Cardiovascular Risk: METHODS

In: Anesthesia

14 Mar 2010

As part of a large investigation (R. J. Middlehurst, unpublished data, 1999), this randomized, blinded, controlled, and comparative study investigated hemodynamic and electrocardiographic responses to lidocaine 2%, noradrenaline 1:50,000, vasopressin 0.25 IU/ mL, and midazolam. Seventy-five patients with heart disease (American Society of Anesthesiologists Categories III and IV) were prescribed dentoalveolar surgery using lidocaine 2%, noradrenaline 1:50,000, and vasopressin 0.25 IU/mL. For 25 of these patients, analgesia was supplemented by intravenous midazolam.

Hemodynamic Data for Local Anesthetic and Sedation Groups

Phase of Investigation Lidocaine 2%, Noradrenaline 1:50,000, and Vasopressin 0.25 IU/mL Lidocaine 2%, Noradrenaline

1:50,000, Vasopressin 0.25 IU/mL, and Midazolam

HR, bpmf SBP, mm Hg

HR, bpm

SBP, mm Hg





77.3 ± 7.8 75.3 ± 2.5 75.3 ± 2.0 75.1 ± 1.7 142.9 ± 12.2 154.9 ± 4.8 153.4 ± 4.7 141.9 ± 3.3 74.6   ± 8.6

66.5 ± 7.5

69.0 ± 5.0

68.4 ± 5.0

77.7      ± 2.5

137.7   ± 10.6

135.8   ± 6.6

131.1 ± 8.0

121.1 ± 7.3

113.7 ± 6.6

A noninvasive pulse and blood pressure monitor with integral printer (Datascope Accutor I, Datascope Corporation, Paramus, NJ) was used to record hemodynamics at 1-minute intervals through the 5 phases of treatment, defined as stabilization, sedation (when used), anesthesia, surgery, and recovery. Patients were placed in a semirecumbent position, a cuff of suitable width was applied, and recording started. After 5 minutes, the baseline reading was taken, followed by at least 30 consecutive measurements. All surgical procedures were performed by 1 operator. Hemodynamic data were stored on a mainframe computer (Amdhal 5890/300) and analyzed using repeated measurements analysis of variance from the Statistical Package for the Social Sciences (SPSS, Version 4.0), commercially available software (Fortran 77, Ghost 80), and designer software (Medplot) to plot a confidence interval framework, with Mauchly Sphericity and Pillai tests for intra- and inter-group comparison. An ambulatory electrocardiogram (ECG) recorder (Holter Tracker) and Reynolds Medical Pathfinder 3 (Model P31 High Speed ECG Analyser) were used to tape and evaluate rhythm and ischemic change. These data were analyzed using nonparametric statistical tests, including Friedman, Mann-Whitney, and Kruskal-Wallis. Finally, the study was conducted with the approval of the Hospital Ethics Committee in accord with the Declaration of Helsinki.

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