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Objective:To observe the different administration methods of methoxamine on the body temperature protection of patients undergoing off-pump coronary artery bypass grafting (OPCABG).Methods:The clinical data of 278 patients underwent OPCABG from January 2019 to December 2021 in Jinzhou Central Hospital were retrospectively analyzed, and the patients were used the methoxamine during the operation. Among them, 157 cases were given methoxamine by continuous intravenous infusion (continuous intravenous infusion group), and 121 cases were given methoxamine by fractional intravenous infusion in stages (fractional intravenous infusion group). The changes of mean arterial pressure (MAP) and heart rate during operation were recorded, and the fluctuation rate of MAP was calculated. The dosage of methoxamine, use time of variable temperature blanket, time from the end of operation to waking up and occurrence of adverse reactions such as hypothermia, rigors, coagulation disorders and renal insufficiency were recorded.Results:During anesthesia, the fluctuation rate of MAP in continuous intravenous infusion group was significantly lower than that in fractional intravenous infusion group: (16.62 ± 3.17)% vs. (23.53±3.69)%, and there was statistical difference ( P<0.05). The MAP and heart rate of continuous intravenous infusion group were more stable at each time point than that of fractional intravenous infusion group. The use time of variable temperature blanket, and incidences of hypothermia, rigors in continuous intravenous infusion group were significantly lower than those in fractional intravenous infusion group: (86.17 ± 19.66) min vs. (146.72 ± 29.37) min, 2.55% (4/157) vs. 9.92% (12/121) and 1.91% (3/157) vs. 8.26% (10/121), and there was statistical difference ( P<0.01 or <0.05); there were no statistical differences in dosage of methoxamine, time from the end of operation to waking up and incidence of coagulation disorders between two groups ( P>0.05); Renal insufficiency did not occur in both groups. Conclusions:Continuous intravenous pumping of methoxamine can obviously reduce the heat loss of human body, enhance the insulation effect of other insulation measures, and reduce the incidence of hypothermia in patients underwent OPCABG.
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Objective:To investigate the effect of methoxyamine combined with target guided fluid in elderly patients undergoing pancreaticoduodenectomy.Methods:90 elderly patients undergoing pancreaticoduodenectomy were randomly divided into methoxyamine group and control group, with 45 cases in each group. The patients in both groups were treated with intravenous inhalation combined anesthesia. The stroke volume variation (SVV) was maintained at 7%-10% and the central venous pressure (CVP) was 4-8 cmH 2O. In methoxyamine group, 3 μg/(kg·min) methoxyamine was continuously pumped, while the control group was pumped with the same amount of normal saline at the same speed. The intraoperative infusion volume, urine volume, bleeding volume, blood transfusion cases, intraoperative mean arterial pressure, heart rate, blood gas analysis results, B-type natriuretic peptide (BNP), creatinine, urea nitrogen level and postoperative exhaust time were compared between the two groups. Results:Compared with the control group, the patients in methoxyamine group had less infusion volume, urine volume, lower postoperative BNP level and heart rate, shorter postoperative exhaust time (all P<0.05), and higher mean arterial pressure ( P<0.05). There was no significant difference in blood loss, blood transfusion cases, PaO 2, PaCO 2, pH, creatinine and urea nitrogen between the two groups (all P>0.05). In addition, the number of patients in the methoxyamine group who used pressor drugs was less than that in the control group ( P<0.05), and the frequency of bradycardia was more than that in the control group ( P<0.05). The proportion of tachycardia and urapidil was similar in the two groups (all P>0.05). Conclusions:Methoxyamine combined with target guided fluid therapy can reduce the intraoperative infusion volume of pancreaticoduodenectomy in elderly patients, stabilize circulation, shorten postoperative exhaust time, and contribute to the recovery of gastrointestinal function.
