Urapidil Research Articles

Возможности урапидила при остром нарушении мозгового кровообращения (обзор литературы и собственные наблюдения)

У подавляющего большинства пациентов с острым нарушением мозгового кровообращения (ОНМК) наблюдается артериальная гипертензия. Не рекомендуется рутинное снижение артериального давления (АД) в остром периоде острого нарушения мозгового кровообращения. Неотложная гипотензивная терапия показана при повышении цифр АД до 220/120 мм рт.ст., ее следует применять с осторожностью при сочетании ОНМК с сердечной недостаточностью, аортальной диссекцией, острым инфарктом миокарда, острой почечной недостаточностью, при необходимости проведения тромболизиса. Препарат выбора в остром периоде ОНМК — урапидил, инъекционная и капсулированная форма. Урапидил является эффективным и безопасным средством гипотензивной терапии при остром нарушении мозгового кровообращения. Он вызывает более быстрое и стойкое снижение систолического и диастолического АД при отсутствии компенсаторной тахикардии. Урапидил улучшает эмоциональный фон больных, наблюдается высокий комплайенс к терапии.

Effect of transcutaneous electrical acupoint stimulation combined with general anesthesia on intraoperative and postoperative recovery in patients undergoing carotid artery stenting

Objective To investigate the effect of transcutaneous electrical acupoint stimulation (TEAS) combined with general anesthesia on intraoperative medication and postoperative recovery in patients undergoing carotid artery stenting (CAS). Methods Eighty-two patients with CAS under general anesthesia were randomly divided into the transcutaneous electrical acupoint stimulation combined with general anesthesia group (group T, n=40) and the traditional general anesthesia control group (group C, n=42). The surgical side acupoints of the body for acupuncture were selected as, Shuigou and Baihui, Hegu and Waiguan. For patients in group T, the electrodes were pateched pasted at the corresponding locations and were stimulated by HANS. For the patients in group C, the electrodes were placed at the same location but not stimulated by HANS. The blood pressure and heart rate are maintained within in the (1±20)% range of the baseline. The hemodynamic changes during the operation, the use of vasoactive drugs and the postoperative recovery of the patients were recorded. Results After 30 min of the transcutaneous electrical acupoint stimulation, the blood pressure in the group T was lower than the level of baseline (P 0.05). At 5 min before extubation and 5 min after extubation, the heart rate of patients in group T was lower than that of patients in group C (P 0.05). There was no statistical difference in among the number of cases and total amount of dopamine, atropine and urapidil in the two groups (P>0.05). The amount of remifentanil used in group T was less than that in group C (P 0.05). The time of respiration recovery, wake-up time and extubation time in the group T were less than those in group C (P 0.05). The numbers of patients with postoperative moderate pain (VAS score more than 4 points above) were analyzed at 9 am and 4 pm at one day after the operation. The incidence of postoperative moderate pain in group T was significantly lower than the incidence in group C (P<0.05). Conclusions TEAS combined with general anesthesia for CAS surgery can stabilize hemodynamics changes, reduce analgesic remifentanil consumption, shorten the wake-up time and extubation time after surgery, reduce the incidence of postoperative pain, and improve the patients′ satisfaction with anesthesia. Key words: Transcutaneous electrical acupoint stimulation; Carotid artery stenting; Anesthesia, general; Postoperative recovery

Development of cerebral anoxia during controlled hypotension with nicardipine or urapidil after carotid endarterectomy

