Montes Félix R, Giraldo Juan C, Betancur Luis A, Rincón José D, Rincón Ismael E, Vanegas María V, Charris Hernán
Department of Anesthesiology, Fundación Cardio Infantil--Instituto de Cardiología, Universidad del Rosario, Bogotá, Colombia.
Can J Anaesth. 2003 Oct;50(8):824-8. doi: 10.1007/BF03019380.
To asses the cardiovascular changes after either lightwand or conventional laryngoscopic endotracheal intubation (EI) in patients with coronary artery disease.
Following Institutional approval and informed consent, 80 consecutive patients undergoing elective coronary artery bypass grafting were enrolled in this prospective, controlled, single-blinded study. General anesthesia was induced with fentanyl 5 micro x kg(-1) and thiopental 5 mg x kg(-1) followed by pancuronium 0.1 mg x kg(-1). After loss-of-eyelash reflex the lungs were manually ventilated with 2% isoflurane in oxygen for five minutes. Patients were then randomly allocated to receive either the lightwand (lightwand group, n = 41) or direct-vision laryngoscopy (laryngoscopy group, n = 39). Heart rate (HR) and direct blood pressure were recorded before induction, after induction but before EI, during EI, immediately after EI and at ten-second intervals for the following five minutes. Hemodynamic management during induction was standardized. Hypotension was treated with volume replacement, ephedrine, or phenylephrine as indicated; hypertension was treated with iv nitroglycerin; tachycardia was treated with boluses of esmolol; and, bradycardia was treated with atropine or ephedrine.
In both groups, mean arterial blood pressures and HR increased significantly after EI. There was a tendency for the lightwand group to have lower arterial blood pressures and slower HR. However, the differences between the two groups did not reach statistical significance. Requirements for drugs to control HR and mean arterial pressure were similar in both groups.
In patients with coronary artery disease using a lightwand intubation technique does not modify the hemodynamic response associated with EI as compared with standard direct-vision laryngoscopy.
评估冠心病患者在使用光棒或传统喉镜进行气管插管（EI）后的心血管变化。
经机构批准并获得知情同意后，80例连续接受择期冠状动脉搭桥手术的患者被纳入这项前瞻性、对照、单盲研究。采用5μg/kg芬太尼和5mg/kg硫喷妥钠诱导全身麻醉，随后给予0.1mg/kg潘库溴铵。睫毛反射消失后，用含2%异氟烷的氧气手动通气5分钟。然后将患者随机分配接受光棒（光棒组，n = 41）或直接喉镜检查（喉镜组，n = 39）。在诱导前、诱导后但在EI前、EI期间、EI后立即以及随后5分钟内每隔10秒记录心率（HR）和直接血压。诱导期间的血流动力学管理标准化。低血压根据情况用补液、麻黄碱或去氧肾上腺素治疗；高血压用静脉注射硝酸甘油治疗；心动过速用艾司洛尔推注治疗；心动过缓用阿托品或麻黄碱治疗。
两组患者EI后平均动脉血压和HR均显著升高。光棒组有动脉血压较低和HR较慢的趋势。然而，两组之间的差异未达到统计学意义。两组控制HR和平均动脉压所需药物相似。
与标准直接喉镜检查相比，冠心病患者使用光棒插管技术不会改变与EI相关的血流动力学反应。
