Intensive Care Unit, Upper Silesian Medical Centre, Katowice, Poland.
Kardiol Pol. 2010 Nov;68(11):1249-55.
Propofol has been previously shown to be superior to etomidate during electrical cardioversion (EC) of atrial tachyarrhythmias. However, literature on this topic is scarce and the optimal anaesthetic technique for EC has not yet been firmly established.
To compare anaesthetic management with propofol against a mixture of etomidate and low-dose fentanyl for EC.
One hundred patients, aged 32 to 87, underwent elective EC for various atrial arrhythmias. All patients were haemodynamically stable before the procedure and were randomly allocated into one of two groups. Group I (n = 50) was given propofol (bolus 1 mg/kg, followed by increments containing 20% of the initial dose). Group II (n = 50) received 1 mg/kg of fentanyl i.v. (single dose) and etomidate (bolus 0.15 mg/kg, followed by increments containing 20% of the initial dose). Heart rate and non-invasive blood pressure values were taken before induction of anaesthesia (T1), before EC (T2), after EC (T3) and when awake (T4). The number of shocks, the total amount of energy, the number of patients in whom EC failed to restore sinus rhythm, and the time taken to achieve maximal Aldrette score, as well as side effects, were all noted.
Heart rate values were similar in both groups. Blood pressure was significantly lower at T2, T3 and T4 in patients who received propofol. Anaesthesia time was similar; however, maximal Aldrette score was achieved quicker in group I than in group II (4.7 ± 2.2 vs 6.7 ± 4.9 min, p < 0.01). Overall, the efficacy of EC was similar in both groups: 41 (82%) patients from group I and 46 (92%) patients from group II regained sinus rhythm (NS). Significantly more side effects, such as pain at the time of injection, muscle tremor, nausea and vomiting, were noted in group II.
In terms of side effects, propofol is superior to etomidate with fentanyl for elective EC of atrial tachyarrhythmias.
先前的研究表明,在心房快速性心律失常的电复律(EC)中,异丙酚优于依托咪酯。然而,关于这一主题的文献很少,EC 的最佳麻醉技术尚未得到明确确立。
比较异丙酚与依托咪酯和低剂量芬太尼混合物用于 EC 的麻醉管理。
100 例年龄 32 至 87 岁的患者因各种心房心律失常接受择期 EC。所有患者在手术前血流动力学均稳定,并随机分为两组。I 组(n = 50)给予异丙酚(推注 1mg/kg,然后递增包含初始剂量 20%的剂量)。II 组(n = 50)给予静脉注射 1mg/kg 芬太尼(单次剂量)和依托咪酯(推注 0.15mg/kg,然后递增包含初始剂量 20%的剂量)。记录麻醉诱导前(T1)、EC 前(T2)、EC 后(T3)和清醒时(T4)的心率和无创血压值。记录电击次数、总能量、EC 未能恢复窦性节律的患者数量以及达到最大 Aldrette 评分所需的时间,以及不良反应。
两组患者的心率值相似。接受异丙酚的患者在 T2、T3 和 T4 时血压明显较低。麻醉时间相似;然而,I 组达到最大 Aldrette 评分的时间快于 II 组(4.7 ± 2.2 与 6.7 ± 4.9 分钟,p < 0.01)。总的来说,两组 EC 的疗效相似:I 组有 41(82%)例患者和 II 组有 46(92%)例患者恢复窦性节律(NS)。II 组观察到更多的不良反应,如注射时疼痛、肌肉震颤、恶心和呕吐。
在不良反应方面,异丙酚优于依托咪酯与芬太尼用于心房快速性心律失常的择期 EC。