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bjective To clarify the heart rate variability (HRV) changes in patients subjected to deliberate hypotension with alprostadil.Methods Eighty-six elderly patients scheduled for nasal endoscopic surgery in general anesthesia were divided into alprostadil group (group A) and nitroglycerin group (group N) with 43 cases each by random digits table.Hypotension was induced with alprostadil and nitroglycerin through continuous infusion respectively,and the mean arterial pressure (MAP) was reduced to about 25％-30％ of baseline MAP.The MAP,heart rate (HR),total power ( TP ),low frequency (LF),high frequency (HF),and LF/HF were continuously monitored and blood was taken for analysis of lactate (LAC) before deliberate hypotension (T0),at the time of dropping to target blood pressure (T1),at 5 and 30 min after deliberate hypotension (T2 and T3),stopping deliberate hypotersion (T4) and 30 min after recovery from hypotension (T5).Results HR at T1-T4 was faster than that at T0in group N(P ＜ 0.05),and faster than that in group A( P ＜ 0.05 ),HR at T5 was faster than that at T0 in group N( P ＜ 0.05 ),but HR was stable at T1-T5 in group A (P ＞ 0.05 ).There was no significant difference in LAC of group A and group N whether in interior group or between two groups (P＞ 0.05).TP,LF and HF at T1-T4 were lower than those at T0 in two groups ( P ＜ 0.05 ),HF at T1-T4 was higher in group A than that in group N(P ＜ 0.05 ) ; LF/HF was no change at T1-T4 compared with that at T0 in group A (P ＞ 0.05),but increased in group N (P ＜ 0.05 ) which was higher than that in group A at the same time ( P ＜ 0.05 ) ;TP,LF and HF was recovered at Ts in two groups,and HF at T5 in group A was higher than that in group N( P ＜ 0.05 ) ; LF/HF at T5 in group A maintained the level at T0,but decreased in group N and lower than that at T5 in group N(P ＜ 0.05).Conclusion Alprostadil for deliberate hypotension is more likely to maintain cardiac autonomic nerve balance that is helpful for perioperative security of elderly patients.
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The disease incidence of aortic dissecting aneurysm showed an increasing tendency.Recently,the clinical application of endovascular stent-graft implantation received good results in treating aortic dissecting aneurysm,which is characterized by minimally invasive,safe,with high success rates.However,the chosen of anesthesia is still in dispute.Local anesthesia,intraspinal anesthesia and general anesthesia can be used in this operation.The investigation demonstrated that intubation general anesthesia is more security in this operation with less complication,which is conductive to controlling blood pressure and braking conditions.
RESUMO
OBJECTIVE: To investigate the analeptic action of Xingnaojing injection(XNJI) in patients undergoing total intravenous anesthesia and the possible mechanism.METHODS: 60 patients undergoing selective abdominal operation with tracheal intubation(scored grade Ⅰ or grade Ⅱ using ASA score) were transferred to post-anesthctic ICU(PACU) after surgery and randomly divided into two groups of 30 each: X group(XNJI 0.5 mL?kg-1) and C group(control group).The X group received XNJI(0.5 mL?kg-1) by drip infusion within 10 minutes,while C group received same amount of normal saline.The vocal reaction recovery time,autonomous breath recovery time,extubation time and duration of PACU stay were recorded.The mean arterial pressure(MAP),heart rate(HR),the concentrations of Epinephrine(E),and Norepinephrine(NE) and ?-endorphin(?-EP) in arterial blood were detected at 0,5,15,30 and 45 minutes before and after medication.RESULTS: No significant differences were noted for X group in hemodynamics parameters after medication as compared with before medication,but significant differences were noted for C group at 30 min and 45 min when compared with before medication or compared with X group at the same different time points.The vocal reaction recovery time,autonomous breath recovery time,extubation time and the duration of PACU stay were all significantly shorter in X group than in C group(P