Objective To evaluate the development of cerebral anoxia during controlled hypotension with nicardipine or urapidil after carotid endarterectomy in patients. Methods Forty-four patients of either sex, aged 48-64 yr, scheduled for elective carotid endarterectomy under general anesthesia, requiring controlled hypotension after operation, were divided into nicardipine group (group N) and urapidil group (group U) using a random number table method, with 22 patients in each group. Nicardipine at 2.5 μg·kg-1·min-1 was intravenously infused in group N, and urapidil 2 μg·kg-1·min-1 was intravenously infused in group U. After systolic blood pressure was decreased to 130-140 mmHg, the consumption of nicardipine was adjusted to 0.2-0.5 μg·kg-1·min-1 and the consumption of urapidil to 1-2 μg·kg-1·min-1 in group N and group U, respectively, to maintain systolic pressure at 130-140 mmHg. Heart rate (HR), cardiac index (CI), bispectral index (BIS) value, regional cerebral oxygen saturation (rSO2) and end-tidal pressure of carbon dioxide (PETCO2) were recorded after entering the operating room (baseline), at the beginning of controlled hypotension (T1), and at 5, 10, 20, 30, 60 and 120 min after systolic blood pressure was decreased to the target hypotension (T2-7). Development of cerebral anoxia (the relative decrease in rSO2 >12% of the baseline value) was recorded in controlled hypotension period. Results Compared with the value at T1, the HR at T2, 3 and CI at T3-7 were significantly increased (P 0.05), and rSO2 was significantly decreased at T3-7 (P 0.05). Compared with group N, the HR at T2, 3, CI at T3-7 and rSO2 at T3-7 were significantly decreased in group U (P<0.05). The incidence of cerebral anoxia was significantly higher in group U than in group N (P<0.05). Conclusion Controlled hypotension with nicardipine is recommended after carotid endarterectomy in order to avoid the development of cerebral anoxia in the patients. Key words: Nicardipine; Hypotension, controlled; Endarterectomy, carotid; Urapidil

Effects of stellate ganglion block on the circulation stability of lower extremity tourniquet and endotracheal intubation

Objective To examine the effect of ultrasound-guided stellate ganglion block (SGB) on the tourniquet reaction of the lower limbs. Methods A total of sixty patients undergoing unilateral knee replacement surgery under general anesthesia were divided into 2 groups (n=30): control group and group SGB. The age of patients was 18-75 years old with ASA gradeⅠ,Ⅱ. Before general anesthesia, 1% lidocaine (10 ml) was injected into the right deltoid muscle in control group, but in the right cervical stellate ganglion in group SGB. HR, SBP, BIS and drug doses were recorded at various time points: before induction of anesthesia (T0), before intubation (T1), 1 min after intubation (T2), before tourninquet inflated (T3), tourniquet inflatable 30 min (T4), tourniquet inflation 1 h (T5), tourniquet deflation(T6), tourniquet deflation 3 min (T7) and tourniquet deflation 30 min (T8) after discharge. Results Compared with control group, group SGB showed significantly lower SBP at T2, T5, T6 and T7 (P 0.05). There was no significant difference in the BIS, the doses of propofol, remifentanil, ephedrine and phenylephrine between the two groups, while the dose of urapidil in group SGB was significantly less than control group. Conclusions SGB can reduce the cardiovascular response to the tourniquet and maintain stable perioperative circulation. Key words: Stellate ganglion block; Tourniquet

A comparison between nicardipine and urapidil used for management of intracerebral hemorrhage

Objective To compare the efficacy and safety of nicardipine versus urapidil in blood pressure (BP) management during the acute phase of intracerebral hemorrhage (ICH). Methods ICH patients admitted in Emergency Intensive Care Unit of Shenzhen People’s Hospital from March, 2013 through March, 2016 were retrospectively studied. Patients were enrolled as nicardipine group or urapidil group depending on the initial antihypertensive drug given at admission. The differences in rate of patients reached the goal BP within the first 24 h, time required for getting goal BP, blood pressure variability (BPV), rebleeding or hematoma expansion during the first 24 h, cerebral state index (CSI) within 7 days and 28-day mortality were compared between the two groups. The differences in adverse events including bradycardia, tachycardia and hypotension were also compared between two groups. An independent t test and χ2 test were performed to compare different variables. An analysis of variance of repeated measurement was performed to compare CSI within 7 days between two groups. Results Seventy-seven patients were included with 42 in nicardipine group and 55 in urapidil group. Rate of patients getting goal BP in nicardipine group was (94±5)% and (86±11)% in urapidil group (P 0.05). Through analysis of variance of repeated measurement, CSI in nicardipine group improves more rapidly than that in urapidil group (F=1 581.115, P=0.000). Hypotension, bradycardia and tachycardia were also comparable between groups (P>0.05). Conclusion Compared with urapidil, nicardipine produces effect more rapidly with more stable BP and higher rate of patients with ICH getting goal BP. Moreover, the application of nicardipine may be better to improve the CSI of ICH patients. Key words: Urapidil; Nicardipine; Blood pressure; Verebral hemorrhage; Acute phase; Cerebral state index

