均动脉压有显著差异。HM组围手术期降压药物需求显著更高。
在高血压患者中，与咪达唑仑相比，右美托咪定术前用药可提供更好的血流动力学稳定性，并且由于它降低了降压需求，其使用可能是有益的。
Clinicaltrials.gov标识符：NCT02058485。
