title: Intravenous trimethaphan during epidural plus general anesthesia decreases the direct radial artery pressure lower than the brachial artery pressure.
abstract: OBJECTIVE
  To determine whether vasodilators such as sodium nitroprusside (SNP) and trimethaphan (TMP) produce a pressure difference between the radial artery and the brachial artery during epidural plus general anesthesia or simple general anesthesia.
  
  
  METHODS
  Randomized study and prospective study.
  
  
  METHODS
  Operating rooms of two hospitals.
  
  
  METHODS
  36 and 6 adult patients in the first and second studies, respectively, who received spherical acetabular osteotomy with induced hypotensive anesthesia.
  
  
  METHODS
  In the first study, 18 patients received epidural plus general anesthesia (epidural group) and 18 patients received general anesthesia alone (general group). All patients received the hypotensive drugs for more than 50 minutes each. In the second study, 6 patients received TMP-induced hypotension for 20 minutes under epidural plus general anesthesia.
  
  
  RESULTS
  In the first study, radial intra-arterial blood pressure (RIBP) and tonometric blood pressure (TBP) calibrated with oscillometric blood pressure of the arm were compared. In the second study, RIBP and the brachial intra-arterial blood pressure (BIBP) were compared. In the first study, the bias between RIBP and TBP for systolic, mean and diastolic blood pressure were significantly less during TMP-induced hypotension in the epidural group (-11.5 +/- 2.5 (mean +/- SD), -6.0 +/- 3.1, and -2.8 +/- 3.7 mmHg, respectively] than during SNP-induced hypotension in the epidural group and SNP- and TMP-induced hypotension in the general group (p < 0.01). The precision of systolic and mean pressures were significantly greater during TMP-induced hypotension in the epidural group (11.8 +/- 2.3 and 7.1 +/- 1.9 mmHg, respectively) than the other three hypotension groups (p < 0.01). In the second study, the bias between RIBP and BIBP for systolic, mean, and diastolic pressures were significantly less (p < 0.01), and precision was significantly greater during hypotension than during normotension (p < 0.01).
  
  
  CONCLUSIONS
  Our results demonstrate that TMP decreases the direct radial artery systolic and mean pressures to levels below the brachial artery systolic and mean pressures in patients who received epidural plus general anesthesia.
authors.affiliation: Department of Anesthesiology, Miyazaki Medical College, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Nagata
authors.forename: M
authors.initials: M
authors.lastname: Takasaki
authors.forename: S
authors.initials: S
authors.lastname: Ibusuki
authors.forename: M
authors.initials: M
authors.lastname: Taniguchi
authors.forename: O
authors.initials: O
authors.lastname: Kondo
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D001916:Brachial Artery; D004359:Drug Therapy, Combination; D006801:Humans; D008875:Middle Aged; D009599:Nitroprusside / Q000627:therapeutic use; D011446:Prospective Studies; D017534:Radial Artery; D015203:Reproducibility of Results; D014294:Trimethaphan / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D000959:Antihypertensive Agents; D014665:Vasodilator Agents; D009599:Nitroprusside; D014294:Trimethaphan