Clinical research on urapidil decompression time in patients with hypertension in recovery period of general anesthesia

Objective To discuss the best time of urapidil decompression in patients with hypertension during recovery period of general anesthesia.Methods A retrospective analysis was carried out to study the clinical data of 90 cases with hypertension from March 2009 to April 2013 in our hospital.And the cases were divided into three groups according to random number table,30 cases in each group.Group A was given urapidil step-down 5 min before tracheal extubation,group B was given urapidil stepdown blood pressure began to rise immediately,group C was given urapidil step-down electrical double index (BIS) of 70 immediately,three groups were compared in the patient's heart rate (HR),mean arterial pressure(MAP) fluctuation trend and heart cerebrovascular accident happening.Results (1) It did not show statistical significant differences between the three groups on general data of sex,age,weight,intraoperative blood loss and fluid volume (P ＞ 0.05),which was comparable.(2) Then we compared with the To (in the operation room),the HR of each time point in the three groups was significantly increased,the MAP in group A after administration of 10 min and in group B after administration of 1 min were significantly increased.Compared with those of group B and C,the MAP after T5 in group A was significantly increased.Compared with group A and group C,the MAP after T3 in group B was significantly increased.It showed statistical significant differences between them (P ＜ 0.05).There was no statistical significant differences about HR between each group at each time point (P ＞ 0.05).(3) It had no statistical significant differences about cardiovascular and cerebrovascular accident (bradycardia,sychnosphygmia,hypopiesia and hypertension) between the three groups (P ＞ 0.05).Conclusion Giving urapidil at BIS rose to 70 immediately in recovery period of general anesthesia,can significantly reduce blood pressure,ensure more stable hemodynamics,and it is worthy of further promotion. Key words: Hypertension; Recovery period of general anesthesia; Decompression time; Urapidil; Hemodynamics

Efficacy of urapidil, nifedipine and nitroglycerin for the treatment of postoperative hypertension after tumorectomy

Objective To compare the clinical efficacy and safety of sublingual nifedipine,intravenous urapidil and micropump nitroglycerin in the treatment of APH (acute postoperative hypertension).Methods A retrospective study was conducted to analyze clinical data of 497 patients with AHP undergoing tumor resection from July 2007 through December 2010.Patients received antihypertensive treatment for APH; hypertension occurred within 24 hours after surgery; patients received no long-acting antihypertensive agents within 24 hours.Patients with a previous history of coronary heart disease,arrhythmia,stroke and incomplete clinical data were excluded.All patients were divided into three groups.Nifedipine group,10 mg nifedipine tablet was administered sublingually; urapidil group,12.5 mg of urapidil was diluted in 20 ml normal saline and administered by intravenous injection; nitroglycerin group,25 mg of nitroglycerin was diluted in 40ml normal saline and infused intravenously by a micropump.The x2 test was employed to compare the efficacy and safety among different treatment.Results Treatment with sublingual nifedipine caused a reduction of the systolic blood pressure by 5.8％,and diastolic blood pressure by 4.7％.Treatment with intravenous urapidil caused a reduction of the systolic blood pressure by 11.1％,and diastolic blood pressure by 8.4％.Treatment with micropump nitroglycerin caused a reduction of the systolic blood pressure by 13.1％,and diastolic blood pressure by 10.2％.There is not different between intravenous urapidil and micropump nitroglycerin (63.4％ vs 57.8％,P =0.506).Intravenous urapidil and micropump nitroglycerin were associated with a significantly higher rate of blood pressure control than sublingual nifedipine (63.4％ vs 33.3％,P =0.000; 57.8％ vs 33.3％,P =0.001).The frequency of cardio-cerebrovascular events in intravenous urapidil group was similar to that in sublingual nifedipine group (6.9％ vs 4.7％,P =0.345),but it was significantly higher in micropump nitroglycerin group compared with intravenous urapidil group and sublingual nifedipine group.(24.4％ vs 6.9％,P =0.001 ; 24.4％ vs 4.7％,P =0.000).Conclusions Considering therapeutic effect and safety,we concluded that intravenous administration of urapidil was more suitable for the treatment of APH compared with sublingual nifedipine and micropump nitroglycerin. Key words: Urapidil ; Nifedipine ; Nitroglycerin ; Acute postoperative hypertension; Carcinoma; Treatment effects ; Safety; Retrospectively analysis

