El-Shmaa Nagat S, El-Baradey Ghada F
Department of Anesthesia & Surgical ICU, Faculty of Medicine, Tanta University.
J Clin Anesth. 2016 Jun;31:267-73. doi: 10.1016/j.jclinane.2016.01.037. Epub 2016 Apr 18.
To assess the effectiveness of labetalol vs dexmedetomidine for attenuation of hemodynamic stress response to laryngoscopy and endotracheal intubation.
Prospective, randomized, controlled, observer-blinded study.
This study was carried out in Tanta University Hospital.
Ninety patients of both sexes; American Society of Anesthesiologists physical status I and II; age range from 20 to 60 years; scheduled for elective surgery under general anesthesia.
Patients were divided into 3 groups (30 each). Group A received 1 μg/kg of dexmedetomidine as intravenous (IV) infusion, group B received labetalol 0.25mg/kg IV, and group C received 10mL saline IV.
The groups were compared for heart rate (HR), mean arterial pressure (MAP), and rate pressure product (RPP). Hemodynamic parameters were recorded during the preinduction; after induction; at intubation; and at 1, 3, 5, 10, and 15minutes. The primary outcomes were hemodynamic changes (HR, MBP, and RPP), and the secondary outcome was propofol dose requirement for induction of general anaesthesia.
Significant decrease (P < .05) in HR, MBP, and RPP in groups A and B in comparison with group C and in group A in comparison with group B. Just before intubation, there was a significant decrease (P < .05) in HR, MBP, and RPP in groups A and B in comparison with group C. In group C, there was a significant increase in HR, MBP, and RPP at all points when compared with the baseline. In group A, the mean propofol induction dose (mg) was statistically significantly low as compared with that in groups B and C.
Dexmedetomidine attenuates the hemodynamic stress response to laryngoscopy and intubation more effectively compared with labetalol without any deleterious effects. Furthermore, dexmedetomidine decreases dose of propofol for induction of anesthesia as guided by bispectral index.
评估拉贝洛尔与右美托咪定减轻喉镜检查和气管插管血流动力学应激反应的效果。
前瞻性、随机、对照、观察者盲法研究。
本研究在坦塔大学医院进行。
90例患者，男女不限；美国麻醉医师协会身体状况I级和II级；年龄范围为20至60岁；计划在全身麻醉下进行择期手术。
患者分为3组（每组30例）。A组静脉输注1μg/kg右美托咪定，B组静脉注射0.25mg/kg拉贝洛尔，C组静脉注射10mL生理盐水。
比较各组的心率（HR）、平均动脉压（MAP）和率压积（RPP）。在诱导前、诱导后、插管时以及1、3、5、10和15分钟记录血流动力学参数。主要结局是血流动力学变化（HR、MBP和RPP），次要结局是全身麻醉诱导所需的丙泊酚剂量。
与C组相比，A组和B组的HR、MBP和RPP显著降低（P <.05），与B组相比，A组显著降低。插管前，与C组相比，A组和B组的HR、MBP和RPP显著降低（P <.05）。与基线相比，C组在所有时间点的HR、MBP和RPP均显著升高。与B组和C组相比，A组的丙泊酚诱导平均剂量（mg）在统计学上显著较低。
与拉贝洛尔相比，右美托咪定能更有效地减轻喉镜检查和插管的血流动力学应激反应，且无任何有害影响。此外，右美托咪定在脑电双频指数引导下可降低麻醉诱导时丙泊酚的剂量。
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