Ramanathan J, Angel J J, Bush A J, Lawson P, Sibai B
Department of Anesthesiology, University of Tennessee College of Medicine, Memphis 38163, USA.
Anesth Analg. 1999 Feb;88(2):357-61. doi: 10.1097/00000539-199902000-00025.
In women with severe preeclampsia, significant increases in mean arterial pressures (MAP) are common after rapid induction of general anesthesia (GA) and tracheal intubation. The objectives of this prospective study were to assess the effects of the rapid induction-intubation technique on middle cerebral artery (MCA) flow velocity in severe preeclampsia and to examine the correlation between mean MCA flow velocity (Vm) and MAP. Eight women with severe preeclampsia (study group) and six normotensive women at term (control group) scheduled to undergo cesarean section under GA were studied. Before induction, patients in the study group received i.v. labetalol in divided doses to lower diastolic pressures to <100 mm Hg. Anesthesia was induced with pentothal 4-5 mg/kg, followed by succinylcholine 1.5 mg/kg to facilitate tracheal intubation. A transcranial Doppler was used to measure Vm. Both Vm and MAP were recorded before induction and every minute for 6 min after intubation. In the study group, after the administration of labetalol, MAP decreased from 129 +/- 9 to 113 +/- 9 mm Hg (P < 0.05), and Vm decreased from 59 +/- 11 to 54 +/- 10 cm/s (P < 0.05). After intubation, MAP increased from 113 +/- 9 to 134 +/- 5 mm Hg (P < 0.001), and Vm increased from 54 +/- 10 to 70 +/- 10 cm/s (P < 0.001). In the control group, while MAP increased significantly from 89 +/- 6 to 96 +/- 4 mm Hg (P < 0.05) after intubation, the concurrent increase in Vm from 49 +/- 5 to 54 +/- 7 cm/s was not significant. There was a significant positive pooled correlation between Vm and MAP (r = 0.5, P < 0.0006) in the study group but not in the control group (r = 0.24). After induction and intubation, both Vm and MAP values were significantly increased in the study group patients at all observation points compared with the control group patients. The findings indicate that Vm increases significantly after rapid-sequence induction of GA and tracheal intubation in women with severe preeclampsia, and there seems to be a direct relationship between MAP and Vm.
In women with severe preeclampsia, rapid-sequence induction of general anesthesia and tracheal intubation can cause severe hypertension. Our results indicate that the increase in blood pressure is associated with a significant increase in maternal cerebral blood flow velocity and that there is a significant correlation between these two variables.
在重度子痫前期女性患者中，快速诱导全身麻醉（GA）和气管插管后平均动脉压（MAP）显著升高很常见。这项前瞻性研究的目的是评估快速诱导插管技术对重度子痫前期患者大脑中动脉（MCA）血流速度的影响，并研究平均MCA血流速度（Vm）与MAP之间的相关性。研究了8例计划在GA下行剖宫产的重度子痫前期女性患者（研究组）和6例足月血压正常的女性患者（对照组）。诱导前，研究组患者静脉注射拉贝洛尔分次给药，将舒张压降至<100 mmHg。用硫喷妥钠4 - 5 mg/kg诱导麻醉，随后用琥珀酰胆碱1.5 mg/kg以利于气管插管。使用经颅多普勒测量Vm。在诱导前以及插管后每分钟记录Vm和MAP，共记录6分钟。在研究组中，给予拉贝洛尔后，MAP从129±9降至113±9 mmHg（P<0.05），Vm从59±11降至54±10 cm/s（P<0.05）。插管后，MAP从113±9升至134±5 mmHg（P<0.001），Vm从54±10升至70±10 cm/s（P<0.001）。在对照组中，插管后MAP从89±6显著升至96±4 mmHg（P<0.05），而Vm从49±5升至54±7 cm/s的同时升高并不显著。研究组中Vm与MAP之间存在显著的正合并相关性（r = 0.5，P<0.0006），而对照组中无此相关性（r = 0.24）。诱导和插管后，研究组患者在所有观察点的Vm和MAP值均显著高于对照组患者。研究结果表明，重度子痫前期女性患者在快速序贯诱导GA和气管插管后Vm显著升高，且MAP与Vm之间似乎存在直接关系。
在重度子痫前期女性患者中，快速序贯诱导全身麻醉和气管插管可导致严重高血压。我们的结果表明，血压升高与产妇脑血流速度显著增加相关，且这两个变量之间存在显著相关性。
