The Effect Of Urapidil And Nitroglycerin On Stroke Volume Variation In Nasal Endoscopic Surgery

Objective:To evaluate the effect of urapidil and nitroglycerin on stroke volume variation in nasal endoscopic surgery.And whether two antihypertensive drugs with different pharmacologocal effects?urapidil and nitroglycerin?had the same effect on the stroke volume variation.In order to correctly assess the capacity of patients,the clinical capacity of treatment options for reference.Methods:Sixty ASA?or?patients underwent nasal endoscopic surgery under general anesthesia were chosen in the study,who were aged 18 to 65 years,body mass index?BMI?20²8kg/m²,no hypertension,diabetes,obvious cardiopulmonary disease and sever liver and kidney insufficiency,abnormal coagulation function or moderate or above anemia.These patients were randomly divided into 3 groups?n=20each?,namely control group?group??,urapidilgroup?group??and nitroglycerin group?group??.On arrived to the operating room,ECG?NIBP?SpO₂ were monitored routinely,establishing vein channels,a catheter was inserted in the radial artery and connected to the FloTrac/Vigileo system to obtain MAP?SVV?CI?CO measurements.Anesthesia was induced with midazolam 0.05 mg/kg,etomidate 0.2 mg/kg,sufentanil 0.2⁰.3?g/kg and cis-atracurium 0.2 mg/kg and maintained with continuous infusion of propofol and remifentanil.Discontinuously intravenous cis-atracurium during surgery.After tracheal intubati,the patiens were volume-controlled ventilati on with tidal volume?VT?8 ml/kg,respiratory rate?RR?12¹5 bmp,inspiration and exhalation?I:E?1:2,the oxygen flow rate 1³L/min,fraction of inspired oxygen?fraction of inspired oxygen?100%,adjusted ventilationmin according to P_ETCO₂ at 35⁴5 mmHg.Controlled hypotension was implemented at the beginning of surgery in group?and?.Urapidil was infused at a rate of 10¹5?g·kg^-1·min^-11 and nitroglycerin was 1³?g·kg^-1·min^-1 until reached target MAP?50-70 mmHg?and MAP was maintained at this level during the operation.The operation time?bleeding volume in surgery and HR?MAP?CI and SVV were recorded after patients enters the operating room and recorded at the beginning of controlled hypotension and after 10 min and 30 min respectively.Results:Sixty patients were finally included in the study,including 31 patients with chronic sinusitis with nasal polys,17 patients with chronic sinusitis and 12patients with nasal polyps.There were 33 males and 27 females.1.General informationThere were no significant difference in general information between the 3groups in gender,age,hight,weight,BMI?P?0.05?.2.The operation time and bleeding volume in surgeryThe operation time and bleeding volume in group II and group III were significantly reduced compared with that in group I?P?0.05?,while group II and group III compared with no obvious difference?P?0.05?.3.The date of the hemodynamicWith the infusion of hypotensive drugs,SVV increased.10min after controlled hypotension,the three groups of SVV were 9.25±2.67?group I?,10.85±2.25?group II?and 10.30±2.76?group III?.The difference has no statistics significance?P>0.05?.30min,SVV were 9.65±2.74?group I?,13.30±2.34?group II?,13.25±2.63?group III?.Compare group II or group III with group I,difference has statistical significance?P<0.05?.That is,the blood pressure dropped to the same target value,and urapidil and nitroglycerin increased SVV,compared with control group.In addition,HR in group II respectively were 74.66±12.47,71.70±10.42,74.63±10.42 at the beginning of controlled hypotension,after 10min and30min.,which was different in group nitroglycerin.Urapidil had almost no significant effect on HR.Urapidil and nitroglycerin had no obvious effect on CI,compared with the control group.4.No adverse events occurred in all patients.No anesthesia related complications were found in postoperative follow-up.Conclusion:The application of antihypertensive drugs for controlled hypotension can significantly reduce the intraoperative blood loss and the duration of surgery,making the operative field clear and more conductive to the operation.Urapidil had no significant effect on HR of patients,but nitroglycerin could increase the HR.The two antihypertensive drugs had no obvious effect on CI.SVV increased after using antihypertensive drugs and this maybe affects the accuracy of SVV for estimate patients'volume state.