Esmolol prevents movement and attenuates the BIS response to orotracheal intubation.
Esmolol prevents movement and attenuates the BIS response to orotracheal intubation.
复制标题
艾司洛尔可防止运动并减弱 BIS 对经口气管插管的反应。
DOI：
10.1093/bja/aef275
复制
发表时间：
2002
影响因子：
9.8
通讯作者：
Marcel Chauvin
中科院分区：
文献类型：
--
作者：
C. Ménigaux;B. Guignard;F. Adam;Daniel I. Sessler;Daniel I. Sessler;V. Joly;Marcel Chauvin
背景
β-肾上腺素能激动剂增强行为和脑电图唤醒反应。我们探讨了在丙泊酚麻醉中加入艾司洛尔（一种短效β（1）-肾上腺素受体拮抗剂）是否会改变麻醉诱导和经口气管插管期间的脑电双频指数（BIS）。
方法
50名患者以双盲方式随机分配，接受艾司洛尔1 mg kg（-1），随后接受250 μ g kg（-1）min（-1）或生理盐水（对照）。靶控输注丙泊酚（效应室浓度4 μ g/ml）后6分钟开始使用艾司洛尔或生理盐水。在意识丧失后，维库溴铵0.1 mg kg（-1）给药前，将止血带绑在一只手臂上，并充气至高于收缩压150 mm Hg。TCI开始后11分钟，气管插管;记录经口气管插管后第一分钟内的大体运动。每隔10 s记录一次BIS。每分钟无创测量平均动脉压（MAP）和心率。
结果
喉镜检查前BIS、心率或MAP无组间差异。仅对照组经口气管插管后BIS显著增加（与喉镜检查前值相比），最大增加40（SD 18）% vs艾司洛尔组8（11）%（P<0.01）。对照组经口气管插管时心率[45（19）% vs 23（14）%]和MAP [62（24）% vs 45（23）%]的最大变化也显著大于艾司洛尔组。经口气管插管后，对照组较艾司洛尔组有更多的患者发生移动（23例vs 12例，P<0.01）。
结论
艾司洛尔不仅能减弱喉镜检查和经口气管插管时的血流动力学和躯体反应，还能预防丙泊酚麻醉患者的BIS唤醒反应。
BACKGROUND
Beta-adrenergic agonists enhance behavioural and electroencephalographic arousal reactions. We explored whether adding esmolol, a short-acting beta(1)-adrenoceptor antagonist, to propofol anaesthesia modified the bispectral index (BIS) during induction of anaesthesia and orotracheal intubation.
METHODS
Fifty patients were randomly allocated, in a double-blind fashion, to receive esmolol 1 mg kg(-1) followed by 250 micro g kg(-1) min(-1) or saline (control). Esmolol or saline was started 6 min after a target-controlled infusion (TCI) of propofol (effect-site concentration 4 micro g ml(-1)). After loss of consciousness, and before administration of vecuronium 0.1 mg kg(-1), a tourniquet was applied to one arm and inflated to 150 mm Hg greater than systolic pressure. Eleven minutes after the TCI began, the trachea was intubated; gross movement within the first min after orotracheal intubation was recorded. BIS was recorded at 10-s intervals. Mean arterial pressure (MAP) and heart rate were measured non-invasively every min.
RESULTS
There were no intergroup differences in BIS, heart rate or MAP before laryngoscopy. BIS increased significantly after orotracheal intubation (compared with the pre-laryngoscopy values) in the control group only, with a maximum increase of 40 (SD 18)% vs 8 (11)% in the esmolol group (P<0.01). Maximum changes in heart rate [45 (19)% vs 23 (14)%] and MAP [62 (24)% vs 45 (23)%] with orotracheal intubation were also significantly greater in the control group than in the esmolol group. More patients in the control than in the esmolol group moved after orotracheal intubation (23 vs 12, P<0.01).
CONCLUSION
Esmolol not only attenuated haemodynamic and somatic responses to laryngoscopy and orotracheal intubation, but also prevented BIS arousal reactions in patients anaesthetized with propofol.