Alleviate side effect of post-anesthesia recovery in patients with esophageal surgery by infusing different doses of dexmedetomidine

Objective To observe alleviation of side effect in post-anesthesia recovery patients with esophageal surgery by continuous infusion of different doses of dexmedetomidine (DEX).Methods A total of 60 patients with esophageal cancer surgery were randomly divided into three groups,20 patients in each group.Before induction of anesthesia,0.8 μg/kg of DEX were pumped into patients of group D,then 0.4 μg·kg-1·h-1 of DEX were continuously infused till the end of surgery in group D1.0.2 μg·kg-1·h-1 of DEX were continuously infused till the end of surgery in group D2.patients of group C were continuously infused saline as controls.Mean artery pressure(MAP) and heart rate(HR) were recorded once in the recovery room(T1),extubation time(T2) and five min after extubation(T3).The recovery time,agitation score and Ramsay score were recorded,the Urapidil injection 25 mg or the esmolol injection 20 mg were given while blood pressure was＞180 mm Hg/100 mm Hg(1 mm Hg=0.133 kPa) or HR was＞110 bpm.Results the recovery time of group D1(30.3±4.7) min was significantly higher than group D2 and group C(P＜0.05),group D2 and group C had no difference (P＞0.05).MAP and HR of group D1 and group D2 at extubation were significantly higher than the recovery room.MAP and HR in group C at T2 (117±12) mm Hg,(107±8) bpm and T3 (108±9) mm Hg,(118±11) bpm were significantly increased compared with the recovery room (P＜0.05).MAP and HR in group D1(88±8) mm Hg,(79±5) bpm and group D2(93±8) mm Hg,(81 ±6) bpm at T2 were significantly descreased compared with group C.the dosage of urapidil and esmolol in group C were significantly increased compared with group D.agitation score of group C (2.9±0.4) significantly higher than group D1 (1.2±0.8) and group D2(1.4±0.6) (P＜0.05).the sedation score of group C (1.1 ±0.5) significantly lower than group D1 (4.5±1.2) and group D2(4.0±0.7)(P＜0.05).Conclusions DEX was able to alleviate the side effect of patients in post-anesthesia recovery.0.2 μg·kg-1 ·h-1 of DEX will not affect the recovery time and can inhibit postoperative agitation,and reduce the adverse effects in the anesthesia recovery period. Key words: Dexmedetomidine; Esophageal surgery; General anesthesia recovery period; Side effect

Effect of dexmedetomidine on responses to endotracheal extubation during recovery from general anesthesia in patients with hypertension:a multicenter, randomized, blind, placebo-controlled clinical trial

Objective To evaluate the effects of dexmedetomidine on the responses to endotracheal extubation during recovery from general anesthesia in patients with hypertension in a muhicenter,randomized,blind,placebo-controlled clinical trial.Methods Five hundred and eighty ASA Ⅱ or Ⅲ patients with hypertension from 26 centers of both sexes,aged 18-64 yr,weighing 40-100 kg,scheduled for elective surgery under general anesthesia,expected surgery time 1-4 h,requiring endotracheal extubation after surgery,were randomly divided into 4groups (n =145 each):control group (group C) and different doses of dexmedetomidine group (group D1-3).Anesthesia was induced with iv injection of midazolam,fentanyl,propofol,and rocuronium or vecuronium.The patients were mechanically ventilated after tracheal intubation.Anesthesia was maintained with inhalation of sevoflurane and intermittent iv boluses of fentanyl and rocuronium or vecuronium.Dexmedetomidine 0.4,0.6 and 0.8 μg/kg (10 ml) were infused intravenously over 10 min starting from 30 min before the end of operation in groups D1-3,respectively.While the equal volume of normal saline was administered instead in group C.The patients were sent to postanesthesia care unit after extubaion.The time for recovery of spontaneous breathing,emergence time,time for recovery of orientation and time for Aldrete score ≥ 9 were recorded.The occurrence of adverse events and amount of vasoactive drugs used were also recorded.Results Compared with group C,the incidence of severe tachycardia and requirement for urapidil were significantly decreased in groups D1-3,and the incidence of severe hypertension was decreased in group D3 (P ＜ 0.05).There was no significant difference in the other indexes among the four groups (P ＞ 0.05).Conclusion Dexmedetomidine 0.8 μg/kg infused intravenously and slowly before the end of surgery can effectively inhibit the responses to endotracheal extubation during recovery form general anesthesia in patients with hypertension. Key words: Dexmedetomidine ; Anesthesia recovery period ; Hypertension ; Hemodynamics ; Postoperative complications

