Billard V, Moulla F, Bourgain J L, Megnigbeto A, Stanski D R
Département d'Anesthésie-Analgésie-Réanimation, Institut Gustave Roussy, Villejuif, France.
Anesthesiology. 1994 Dec;81(6):1384-93. doi: 10.1097/00000542-199412000-00013.
When given as an intravenous bolus for induction of anesthesia, propofol can decrease postintubation hypertension but can also create moderate to severe postinduction, preintubation hypotension. The addition of fentanyl usually decreases the postintubation hypertension but can increase the propofol-induced preintubation hypotension. The goal of the study was to determine the relation between propofol and fentanyl doses and the hemodynamic changes post-induction, preintubation and postintubation.
Twelve groups of 10 patients, ASA physical status 1 or 2, first received fentanyl 0, 2, or 4 micrograms.kg-1 and then 5 min later received propofol 2.0, 2.5, 3.0, or 3.5 mg.kg-1 as an intravenous bolus for induction of anesthesia. Arterial blood pressure was continuously monitored. The trachea was intubated 4 min after propofol administration.
The mean decrease in systolic blood pressure after propofol was 28 mmHg when no fentanyl was given, 53 mmHg after 2 microgram.kg-1 of fentanyl (P < 0.05 vs. no fentanyl), and 50 mmHg after 4 micrograms.kg-1 (P < 0.05 vs. no fentanyl; no statistically significant difference 4 vs. 2 micrograms.kg-1). There was no statistically significant difference in hemodynamic response to intubation relative to propofol dose. Hemodynamic response to intubation was decreased by the administration of fentanyl; the mean increase of systolic blood pressure after intubation was 65 mmHg from preintubation value without fentanyl, 50 mmHg after 2 micrograms.kg-1, and 37 mmHg after 4 micrograms.kg-1 (P < 0.05 for 2 and 4 micrograms.kg-1 vs. no fentanyl and for 4 vs. 2 micrograms.kg-1). Hemodynamic changes postintubation were not statistically different with increasing doses of propofol.
Hemodynamic changes after induction with propofol or propofol/fentanyl, pre- or postintubation, are not modified when the propofol dose is increased from 2 to 3.5 mg.kg-1. Maximal hypotension preintubation occurs with a fentanyl dose of 2 micrograms.kg-1, whereas the magnitude of postintubation hypertension is significantly decreased with an increase in the fentanyl dose to 4 micrograms.kg-1.
丙泊酚静脉推注用于麻醉诱导时，可降低气管插管后高血压，但也可导致麻醉诱导后、气管插管前出现中度至重度低血压。添加芬太尼通常可降低气管插管后高血压，但会加重丙泊酚诱导的气管插管前低血压。本研究的目的是确定丙泊酚和芬太尼剂量与诱导后、气管插管前和气管插管后血流动力学变化之间的关系。
12组患者，每组10例，美国麻醉医师协会（ASA）身体状况分级为1或2级，首先接受0、2或4微克/千克的芬太尼，5分钟后接受2.0、2.5、3.0或3.5毫克/千克的丙泊酚静脉推注用于麻醉诱导。持续监测动脉血压。丙泊酚给药4分钟后进行气管插管。
未给予芬太尼时，丙泊酚给药后收缩压平均下降28 mmHg；给予2微克/千克芬太尼后，收缩压平均下降53 mmHg（与未给予芬太尼相比，P<0.05）；给予4微克/千克芬太尼后，收缩压平均下降50 mmHg（与未给予芬太尼相比，P<0.05；4微克/千克与2微克/千克相比无统计学显著差异）。相对于丙泊酚剂量，气管插管时的血流动力学反应无统计学显著差异。芬太尼给药可降低气管插管时的血流动力学反应；未给予芬太尼时，气管插管后收缩压较插管前平均升高65 mmHg，给予2微克/千克芬太尼后升高50 mmHg，给予4微克/千克芬太尼后升高37 mmHg（2微克/千克和4微克/千克与未给予芬太尼相比，以及4微克/千克与2微克/千克相比，P<0.05）。随着丙泊酚剂量增加，气管插管后的血流动力学变化无统计学差异。
当丙泊酚剂量从2毫克/千克增加到3.5毫克/千克时，丙泊酚或丙泊酚/芬太尼诱导后、气管插管前后的血流动力学变化未改变。气管插管前最大低血压出现在芬太尼剂量为2微克/千克时，而当芬太尼剂量增加到4微克/千克时，气管插管后高血压的程度显著降低。
