Igarashi M, Nishikawa K, Nakayama M, Sato K, Kita A, Tsunoda K, Tsuchida H, Namiki A
Department of Anesthesia, Nikko Memorial Hospital, Muroran.
Masui. 1998 Oct;47(10):1193-9.
We examined the circulatory changes after intravenous thiamylal with additional injection of thiamylal 1 minute before intubation and after propofol at the time of anesthetic induction and endotracheal intubation. Sixty ASA I or II patients were studied after the institutional and informed consents. We compared the following three groups. Group I (n = 20): Anesthesia was induced with thiamylal 5 mg.kg-1 and intubation with the aid of vecuronium 0.1 mg.kg-1. Group II (n = 20): Anesthesia was induced with thiamylal 3 mg.kg-1 and vecuronium 0.1 mg.kg-1. One minute before the intubation, the patients received additional thiamylal 4 mg.kg-1. Group III (n = 20): Anesthesia was induced with propofol 2.5 mg.kg-1 and intubation was performed with the aid of vecuronium 0.1 mg.kg-1. We examined the systolic, diastolic and mean blood pressures, heart rate, and rate pressure product (RPP) in the three groups. The examinations were performed before and after induction, soon after intubation, and every one minute after intubation for 5 minutes. After the endotracheal intubation, the systolic blood pressure and heart rate increased in Group I. But the systolic and diastolic pressures were significantly more stable in Group II and Group III. The change of the RPP was slight and most stable in Group II compared with the other two groups. We conclude that additional injection of thiamylal 4 mg.kg-1 following induction of anesthesia with thyamylal 3 mg.kg-1 1 minute before endotracheal intubation is an effective method for minimizing the increase in blood pressure and circulatory changes at the time of rapid induction of anesthesia and endotracheal intubation.
我们研究了静脉注射硫喷妥钠后，在插管前1分钟额外注射硫喷妥钠以及麻醉诱导和气管插管时使用丙泊酚后的循环变化。在获得机构批准和患者知情同意后，对60例美国麻醉医师协会（ASA）分级为I或II级的患者进行了研究。我们比较了以下三组。第一组（n = 20）：用5mg.kg-1硫喷妥钠诱导麻醉，并借助0.1mg.kg-1维库溴铵进行插管。第二组（n = 20）：用3mg.kg-1硫喷妥钠和0.1mg.kg-1维库溴铵诱导麻醉。在插管前1分钟，患者额外接受4mg.kg-1硫喷妥钠。第三组（n = 20）：用2.5mg.kg-1丙泊酚诱导麻醉，并借助0.1mg.kg-1维库溴铵进行插管。我们检测了三组患者的收缩压、舒张压、平均血压、心率和心率血压乘积（RPP）。检测在诱导前、诱导后、插管后即刻以及插管后每分钟进行，共持续5分钟。气管插管后，第一组的收缩压和心率升高。但第二组和第三组的收缩压和舒张压明显更稳定。与其他两组相比，第二组的RPP变化轻微且最稳定。我们得出结论，在气管插管前1分钟用3mg.kg-1硫喷妥钠诱导麻醉后额外注射4mg.kg-1硫喷妥钠是一种有效方法，可将快速诱导麻醉和气管插管时血压升高及循环变化降至最低。
