20.500.12556/DKUM-76306 Vpliv infuzije efedrina in feniefrina na stabilnost obtočil po subarahnoidni anesteziji pri starejših bolnikih The influence of the infusion of ephedrine and phenylephrine on the hemodynamic stability after subarachnoid anesthesia in senior adults Pri starejših ortopedskih bolnikih v subarahnoidni anesteziji (SA) smo raziskovali vpliv infuzije efedrina ali fenilefrina na hemodinamiko. Metode Prospektivna, randomizirana, dvojno slepa, s placebom nadzorovana raziskava. Po subarahnoidni injekciji levobupivakaina 15 mg smo primerjali infuzijo efedrina 20 mg (skupina E), fenilefrina 250 μg (skupina P) ali fiziološke raztopine (skupina C). Spremljali smo krvni tlak, srčni indeks (CI) in srčni utrip (SU) od 15 min pred subarahnoidnim blokom (SAB) do 30 min po njem. Rezultati V raziskavo smo vključili 70 bolnikov. Povprečni arterijski tlak (SAT) se je bistveno zmanjšal na koncu meritev v primerjavi z izhodiščnim v skupini C, v skupinah P in E pa se je ohranil, in to brez znatnih razlik med skupinama. CI se je zmanjšal po SA v skupini C, se ohranil v skupini P in se znatno povečal v skupini E z znatnimi razlikami med skupinama C in E (p = 0,049) ter skupinama P in E (p = 0,01) na koncu meritev. HR se je po SA v skupinah C in P bistveno zmanjšal, v skupini E pa se je ohranil. Na koncu meritev se je znatno razlikoval med skupinama P in E (p = 0,033). Zaključki Hemodinamske spremembe po SA pri starejših ortopedskih bolnikih je mogoče preprečiti s takojšnjo infuzijo fenilefrina ali efedrina. Z efedrinom se ob krvnem tlaku vzdržuje tudi SU in povečuje CI po SAB. Registracija klinične raziskave: ISRCTN44377602 : We studied the influence of ephedrine or phenylephrine infusion administered immediately after subarachnoid anesthesia (SA) on hemodynamics in elderly orthopedic patients. Methods: A prospective, randomized, double-blind, placebo-controlled study. After a subarachnoid injection of 15 mg of levobupivacaine, the participants received an infusion of either ephedrine 20 mg (E group), phenylephrine 250 mcg (P group) or saline (C group) within 30 min. We measured blood pressure, cardiac index (CI) and heart rate (HR) from 15 min before to 30 min after SA. Results: Seventy patients were studied. At final measurement mean arterial pressure (MAP) decreased significantly in comparison to the baseline value in the C group but was maintained in the P and E, with no significant differences between the groups. CI decreased after SA in the C group, was maintained in the P group, and increased significantly in the E group with significant differences between the C and E group (p = 0.049) and between the P and E (p = 0.01) final measurement. HR decreased significantly after SA in the C and P group but was maintained in the E group, with significant differences between the P and E group (p = 0.033) at final measurement. Conclusions: Hemodynamic changes after SA in elderly orthopedic patients can be prevented by an immediate infusion of phenylephrine or ephedrine. In addition to maintaining blood pressure, the ephedrine infusion also maintains HR and increases CI after SA. ISRCTN registry: ISRCTN44377602 subarahnoidna anestezija hemodinamska stabilnost fenilefrin efedrin starejši Spinal anesthesia Hemodynamic stability Phenylephrine Ephedrine senior adults true true false Slovenski jezik Angleški jezik Doktorsko delo/naloga 2020-05-10 20:12:17 2020-11-27 10:53:40 2022-08-09 13:26:24 2020-11-28 03:17:41 2020 0 Maribor 0 0000-00-00 NiDoloceno NiDoloceno NiDoloceno 0000-00-00 0000-00-00 0000-00-00 39744771 URN:SI:UM:DK:KIQ2OPNF DOK_Zunic_Miodrag_2020.pdf DOK_Zunic_Miodrag_2020.pdf 1 E80162D94BDA66F6779BD5D201B9B245 902fb4c89df249c6a99bc37ae127af69b10c046e2ce9bc2c7dc6fc63a008cae9 03e964d9-7c12-11eb-bb7a-00155d0001ca 20.500.12556/dkum/c4aab44b-1556-4373-9c0d-ce2484554688 https://dk.um.si/Dokument.php?lang=slv&id=147717 Medicinska fakulteta 0 0 0