Xin Y, Wei Z, Wang S S, Wu L L, Wang Y, Wang G Y
Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
Zhonghua Yi Xue Za Zhi. 2023 Jul 4;103(25):1892-1896. doi: 10.3760/cma.j.cn112137-20221124-02488.
To evaluate the preventive effect of atropine premedication during anesthesia induction on vagal reflex in patients undergoing suspension laryngoscopy. A total of 342 patients (202 males and 140 females) scheduled for suspension laryngoscopy under general anesthesia in Beijing Tongren Hospital from October 2021 to March 2022 were prospectively enrolled, with a mean age of (48.1±11.9) years. The patients were randomly divided into two groups using the random number table method: the treatment group (=171) and the control group (=171). Patients in the treatment group were administrated with 0.5 mg atropine intravenously guttae (ivgtt) while patients in the control group were given equivalent volume of normal saline. For all patients, if heart rate (HR)<50 beats/min happened during the insertion of the suspension laryngoscope, the operation should be stopped and the laryngoscope should be removed. Patients without HR recovery after the removal of the laryngoscope should be given 0.5 mg atropine, and the operation should be continued after the HR recovered. The primary outcome was the incidence of HR fluctuation over 20% (ΔHR>20%) before and immediately after suspension laryngoscope fixation, and the secondary outcomes included HR, mean arterial pressure (MAP) of the two groups recorded before and after anesthesia induction, before and immediately after suspension laryngoscope fixation, and the incidences of sinus bradycardia, laryngoscope removal and atropine treatment during operation. The incidences of ΔHR>20% and bradycardia immediately after the suspension laryngoscope fixation were 14.6% (25/171) and 12.9% (22/171) in the treatment group, which were significantly lower than those in the control group [28.1% (48/171) and 29.8% (51/171)] (both <0.05). The HR immediately after the suspension laryngoscope fixation in the treatment group [(66.4±13.5) beats/min] and in the control group [(60.8±15.7) beats/min] was significantly lower than those before the suspension laryngoscope fixation [(74.7±11.1) beats/min and (67.6±12.8) beats/min, respectively] (both <0.05). There were no significant differences in MAP between the two groups at each time point (all >0.05). The incidence of laryngoscope removal once plus 0.5 mg atropine administration, laryngoscope removal twice plus 0.5 mg atropine administration and laryngoscope removal twice plus 1.0 mg atropine administration was 9.9% (17/171), 1.8% (3/171) and 0 (0) in the treatment group, respectively, which was significantly lower than those in the control group [24.0% (41/171), 5.8% (10/171) and 2.3% (4/171), respectively] (all <0.05). Atropine premedication during anesthesia induction can effectively reduce the occurrence of vagal reflex in patients undergoing suspension laryngoscopy.
评估麻醉诱导期阿托品预处理对支撑喉镜手术患者迷走神经反射的预防效果。前瞻性纳入2021年10月至2022年3月在北京同仁医院择期行全身麻醉下支撑喉镜手术的342例患者（男202例，女140例），平均年龄（48.1±11.9）岁。采用随机数字表法将患者随机分为两组：治疗组（n = 171）和对照组（n = 171）。治疗组患者静脉滴注0.5 mg阿托品，对照组患者给予等量生理盐水。所有患者在支撑喉镜插入过程中若心率（HR）<50次/分，应停止手术并拔出喉镜。拔出喉镜后心率未恢复的患者应给予0.5 mg阿托品，心率恢复后继续手术。主要观察指标为支撑喉镜固定前后HR波动超过20%（ΔHR>20%）的发生率，次要观察指标包括两组患者麻醉诱导前、支撑喉镜固定前后的HR、平均动脉压（MAP），以及术中窦性心动过缓、喉镜拔出和阿托品治疗的发生率。治疗组支撑喉镜固定后ΔHR>20%和心动过缓的发生率分别为14.6%（25/（171）和12.9%（22/171），显著低于对照组[28.1%（48/171）和29.8%（51/171）]（均P<0.05）。治疗组支撑喉镜固定后HR[（66.4±13.5）次/分]和对照组[（60.8±15.7）次/分]均显著低于支撑喉镜固定前[分别为（74.7±11.1）次/分和（67.6±12.8）次/分]（均P<0.05）。两组各时间点MAP差异均无统计学意义（均P>0.05）。治疗组喉镜拔出1次加用0.5 mg阿托品、喉镜拔出2次加用0.5 mg阿托品和喉镜拔出2次加用1.0 mg阿托品的发生率分别为9.9%（17/171）、1.8%（3/171）和0（0），显著低于对照组[分别为24.0%（41/171）、5.8%（10/171）和2.3%（4/171）]（均P<0.05）。麻醉诱导期阿托品预处理可有效降低支撑喉镜手术患者迷走神经反射的发生。
