Polyclinic Bagatin for maxillofacial, general and plastic surgery and anesthesiology, Zagreb.
Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Croatia.
Acta Clin Croat. 2022 Sep;61(Suppl 2):28-40. doi: 10.20471/acc.2022.61.s2.04.
Hemodynamic changes and cardiac arrhythmias are not uncommon in clinical practice, depending on including patient features, surgical treatment and drugs administered. We describe hemodynamic changes developed in young patients, soon after a local infiltration anesthesia in day surgery.
We retrospectively assessed the hemodynamic effect of 2% lidocaine with 0,0125mg/ml adrenaline (Li & AD) administered for septorhinoplasty in 44 participants and combination of 0.5% bupivacaine and 2% lidocaine with 0.0125mg/ml adrenaline (BLi & AD) for breast augmentation in 48 participants. Blood pressure and heart rate were recorded before the introduction of general anesthesia, immediately 5.10 and 20 minutes after administration of local infiltration, anesthetic (LIA) and data were analyzed.
The mean systolic blood pressure (SBP) in all observed measurements before general anesthesia (0), immediately, 5 minutes, 10 minutes and 20 minutes after local infiltration anesthesia was higher among patients who underwent septorinoplasty (Li & AD), in relation to patients who underwent breast augmentation (BLi & AD) (p <05). The level of diastolic blood pressure (DBP) in measurement 20 minutes compared to measurement in 10 minutes was increased by 9,52 mmHg. The septorhinoplasty group showed a significant increase in heart rate measured 20 minutes after local infiltration anesthesia with adrenaline.
Measured transitory changes in heart rate and blood pressure after local infiltration of vasoconstrictor anesthetics in healthy patients prior to septorinoplasty and breast augmentation may be induced by endogenous and / or exogenous epinephrine. Bupivacaine solution for local infiltration analgesia reduces hemodynamic disturbances and prolongs analgesic effect. We highlight the need for careful preoperative evaluation, including anxiety assessment and treatment in all patients in day surgery.
在临床实践中，血流动力学变化和心律失常并不少见，这取决于患者的特征、手术治疗和给予的药物。我们描述了在日间手术中局部浸润麻醉后不久，年轻患者出现的血流动力学变化。
我们回顾性评估了 44 名接受鼻中隔成形术的患者中 2%利多卡因加 0.0125mg/ml 肾上腺素（Li & AD）的血流动力学效应，以及 48 名接受乳房增大术的患者中 0.5%布比卡因加 2%利多卡因加 0.0125mg/ml 肾上腺素（BLi & AD）的血流动力学效应。在全身麻醉前、局部浸润麻醉后立即、5 分钟、10 分钟和 20 分钟记录血压和心率，并进行数据分析。
在全身麻醉前（0）的所有观察测量中，接受鼻中隔成形术（Li & AD）的患者的平均收缩压（SBP）均高于接受乳房增大术（BLi & AD）的患者（p<0.05）。与 10 分钟测量相比，20 分钟测量的舒张压（DBP）升高 9.52mmHg。鼻中隔成形术组在局部浸润麻醉后 20 分钟测量的心率显著增加，同时使用肾上腺素。
在鼻中隔成形术和乳房增大术之前，健康患者局部浸润血管收缩麻醉后，心率和血压的短暂变化可能是内源性和/或外源性肾上腺素引起的。局部浸润镇痛的布比卡因溶液可减少血流动力学紊乱并延长镇痛效果。我们强调需要对所有日间手术患者进行术前仔细评估，包括焦虑评估和治疗。
