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Dexmedetomidine combined with nicardipine for controlled anti-hypertensive therapy in orthopedic surgery

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Author:
No author available
Journal Title:
Chinese Journal of Biomedical Engineering
Issue:
4
DOI:
10.3760/cma.j.issn.1674-1927.2013.04.012
Key Word:
右美托咪定;尼卡地平;降压,控制性;骨疾病;Dexmedetomidine; Nicardipine; Hypotension,controlled; Bone diseases

Abstract: Objective To evaluate the efficacy of dexmedetomidine combined with nicardipine for controlled anti-hypertensive therapy in orthopedic surgery.Methods Ninety patients with ASA Ⅰ or Ⅱ grading scheduled for hip joint replacement and femoral lock nailing internal fixation surgery under general anesthesia between January 2011 and June 2012 were randomly allocated to nicardipine group (group N,n=30),dexmedetomidine plus nicardipine group (group DN,n=30) and control group (group C,n=30),respectively.Patients in group DN received a loading dose of dexmedetomidine (1 μg/kg) intravenous injection for 10 min before induction,followed by maintenance infusion at the dose of 0.5 μg· kg-1· h-1 till 30 min before cessation of surgery.Patients in groups C and N received normal saline intravenous injection at an identical rate throughout the course.Nicardipine was administered in groups N and DN,with the dose of nicardipine 2.5 μg· kg-1· min-1 at the beginning of operation,and adjusted by maintaining the mean arterial pressure (MAP) between 60 and 65 mm Hg (1 mm Hg=0.133 kPa) before suturing of the wound.The dose of propofol,fentanyl and nicardipine,the volume of hemorrhage,transfusion and blood transfusion,the duration of surgery and recovery of consciousness and extubation were recorded.Results Compared with group C,the volume of hemorrhage,transfusion and blood transfusion were significantly lower in groups N and DN with significant difference (all P<0.05),while there is no difference between group N and group DN (all P>0.05).Compared with group DN,group N required an increased dose of propofol,fentanyl and nicardipine, and was characterized by a prolonged duration to recovery of consciousness and extubation ( all P<0.05).Compared with group DN,a higher dose of propofol and fentanyl was administered in group C (all P<0.05).Croup N was characterized by a prolonged duration to consciousness and extubation as compared with group C (all P<0.05).Conclusion The combination of dexmedetomidine and nicardipine during orthopedic surgery is associated with reduced dose of nicardipine and anesthetic drugs,shorter time to recovery of consciousness,improved outcomes of controlled anti-hypertensive therapy and reduced volume of hemorrhage.

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