Channaiah Vijayalakshmi B, Kurek Nicholas S, Moses Ryder, Chandra Sathees B
Krishna Rajendra Hospital and Cheluvamba Hospital, Mysore Medical College, Rajiv Gandhi University, India.
Department of Biological, Chemical and Physical Sciences, Roosevelt University, Chicago, IL 60605, USA.
Med Arch. 2014 Oct;68(5):339-44. doi: 10.5455/medarh.2014.68.339-344. Epub 2014 Oct 15.
Endotracheal intubation is one of the most invasive stimuli in anesthesia and it's often accompanied by a hemodynamic pressor response. The purpose of this study was to investigate the efficacy of a single pre-induction 2 µg/kg bolus injection of fentanyl followed by two puffs of nitroglycerin sub lingual spray (400 µg /spray) with a thiopentone/suxamethonium sequence in the attenuation of the hemodynamic response to endotracheal intubation in normotensive patients.
The study consisted of 80 randomly selected ASA physical status I/II male/female adults who were aged between 18 through 60 years and scheduled for elective surgery. Group I received a single 2 µg/kg IV bolus of fentanyl diluted to 5 ml with normal saline 5 min prior to laryngoscopy followed by two puffs of nitroglycerin sub lingual spray (400 µg/spray) 2 minutes prior to intubation (n=40). Group II received a single 2 µg/kg IV bolus of fentanyl diluted to 5 ml with normal saline 5 min prior to laryngoscopy (n=40). Heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and rate pressure product were compared to basal values at pre-induction, induction, intubation and post-intubation as well as at time increments of 1, 3, 5, 7 and 10 min.
Fentanyl combined with nitroglycerin did not attenuate hemodynamic pressor responses more than fentanyl alone. Increases of HR (7.9%), DBP (4.0%), MAP (3.6%) and RPP (6.0%) along with attenuation of SBP (2.7%) were observed in the fentanyl-nitroglycerin group as compared to the equivalent control measured values.
A single pre-induction bolus injection of fentanyl followed by two puffs of nitroglycerin sub lingual spray in a thiopentone/suxamethonium anesthetic sequence neither successfully attenuates nor successfully suppresses the hemodynamic pressor response more effectively than fentanyl alone in normotensive patients resulting from endotracheal intubation.
气管插管是麻醉中最具侵入性的刺激之一，常伴有血流动力学升压反应。本研究的目的是探讨在正常血压患者中，诱导前单次静脉注射2µg/kg芬太尼，随后在硫喷妥钠/琥珀酰胆碱诱导过程中舌下喷两次硝酸甘油（400µg/喷）对减轻气管插管血流动力学反应的效果。
本研究包括80例随机选择的ASA身体状况为I/II级、年龄在18至60岁之间、计划进行择期手术的成年男女。第一组在喉镜检查前5分钟静脉注射单次2µg/kg芬太尼，用生理盐水稀释至5ml，然后在插管前2分钟舌下喷两次硝酸甘油（400µg/喷）（n = 40）。第二组在喉镜检查前5分钟静脉注射单次2µg/kg芬太尼，用生理盐水稀释至5ml（n = 40）。比较诱导前、诱导时、插管时、插管后以及1、3、5、7和10分钟时间点的心率、收缩压、舒张压、平均动脉压和率压乘积与基础值。
与单独使用芬太尼相比，芬太尼联合硝酸甘油并没有更有效地减轻血流动力学升压反应。与等效对照组测量值相比，芬太尼-硝酸甘油组观察到心率升高（7.9%）、舒张压升高（4.0%）、平均动脉压升高（3.6%）和率压乘积升高（6.0%），同时收缩压降低（2.7%）。
在硫喷妥钠/琥珀酰胆碱麻醉过程中，诱导前单次静脉注射芬太尼，随后舌下喷两次硝酸甘油，在正常血压患者中，对于气管插管引起的血流动力学升压反应，既不能比单独使用芬太尼更有效地减轻，也不能更有效地抑制。