Comparison of 7 α(1)-adrenoceptor antagonists in patients with lower urinary tract symptoms associated with benign prostatic hyperplasia:a short-term crossover study.

A crossover study was conducted to identify the best α1-adrenoceptor (α1AR) antagonist for individual patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). One hundred thirteen patients (mean age 70.8 years) were enrolled. All patients met BPH clinical study guidelines. Seven agents were utilized:tamsulosin 0.2mg, silodosin 8mg, urapidil 60mg, naftopidil 50mg, prazosin 1mg, terazosin 2mg, and doxazosin 1mg. Patients were initially prescribed tamsulosin or silodosin for a week and then urapidil for a week. Two weeks later, they were prescribed the better of the 2 agents for a week and a new agent for the next week. This cycle was repeated until all 7 agents were tested. Efficacy was evaluated with the International Prostate Symptom Score. The agent rankings were doxazosin (25 [22%]), silodosin (22 [19%]), urapidil (19 [17%]), naftopidil (17 [15%]), terazosin (12 [11%]), tamsulosin (11 [10%]), prazosin (7 [6%]). Only 12 patients (11%) changed agents after the crossover study was completed. The major reason was adverse events (83%). We found that each of the 7 α1AR antagonists has its own supporters. Further, the one-week crossover study was useful in identifying the best agent for the treatment of each individual with LUTS.

Efficacy of different target concentrations of etomidate in combination with midazolam, fentanyl and rocuronium used to induce anesthesia for tracheal intubation

Objective To compare the efficacy of different target concentrations of etomidate in combination with midazolam,fentanyl and rocuronium used to induce anesthesia for tracheal intubation.Methods Eighty ASA Ⅰ or Ⅱ and Mallampati Ⅰ or Ⅱ patients of both sexes,aged 25-50 yr,weighing 57-76 kg,scheduled for elective non-cardiac surgery under general anesthesia,were randomly allocated into 4 groups according to the target effect-site concentration of etomidate (n =20 each) ∶ 0.5 μg/ml group (group E0.5),0.7 μg/ml group (group E0.7),0.9μg/ml group (group E0.9) and 1.1 μg/ml group (group E1.1).The patients were unpremedicated.Anesthesia was induced with midazolam 0.05 mg/kg,fentanyl 3 μg/kg,rocuronium 0.6 mg/kg and etomidate given by target-controlled infusion.When the effect-site concentration of etomidate reached 0.5,0.7,0.9 or 1.1 μg/ml,endotracheal intubation was performed.Auditory evoked potential index was recorded before induction of anesthesia (baseline),immediately before intubation,during insertion of the laryngoscope,and at 1,3 and 5 min after intubation.Myoclonus,injection pain,the requirement for vasoactive agents and burst suppression (BS) were recorded during induction of anesthesia.Results Compared with group E0.5,the requirement for urapidil was significantly decreased in group E0.7,the requirement for esmolol and urapidil was significantly decreased and the incidence of BS was increased in group E0.9,the requirement for esmolol and urapidil was significantly decreased,and the requirement for atropine and ephedrine and incidence of BS were increased in group E1.1 (P ＜ 0.05).The incidence of BS was significantly higher in group E0.9,and the requirement for atropine and incidence of BS were significantly higher in group E1.1 than in group E0.7 (P ＜ 0.05).The incidence of BS was significantly higher in group E1.1 than in group E0.9 (P ＜ 0.05).There was no significant difference in auditory evoked potential index and incidences of myoclonus and injection pain among the four groups (P ＞ 0.05).Conclusion The optimum target concentration of etomidate is 0.7μg/ml when combined with midazolam,fentanyl and rocuronium used to induce anesthesia. Key words: Etomidate ; Drug release systems ; Midazolam ; Fentanyl; Androstanols ; Intubation,intratracheal

