Erdivanlı Başar, Erdivanlı Özlem Çelebi, Şen Ahmet, Özdemir Abdullah, Tuğcugil Ersagun, Dursun Engin
Department of Anaesthesiology and Reanimation, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey.
Department of Otorhinolaryngology, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey.
Turk J Anaesthesiol Reanim. 2018 Dec;46(6):424-433. doi: 10.5152/TJAR.2018.28999. Epub 2018 Sep 6.
Controlled hypotension is commonly induced during functional endoscopic sinus surgery to limit mucosal bleeding. This may be detrimental to elderly patients and patients with arterial stenosis. The aim of this pilot study was to determine if a normotensive anaesthetic technique with sufficient analgesia and without profound vasodilation may reduce intraoperative bleeding and incidence of adverse haemodynamic effects associated with vasodilation and variable rate continuous infusions.
In this double-blind randomised controlled trial in a tertiary care centre, a total of 88 patients were randomised to receive intravenously either 0.1 mg kg metoprolol and 1 mg kg tramadol following anaesthesia induction (MT group) or a bolus dose of 0.5 μg kg remifentanil following anaesthesia induction, followed by 0.25-0.5 μg kg min remifentanil infusion (R group). The primary outcome was quality of surgical field and incidence of adverse haemodynamic effects. The secondary outcomes were time to achieve intraoperative bleeding score <3, bleeding rate and changes in cerebral regional oximetry.
A total of 105 patients were recruited, in which 88 were randomised. The median intraoperative bleeding score was similar (1, interquartile range: 1-1, p=0.69). The mean bleeding rate was lower in the MT group, although the difference was not significant (p=0.052, 95% CI 0 to 8.8). Hypotension, bradycardia and cerebral desaturation in the MT group were not observed compared to hypotension in 3 (7%), bradycardia in 18 (41%) and cerebral desaturation in 2 (5%) patients in the R group (p=0.241, p<0.001, p=0.474, respectively).
Providing sufficient analgesia and eliminating stress response can provide stable heart rate and good surgical field with no need for additional hypotension. This normotensive technique may be useful in patients with stenotic arteries or ischaemic organ diseases.
功能性鼻内镜鼻窦手术中常采用控制性低血压来减少黏膜出血。这可能对老年患者和动脉狭窄患者有害。本初步研究的目的是确定一种具有充分镇痛且无深度血管扩张的正常血压麻醉技术是否可减少术中出血以及与血管扩张和可变速率持续输注相关的不良血流动力学效应的发生率。
在一家三级医疗中心进行的这项双盲随机对照试验中，共有88例患者被随机分组，在麻醉诱导后静脉注射0.1 mg/kg美托洛尔和1 mg/kg曲马多（MT组）或麻醉诱导后静脉注射0.5 μg/kg瑞芬太尼推注剂量，随后以0.25 - 0.5 μg·kg⁻¹·min⁻¹输注瑞芬太尼（R组）。主要结局是手术视野质量和不良血流动力学效应的发生率。次要结局是达到术中出血评分<3的时间、出血率和脑局部血氧饱和度的变化。
共招募了105例患者，其中88例被随机分组。术中出血评分中位数相似（1，四分位间距：1 - 1，p = 0.69）。MT组的平均出血率较低，尽管差异不显著（p = 0.052，95%可信区间0至8.）。与R组3例（7%）出现低血压、18例（41%）出现心动过缓和2例（5%）出现脑去饱和相比，MT组未观察到低血压、心动过缓和脑去饱和（分别为p = 0.241、p < 0.001、p = 0.474）。
提供充分镇痛并消除应激反应可提供稳定的心率和良好的手术视野，无需额外的低血压处理。这种正常血压技术可能对动脉狭窄或缺血性器官疾病患者有用。
