Jellish W S, Riche H, Salord F, Ravussin P, Tempelhoff R
Department of Anesthesiology, Loyola University Medical Center, Maywood, IL, USA.
J Clin Anesth. 1997 Feb;9(1):36-41. doi: 10.1016/S0952-8180(96)00211-5.
To determine whether etomidate-based induction can provide better hemodynamics than a standard thiopental sodium-based anesthetic induction.
Prospective, single-blind clinical trial.
Multicenter university neurosurgical operating room.
66 ASA physical status II and III inpatients undergoing neurosurgical procedures for intracranial tumor or other pathology.
Patients were divided into two groups for anesthetic induction. The first group (control) was divided into two subgroups, with the first subgroup receiving "low-dose" etomidate (LET) 0.4 to 0.6 mg/kg titrated to an electroencephalographic (EEG) spectral edge frequency (SEF) of 10 to 12 Hz. The second subgroup received thiopental sodium (THIO) 3 to 6 mg/kg titrated to the same EEG endpoint. The study group was given high-dose etomidate (HET) 0.5 to 1.7 mg/kg titrated to an early burst suppression pattern.
Baseline (awake) measurements of mean arterial pressure (MAP) heart rate (HR), and SEF were obtained prior to anesthetic induction that was accomplished using a small bolus plus an infusion of the induction drug titrated to the EEG target. MAP, HR, and SEF were recorded just prior to laryngoscopy and intubation (T1), 30 seconds after laryngoscopy and intubation (T2), and 90 seconds after (T3) laryngoscopy and intubation. Times to reach EEG endpoint, along with total dose of anesthetic given, were also recorded. Compared with baseline values, the THIO group had the highest increase in both HR (22.9 +/- 4.4 bpm.) and MAP (16.8 +/- 4.2 mmHg) (P < 0.05) after laryngoscopy and intubation. The LET group also had significant increases compared with the HET group that demonstrated the least hemodynamic variability. No correlations could be made between age and dose of induction drug.
Etomidate-based anesthetic induction, titrated to EEG burst suppression, produced stable hemodynamics during laryngoscopy and intubation as compared with lower dose, more "classic" inductions with etomidate or thiopental.
确定依托咪酯诱导麻醉是否比标准硫喷妥钠诱导麻醉能提供更好的血流动力学。
前瞻性单盲临床试验。
多中心大学神经外科手术室。
66例美国麻醉医师协会（ASA）身体状况为Ⅱ级和Ⅲ级的住院患者，接受颅内肿瘤或其他病变的神经外科手术。
患者被分为两组进行麻醉诱导。第一组（对照组）分为两个亚组，第一个亚组接受“低剂量”依托咪酯（LET）0.4至0.6mg/kg，滴定至脑电图（EEG）频谱边缘频率（SEF）为10至12Hz。第二个亚组接受硫喷妥钠（THIO）3至6mg/kg，滴定至相同的EEG终点。研究组给予高剂量依托咪酯（HET）0.5至1.7mg/kg，滴定至早期爆发抑制模式。
在麻醉诱导前获得平均动脉压（MAP）、心率（HR）和SEF的基线（清醒）测量值，麻醉诱导采用小剂量推注加输注诱导药物并滴定至EEG目标值。在喉镜检查和插管前（T1）、喉镜检查和插管后30秒（T2）以及喉镜检查和插管后90秒（T3）记录MAP、HR和SEF。还记录达到EEG终点的时间以及给予的麻醉药物总剂量。与基线值相比，硫喷妥钠组在喉镜检查和插管后HR（22.9±4.4次/分钟）和MAP（16.8±4.2mmHg）的升高幅度最大（P<0.05）。依托咪酯低剂量组与高剂量组相比也有显著升高，高剂量组血流动力学变异性最小。年龄与诱导药物剂量之间无相关性。
与较低剂量、更“经典”的依托咪酯或硫喷妥钠诱导相比，滴定至EEG爆发抑制的依托咪酯诱导麻醉在喉镜检查和插管期间产生稳定的血流动力学。