Effect of single-dose dexmedetomidine on general anesthesia in laparoscopic cholecystectomy

Objective To observe the effect of single dose dexmedetomine (Dex) on general anesthesia in laparoscpic cholecystectomy.Methods Fifty ASA Ⅰ -Ⅱ patients of both sexes,aged 21 y-57 y,weighing 42.5 kg-80 kg undergoing elective laparoscopic cholecystectomy (LC),were randomly divided into 2 groups (n=25):dexmedetomidine (Dex) group (group D) and control group (group C).Group C received normal saline 10 ml given within 10 min.Group D received equal volume of Dex 0.6 μg/ kg intravenously as group C.MAP and HR were recorded at the time points of pre-administration of Dex (T0),5 min after administration(T1),before anesthesia induction(T2),1 min and 2 min after injecting propofol respectively(T3-4),immediately after intubation (T5),1,3 min and 5 min after intubation (T6～8).The following variables were also recorded:duration of anesthesia and operation,extubation time,regain consciousness time,coughing when extubating,consumption of propofol and sufentanil,and frequency of using vasoactive drugs.Results The occurrence of coughing when extubating was decreased (5 vs 14,P＜0.05),and the requirements of propofol,sufentanil,urapidil and esmolol were decreased [(385±120) mg vs (493±158) mg,P＜0.05; (33±7)μg vs (38±6) μg,P＜0.01; 4 vs 12,P＜0.05; 4 vs 11,P＜0.05)],but the requirement of atropine was increased in group D than in group C(6 vs 2,P＜0.05).Compared with To or every time points of group D,MAP was significantly decreased at T3-8 in group C (P＜0.05).MAP was significantly high in group D at T1 (P＜0.05).HR was significantly low in group C at T4 and T5 (P＜0.05).In addition,HR decreased in group D at T1-8(P＜0.05 ),and HR was lower in group D than in group C at T1-3 and T6-8(P＜0.05 ).Conclusion 0.6 μg/ kg Dex given intravenously before induction is beneficial to general anesthesia patients undergoing laparoscopic cholecystectomy. Key words: Dexmedetomidine; Laparoscopic cholecystectomy; General anesthesia

Efficacy of different doses of urapidil in preventing pituitrin-induced cardiovascular responses in patients undergoing laparoscopic myomectomy

Objective To evaluate the efficacy of different dones of urapidil in preventing pituitrin-induced cardiovascular responses in patients undergoing laparoscopic myomectomy.Methods Sixty ASA Ⅰ or Ⅱ patients,aged 27-41 yr,weighing 55-65 kg,scheduled for elective laparoscopic myomectomy under general anesthesia,were randonly divided into 4 groups (n =15 each):control group (group C) and urapidil 0.3,0.5 and 0.8 mg/kg groups (groups U1-3).Urapidil 0.3,0.5 and 0.8 mg/kg were injected intravenously in U1-3 groups respectively,while normal saline 5 ml was given in group C.The mixture of pituitrin 6 U and normal saline 20 ml was injected into the site of hysteromyoma 5 min later.The operation was then started.BIS value was maintained at 45-55.The occurrence of cardiovascular responses was recorded.Results The incidences of cardiovascular responses were 100％,67％,40％ and 20％ in groups C and U1-3 respectively.The incidence of cardiovascular responses was significantly lower in groups U1-3 than in group C,and in groups U2.3 than in group U1 ( P ＜ 0.01 ).There was no significant difference in the incidence of cordiovascular responses between U2 and U3 groups (P ＞ 0.05).Conclusion Urapidil can prevent pituitrin-induced cardiovascular responses in patients undergoing laparoscopic myomectomy and the optimal dose is 0.5 mg/kg. Key words: Piperazines; Pituitary hormones, posterior; Laparoscopy; Leiomyoma; Gynecologic surgical procedures; Hemodynamics

