Atlee J L, Dhamee M S, Olund T L, George V
Departments of Anesthesiology and Biostatistics, Medical College of Wisconsin, Milwaukee 53226-3596, USA.
Anesth Analg. 2000 Feb;90(2):280-5. doi: 10.1097/00000539-200002000-00008.
Laryngoscopy and tracheal intubation (LTI) often provoke an undesirable increase in blood pressure (BP) and/or heart rate (HR). We tested the premise that nicardipine (NIC) and esmolol (ESM) in combination (COMB) would oppose both. Adult surgical patients received pretreatment (randomized) with IV bolus NIC 30 microg/kg (n = 31), ESM 1.0 mg/kg (n = 34), or COMB (one-half dose each, n = 32). Peak BP and HR after LTI were compared with controls (CONT; n = 35) with no pretreatment. Anesthetic induction was standardized: IV thiopental (5-7 mg/kg), fentanyl (1-2 microg/kg), and succinylcholine (1.5 mg/kg). Systolic (S), diastolic (D), and mean (M) BP and HR awake before pretreatment (baseline) were similar in all test groups. No patient was treated for hypotension, bradycardia, or tachycardia after pretreatment or anesthetic induction. Peak HR after LTI was increased versus baseline in CONT and all test groups, but did not differ from CONT among the test groups. Peak SBP and DBP increased versus baseline in CONT, and with ESM and NIC, but not COMB. Peak SBP, DBP, and MBP were increased with ESM versus COMB, and peak DBP with ESM versus NIC. Compared with no pretreatment before the IV induction of general anesthesia, the peak increase in BP after LTI is best blunted by the combination of nicardipine and ESM, compared with either drug alone. No single drug or combination in the doses tested opposed increased HR.
Compared with no pretreatment before the IV induction of general anesthesia, the peak increase in blood pressure after laryngoscopy and tracheal intubation is best blunted by the combination of nicardipine and esmolol, compared with either drug alone. No single drug or combination in the doses tested opposed increased heart rate.
喉镜检查和气管插管（LTI）常常会引起血压（BP）和/或心率（HR）不良升高。我们检验了尼卡地平（NIC）和艾司洛尔（ESM）联合使用（COMB）能对抗二者升高的假设。成年外科手术患者接受静脉推注NIC 30微克/千克（n = 31）、ESM 1.0毫克/千克（n = 34）或COMB（各一半剂量，n = 32）的预处理（随机分组）。将LTI后的血压峰值和心率与未进行预处理的对照组（CONT；n = 35）进行比较。麻醉诱导标准化：静脉注射硫喷妥钠（5 - 7毫克/千克）、芬太尼（1 - 2微克/千克）和琥珀酰胆碱（1.5毫克/千克）。所有测试组在预处理前清醒时的收缩压（S）、舒张压（D）、平均血压（M）和心率（基线）相似。预处理或麻醉诱导后，无患者因低血压、心动过缓或心动过速接受治疗。与基线相比，CONT组和所有测试组LTI后的心率峰值均升高，但测试组之间与CONT组无差异。与基线相比，CONT组以及使用ESM和NIC组的收缩压峰值和舒张压峰值升高，但COMB组未升高。与COMB组相比，ESM组的收缩压峰值、舒张压峰值和平均血压升高，与NIC组相比，ESM组的舒张压峰值升高。与全身麻醉静脉诱导前未进行预处理相比，LTI后血压的峰值升高与单独使用任何一种药物相比，尼卡地平和艾司洛尔联合使用能更好地抑制。在测试剂量下，没有单一药物或联合用药能对抗心率升高。
与全身麻醉静脉诱导前未进行预处理相比，与单独使用任何一种药物相比，尼卡地平和艾司洛尔联合使用能更好地抑制喉镜检查和气管插管后血压的峰值升高。在测试剂量下，没有单一药物或联合用药能对抗心率升高。
