Perioperative Period Clinical Trial
Official title:
Treatment of Supraventricular Tachycardia in Patients With Non-cardiac Surgery by Dexmedetomidine During the Perioperative Period
Supraventricular tachycardia (SVT) is a common arrhythmia in the perioperative period, which
is associated with adverse stimulus such as cardiovascular risk factors, emotional tension,
hypoxia, CO2 accumulation, hypokalemia, atropine and pain. To treat perioperative SVT, in
addition to massage the vagus nerve, the use of antiarrhythmic drugs and other internal
medicine classic methods, the cardiovascular protection of anesthetic drugs is also a common
adjuvant treatment. Dexmedetomidine which is widely used as an adjuvant to general
anesthesia, can excite α2 receptor to produce sedation, analgesia, inhibition of sympathetic
activity, stabilization of hemodynamics and other effects.
Dexmedetomidine is approved by FDA for use in operating room anesthesia and intensive care
unit sedation in adults. Although dexmedetomidine is not approved for the treatment of
arrhythmias, a growing number of evidences indicated dexmedetomidine can serve as a potential
treatment for arrhythmias in perioperative patients. Liu et al. confirmed that
dexmedetomidine can reduce ventricular rate and improve atrial fibrillation in cardiac
surgery patient. Ji et al. showed that dexmedetomidine anesthesia can be effective in
lowering cardiovascular and cerebrovascular complications and mortality in patients one year
after coronary bypass surgery. A number of retrospective analyses of pediatric patients
undergoing cardiac surgery have shown the incidence of perioperative SVT in patients treated
with dexmedetomidine sedation is significantly decreased, which prompts that dexmedetomidine
has the potential prevention and treatment for tachyarrhythmia. Therefore, the investigators
selected dexmedetomidine for sedation in patients with perioperative SVT to explore the
effect for treating SVT via its sedation and mechanism of anti-sympatheticon in this study.
Forty patients with SVT of both sexes, aged 35-61 yr, of American Society of Anesthesiologists physical status Ⅰ-Ⅱ, who undergo elective surgery, were randomly divided into two groups (n=30) including dexmedetomidine group (group D) and midazolam group (group M). For comparison of the efficacy of dexmedetomidine and midazolam in the treatment of SVT, the following needs to be done. The patients calm down for 5-10 minutes after getting into the operating room, group D and group M started as a continuous infusion with dexmedetomidine 0.5µg/kg or midazolam 0.06mg/kg using a micro-pump for 10 minutes. The alarm/sedation (OAA/S) score, heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2) and occurrence of SVT were recorded before the infusion (T0), 5 minutes after the infusion (T1), at the end of the infusion (T2), 5 minutes after the end of the infusion (T3) and 10 minutes after the end of the infusion (T4). In two groups, miniature electrocardiograph was used to monitor the frequency domain index of heart rate variability (HRV) in 5 minutes at each time point including normalized low frequency power (LFnorm), normalized high frequency power (HFnorm) and the balance ratio of sympathetic to vagal tone (LF/HF). ;
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