title: Comparison between nitroglycerin and remifentanil in acute hypervolemic hemodilution combined with controlled hypotension during intracranial aneurysm surgery.
abstract: Allogenetic transfusion has long been considered to be a relatively safe and extremely effective blood transfusion treatment. However, acute hypervolemic hemodilution (AHH) combined with the remifentanil-induced controlled hypotension (CH) have rarely been examined. Herein, 40 intracranial aneurysm surgery patients were randomly divided into nitroglycerin group (A group, n=20) and remifentanil group (B group, n=20). During intracranial aneurysm surgery, MAP, HR, Hb, and Hct were recorded. SjvO2, PjvO2, SaO2, PaO2 were measured, and CaO2, Da-jvO2, CjvO2, CERO2, VADL were calculated. In addition, The venous blood samples were collected for determining PT, TT, APTT, FBG, VIII, VWF and electrolytes. The results show that HR in nitroglycerin group dramatically accelerated and HR in remifentanil group slowed at 30 minutes after hypotension and 5 minutes after aneurysm occlusion (P<0.01) after hypotension. Compared with A group, the SjvO2 and CjvO2 of B group increased significantly and the Da-jvO2 and CERO2 decreased significantly at T3, T4. In addition, There were no significant differences between after AHH and before AHH in two groups (P>0.05) on TT, PT, APTT, FIB, VIII, VWF, Na(+), Cl(-), K(+), Ca(2+). These results suggest that AHH combined with remifentanil-based CH significantly lowered cerebral metabolic rate of oxygen and had effects on blood coagulation without clinical hemorrhagic signs increased and had important clinical significance for blood conservation.
authors.affiliation: Department of Anesthesiology, First Affiliated Hospital of Nanchang University Jiangxi, China.
authors.forename: Xuekang
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Grade 2014 of Medical Department of Graduate School, Nanchang University Jiangxi, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Hu
authors.affiliation: Department of Anesthesiology, First Affiliated Hospital of Nanchang University Jiangxi, China.
authors.forename: Zhiyi
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Department of Anesthesiology, First Affiliated Hospital of Nanchang University Jiangxi, China.
authors.forename: Haijin
authors.initials: H
authors.lastname: Huang
authors.affiliation: Department of Anesthesiology, First Affiliated Hospital of Nanchang University Jiangxi, China.
authors.forename: Qin
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Department of Anesthesiology, First Affiliated Hospital of Nanchang University Jiangxi, China.
authors.forename: Hanying
authors.initials: H
authors.lastname: Dai
keywords: Acute hypervolemic hemodilution; controlled hypotension; intracranial aneurysm surgery; remifentanil