Nitroglycerin과 nicardipine을 이용한 유도 저혈압 마취시 국소 조직 혈류량의 변화 = The comparison of the effects of nitroglycerin and nicardipine on the regional blood flow during controlled hypotension

다국어 초록 (Multilingual Abstract)

Background: Nicardipine or nitroglycerin has been used to induce controlled hypotension in healthy patients undergoing orthopedic surgery. Despite the fact that controlled hypotension reduces the amount of blood loss during surgery, the changes in the regional blood flow (RBF) are unclear. This study compared the effects of nicardipine and nitroglycerin on the RBF using a laser Doppler flowmeter.
Methods: Twenty adult patients, ASA physical status I or II, who were scheduled for hip or spine surgery under general anesthesia, were randomly divided into two groups. After inducing general anesthesia, Group N (n = 10) was infused with nitroglycerin to induce hypotension, and group P (n = 10) was infused with nicardipine. The RBF was measured at the upper arm (1 cm lateral from the acromion of the scapula and deltoid region) and the second fingernail of the same side during the prehypotensive and hypotensive states.
Results: There was no significant difference in the estimated level of blood loss and urine output between the groups. The reduction in the mean arterial pressure was faster in group P than in group N. There was no difference in the time for the mean arterial pressure to return to the baseline after the stopping drug infusion. Although the change in the RBF during the hypotensive period was significantly higher in group N than in group P, there was a similar estimated level of blood loss.
Conclusions: Nicardipine is better than nitroglycerin in maintaining the regional blood flow in the peripheral tissue during controlled hypotension and induces controlled hypotension more rapidly. (Korean J Anesthesiol 2006; 50: 519～24)

참고문헌 (Reference)

1 "action of sodium nitroprusside and nitroglycerin on the microcirculation" 605-13, anesthesiology1987

2 "The use of induced hypotension to control bleeding during posterior fusion for scoliosis" 65 : 255-8, 1983

3 "The role of nicardipine during anesthesia and surgery" 11 : 84-93, 1989

4 "Study of measuring the velocity of erythrocytes in tissue by the dynamic light scattering methods" 32 : 2177-82, 1993

5 "Monitoring of autoregulation using laser Doppler flowmetry in patients with head injury" 86 : 438-445, 1997

6 "Long-term hypotensive technique with nicardipine and nitroprusside during isoflurane anesthesia for spinal surgery" 75 : 179-, 1992

7 "Laser Doppler flowmeter measurements of skin perfusion changes associated with arterial and venous compromise in the cutaneous island flap" 6 : 238-43, 1985

8 "Laser Doppler assessment of skin blood flow in arteriopathic limbs" 8 : 179-82, 1987

9 "Influence of hypotensive anesthesia on the organ blood flow:comparison of trinitroglycerine and nicardipine" 44 : 956-962, 1995

10 "Induced hypotension in orthopaedic surgery" 846-54,

11 "Induced hypertension improves regional blood flow and protects against infarction during focal ischemia:time course of changes in blood flow measured by laser Doppler imaging" 42 : 617-624, 1998

12 "In vivo evaluation of microcirculation by coherent light scattering" 254 : 56-8, 1975

13 "Hypotensive and normotensive anaesthesia in total hip replacement a comparative study" 37 : 16-8, 1983

14 "Haemodynamic effects and outcome analysis of hypotensive extradural anaesthesia in controlled hypertensive patients undergoing total hip arthroplasty" 67 : 17-25, 1991

15 "Epidural anaesthesia,induced hypotension and blood loss during surgery" 27 : 91-3, 1983

16 "Effects of nilvadipine on regional cerebral blood flow and skin blood flow in anesthetized cats" 319 : 38-48, 1992

17 "Effect of isoflurane versus nicardipine on blood flow of lumbar paraspinal muscles during controlled hypotension for spinal surgery" 26 : 105-109, 2001

18 "Drug management of hypertensive disorders of pregnancy" 74 : 221-258, 1997

19 "Deliberate hypotension." Churchill Livingstone 1470-1490, 1999

20 "Deliberate hypotension with nicardipine or nitroprusside during total hip arthroplasty" 73 : 341-5, 1991

21 "Controlled hypotensive anesthesia during spinal surgery.A retrospective study" 9 : 450-3, 1984

22 "Comparison of cerebral blood flow measured by laser Doppler flowmetry and hydrogen clearance in cats after cerebral insult and hypervolemic hemodilution" 38 : 355-361, 1996

23 "Cardiovascular effects of nitroglycerin as a hypotensive agent in cerebral aneurysm surgery" 26 : 453-7, 1982

24 "Blood flow in the operating field during controlled hypotension by nitroglycerin,trimetaphan and prostaglandin E1" 39 : 144-7, 1990

25 "A comparison of nitroglycerin and nitroprusside for inducing hypotension in children:a double-blind study" 65 : 175-, 1986