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Objective:To investigate the preventive effects of hydroxyethyl starch and methoxamine on complications of combined spinal and epidural anesthesia in older adult patients and its influence on hemodynamics.Methods:The clinical data of 120 older adult patients who underwent combined spinal and epidural anesthesia in General Hospital of Armed Police and Marine Police between February 2017 and April 2019 were retrospectively analyzed. The included patients were divided into two groups according to the adverse reactions of drugs used to induce anesthesia: control group (methoxamine injection, n = 55) and observation group (methoxamine + hydroxyethyl starch, n = 65). The changes in hemodynamic index, complications and cognitive function were analyzed in each group. Results:Systolic blood pressures measured at 5, 15 and 30 minutes after anesthesia were (127.53 ± 10.63) mmHg, (119.85 ± 10.86) mmHg, (125.45 ± 10.74) mmHg, respectively in the observation group, which were significantly higher than (118.23 ± 11.32) mmHg, (114.34 ± 10.32) mmHg, (119.01 ± 10.34) mmHg in the control group ( t = 3.66, 2.24, 2.63, all P < 0.05). Diastolic blood pressures measured at 5, 15 and 30 minutes after anesthesia were (76.65 ± 9.07) mmHg, (78.43 ± 9.32) mmHg, (80.19 ± 9.43) mmHg, respectively in the observation group, which were significantly higher than (63.30 ± 9.43) mmHg, (65.98 ± 9.26) mmHg, (70.38 ± 9.17) mmHg in the control group ( t = 6.24, 5.78, 4.55, all P < 0.05). Heart rates measured at 5, 15 and 30 minutes after anesthesia were (73.65 ± 7.67) beats/min, (83.27 ± 9.57) beats/min, (84.10 ± 9.67) beats/min respectively in the observation group, which were significantly higher than (69.76 ± 7.82) beats/min, (64.70 ± 9.38) beats/min, (65.80 ± 9.43) beats/min in the control group ( t = 2.17, 8.46, 8.27, all P < 0.05). The incidences of hypotension and bradycardia in the observation group were 3.08% (2/65) and 3.08% (2/65), respectively, which were significantly lower than 25.45% (14/55) and 21.82% (12/55) in the control group ( χ2 = 12.91, 10.15, both P < 0.05). The Mini Mental State Examination scores measured at 1, 6 and 24 hours after surgery were (26.69 ± 2.51) points, (26.74 ± 2.75) points, and (26.99 ± 2.36) points, respectively in the observation group, which were significantly higher than (23.17 ± 2.41) points, (23.43 ± 2.36) points, and (24.18 ± 2.12) points in the control group ( t = 6.17, 5.55, 5.39, all P < 0.05). Conclusion:Hydroxyethyl starch combined with methoxamine for combined spinal and epidural anesthesia in older adult patients can effectively reduce the hemodynamic fluctuations, decrease the incidences of hypotension and bradycardia, and does not produce a remarkable effect on postoperative cognitive function.
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Objective To investigate the effects of intravenous infusion of methoxamine and phenylephrine on blood pressure and coronary artery blood flow in elderly patients with post volume treatment hypotension after cardiopulmonary bypass (CPB ) undergoing coronary artery bypass grafting (CABG).Methods Forty patients,physical status ASA Ⅱ or Ⅲ,>65 years old,undergo-ing CABG,following CPB,with a mean arterial pressure (MAP)<70% of baseline,despite adequate volume replacement (based on achieving a normal CVP),were randomly assigned to me-thoxamine group (group M,n=20)or phenylephrine group (group P,n=20).The initial infusion rate was 3 μg·kg-1·min-1in group M and 0.24 μg·kg-1·min-1in group P,respectively.The rate was increased or decreased by one third of initial dose in order to maintain the MAP at the target level (±20% of baseline MAP).Coronary sinus (CS),systolic blood flow velocity time integral (SV-TI),diastolic velocity time integral (DVTI),CS blood flow (CSBF)were recorded before adminis-tration,at 3,5,10,15,30 min after administration.Results Compared with pre-administration,SV-TI,DVTI,CSBF were increased at each point in the two groups (P<0.05 or P<0.01).SVI was in-creased at 15 min and 30 min in group M (P<0.05).Compared with group P,DVTI and CSBF at 10,15 min and 30 min was higher in group M (P<0.05 or P<0.01).There were 2 cases of atrial fibrillation and 1 case of frequent ventricular premature beat after operation in group M;1 case of bradycardia and 1 case of frequent ventricular premature beats after operation in group P.Conclusion Intravenous infusion of methox-amine and phenylephrine both can correct post volume treatment hypotension after CPB in elderly patients undergoing CABG,but methoxamine increases coronary blood flow more significantly and may be more ben-eficial to patients with coronary heart disease.
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Objective:To investigate the cycling stability effect of methoxamine at low dose in cesarean section in order to find the optimal regimen for the prevention and treatment of hypotension during cesarean section. Methods:Totally 200 patients with scheduled cesarean section were selected and randomly divided into the experimental group and the control group with 100 ones in each. The ex-perimental group was anesthetized through L3-4 lumbar-peridural puncture immediately followed by the infusion of methoxamine, and the control group was anesthetized in the same way, and only when the blood pressure was dropped by more than 15%, the infusion of me-thoxamine was given immediately (2-3mg diluted to 20ml). The systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate ( HR) were compared between the two groups at five time points of before spinal anesthesia ( T0 ) , 5 min after spinal anesthe-sia ( T1 ) , 10 min after spinal anesthesia ( T2 ) , 15 min after spinal anesthesia ( T3 ) and the end of the operation ( T4 ) . The umbilical arterial blood gas and the 1-minute Apgar score of the newborn were recorded, and the adverse reactions in the two groups were com-pared. Results:In T1-T3, SBP and DBP in the two groups were significantly lower than those at T0(P0.05), and HR in the control group was significantly lower than that in the experimental group in T1-T3(P0. 05). The incidence of adverse reactions in the experimental group was significantly lower than that in the control group (P<0. 05). Conclusion: The prophylactic use of methoxamine through micro pump can maintain the cycling stability of cesarean section with higher reliability and without adverse effects on the newborn.