Laurito C E, Baughman V L, Becker G L, Cunningham F, Pygon B H, Citron G M
Department of Anesthesiology, University of Illinois College of Medicine, Chicago.
J Clin Anesth. 1993 Jan-Feb;5(1):54-7. doi: 10.1016/0952-8180(93)90089-w.
To determine whether a 300 micrograms dose of oral clonidine given 90 minutes prior to laryngoscopy and intubation provides hemodynamic protection from the stress of a brief (15-second) and/or a prolonged (45-second) laryngoscopy.
Randomized, double-blind, placebo-controlled study.
Inpatients and outpatients scheduled for general anesthesia with intubation at a university-affiliated medical center.
Forty patients who gave informed, written consent to receive either an oral placebo or clonidine 5 micrograms/kg (up to a maximum dose of 300 micrograms) 90 minutes prior to induction of anesthesia and to undergo either brief or prolonged laryngoscopy prior to intubation.
The patients underwent a standardized induction sequence that included d-tubocurarine 3 mg, thiopental sodium 5 mg/kg, and succinylcholine 1.5 mg/kg. The four treatment groups (each n = 10) included (1) placebo with 15-second laryngoscopy, (2) placebo with 45-second laryngoscopy, (3) clonidine with 15-second laryngoscopy, and (4) clonidine with 45-second laryngoscopy. Heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were mechanically obtained and recorded at 1-minute intervals for 12 minutes.
There were no differences between groups in the premedication hemodynamic measurements. Within each group, maximal hemodynamic variables increased significantly over the corresponding baseline values for that group. In the 15-second, but not the 45-second, laryngoscopy, clonidine successfully blunted the maximum SBP and DBP obtained when compared with the corresponding control group. In both the 15- and 45-second clonidine groups, maximum HR was significantly lower than in the corresponding placebo groups.
Oral clonidine, when used as a preoperative medication, affords hemodynamic protection to patients undergoing a 15-second laryngoscopy. However, the stress of a 45-second laryngoscopy may be too great or the 300 micrograms dose of clonidine too low to provide hemodynamic protection for patients in this group.
确定在喉镜检查和气管插管前90分钟给予300微克口服可乐定是否能为患者提供血流动力学保护，使其免受短暂（15秒）和/或延长（45秒）喉镜检查应激的影响。
随机、双盲、安慰剂对照研究。
在一所大学附属医院接受全身麻醉并插管的住院患者和门诊患者。
40名患者书面知情同意在麻醉诱导前90分钟接受口服安慰剂或5微克/千克（最大剂量300微克）可乐定，并在插管前接受短暂或延长的喉镜检查。
患者接受标准化诱导程序，包括3毫克右旋筒箭毒碱、5毫克/千克硫喷妥钠和1.5毫克/千克琥珀酰胆碱。四个治疗组（每组n = 10）包括：（1）安慰剂组，接受15秒喉镜检查；（2）安慰剂组，接受45秒喉镜检查；（3）可乐定组，接受15秒喉镜检查；（4）可乐定组，接受45秒喉镜检查。心率（HR）、收缩压（SBP）和舒张压（DBP）通过机械测量，每隔1分钟记录一次，共记录12分钟。
用药前血流动力学测量结果在各组之间无差异。在每组中，最大血流动力学变量均较该组相应的基线值显著增加。在15秒喉镜检查组（而非45秒喉镜检查组）中，与相应对照组相比，可乐定成功抑制了所测得的最大收缩压和舒张压。在15秒和45秒可乐定组中，最大心率均显著低于相应的安慰剂组。
口服可乐定作为术前用药，可为接受15秒喉镜检查的患者提供血流动力学保护。然而，45秒喉镜检查的应激可能过大，或者300微克剂量的可乐定过低，无法为该组患者提供血流动力学保护。
