Gore Mangesh S, Harnagale Kalpana D
Resident, Dept. of Anesthesiology, Grant Medical College, Mumbai, India.
J Anaesthesiol Clin Pharmacol. 2011 Jan;27(1):27-30.
Since 1988 anaesthesiologist have proved that induction dose of propofol is sufficient to intubate patient without muscle relaxants. Propofol is unique in having property to suppress airway reflexes better than any other agent. Therefore study was undertaken to evaluate clinically acceptable intubating conditions with different doses of propofol without muscle relaxants.
90 ASA grade I and II patients posted for elective surgery requiring general anesthesia divided randomly into group I (propofol 2 mg kg(-1)); group II (2.5 mg kg(-1)); groupIII (3mg kg(-1)). Premedication with inj.Glycopyrollate, inj.Ranitidine, Inj.Ondensetron; inj.Midazolam and inj.fentanyl was done. After waiting for 5 minutes, induction dose of propofol was given followed by inj.lignocaine 90 seconds prior to intubation. Intubating conditions were assessed and hemodynamic changes were recorded at various levels.
Ideal intubating conditions were obtained in 96.7%of patients in group II (2.5 mg kg(-1) propofol) and 100% in group III (3 mg kg(-1) propofol). We found that clinically acceptable intubating conditions can be achieved with 2.5 mg kg(-1) and 3 mg kg(-1) propofol without significant hemodynamic changes and 100% success can be obtained with 3 mg kg(-1) of propofol
Ideal intubating conditions without muscle relaxants can be achieved with propofol 3 mg kg(-1) with fentanyl 2 μg kg(-1) and lignocaine 1.5 mg kg(-1) without significant hemodynamic changes.
自1988年以来,麻醉医生已证实丙泊酚的诱导剂量足以在不使用肌肉松弛剂的情况下为患者进行插管。丙泊酚的独特之处在于,它比任何其他药物都更能有效抑制气道反射。因此,本研究旨在评估在不使用肌肉松弛剂的情况下,不同剂量丙泊酚的临床可接受插管条件。
90例拟行择期手术、需要全身麻醉的ASA I级和II级患者,随机分为I组(丙泊酚2mg/kg)、II组(2.5mg/kg)、III组(3mg/kg)。给予格隆溴铵注射液、雷尼替丁注射液、昂丹司琼注射液、咪达唑仑注射液和芬太尼注射液进行术前用药。等待5分钟后,给予丙泊酚诱导剂量,在插管前90秒给予利多卡因注射液。评估插管条件,并记录不同水平的血流动力学变化。
II组(丙泊酚2.5mg/kg)96.7%的患者和III组(丙泊酚3mg/kg)100%的患者获得了理想的插管条件。我们发现,2.5mg/kg和3mg/kg的丙泊酚可实现临床可接受的插管条件,且无明显血流动力学变化,3mg/kg的丙泊酚成功率可达100%。
丙泊酚3mg/kg联合芬太尼2μg/kg和利多卡因1.5mg/kg可在不使用肌肉松弛剂的情况下获得理想的插管条件,且无明显血流动力学变化。