Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery

The choice of drug to create controlled systemic arterial hypertension during carotid endarterectomy operation

Authors: Vachev A.N., Prozhoga M.G., Dmitriev O.V.

Samara State Medical University, Samara, 443099, Russian Federation

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UDC: 616.12-008.331.1:616.13-007.271-089.87

Link: Clinical Physiology of Blood Circulaiton. 2020; 17 (2): 116-120

Quote as: Vachev A.N., Prozhoga M.G., Dmitriev O.V. The choice of drug to create controlled systemic arterial hypertension during carotid endarterectomy operation. Clinical Physiology of Circulation. 2020; 17 (2): 116–20 (in Russ.). DOI: 10.24022/1814-6910-2020-17-2-116-120

Received / Accepted:  26.03.2020/15.04.2020

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Objective. Identify drugs with which it is possible to quickly and safely for the patient to achieve systemic arterial hypertension during carotid endarterectomy (CEA).

Material and methods. 120 patients who underwent CEA were examined. The operation was performed under general combined anesthesia with mechanical ventilation. Systemic arterial hypertension was used to protect the brain from ischemia. Before squeezing the pre-cerebral vessels under conditions of primarily corrected central hemodynamics, controlled systemic hypertension was created. For the study, drugs were taken, still recommended by different teams to increase systemic blood pressure in vascular surgery. Patients were divided into groups depending on the drug used: 1) dobutamine; 2) intravenous volume infusion; 3) phenylephrine; 4) norepinephrine. The ability of the drugs to quickly and safely reach target blood pressure levels was assessed. In addition, the presence of rhythm disturbances, a change in the ST segment on the ECG monitor when exposed to drugs, and the reversibility of the hypertensive effect after the termination of drug administration were taken into account.

Results. In patient groups, there was no difference in the number of episodes of rhythm disorder, the elevation of the ST segment on ECG, and the time of regression of the hypertensive effect (p>0.05). Heart rate in the dobutamine group increased statistically significantly when used (p<0.05). The heart rate in other groups did not change from the effects of the drugs (p>0.05). Use of cardiotonic preparation dobutamine and carrying out volume infusion load in not all patients leads to achievement of target values of blood pressure. Application for creation of controlled arterial hypertension phenylephrine and norepinephrine proved effective in 100% of patients.

Conclusion. The preparations phenylephrine and norepinephrine should be considered optimal for the creation of controlled arterial hypertension during carotid endarterectomy.


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About Authors

  • Aleksey N. Vachev, Dr. Med. Sc., Professor, Head of Chair and Clinic of Faculty Surgery;
  • Mikhail G. Prozhoga, Postgraduate, Anesthesiologist-Intensivist;
  • Oleg V. Dmitriev, Cand. Med. Sc., Head of Department of Vascular Surgery № 1, Clinics of SSMU;

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