在手术前5 - 氨基氨酸给药时间和外科手术期间低血压之间的关联
Tomohiro Hori1, Takahiro Nohara1, Tetsuya Kawahara1
1Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
概括
将5-氨基联酸 (ALA) 给药和手术之间的间隔延长到4小时以上,可能会降低光动力学诊断辅助膀瘤穿尿管切除过程中低血压的风险.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 在瘤学瘤学.
- 麻醉学 麻醉学
背景情况:
- 使用5-氨基诺列维林酸 (ALA) 的光动力学诊断 (PDD) 在经尿道切除 (TURBT) 期间提高了膀瘤的可见性.
- 周围手术性低血压是PDD辅助TURBT中ALA的已知并发症.
- 最近的指导方针建议在手术前2-8小时口服ALA,允许灵活的时间安排.
研究的目的:
- 调查ALA注射时间和手术开始之间的关联.
- 评估ALA-to-surgery间隔对外科手术期间血压和低血压严重性的影响.
主要方法:
- 对112名接受PDD辅助TURBT的患者进行了回顾性分析.
- 患者被分为两组:控制组 (<4小时间隔) 和ALA摄入和麻醉之间的延长时间 (≥4小时间隔).
- 术后血压的比较,低血压的发生率和血管压缩剂的使用.
主要成果:
- 延长时间组 (≥4小时) 显示中度至重度低血压的发生率明显较低 (38%对61%,p=0.039).
- 术后血压在延长时间组显著更高.
- 在延长时间组中,需要较少的血管压缩剂剂量 (p=0.025).
结论:
- 从口服5-aminolevulinic acid摄入到麻醉的间隔超过4小时可能会减轻外科手术期间的低血压.
- 优化ALA的时间管理可以提高PDD辅助 TURBT期间的患者安全.
- 这一发现支持了2024年修订的ALA给药时间指南.
相关概念视频
01:15Chronopharmacokinetics: Circadian Rhythms and Influence on Drug Response
353
Circadian rhythms are cyclic changes that are crucial in plasma drug concentrations. Various standard circadian parameters, including core body temperature, heart rate, and other cardiovascular factors, directly impact disease states and the therapeutic response to drug therapy.
The time of drug administration is an important factor to consider, as it can influence the toxic dose of a drug. For example, a study conducted by Prins et al. in 1997 examined the effects of the timing of...
The time of drug administration is an important factor to consider, as it can influence the toxic dose of a drug. For example, a study conducted by Prins et al. in 1997 examined the effects of the timing of...
353
01:13Local Anesthetics: Pharmacokinetics
1.2K
The potency and duration of action of local anesthetics (LAs) are determined by their pharmacokinetics. Pharmacokinetics describes how LAs are absorbed, distributed, metabolized, and eliminated from the body. When administered to the vascular tissues, LAs are quickly absorbed and enter the systemic circulation, reducing their localized effects. Adding vasoconstrictors such as epinephrine to LAs reduces their absorption into the systemic circulation, making them clinically effective. The...
1.2K
01:26Cardiac Catheterization IV: Nursing Management
656
Nursing responsibilities before cardiac catheterization include:Assess for allergies and establish baseline health status.Before cardiac catheterization, assess the patient for allergies to contrast dye. Perform a comprehensive baseline assessment, including vital signs, heart and breath sounds, and a neurovascular assessment of the extremities, noting distal pulses, skin color, and temperature. Instruct the patient to fast for 8-12 hours before the procedure. Evaluate baseline laboratory...
656
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
287
Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
287
01:22Aneurysm IV: Nursing Management
380
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
380
01:24Parenteral Anesthetics: Overview
602
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
602