Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea.
Korean J Anesthesiol. 2012 Jun;62(6):536-42. doi: 10.4097/kjae.2012.62.6.536. Epub 2012 Jun 19.
The aim of this study was to investigate whether a small dose of midazolam and lessening the propofol dosage could prevent cardiovascular change at tracheal intubation for induction in aged patients.
Eighty patients over 65 years (ASA physical status 1, 2) scheduled for elective surgery received general anesthesia with remifentanil and propofol or midazolam. Patients in group P (n = 40) were induced with 0.9% NaCl 0.03 ml/kg, propofol 1. 2 mg/kg and remifentanil. Patients in group MP (n = 40) were induced with midazolam 0.03 mg/kg, propofol 0.8 mg/kg and remifentanil. The time taken to reach loss of consciousness (LOC) and the value of bispectral index score (BIS) at LOC were recorded. After LOC, 0.8 mg/kg of rocuronium was given and tracheal intubation was performed. The mean blood pressure (MBP) and heart rate (HR) were recorded before induction as the base value, before intubation, immediately post-intubation and 3 minutes after intubation.
Compared with the base values, MBP at before intubation and 3 minutes after intubation was significantly decreased in group P and group MP (P < 0.05). Compared with group P, the decrease of MBP was significantly less at before intubation, immediately after intubation and 3 minutes after intubation in group MP (P < 0.05). The time taken to reach LOC was significantly decreased in group MP compared with that in group P (P < 0.05). There were no significant differences of HR at any time between the two groups.
Co-induction with midazolam and propofol could prevent a marked BP decrease at tracheal intubation for induction in aged patients.
本研究旨在探讨小剂量咪达唑仑联合减少丙泊酚剂量是否可以预防老年患者诱导插管时心血管变化。
80 例年龄超过 65 岁（ASA 身体状况 1 级、2 级）择期手术患者接受瑞芬太尼和丙泊酚或咪达唑仑全身麻醉。P 组（n = 40）患者以 0.9%氯化钠 0.03ml/kg、丙泊酚 1.2mg/kg 和瑞芬太尼诱导。MP 组（n = 40）患者以咪达唑仑 0.03mg/kg、丙泊酚 0.8mg/kg 和瑞芬太尼诱导。记录达到意识丧失（LOC）的时间和 LOC 时双频谱指数（BIS）值。LOC 后给予 0.8mg/kg 罗库溴铵行气管插管。记录诱导前（基础值）、插管前、插管即刻和插管后 3 分钟的平均血压（MBP）和心率（HR）。
与基础值相比，P 组和 MP 组插管前和插管后 3 分钟的 MBP 明显降低（P < 0.05）。与 P 组相比，MP 组插管前、插管即刻和插管后 3 分钟的 MBP 下降明显较少（P < 0.05）。MP 组达到 LOC 的时间明显短于 P 组（P < 0.05）。两组任何时间点 HR 均无显著差异。
咪达唑仑与丙泊酚联合诱导可预防老年患者诱导插管时血压明显下降。
