Department of Anesthesiology, Southwest Hospital, Third Military Medical University, 30 Gaotanyan Road, Chongqing, 400038, China.
Department of Nephrology, Southwest Hospital, Third Military Medical University, 30 Gaotanyan Road, Chongqing, 400038, China.
J Gastrointest Surg. 2023 Sep;27(9):1837-1845. doi: 10.1007/s11605-022-05499-3. Epub 2023 Apr 26.
Patients with obstruction jaundice are at a high risk of hypotension and need high volume of fluids and a high dose of catecholamine to maintain organ perfusion during operation procedure. All these likely contribute to high perioperative morbidity and mortality. The aim of the study is to evaluate the effects of methylene blue on the hemodynamics in patients undergoing surgeries associated with obstructive jaundice.
A prospective, randomized, and controlled clinical study.
The enrolled patients randomly received 2 mg/kg of methylene blue in saline or saline (50 ml) before anesthesia induction. The primary outcome was the frequency and dose of noradrenaline administration to maintain mean arterial blood pressure over 65 mmHg or > 80% of baseline, and systemic vascular resistance (SVR) over 800 dyne/s/cm during operation. The secondary outcomes were liver and kidney functions, and ICU stay.
Seventy patients were enrolled in the study and randomly assigned to receive either methylene blue or control (n = 35/group).
Fewer patients received noradrenaline in the methylene blue group when compared with the control group (13/35 vs 23/35, P = 0.017), and the noradrenaline dose administrated during operation was reduced in the methylene blue group when compared with the control group (0.32 ± 0.57 mg vs 1.787 ± 3.51 mg, P = 0.018). The blood level of creatinine, glutamic oxalacetic transaminase, and glutamic-pyruvic transaminase after the operation was reduced in the methylene blue group when compared with the control group.
Prophylactic administration of methylene blue before operation associated with obstructive jaundice improves hemodynamic stability and short-term prognosis.
Methylene blue use prevented refractory hypotension during cardiac surgery, sepsis, or anaphylactic shock. It is still unknown that methylene blue on the vascular hypo-tone associated with obstructive jaundice.
Prophylactic administration with methylene blue improved peri-operative hemodynamic stability, and hepatic and kidney function on the patients with obstructive jaundice.
Methylene blue is a promising and recommended drug for the patients undergoing the surgeries of relief obstructive jaundice during peri-operation management.
梗阻性黄疸患者在手术过程中容易出现低血压，需要大量液体和大剂量儿茶酚胺来维持器官灌注。所有这些都可能导致围手术期发病率和死亡率升高。本研究旨在评估亚甲蓝对梗阻性黄疸患者手术期间血流动力学的影响。
前瞻性、随机、对照临床试验。
纳入的患者在麻醉诱导前随机接受生理盐水或生理盐水（50ml）2mg/kg 的亚甲蓝。主要结局是维持平均动脉压在 65mmHg 以上或基线的 80%以上，以及全身血管阻力（SVR）在 800dyne/s/cm 以上所需去甲肾上腺素的频率和剂量。次要结局是肝肾功能和 ICU 住院时间。
本研究共纳入 70 例患者，随机分为亚甲蓝组（n=35）和对照组（n=35）。
与对照组相比，亚甲蓝组接受去甲肾上腺素治疗的患者更少（13/35 与 23/35，P=0.017），术中去甲肾上腺素剂量也减少（0.32±0.57mg 与 1.787±3.51mg，P=0.018）。与对照组相比，亚甲蓝组术后血肌酐、谷氨酸草酰乙酸转氨酶和谷氨酸丙酮酸转氨酶水平降低。
术前预防性给予亚甲蓝可改善梗阻性黄疸患者的血流动力学稳定性和短期预后。
