Uysal Hale Yarkan, Tezer Esma, Türkoğlu Müge, Aslanargun Pinar, Başar Hülya
Specialist, Anesthesiology and Reanimation Clinic, Ankara Training and Research Hospital, The Ministry of Health, Ankara, Turkey.
J Res Med Sci. 2012 Jan;17(1):22-31.
Hypertension and tachycardia caused by tracheal intubation can be detrimental in hypertensive patients. This study was conducted in order to compare the effects of dexmedetomidine on hemodynamic response to tracheal intubation in hypertensive patients with esmolol and sufentanyl.
Sixty hypertensive patients scheduled for noncardiac surgery under general anesthesia were randomly assigned to receive one of the three drugs before induction of anesthesia. Groups I, II, and III respectively received esmolol (100 mg) dexmedetomidine (1 μg/kg) and sufentanyl (0.25 μg/kg). Heart Rate (HR), systolic (SAP) and diastolic (DAP) arterial pressures were recorded before drug administration (baseline; T1), after drug administration (T2), after induction of anesthesia (T3), immediately after intubation (T4) and 3, 5 and 10 minutes after intubation (T5, T6, and T7, respectively). The mean percentage variations from T1 to T4 were calculated for all variables (HR, SAP and DAP). Thiopental dose, onset time of vecuronium and intubation time were also assessed.
No differences were observed between the three groups regarding demographic data (p > 0.05). Median thiopental dose was significantly lower in Group II (325 mg; range: 250-500) compared to Group I (425 mg; range: 325-500; p < 0.01) and Group III (375 mg; range: 275-500; p = 0.02). The onset time of vecuronium was longest in Group I (245.2 ± 63 s vs. 193.9 ± 46.6 s and 205.5 ± 43.5 s; p < 0.01 and p < 0.05). In Group I, HR significantly decreased after drug administration compared to baseline (83.8 ± 20.4 vs. 71.7 ± 14.8; p = 0.002). Compared to the baseline (90.4 ± 8.4), DAP decreased after induction and remained below baseline values at T5, T6 and T7 (71.3 ± 12.8, 76.2 ± 10.7, 68.9 ± 10.8 and 62.1 ± 8.7, respectively; p < 0.05) in Group II. According to the mean percentage variation, a significant reduction in HR was assessed in Group II compared to Group III (-13.4 ± 17.6% vs. 11.0 ± 27.8%; p = 0.003). Increment in SAP was significant in Group I when compared to Group II (9.8 ± 20.9% vs. -9.2 ± 20.2%; p < 0.05). Increment in DAP in Group III was significant compared to Group II (0.07 ± 19.8 vs. 24.5 ± 39.1; p < 0.05).
In hypertensive patients, administration of dexmedetomidine before anesthesia induction blunts the hemodynamic response to tracheal intubation and reduces the thiopental dose.
气管插管引起的高血压和心动过速对高血压患者可能有害。本研究旨在比较右美托咪定与艾司洛尔和舒芬太尼对高血压患者气管插管血流动力学反应的影响。
60例计划在全身麻醉下行非心脏手术的高血压患者在麻醉诱导前随机分配接受三种药物之一。I组、II组和III组分别接受艾司洛尔（100mg）、右美托咪定（1μg/kg）和舒芬太尼（0.25μg/kg）。在给药前（基线；T1）、给药后（T2）、麻醉诱导后（T3）、插管后即刻（T4）以及插管后3、5和10分钟（分别为T5、T6和T7）记录心率（HR）、收缩压（SAP）和舒张压（DAP）。计算所有变量（HR、SAP和DAP）从T1到T4的平均百分比变化。还评估了硫喷妥钠剂量、维库溴铵起效时间和插管时间。
三组患者的人口统计学数据无差异（p>0.05）。与I组（425mg；范围：325 - 500）和III组（375mg；范围：275 - 500；p = 0.02）相比，II组硫喷妥钠的中位剂量显著更低（325mg；范围：250 - 500）。I组维库溴铵的起效时间最长（245.2±63秒，相比之下为193.9±46.6秒和205.5±43.5秒；p<0.01和p<0.05）。在I组中，给药后HR与基线相比显著降低（83.8±20.4对71.7±14.8；p = 0.002）。与基线（90.4±8.4）相比，II组诱导后DAP降低，并在T5、T6和T7时保持低于基线值（分别为71.3±12.8、76.2±10.7、68.9±10.8和62.1±8.7；p<0.05）。根据平均百分比变化，与III组相比，II组HR显著降低（-13.4±17.6%对11.0±27.8%；p = 0.003）。与II组相比，I组SAP的升高显著（9.8±20.9%对-9.2±20.2%；p<0.05）。与II组相比，III组DAP的升高显著（0.07±19.8对24.5±39.1；p<0.05）。
在高血压患者中，麻醉诱导前给予右美托咪定可减弱气管插管的血流动力学反应并降低硫喷妥钠剂量。
