Objective.To compare the effects of alfentanil and esmolol on hemodynamic and catecholamine response to tracheal intubation. Methods.Thirty five adult patients were randomly allocated to on...Objective.To compare the effects of alfentanil and esmolol on hemodynamic and catecholamine response to tracheal intubation. Methods.Thirty five adult patients were randomly allocated to one of three groups,Group A(control group),Group B(esmolol group)and Group C(alfentanil group).The patients received either 2 mg/kg esmolol(in Group B)or 30 μg/kg alfentanil(in Group C)before intubation.Tracheal intubation was performed with 4 mg/kg thiopental and 0 1 mg/kg vecuronium and 3% isoflurane.Systolic blood pressure(SBP),diastolic blood pressure(DBP),mean blood pressure(MBP),heart rate(HR),norepinephrine(NE),epinephrine(E)and dopamine(DA)were measured before and after intubation. Results.The control group had a baseline SBP of 149±23 mmHg while Groups B,C had a baseline SBP of 148±23,and 150±21mmHg,respectively(P>0 05).Three min after tracheal intubation,the control group SBP increased to 160±30 mmHg and Group B remained at the baseline level,147±5 mmHg,and Group C significantly decreased to 91±22 mmHg(P<0 01).Two min after intubation HR in Group B increased significantly but 3 min after intubation HR in Groups B and C were significantly lower than that of control group(P<0 05).NE in Groups A and B increased significantly to 5 75±3 51 and 6 75±3 30 nmol/L 3 min after intubation(P<0 01).In Group C,3 min after intubation NE was not significantly different from the baseline but E decreased significantly(P<0 01). Conclusion.2 mg/kg esmolol can moderate the hemodynamic response to tracheal intubation to a certain extent and 30μg/kg alfentanil can completely attenuate the hemodynamic and catecholamine responses.展开更多
Background Although etomidate is associated with very few cardiovascular side-effects and minimal histamine release it has a less inhibitory effect on the pharyngolaryngeal reflex. Hence, blunting the responses to end...Background Although etomidate is associated with very few cardiovascular side-effects and minimal histamine release it has a less inhibitory effect on the pharyngolaryngeal reflex. Hence, blunting the responses to endotracheal intubation is more dependent of opioids for etomidate-based anesthetic induction. This prospective, randomized, double-blinded study was designed to investigate the effects of low dose remifentanil, fentanyl or sufentanil on etomidate induction with respect to hemodynamics, conscious level changes and drug consumption. Methods Ninety unpremedicated and normotensive patients with American Society of Anesthesiologists （ASA） physical status I or II undergoing elective major abdominal surgery were randomly assigned in a double blinded fashion to each of the three groups： groups F, R and S. A bolus dose of fentanyl 1μg/kg, sufentanil 0.1 μg/kg or remifentanil 1 1 μg/kg was given over 60 seconds in groups F, S and R, respectively. In each instance this loading dose was followed by a continuous infusion （0.1, 0.01 or 0.1 μg·kg^-1·min^-1 of fentanyl, sufentanil or remifentanil, respectively）. After 5 minutes from start of opioid infusion, etomidate was titrated at a rate of 20 mg/min to a decrease in bispectral index （BIS） to 50. The time from administration of etomidate to loss of eyelash reflex or to a decrease in BIS to 50 was recorded. The blood pressure and heart rate were also recorded at different five time points. The average maximum percent changes of systolic blood pressure （Imaximal or minimal measuring value-baselinel/baselinex100%） were calculated. Results The time and the dosage of etomidate necessary to loss consciousness were greater in group F （（70.0±15.6） seconds; （0.35±0.05） mg/kg） than in groups S （（52.3±15.9） seconds; （0.26±0.06） mg/kg） and R （（56.2±20.2） seconds; （0.27±0.07） mg/kg） （P 〈0.01）. The three groups took similar time and amount of etomidate to achieve an adequate depth anesthesia （BIS=50）. The average maximum changes of systolic blood pressure were significantly different among the three groups： F, （25±6）% vs R, （13±4）% or S, （12±5）% （P 〈0.001）. The endotracheal intubation caused marked increases in blood pressure and heart rate in groups F and S, but not in group R, respectively （P 〈0.01）. The great hemodynamic changes occurred more frequently in group F than in groups R and S （P 〈0.01）. The incidence of heart rate decreases of more than 30% of the baselines after induction was higher in group R compared with groups F and S （P 〈0.01）. Conclusions In normotensive and unpremedicated young adult patients receiving etomidate induction, low dose remifentanil or sufentanil significantly reduced the time and the amount of etomidate taken to loss unconsciousness compared with low dose fentanyl, but similar time interval and doses of etomidate were required to acquire adequate depth of anesthesia （BIS=50） for these three opioids. Remifentanil was more effective in blunting the cardiovascular responses to endotracheal intubation, nevertheless, accompanying significant lower heart rate after induction.展开更多
