Chen C C, Tsai P S, Yang L C, Jawan B, Lee J H
Department of Anesthesiology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan, R.O.C.
Acta Anaesthesiol Sin. 1996 Dec;34(4):197-202.
Two different types of calcium channel blockers (namely nicardipine and verapamil) have been used widely in clinical practice. However, no clinical studies have previously been performed to ascertain the relative potency of intravenous verapamil and nicardipine in the attenuation of cardiovascular response to tracheal intubation.
We assessed the optimal dose and relative potency of verapamil and nicardipine in the attenuation of hemodynamic response to tracheal intubation in 135 healthy patients. Control group (Group D received normal saline i.v. Patients in Groups II-V received nicardipine 0.005, 0.01, 0.03 and 0.06 mg/kg i.v., respectively. Patients in Groups VI-IX received verapamil 0.03, 0.05, 0.1 and 0.15 mg/kg i.v., respectively. Anaesthesia was induced with propofol (2.5 mg/kg) and muscle relaxation was facilitated by vecuronium (0.2 mg/kg, i.v.). One min after induction, tracheal intubation was performed. Mean arterial pressure (MAP) was measured at 1 min interval from 10 min before induction to 15 min after induction.
The ED50 with 95% confidence interval of nicardipine and verapamil for the attenuation of 50% mean arterial pressure (MAP) increase after tracheal intubation were 14.55 micrograms/kg (8.25-25.67) and 75.4 micrograms/kg (58.7-96.95), respectively. The ED50 with 95% confidence interval of verapamil for the reduction of the 50% heart rate (HR) increase post tracheal intubation was 57.4 micrograms/kg (18-182.2). No differences were found in the frequency of perioperative arrhythmia, post-operative hypotension, postoperative emesis, dizziness, muscle weakness and muscle soreness within two hours following surgery, when compared control with experimental groups (p > 0.05).
These results suggest that verapamil and nicardipine attenuate the hypertensive response to tracheal intubation without significant adverse effects in healthy patients. The dose ratio (ED50 nicardipine and ED50 verapamil for MAP) with 95% confidence interval was revealed to be 2.3 (1.82-7.41).
两种不同类型的钙通道阻滞剂（即尼卡地平和维拉帕米）已在临床实践中广泛应用。然而，此前尚未进行临床研究以确定静脉注射维拉帕米和尼卡地平在减轻气管插管引起的心血管反应方面的相对效力。
我们评估了维拉帕米和尼卡地平在135例健康患者中减轻气管插管引起的血流动力学反应的最佳剂量和相对效力。对照组（D组）静脉注射生理盐水。II - V组患者分别静脉注射0.005、0.01、0.03和0.06 mg/kg的尼卡地平。VI - IX组患者分别静脉注射0.03、0.05、0.1和0.15 mg/kg的维拉帕米。用丙泊酚（2.5 mg/kg）诱导麻醉，并用维库溴铵（0.2 mg/kg，静脉注射）辅助肌肉松弛。诱导后1分钟进行气管插管。从诱导前10分钟到诱导后15分钟，每隔1分钟测量平均动脉压（MAP）。
气管插管后尼卡地平和维拉帕米减轻50%平均动脉压（MAP）升高的半数有效剂量（ED50）及其95%置信区间分别为14.55微克/千克（8.25 - 25.67）和75.4微克/千克（58.7 - 96.95）。维拉帕米减轻气管插管后50%心率（HR）升高的ED50及其95%置信区间为57.4微克/千克（18 - 182.2）。与对照组相比，实验组围手术期心律失常、术后低血压、术后呕吐、头晕、肌肉无力和术后两小时内肌肉酸痛的发生率无差异（p > 0.05）。
这些结果表明，维拉帕米和尼卡地平可减轻气管插管引起的高血压反应，且对健康患者无明显不良反应。尼卡地平和维拉帕米减轻MAP升高的剂量比（ED50）及其95%置信区间为2.3（1.82 - 7.41）。
