The effect of β-blocker premedication on the surgical field during endoscopic sinus surgery
The effect of β-blocker premedication on the surgical field during endoscopic sinus surgery
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DOI：
10.1097/00005537-200406000-00016
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发表时间：
2004-06-01
期刊：
影响因子：
2.6
通讯作者：
Wormald, PJ
中科院分区：
文献类型：
--
作者：
Nair, S;Collins, M;Wormald, PJ
目的/假说。许多先前的研究试图评估在鼻窦内窥镜手术中低血压对手术视野的影响。这些研究受到样本量不足、缺乏对照组和数据收集有限的限制。本研究的目的是确定常规使用受体阻滞剂作为前用药是否可以改善内窥镜鼻窦手术的手术视野。研究设计。一项前瞻性、随机、双盲、安慰剂对照试验。方法：80例符合纳入和排除标准的内窥镜鼻窦手术患者，随机分配在手术前30分钟接受β -受体阻滞剂美托洛尔（1组）或安慰剂片（2组）。采用标准麻醉方案。在手术开始时和每隔15分钟评估一次手术野、出血量、心率、血压和异氟烷浓度。结果：安慰剂组和受体阻滞剂组的总平均心率有显著差异（P < 0.0001）。在整个组中，手术分级与心率相关（r = 0.36, P < 0.05），但与平均动脉血压无关。安慰剂组和受体阻滞剂组的平均手术分级相似，但在研究早期，受体阻滞剂组的手术范围明显更好（P < 0.001）。平均心率小于60次/分钟的患者的手术分级明显更好（P < 0.02）。结论：虽然在接受受体阻滞剂治疗的患者中存在“最佳”条件，但作者认为分级系统的区别不足以证明组间的显著差异。这项研究的关键发现是整个组的心率和手术分级之间的相关性。在内镜鼻窦手术过程中，麻醉操作应以保持低心率为目的。
Objectives/Hypothesis. A number of previous studies have tried to assess the effects of hypotension on the surgical field during endoscopic sinus surgery. These studies have been limited by inadequate sample sizes, lack of a control group, and limited data collection. The aim of the present study was to determine whether the routine use of beta-blockers as a premedication could improve the operative field in endoscopic sinus surgery. Study Design. A prospective, randomized, double-blinded, placebo-controlled trial. Methods: Eighty patients undergoing endoscopic sinus surgery who fit the inclusion and exclusion criteria were randomly assigned to receive either a beta3-blocker, Metoprolol (group 1), or a placebo tablet (group 2) 30 minutes before surgery. A standard anesthetic protocol was followed. At the commencement of surgery and at regular 15-minute intervals the surgical field, blood loss, heart rate, blood pressure, and isoflurane concentration were assessed. Results: There was a significant difference in overall mean heart rate between the placebo and beta-blocker groups (P < .0001). In the entire group, surgical grade correlated with heart rate (r = 0.36, P < .05) but not with mean arterial blood pressure. Mean surgical grade was similar between the placebo and beta-blocker groups, but early in the study a significantly better surgical field was recorded in the beta-blocker group (P < .001). Surgical grade was significantly better in those with a mean heart rate of less than 60 beats per minute (P < .02). Conclusion: Although "optimum" conditions were present in the patients receiving beta-blocker, the authors thought that the grading system was not discriminating enough to demonstrate a significant difference between the groups. The crucial finding in the study was the correlation between heart rate and surgical grade in the entire group. During endoscopic sinus surgery surgery, anesthetic manipulations should be directed at maintaining a low heart rate.