RESUMEN
Objective:To investigate the effects of the non-steroidal anti-inflammatory drugs Parecoxib and Flurbiprofen administered at different time points on mesenteric traction syndrome(MTS).Methods:This was a prospective, randomized, controlled clinical trial.One hundred elderly patients scheduled for open radical gastrectomy under general anesthesia were randomly allocated to four groups: the control group, the P-Pre-MT group, the F-Pre-MT group, and the F-Post-MT group(n=25, each group). Parecoxib 40 mg and Flurbiprofen 50 mg were intravenously administered 30 min and 5 min before skin incision in the P-Pre-MTS group and the F-Pre-MTS group, respectively.Flurbiprofen 50 mg was infused at the moment of MTS in the F-Post-MTS group while the control group was intravenously injected with saline.Anesthesia induction and maintenance were performed with plasma target-controlled infusion of Propofol and Remifentanil.After the incision of the peritoneum.The incidence of MTS, the duration of hypotension, and the use of norepinephrine during MTS were recorded.Systolic blood pressure(SBP), heart rate(HR), and effect-site concentration of Remifentanil were monitored at MT(T 0), 10 min(T 10), 20 min(T 20), 30 min(T 30), 45 min(T 45), and 60 min(T 60)after MT in patients with MTS. Results:MTS was observed in 19 of 22 patients(86%), 19 of 23 patients(83%), 0 of 24 patients(0%)and 20 of 23 patients(87%)in the control, P-Pre-MT, F-Pre-MT and F-Post-MT groups, respectively.The incidence of MTS in the F-Pre-MT group was lower than that in the control group( χ2=35.313, P=0.000). The duration of hypotension and the use of norepinephrine in patients with MTS were less in the F-Post-MT group than in the control group( P=0.007 and 0.015). SBP and HR at different time points after MT had significant differences in patients with MTS in the control group( F=47.425 and 26.318, P=0.000 and 0.000), but did not differ in the F-Pre-MT group( F=2.140 and 1.013, P=0.066 and 0.413). SBP and the effect-site concentration of Remifentanil were lower and HR was higher in the control group than in the F-Pre-MT group at T 10and T 20after MT( P=0.000), and SBP was higher and HR was lower in the F-Post-MT group than in the control group C at T 20after MT( P=0.002 and 0.002). Conclusions:Flurbiprofen not only can prevent the occurrence of MTS, maintain blood pressure stability and heart rate after MT, but also can reduce the duration of hypotension and the amplitude of heart rate increase when MTS occurs in elderly patients undergoing open radical gastrectomy.Parecoxib has no effect on MTS.
RESUMEN
Objective To explore the effect of dexmedetomidine on blood coagulation following radical gastrectomy.Methods ASA Ⅰ or Ⅱ patients aged 51-70 years weighing 53-75 kg scheduled for radical gastrectomy were randomly allocated to two groups:dexmedetomidine group (group D)and control group (group C).Dexmedetomidine 0.5 μg/kg was intravenously infused over 10 minutes before anesthesia induction,followed by a rate of 0.5 μg·kg-1 ·h-1 until peritoneal closure in group D and volume-matched normal saline was administrated in group C.Radical gastrectomy was performed under total intravenous anesthesia with propofol and remffentanil.A series of warming measures were implemented and artificial colloid and heparin flushing fluid were not used.Postoperative patient-controlled intravenous analgesia was performed to maintain visual analogue scale≤3.The blood samples were collected for TEG and standard coagulation monitoring before dexmedetomidine and saline administration and 3 h after surgery.Results The temperature and hematocrit in the postoperative period were significantly less than the preoperative period in two groups (P＜0.01).In both groups,the activity of plasma antithrombin Ⅲ was significantly decreased and the concentration of plasma FDP was significantly increased in the postoperative period when compared with the preoperative period (P ＜0.01).In group D,the R time was significantly shortened and MA value was significantly increased in the postoperative period when compared with the preoperative period (P＜0.05) and there were no significant differences in the K time and α angle between the preoperative and postoperative period.In group C,the R and K time were significantly shortened and the value for MA and α angle were significantly increased in the postoperative period compared with the preoperative period (P＜0.01).The platelet counts,PT,APTT,and plasma fibrinogen concentration were comparable between the preoperative and postoperative period in both groups.The requirements of propofol and remifentanil in group D were significantly less than group C (P＜0.05).In the preoperative period,the plasma antithrombin Ⅲ activity,FDP concentration,and the values for all TEG variables were similar in both groups.In the postoperative period,the value for MA and the concentration of plasma FDP in group D were less than that in group C and the value for R and the activity of plasma AT Ⅲ in group D were more than group C (P＜0.05 or P＜0.01) and there were no significant differences in the K time and α angle in both groups.There were no significant differences in the temperature,hematocrit,platelet counts,PT,APTT,and plasma fibrinogen concentration in the preoperative and postoperative periods between the two study groups.Conclusion Adjunctive dexmedetomidine in general anesthesia could inhibit the decrease of R time and raise of the value for MA,inhibit the decrease of plasma an tithrombin Ⅲ activity and raise of FDP concentration,which indicated that dexmedetomidine can improve blood coagulation state after radical gastrectomy.