Adachi Yushi U, Satomoto Maiko, Higuchi Hideyuki, Watanabe Kazuhiko
Department of Anesthesiology, Medical Clinic of Kumagaya Base, National Defense Medical College, 3-2 Namiki, Tokorozawa City, Saitama, Japan 359-8513.
Anesth Analg. 2002 Jul;95(1):233-7, table of contents. doi: 10.1097/00000539-200207000-00043.
We examined the effectiveness of avoiding laryngoscopy in reducing the hemodynamic responses to orotracheal intubation during the induction of anesthesia. One hundred surgical patients who required orotracheal intubation were randomly allocated into four groups. The first and third groups underwent fiberoptic intubation, in which an anesthesiologist inserted the endotracheal tube into the trachea under TV monitoring through a bronchoscope, and the second and fourth groups underwent conventional orotracheal intubation using a rigid laryngoscope. The third and fourth groups were pretreated with 2 microg/kg fentanyl IV immediately before the induction of anesthesia. Blood pressure and heart rate were measured noninvasively. A significant reduction in hemodynamic response was seen in only the group treated with fentanyl and intubated using the fiberoptic technique. Without fentanyl, there was no significant difference in hemodynamic changes between the groups. We conclude that the administration of fentanyl suppresses the hemodynamic responses to endotracheal intubation more than it does to laryngoscopy. There was no significant difference in the hemodynamic responses to orotracheal intubation by fiberscopy and laryngoscopy without fentanyl pretreatment, whereas 2 microg/kg fentanyl significantly reduced the hemodynamic responses in the group intubated by fiberscopy.
We assessed the effectiveness of avoiding laryngoscopy for orotracheal intubation. There was no significant difference in the hemodynamic responses to orotracheal intubation by fiberscopy and laryngoscopy without fentanyl pretreatment, whereas 2 microg/kg fentanyl significantly reduced the hemodynamic responses in the group intubated by fiberscopy. Pretreatment of fentanyl and fiberoptic intubation might be recommended for avoiding hyperdynamic responses.
我们研究了在麻醉诱导期间避免喉镜检查对减轻经口气管插管血流动力学反应的有效性。100例需要经口气管插管的外科手术患者被随机分为四组。第一组和第三组接受纤维支气管镜引导插管，麻醉医生在电视监测下通过支气管镜将气管导管插入气管，第二组和第四组使用硬式喉镜进行传统经口气管插管。第三组和第四组在麻醉诱导前即刻静脉注射2μg/kg芬太尼进行预处理。采用无创方式测量血压和心率。仅在接受芬太尼治疗并采用纤维支气管镜引导插管技术的组中观察到血流动力学反应显著降低。未使用芬太尼时，各组间血流动力学变化无显著差异。我们得出结论，与喉镜检查相比，芬太尼给药对气管插管血流动力学反应的抑制作用更强。在未进行芬太尼预处理的情况下，纤维支气管镜引导插管和喉镜引导经口气管插管的血流动力学反应无显著差异，而2μg/kg芬太尼显著降低了纤维支气管镜引导插管组的血流动力学反应。
我们评估了避免喉镜检查用于经口气管插管的有效性。在未进行芬太尼预处理的情况下，纤维支气管镜引导插管和喉镜引导经口气管插管的血流动力学反应无显著差异，而2μg/kg芬太尼显著降低了纤维支气管镜引导插管组的血流动力学反应。为避免高动力反应，可能推荐芬太尼预处理和纤维支气管镜引导插管。