Efficacy of ultrasound-guided lower extremity nerve block combined with general anesthesia with laryngeal mask airway in patients undergoing total knee arthroplasty

Objective To evaluate the efficacy of uhrasound-guided lower extremity nerve block combined with general anesthesia with laryngeal mask airway in patients undergoing total knee arthroplasty.Methods Forty ASA Ⅰ-Ⅲ patients of both sexes,aged 52-80 yr,weighing 67-94 kg,undergoing total knee arthroplasty under general anesthesia,were randomly divided into 2 groups(n=20 each).Group Ⅰ received combined intravenous-inhalational anesthesia with endotracheal tube.Group Ⅱ received lower extremity nerve block guided by ultrasound and then combined intravenous-inhalational anesthesia with laryngeal mask airway.HR was maintained at 50-100bpm,MAP was maintained at the preoperative baseline level(increase or decrease amplitude<20%of the baseline level)during operation and in pestanesthesia care unit(PACU)and vasoaetive drugs(atropine,esmolol,efedrina,urapidil or labetalol)were given when necessary.The patients received patient-controlled intravenous analgesia with tramedol and lornoxicam(background infusion 2 ml/h,bolus dose 1 ml,lockout interval 15 min)after operation and VAS score was maintained at≤2.The requirement for vasoactive drugs during operation and in PACU,PACU stay length,and consumption of analgesics and occurrence of nausea and vomiting within 24 h after operation were recorded.Results Compared with group Ⅰ,the requirement for all vasoaetive drugs during operation and for esmolol,urapidil and labetalol in PACU was significantly reduced,PACU stay length Was significantly shortened,and the consumption of analgesics and incidence of nausea and vomiting were significantly reduced in group Ⅱ(P<0.01).Conclusion Ultrasound-guided lower extremity nerve block combined with general anesthesia with laryngeal mask airway provides better emcacy with fewer complications and less consumption of postoperative analgesics than general anesthesia with endotracheal tube in patients undergoing total knee arthroplasty. Key words: Ultrasonography; Nerve block; Laryngeal masks; Anesthesia,general; Arthroplasty,replacement,knee

The efficacyh of urapidil and captopril in the treatment of hypertensive urgencies

Objective To explore the efficacy of urapidil and captopril in the treatment of hypertensive urgencies. Methods 60 patients with hypertensive urgencies in our hospital from January 2009 to January 2010 were randomly assigned to receive sublingual captopril (control group) or intravenous urapidil (study group). Results Levels of SBP, DBP, and HR did not differ significantly between the two groups at different time points (P＞0.05). There was significant difference in the total effective rate between the study group and the control group (96.67% vs. 93.33%, P＞0.05). No obvious adverse reactions were found in the two groups. Conclusions Both urapidil and captopril are effective in the treatment of hypertensive urgencies. Key words: Urapidil; Captopril; Hypertensive urgencies

Comparison of efficacy of sevoflurane combined anesthesia and propofol combined anesthesia in elderly patients

Objective To compare the efficacy of sevoflurane combined anesthesia and propofol combined anesthesia in elderly patients undergoing abdominal surgery.Methods Sixty patients aged 65-80 yr scheduled for elective abdominal surgery under general anesthesia were randomly divided into 2 groups (n = 30 each): sevoflurane group (group S) and propofol group (group P).Anesthesia was induced with TCI of sufentanil and propofol.The initial target effect-site concentration (Ce) of sufentanil was set at 0.25 ng/ml and initial target plasma concentration (Cp) of propofol set at 2.0 μg/ml,and then both concentrations were increased in 0.5 μg/ml increment when they reached the balance until loss of consciousness.Tracheal intubation was facilitated with rocuromitm 0.6 mg/kg and the patients were mechanically ventilated.Anesthesia was maintained with inhalation of sevoflurane (end-tidal concentration set at 1.0%-2.0%) in group S,TCI of prepofol (Cp set at 2-4 μg/ml) in groups P, and sufentanil by TCI ( Ce set at 0.15 ng/ml) and iv infusion of vecurenium 0.15 mg·g-1·h-1 in both groups..BIS value was maintained at 40-60,and changes of MAP and HR were less than 30% of the baseline value in both groups.The use of vasoactive drugs during perioperative peried,time of awakening,extubation and consciousness were recorded and compared between the 2 groups.Results The usage rate of urapidil was significantly decreased,and the awakening time,extubation time and consciousness time shortened in group S compared with group P.Conclusion Sevoflurane-sufentanil combined anesthesia provides better hemodynamic stability and faster recovery than propofol-sufentanil combined anesthesia in elderly patients. Key words: Aged; Anesthetics,inhalation; Propofol; Sufentanil

