Chraemmer-Jørgensen B, Høilund-Carlsen P F, Marving J, Christensen V
Can Anaesth Soc J. 1986 Nov;33(6):754-9. doi: 10.1007/BF03027126.
A randomized clinical trial was conducted in 14 women, aged 24-60 years, to compare the effects of rapid-sequence induction of anaesthesia and elective induction on heart rate, blood pressure and left ventricular ejection fraction (LVEF). None of the patients suffered from heart or lung diseases, and all were scheduled for hysterectomy. Cuff blood pressure was measured repeatedly by an automatic recording device, and heart rate and LVEF were monitored by a portable nonimaging nuclear probe. In seven patients, a rapid-sequence induction was performed following preoxygenation and with simultaneous injection of thiopentone (5 mg X kg-1) and succinylcholine, without starting manual ventilation until the airway was secured with the endotracheal tube. In another seven patients, elective induction was carried out by sequential administration of the same drugs. Forty seconds after laryngoscopy and intubation mean blood pressure had increased by 38 per cent and heart rate by 29 per cent from preintubation values in the rapid sequence induction group, compared to 30 and 12 per cent respectively, in the elective induction group (p less than 0.05). Similar decreases in LVEF was observed in both groups, from 0.60 to 0.42 in the elective induction group, and from 0.60 to 0.41 in the rapid-sequence induction group. The equal depression of LVEF indicates that laryngoscopy and intubation produce, with both induction regimens, sudden impairment of cardiac function. The more pronounced hypertension and tachycardia observed during rapid-sequence induction suggests a higher myocardial oxygen consumption which may represent a serious additional burden for the poorly perfused heart.
对14名年龄在24至60岁之间的女性进行了一项随机临床试验，以比较快速顺序诱导麻醉和择期诱导对心率、血压和左心室射血分数（LVEF）的影响。所有患者均无心肺疾病，均计划进行子宫切除术。通过自动记录装置反复测量袖带血压，并用便携式非成像核探头监测心率和LVEF。7名患者在预充氧后进行快速顺序诱导，同时注射硫喷妥钠（5mg/kg-1）和琥珀酰胆碱，在通过气管内导管确保气道安全之前不开始手动通气。另外7名患者通过依次给予相同药物进行择期诱导。与择期诱导组分别为30%和12%相比，快速顺序诱导组在喉镜检查和插管后40秒时，平均血压比插管前值升高了38%，心率升高了29%（p<0.05）。两组LVEF均有类似下降，择期诱导组从0.60降至0.42，快速顺序诱导组从0.60降至0.41。LVEF的同等降低表明，两种诱导方案下，喉镜检查和插管都会导致心功能突然受损。快速顺序诱导期间观察到的更明显的高血压和心动过速表明心肌氧消耗更高，这可能对灌注不良的心脏造成严重的额外负担。
