Efficacy of landiolol in attenuating hemodynamic responses to local epinephrine infiltration in patients undergoing vaginal total hysterectomy

被引：11

作者：

Hirota K. ^{[1
,2
]}

Baba S. ^{[2
]}

Fukushi S. ^{[2
]}

Muraoka M. ^{[2
]}

Matsuki A. ^{[1
]}

机构：

[1] Department of Anesthesiology, Univ. of Hirosaki School of Medicine, Hirosaki 036-8563

[2] Department of Anesthesiology, Kuroishi City Hospital, Kuroishi

来源：

Journal of Anesthesia | 2005年 / 19卷 / 1期

关键词：

β-blocker; Epinephrine; Hypertension; Tachycardia;

D O I：

10.1007/s00540-004-0281-1

中图分类号：

学科分类号：

摘要：

Purpose: Local epinephrine infiltration often causes β1-adrenoceptor-mediated tachycardia, hypertension, and arrhythmia. Landiolol, a short acting β1-adrenoceptor blocker, may represent the most ideal agent to attenuate these adverse effects. In this study, we examined the effects of landiolol on the hemodynamic changes resulting from local infiltration of epinephrine. Methods: Thirty-six patients undergoing vaginal total hysterectomy under general anesthesia were randomly assigned to one of three groups: Control group (n = 12), L5 group (n = 12), and L10 group (n = 12). In the control, L5, and L10 groups, the patients were given saline, landiolol 5 mg, and 10 mg, respectively, just before infiltration of epinephrine(1:300 000; total dose, about 100 μg) into the surgical field. Blood pressure and heart rate was assessed before and 5, 10, 15, 20, 25, 30 min after the initiation of epinephrine infiltration. If systolic blood pressure and heart rate exceeded 160 mmHg and 120 beats·min-1, respectively, Ca blockers of either diltiazem 5 mg or nicardipine 1 mg and/or 2% sevoflurane were given. Results: Epinephrine infiltration significantly increased systolic blood pressure from 122 ± 15 to 170 ± 29 mmHg and heart rate from 63 ± 8 to 106 ± 10 beats·min-1. In both the L5 and L10 groups, the increase in heart rate (from 69 ± 16 to 87 ± 16 beats·min-1, P < 0.01, and from 70 ± 18 to 76 ± 9 beats·min-1, P < 0.01, respectively) was significantly smaller compared to the control group, but the increase in systolic blood pressure was significantly attenuated in the L10 group (from 116 ± 18 to 140 ± 27 mmHg, P < 0.01). The number of patients given either Ca blockers or sevoflurane in the control group was significantly higher than that in the landiolol groups (P < 0.01). Conclusion: The present study suggests that landiolol 10mg may be a more suitable dose than landiolol 5 mg to antagonize hyperdynamic states induced by local administration of epinephrine. © JSA 2005.

引用

页码：17 / 20

页数：3

共 14 条

[1]

Bartos P., Popelka P., Adamcova P., Struppl D., Adrenalin versus terlipressin: Blood loss and cardiovascular side-effects in the vaginal part of laparoscopically-assisted vaginal hysterectomy or vaginal hysterectomy, Clin. Exp. Obstet. Gynecol., 27, pp. 182-184, (2000)

[2]

Pontinen P.J., Cardiovascular effects of local adrenaline infiltration during neurolept analgesia and adrenergic beta-receptor blockade in man, Acta Anaesthesiol. Scand., 22, pp. 145-153, (1978)

[3]

Murakawa T., Koh H., Tsubo T., Ishihara H., Matsuki A., Two cases of circulatory failure after local infiltration of epinephrine during tonsillectomy, Masui Jpn. J. Anesthesiol., 47, pp. 955-962, (1998)

[4]

Matsumae T., Circulatory disaster following infiltration of epinephrine contained in local anesthetic, Masui Jpn. J. Anesthesiol., 48, pp. 1020-1023, (1999)

[5]

Hayashi Y., Sumikawa K., Kamibayashi T., Yamatodani A., Mammoto T., Kuro M., Yoshiya I., Selective beta1 and beta2 adrenoceptor blockade on epinephrine-induced arrhythmias in halothane anaesthetized dogs, Can. J. Anaesth., 39, pp. 873-876, (1992)

[6]

Dimich I., Lingham R., Narang J., Sampson I., Shiang H., Esmolol prevents and suppresses arrhythmias during halothane anaesthesia in dogs, Can. J. Anaesth., 39, pp. 83-86, (1992)

[7]

Maze M., Hayward Jr. E., Gaba D.M., Alpha1-adrenergic blockade raises epinephrine-arrhythmia threshold in halothane-anesthetized dogs in a dose-dependent fashion, Anesthesiology, 63, pp. 611-615, (1985)

[8]

Kitamura A., Sakamoto A., Inoue T., Ogawa R., Efficacy of an ultrashort-acting β-adrenoceptor blocker (ONO-1101) in attenuating cardiovascular responses to endotracheal intubation, Eur. J. Clin. Pharmacol., 51, pp. 467-471, (1997)

[9]

Low J.M., Harvey J.T., Cooper G.M., Prendiville W.J., Plasma concentrations of catecholamines following adrenaline infiltration during gynaecological surgery, Br. J. Anaesth., 56, pp. 849-853, (1984)

[10]

Hoffman B.B., Lefkowitz R.J., Catecholamines, sympathomimetic drugs, and adrenergic receptor antagonists, Goodman & Gilman's The Pharmacological Basis of Therapeutics, pp. 199-249, (1996)

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