Imani Farsad, Behseresht Alireza, Pourfakhr Pejman, Shariat Moharari Reza, Etezadi Farhad, Khajavi Mohamadreza
Department of Anesthesiology, Tehran University of Medical Sciences, Tehran, Iran.
Anesth Pain Med. 2019 Jun 3;9(3):e85852. doi: 10.5812/aapm.85852. eCollection 2019 Jun.
One of the complications of nitroglycerin infusion during surgery is methemoglobinemia.
The aim of this study was to investigate the prevalence of methemoglobinemia and its association with nitroglycerin infusion for the treatment of hypertension during general anesthesia.
Patients received nitroglycerin infusion at a dose of 2 μ/kg/min. The aim of controlling blood pressure was to set the blood pressure at 20% of the patient's baseline. Then, the amount of methemoglobin was recorded at 15-minute intervals. Backward stepwise logistic regression test was used to determine the factors affecting methemoglobinemia.
Based on the criterion of methemoglobin level above 2%, the prevalence of pathologic methemoglobinemia was 56.6%. After adjusting for confounding variables in the final model, the total prescribed dose was the only factor affecting pathologic methemoglobinemia.
For the first time, we showed that more than half of the patients undergoing surgery suffered from methemoglobin level above 2% after prescribing nitroglycerin, and the only predictor of abnormal methemoglobin level was the rate of nitroglycerin prescription. Anesthesiologists are recommended to be more careful about the speed of nitroglycerin infusion, and if the patient needs higher doses, patient care for the early detection of methemoglobinemia should be the priority.
手术期间输注硝酸甘油的并发症之一是高铁血红蛋白血症。
本研究旨在调查全身麻醉期间高铁血红蛋白血症的患病率及其与输注硝酸甘油治疗高血压的相关性。
患者以2μg/kg/min的剂量接受硝酸甘油输注。控制血压的目标是将血压设定为患者基线血压的20%。然后，每隔15分钟记录一次高铁血红蛋白量。采用向后逐步逻辑回归检验来确定影响高铁血红蛋白血症的因素。
根据高铁血红蛋白水平高于2%的标准，病理性高铁血红蛋白血症的患病率为56.6%。在最终模型中对混杂变量进行校正后，总处方剂量是影响病理性高铁血红蛋白血症的唯一因素。
我们首次表明，超过一半的手术患者在使用硝酸甘油后高铁血红蛋白水平高于2%，高铁血红蛋白水平异常的唯一预测因素是硝酸甘油的处方速率。建议麻醉医生在输注硝酸甘油的速度上更加谨慎，如果患者需要更高剂量，应优先关注对高铁血红蛋白血症的早期检测。
