Effect of Hypotensive Anesthesia on Cerebral Perfusion and Blood Antioxidant Levels and HIF 1a
Słowa kluczowe
Abstrakcyjny
Opis
Controlled hypotension is the voluntary reversible reduction of arterial blood pressure. Hypotensive anesthesia is a method of anesthesia in which blood pressure is reduced in a controlled manner, especially in certain surgeries. İt reduces intraoperative bleeding and need for blood transfusion and provides a clean surgical vision in narrow-field surgeries or with high bleeding potential. Hypotensive anesthesia can be performed according to mean blood pressure (MBP) or systolic blood pressure (SBP).
A non-invasive cerebral oximeter is used to see the changes in the brain due to high oxygen-dependent metabolism during induction and maintenance of anesthesia.
Hypoxia inducible factor (HIF) is a transcription factor involved in cell adaptation mechanism activated in response to hypoxia.
The biological activity of HIF 1 is determined by the expression and activity of the HIF 1a subunit.
Total antioxidant status (TAS) shows the total effect of all antioxidants in the human body and total oxidant status (TOS) shows the total effect of oxidants.
Near Infrared Spectroscopy (NIRS) allows continuous and non-invasive monitoring of cerebral oxygenation. HIF 1a, TAS and TOS are laboratory markers that predict tissue oxygenation and perfusion.
Hypotensive anesthesia can be performed according to both MBP and SBP. However, in our study that follow-up MBP is more advantageous/protective, although it is not supported by very strong data. The investigators recommend hypotensive anesthesia compared to MBP; but further studies are needed.
Daktyle
Ostatnia weryfikacja: | 11/30/2019 |
Pierwsze przesłane: | 11/11/2019 |
Szacowana liczba przesłanych rejestracji: | 11/19/2019 |
Wysłany pierwszy: | 11/21/2019 |
Ostatnia aktualizacja przesłana: | 12/01/2019 |
Ostatnia opublikowana aktualizacja: | 12/02/2019 |
Rzeczywista data rozpoczęcia badania: | 11/13/2018 |
Szacowana data zakończenia podstawowej działalności: | 05/14/2019 |
Szacowana data zakończenia badania: | 06/29/2019 |
Stan lub choroba
Interwencja / leczenie
Procedure: systolic blood pressure (SBP)
Procedure: mean blood pressure (MBP)
Faza
Grupy ramion
Ramię | Interwencja / leczenie |
---|---|
Active Comparator: systolic blood pressure (SBP) Systolic blood pressure (SBP) for group 1 patients 80-90 mmHg | Procedure: systolic blood pressure (SBP) Systolic blood pressure (SBP) 80-90 mmHg remifentanil infusion was applied to Group 1 patients. In addition to remifentanil infusion, 0.002 μg.kg of glycerol trinitrate (Perlinganit) was administered as an intermittent bolus in patients who needed to achieve target blood pressure. All patients received 5-8 ml / kg / h IV infusion of balanced electrolyte solution (Isolyte-S) during the operation.
Hemodynamic parameters (HR, SBP, OCD), BIS, SpO2 and NIRS were recorded at 5 minute intervals. At the end of the operation, 3 ml of blood was taken from the untreated arm of all patients to the HIF1a, TAS and TOS values and sent to the biochemistry laboratory |
Active Comparator: mean blood pressure (MBP) Mean blood pressure (MBP) for group 2 patients 50-65 mmHg | Procedure: mean blood pressure (MBP) For group 2, remifentanil infusion was performed with a mean blood pressure (OCD) of 50-65 mmHg. In addition to remifentanil infusion, 0.002 μg.kg of glycerol trinitrate (Perlinganit) was administered as an intermittent bolus in patients who needed to achieve target blood pressure. All patients received 5-8 ml / kg / h IV infusion of balanced electrolyte solution (Isolyte-S) during the operation.
Hemodynamic parameters (HR, SBP, OCD), BIS, SpO2 and NIRS were recorded at 5 minute intervals. At the end of the operation, 3 ml of blood was taken from the untreated arm of all patients to the HIF1a, TAS and TOS values and sent to the biochemistry laboratory. |
Kryteria kwalifikacji
Wiek kwalifikujący się do nauki | 18 Years Do 18 Years |
Płeć kwalifikująca się do nauki | All |
Przyjmuje zdrowych wolontariuszy | tak |
Kryteria | Inclusion Criteria: - 18-75 years old - ASA Physical Status Classification System 1-2 - Undergoing to Elective rhinoplasty or maxillofacial surgery Exclusion Criteria: - 1. Those with SVO history 2. Patients with carotid stenosis and cardiac failure 3. Chronic smoking 4. Patients with allergies to drugs to be used 5. Patients without intraoperative hypotension 6. Presence of morbid obesity (BMI> 40 kg / m2) 7. Patients who refused to participate in the study Termination criteria 1. Development of severe hypotension and bradycardia during measurements 2. Development of severe drug allergy during follow-up 3. In the event of any complications related to the surgical procedure |
Wynik
Podstawowe miary wyników
1. Evaluation of the relationship between hypotensive anesthesia technique and brain hypoxia by the rate of NIRS [intraoperative 2 hours]
2. Evaluation of the relationship between hypotensive anesthesia technique and tissue hypoxia by HIF1a [Change from Baseline HIF 1a at 2 hours]
3. Evaluation of the relationship between hypotensive anesthesia technique and tissue hypoxia by the concentration of TAS [Change from Baseline TAS levels at 2 hours]
4. Evaluation of the relationship between hypotensive anesthesia technique and tissue hypoxia by the concentration of TOS [Change from Baseline TOS levels at 2 hours]
Miary wyników wtórnych
1. surgical satisfaction [postoperative 1 minute]
2. bleeding scores [postoperative 1 minute]
3. anesthetic consumption [postoperative 1 minute]