文摘Objective.To compare the effects of alfentanil and esmolol on hemodynamic and catecholamine response to tracheal intubation. Methods.Thirty five adult patients were randomly allocated to one of three groups,Group A(control group),Group B(esmolol group)and Group C(alfentanil group).The patients received either 2 mg/kg esmolol(in Group B)or 30 μg/kg alfentanil(in Group C)before intubation.Tracheal intubation was performed with 4 mg/kg thiopental and 0 1 mg/kg vecuronium and 3% isoflurane.Systolic blood pressure(SBP),diastolic blood pressure(DBP),mean blood pressure(MBP),heart rate(HR),norepinephrine(NE),epinephrine(E)and dopamine(DA)were measured before and after intubation. Results.The control group had a baseline SBP of 149±23 mmHg while Groups B,C had a baseline SBP of 148±23,and 150±21mmHg,respectively(P>0 05).Three min after tracheal intubation,the control group SBP increased to 160±30 mmHg and Group B remained at the baseline level,147±5 mmHg,and Group C significantly decreased to 91±22 mmHg(P<0 01).Two min after intubation HR in Group B increased significantly but 3 min after intubation HR in Groups B and C were significantly lower than that of control group(P<0 05).NE in Groups A and B increased significantly to 5 75±3 51 and 6 75±3 30 nmol/L 3 min after intubation(P<0 01).In Group C,3 min after intubation NE was not significantly different from the baseline but E decreased significantly(P<0 01). Conclusion.2 mg/kg esmolol can moderate the hemodynamic response to tracheal intubation to a certain extent and 30μg/kg alfentanil can completely attenuate the hemodynamic and catecholamine responses.
文摘Background Although etomidate is associated with very few cardiovascular side-effects and minimal histamine release it has a less inhibitory effect on the pharyngolaryngeal reflex. Hence, blunting the responses to endotracheal intubation is more dependent of opioids for etomidate-based anesthetic induction. This prospective, randomized, double-blinded study was designed to investigate the effects of low dose remifentanil, fentanyl or sufentanil on etomidate induction with respect to hemodynamics, conscious level changes and drug consumption. Methods Ninety unpremedicated and normotensive patients with American Society of Anesthesiologists （ASA） physical status I or II undergoing elective major abdominal surgery were randomly assigned in a double blinded fashion to each of the three groups： groups F, R and S. A bolus dose of fentanyl 1μg/kg, sufentanil 0.1 μg/kg or remifentanil 1 1 μg/kg was given over 60 seconds in groups F, S and R, respectively. In each instance this loading dose was followed by a continuous infusion （0.1, 0.01 or 0.1 μg·kg^-1·min^-1 of fentanyl, sufentanil or remifentanil, respectively）. After 5 minutes from start of opioid infusion, etomidate was titrated at a rate of 20 mg/min to a decrease in bispectral index （BIS） to 50. The time from administration of etomidate to loss of eyelash reflex or to a decrease in BIS to 50 was recorded. The blood pressure and heart rate were also recorded at different five time points. The average maximum percent changes of systolic blood pressure （Imaximal or minimal measuring value-baselinel/baselinex100%） were calculated. Results The time and the dosage of etomidate necessary to loss consciousness were greater in group F （（70.0±15.6） seconds; （0.35±0.05） mg/kg） than in groups S （（52.3±15.9） seconds; （0.26±0.06） mg/kg） and R （（56.2±20.2） seconds; （0.27±0.07） mg/kg） （P 〈0.01）. The three groups took similar time and amount of etomidate to achieve an adequate depth anesthesia （BIS=50）. The average maximum changes of systolic blood pressure were significantly different among the three groups： F, （25±6）% vs R, （13±4）% or S, （12±5）% （P 〈0.001）. The endotracheal intubation caused marked increases in blood pressure and heart rate in groups F and S, but not in group R, respectively （P 〈0.01）. The great hemodynamic changes occurred more frequently in group F than in groups R and S （P 〈0.01）. The incidence of heart rate decreases of more than 30% of the baselines after induction was higher in group R compared with groups F and S （P 〈0.01）. Conclusions In normotensive and unpremedicated young adult patients receiving etomidate induction, low dose remifentanil or sufentanil significantly reduced the time and the amount of etomidate taken to loss unconsciousness compared with low dose fentanyl, but similar time interval and doses of etomidate were required to acquire adequate depth of anesthesia （BIS=50） for these three opioids. Remifentanil was more effective in blunting the cardiovascular responses to endotracheal intubation, nevertheless, accompanying significant lower heart rate after induction.
