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Efficacy of Preoperative Oral Midodrine in Preventing Hypotension After Spinal Anesthesia in Young Adults: A Randomized Controlled Trial
Anesthesia & Analgesia ( IF 5.7 ) Pub Date : 2022-08-10 , DOI: 10.1213/ane.0000000000006173
Mahmoud Mohammed Alseoudy 1 , Mohamed Osama Nasr , Tamer Ahmed Abdelsalam
Affiliation  

before spinal anesthesia in reducing the occurrence of hypotension. METHODS: This randomized placebo-controlled study embraced 67 patients aged 18 to 40 years undergoing elective knee surgery under spinal anesthesia. Patients were randomized to midodrine group (given 10-mg tablets of midodrine) or placebo group (given placebo tablets), and tablets were administered 1 hour before spinal anesthesia (intrathecal injection of 12.5-mg 0.5% hyperbaric bupivacaine and 15-μg fentanyl). The primary outcome was the occurrence of hypotension, defined as a systolic blood pressure <90 mm Hg or <80% of baseline. Secondary outcomes were hemodynamic characteristics (mean arterial pressure [MAP] and heart rate [HR]) after spinal anesthesia, ephedrine dose, and occurrence of complications including bradycardia, vasovagal attacks, reactive hypertension nausea, vomiting, and shivering. RESULTS: The number of patients who became hypotensive after spinal anesthesia was 5 (14.7%) in midodrine group versus 14 (42.4%) in the placebo group; relative risk (95% confidence interval) was 0.35 (0.14–0.85) (P = .021). The median (interquartile range) total dose of ephedrine was significantly lower in midodrine group 0 (0–10) mg than in placebo group (0 (0–15) mg; the Hodges-Lehmann median difference (95% confidence interval) was 0 (0–5) mg (P = .015). For MAP data, the group × time interaction was significant (P = .038), and the MAP was significantly lower in the placebo group than in the midodrine group after intrathecal injection at 2 minutes (P = .047), 10 minutes (P = .045), 15 minutes (P < .001), 20 minutes (P = .007), 30 minutes (P =.013), 45 minutes (P = .029), 60 minutes (P = .029), and at the end of surgery (P < .001). For HR data, the group × time interaction was nonsignificant (P = .807), and the difference in means (95% confidence interval) between groups collapsing over time was −1.4 (−3.1 to 0.2) beats/min (P = .096). There was no significant difference between the 2 groups regarding the occurrence of complications. CONCLUSIONS: Prophylactic administration of 10-mg midodrine tablets before spinal anesthesia is an effective method in the prevention of hypotension in young adult patients undergoing elective orthopedic knee surgery....

中文翻译:

术前口服米多君预防年轻成人腰麻后低血压的疗效:一项随机对照试验

腰麻前可减少低血压的发生。方法:这项随机安慰剂对照研究包括 67 名年龄在 18 至 40 岁之间、在脊髓麻醉下接受择期膝关节手术的患者。患者随机分为米多君组(给予10mg米多君片)或安慰剂组(给予安慰剂片),在腰麻前1小时给药(鞘内注射12.5mg 0.5%高压布比卡因和15μg芬太尼) . 主要结果是低血压的发生,定义为收缩压 <90 mm Hg 或 < 基线的 80%。次要结果是脊髓麻醉后的血流动力学特征(平均动脉压 [MAP] 和心率 [HR])、麻黄碱剂量和并发症的发生,包括心动过缓、血管迷走神经发作、反应性高血压恶心、呕吐和发抖。结果:腰麻后出现低血压的患者人数在米多君组中为 5 例(14.7%),在安慰剂组中为 14 例(42.4%);相对风险(95% 置信区间)为 0.35 (0.14–0.85) (P = .021)。米多君 0 (0–10) mg 麻黄碱总剂量的中位数(四分位数范围)显着低于安慰剂组(0 (0–15) mg;Hodges-Lehmann 中位数差异(95% 置信区间)为 0 (0–5) mg (P = .015)。对于 MAP 数据,组 × 时间交互作用显着 (P = .038),在鞘内注射后安慰剂组的 MAP 显着低于米多君组2 分钟 (P = .047)、10 分钟 (P = .045)、15 分钟 (P < .001)、20 分钟 (P = .007)、30 分钟 (P = .013)、45 分钟 (P = .029), 60 分钟 (P = .029), 在手术结束时 (P < .001)。对于 HR 数据,组 × 时间交互作用不显着 (P = .807),随着时间的推移,组间塌陷的均值差异(95% 置信区间)为 -1.4(-3.1 至 0.2)次/分钟(P = .807)。 096). 两组在并发症发生方面无显着差异。结论:在脊髓麻醉前预防性服用 10 mg 米多君片是预防接受选择性膝关节骨科手术的年轻成年患者低血压的有效方法。两组在并发症发生方面无显着差异。结论:在脊髓麻醉前预防性服用 10 mg 米多君片是预防接受选择性膝关节骨科手术的年轻成年患者低血压的有效方法。两组在并发症发生方面无显着差异。结论:在脊髓麻醉前预防性服用 10 mg 米多君片是预防接受选择性膝关节骨科手术的年轻成年患者低血压的有效方法。
更新日期:2022-08-10
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