The Effect Of Three Different Methods Of General Anesthesia Combined With Controlled Hypotension Induced By Sodium Nitroprusside On The Renal Function

ObjectiveTo study the effect of hemodynamics and the renal function made by combination of three different methods of general anesthesia with controlled hypotension with Sodium Nitroprusside(SNP).MethodsThirty patients,ASAⅠ～Ⅱ,scheduled for oral and maxillofacial plastic surgery, were randomly divided into three groups.All of them were under the condition of controlled hypotension induced by SNP.Groupâ… :isoflurane-fentanyl group(n =10); groupâ…¡:isoflurane-propofol-fentanyl group(n =10);groupâ…¢:propofol-remifentanil group(n =10).The objectives of anesthesia were to reduce MAP by 30%and to maintain more than 40 minutes.Before anesthesia(T₀);before controlled hypotension (basic values,T₁);10 minutes(T₂),20 minutes(T₃),40 minutes(T₄)after controlled hypotension;2 minutes(T₅),5 minutes(T₆),10 minutes(T₇),15 minutes(T₈),20 minutes(T₉)after stopping controlled hypotension,to record the date of these parameters:systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP)and heart rate(HR),RPP(SBP×HR)value,pulse oxygen saturation(SpO₂),end-tidal carbon dioxide partial pressure(P_ETCO₂),rebound hypertension.Collected the arterial blood samples to assay the levels ofβ₂-MG by radioimmunoassay at T₁,T₄,T₇.Results1.MAP:In groupâ…¢,MAP was significantly lower than groupâ… (P＜0.05)at T₅,T₇. In groupâ…¢,MAP was significantly lower than that in groupâ… and groupâ…¡(P＜0.05)at T6.In group,MAP were significantly increased(P＜0.05)than groupâ…¡at the T₅,T₆,T₇, T₈.In groupâ…¡,MAP began to increase at T₆,and still higher than basic level(P＜0.05) at T₇,T₈.2.HR:At T2,T3,T4,HR increased(P＜0.05)in all three groups compared with T₁. But HR of groupâ…¢was significantly lower than that of groupâ… and groupâ…¡(P＜0.05).3.RPP:In groupâ… andâ…¡,RPP were significantly higher than the basic level (P＜0.05)at T₂,T₃,T₄,T₅,T₆,T₇.In groupâ…¢,RPP was significantly lower than that of groupâ… andâ…¡(P＜0.05)at T₂,T₃,T₄.In groupâ…¢,RPP was still significantly lower than that of groupâ… (P＜0.05)at T₅,T₆,T₇.4.β₂-MG:At T₄,the level ofβ₂-MG was significantly higher than the basic level (P＜0.05)at T₁ and at T₇ the level ofβ₂-MG was still significantly lower than the basic level at T₁ in all the three groups(P＜0.05).There were no significantly differences of theβ₂-MG levels in each group at T₁,T₄,T₇.But in groupâ…¢,the rate of change inβ₂-MG level was significantly lower than that of groupâ… (P＜0.01)and groupâ…¡(P＜0.05) at T₄;the rate of change inβ₂-MG level was significantly higher than that of groupâ… (P＜0.01)and groupâ…¡(P＜0.05)at T₇ In groupâ…¡,the rate of change inβ₂-MG level was significantly lower than that of groupâ… (P＜0.05)at T₄ and higher than that of groupâ… (P＜0.05)at T₇ significantly.ConclusionTotal intravenous anesthesia,which maintained by propofol and remifentanil and controlled hypotension induced by Sodium Nitroprusside,can provide the stable status of hemodynamics and reduce the influence on the renal function raise the tolerance of kidney on the stress of stimulations under the conditions of controlled hypotension in surgical operations.