Urapidil has a less profound effect on HR than doxazosin,

Urapidil has a less profound effect on HR than doxazosin,

Chronic alpha1-adrenoreceptor blockade produces age-dependent changes in rat thymus structure and thymocyte differentiation.

In order to examine the influence of chronic alpha1-adrenergic receptor (alpha1-AR) blockade on the thymus structure and T-cell maturation, peripubertal and adult male rats were treated with urapidil (0.20 mg/kg BW/d; s.c.) over 15 consecutive days. Thymic structure and phenotypic characteristics of the thymocytes were assessed by stereological and flow cytometry analysis, respectively. In immature rats, treatment with urapidil reduced the body weight gain and, affecting the volume of cortical compartment and its cellularity decreased the organ size and the total number of thymocytes compared to age-matched saline-injected controls. The percentage of CD4+8- single positive (SP) thymocytes was decreased, while that of CD4-8+ was increased suggesting, most likely, a disregulation in final steps of the positively selected cells maturation. However, alpha1-AR blockade in adult rats increased the thymus weight as a consequence of increase in the cortical size and cellularity. The increased percentage of most immature CD4-8- double negative (DN) cells associated with decreased percentage of immature CD4+8+ double positive (DP) thymocytes suggests a decelerated transition from DN to DP stage of T-cell development. As in immature rats, the treatment in adult rats evoked changes in the relative numbers of SP cells, but contrary to immature animals, favoring the maturation of CD4+8- over CD4-8+ thymocytes. These results demonstrate that: i) chronic blockade of alpha1-ARs affects both the thymus structure and thymocyte differentiation, ii) these effects are age-dependent, pointing out to pharmacological manipulation of alpha1-AR-mediated signaling as potential means for modulation of the intrathymic T-cell maturation.

Hypertensive Krisen endokriner Ursache am Beispiel des Ph�ochromozytoms

Die Kenntnis des Spektrums der Symptomatologie des Phaochromozytoms und der Phaochromozytomkrise sind unabdingbare Voraussetzungen fur das Erkennen der Erkrankung, der Vermeidung einer kontraindizierten und deletaren Betablocker-Applikation ohne initiale Alpha-Blockade sowie der Bahnung der richtigen Diagnostik. Die biochemische Sicherung der Verdachtsdiagnose erfolgt heute unkompliziert uber die Bestimmung der Katecholamine und der Metanephrine im 24h-Sammelurin. Nach erfolgter Lokalisationsdiagnostik ist die praoperative pharmakologische Therapie entscheidend fur die Vermeidung von Komplikationen und Endorganschaden. Fur die praoperative Therapie wird eine initiale Alpha-Blockade mittels des nicht-spezifischen, nicht-kompetitiven, irreversiblen α-Rezeptorantagonisten Phenoxybenzamin dringend empfohlen. Nach einer maximal moglichen Auftitrierung bis zur Normotonie und bis zum Auftreten orthostatischer Beschwerden folgt die Applikation eines nicht-kardioselektiven Beta-Blockers, z. B. Propranolol. Durch konsequente Befolgung dieser Richtlinien sowie durch verbessertes Monitoring und Fortschritte in der Anasthesie konnten die perioperativen Komplikationen deutlich gesenkt werden. Hinsichtlich der Notfalltherapie der hypertensiven Krise beim Phaochromozytom ware Phentolamin prinzipiell das Mittel der Wahl. Aufgrund schwieriger Verfugbarkeit (importierbar uber die Auslands-Apotheke) ist hier Urapidil eine gute Alternative. Beim Gebrauch von Nitroprussid-Natrium sind komplexere pharmakologische und toxikologische Effekte zu beachten.

The mechanism of enuresis with urapidil discussed

The mechanism of enuresis with urapidil discussed