Murugesan Nandhakumar, Kamalnath Amoolya, Ranjan R V, Segaran Sivakumar
Anaesthesiology, Muthus Ortho Hospital, Coimbatore, IND.
Anaesthesiology, Pondicherry Institute of Medical Sciences, Pondicherry, IND.
Cureus. 2024 Aug 5;16(8):e66241. doi: 10.7759/cureus.66241. eCollection 2024 Aug.
Background and aims Laryngoscopy and intubation cause an increased sympatho-adrenergic pressor response, which can be detrimental to patients with coronary artery disease, hypertension, etc. Various drugs and manoeuvres have been tried to reduce the pressor response with acceptable results but the quest for the ideal drug still continues. Hence, we planned to compare the effects of magnesium sulfate with paracetamol and fentanyl with lignocaine on attenuating the hemodynamic responses due to direct laryngoscopy and intubation and to note the complications of these drugs. Methods We studied 60 adult patients of the American Society of Anaesthesiologists (ASA) physical status I and II of either sex, scheduled for elective surgery under general anaesthesia. The patients were randomly divided into two groups. Group A received 25 mg/kg magnesium sulphate mixed with paracetamol 1 gram IV (100 ml) given over 10 minutes before induction and Group B received 2 mcg/kg fentanyl and 1.5 mg/kg lignocaine, 3 minutes before intubation. All patients were uniformly pre-medicated, induced, and intubated as per standard protocol. Heart rate (HR) and systemic arterial pressures were recorded at baseline, after study drug infusion, after induction, and 1, 3, 5, 10, and 15 mins after intubation. Hemodynamic parameters were compared using repeated measures analysis of variance (ANOVA). In the post-hoc tests, p value < 0.05 was considered statistically significant. Results We observed the mean pre-op HR (p = 0.161) and mean HR one-minute post-induction (p = 0.144). The percentage change from baseline at one-minute post-induction was 9.7 in Group A and 15.2 in Group B. We observed the mean pre-op mean arterial pressure (MAP) (p = 0.119) and mean MAP one minute post-induction (p = 0.585). The percentage change from baseline at one-minute post-induction was 3.3 in Group A and 2.8 in Group B. The percentage change from baseline was found to be within 15%, for HR in Group A and for systolic blood pressure (SBP), diastolic blood pressure (DBP), and MAP in Group B. However, there was no statistically significant difference (p > 0.05) between the mean HR, SBP, DBP, and MAP between the time points. Conclusion In our study, both the combinations of drugs, magnesium sulphate with paracetamol (Group A drugs) and fentanyl with lignocaine (Group B drugs) were found to be equally effective (i.e. neither group was superior to the other) in attenuating the hemodynamic response to laryngoscopy and intubation.
背景与目的 喉镜检查和气管插管会引起交感 - 肾上腺素能升压反应增强，这对冠心病、高血压等患者可能有害。人们尝试了各种药物和操作来降低这种升压反应，取得了一定效果，但对理想药物的探索仍在继续。因此，我们计划比较硫酸镁与对乙酰氨基酚联用、芬太尼与利多卡因联用对减轻直接喉镜检查和气管插管引起的血流动力学反应的效果，并记录这些药物的并发症。方法 我们研究了60例美国麻醉医师协会（ASA）身体状况为I级和II级的成年患者，男女不限，计划在全身麻醉下进行择期手术。患者被随机分为两组。A组在诱导前10分钟静脉输注25mg/kg硫酸镁与1克对乙酰氨基酚混合液（100ml），B组在插管前3分钟静脉输注2μg/kg芬太尼和1.5mg/kg利多卡因。所有患者均按照标准方案进行统一的术前用药、诱导和插管。在基线、研究药物输注后、诱导后以及插管后1、3、5、10和15分钟记录心率（HR）和体循环动脉压。使用重复测量方差分析（ANOVA）比较血流动力学参数。在事后检验中，p值<0.05被认为具有统计学意义。结果 我们观察到术前平均HR（p = 0.161）和诱导后1分钟平均HR（p = 0.144）。诱导后1分钟A组相对于基线的变化百分比为9.7，B组为15.2。我们观察到术前平均动脉压（MAP）（p = 0.119）和诱导后1分钟平均MAP（p = 0.585）。诱导后1分钟A组相对于基线的变化百分比为3.3，B组为2.8。发现A组HR以及B组收缩压（SBP）、舒张压（DBP）和MAP相对于基线的变化百分比在15%以内。然而，各时间点之间的平均HR、SBP、DBP和MAP之间无统计学显著差异（p>0.05）。结论 在我们的研究中，发现硫酸镁与对乙酰氨基酚联用（A组药物）和芬太尼与利多卡因联用（B组药物）在减轻喉镜检查和气管插管引起的血流动力学反应方面同样有效（即两组无优劣之分）。
