PROPHYLAXIS AGAINST THE SYSTEMIC HYPOTENSION INDUCED BY PROPOFOL DURING RAPID-SEQUENCE INTUBATION
PROPHYLAXIS AGAINST THE SYSTEMIC HYPOTENSION INDUCED BY PROPOFOL DURING RAPID-SEQUENCE INTUBATION
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DOI：
10.1007/bf03011034
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发表时间：
1995-10-01
期刊：
影响因子：
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通讯作者：
SEEGOBIN, R
中科院分区：
文献类型：
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作者：
ELBEHEIRY, H;KIM, J;SEEGOBIN, R
本研究的目的是确定两种预防方法对快速序贯插管期间异丙酚引起的预期低血压的有效性。36名年龄在21-60岁、接受选择性门诊手术的非预用药ASA I-II级患者被纳入研究。患者随机分配接受诱导前硫酸麻黄碱（70 μ g）。Kg (-1) iv)，诱导前体积加载（12ml）。kg（-1）乳酸林格氏盐)或不治疗。然后用异丙酚（2.5 mg）在环状膜压力下进行快速插管。Kg（-1）和琥珀酰胆碱（1.5 mg）。公斤(1)。随后用0.25-0.5%异氟烷在2:1的N2O/O-2混合物中进行肺部通气。琥珀胆碱治疗后神经肌肉功能恢复后给予维库溴铵。在诱导前、异丙酚给药后和插管后10分钟每分钟测量一次心率和全身动脉血压。对照组和麻黄碱组的诱导前容量负荷可预防手术刺激前观察到的低血压。此外，诱导前的容积负荷与插管后心率的增加无关，而麻黄碱的使用与此无关。大多数患者插管情况良好至满意，诱导过程中不良事件的总体发生率主要是注射异丙酚时的疼痛。本研究表明，在异丙酚和琥珀胆碱快速序列诱导过程中，术前容量负荷比诱导前给予硫酸麻黄碱更有效地维持血流动力学稳定性。此外，异丙酚联合琥珀胆碱为快速序贯插管提供了良好的条件。
The objective of this study was to determine the effectiveness of two prophylactic approaches against the anticipated hypotension induced by propofol during rapid-sequence intubation. Thirty-six male or female nonpremedicated ASA class I-II patients aged 21-60 yr undergoing elective outpatient surgery were included in the study. Patients were randomly allocated to receive pre-induction ephedrine sulphate (70 mu g . kg(-1) iv), preinduction volume loading (12 ml . kg(-1) Ringer's lactate) or no treatment. Rapid-sequence intubation with cricoid pressure was then performed with propofol (2.5 mg . kg(-1) and succinylcholine (1.5 mg . kg(-1). The lungs were subsequently ventilated with 0.25-0.5% isoflurane in a 2:1 N2O/O-2 mixture. Vecuronium was given once neuromuscular function had recovered from the succinylcholine. Heart rate and systemic arterial blood pressure were measured non-invasively before induction, after propofol administration and every minute for ten minutes after intubation. Pre-induction volume loading prevented the hypotension observed before surgical stimulation in control and ephedrine groups. Moreover pre-induction volume loading was not associated with increases in heart rate after intubation as was ephedrine administration. The intubating conditions were excellent to satisfactory in most patients and the overall incidence of adverse events during induction was mainly due to pain during injection of propofol. The present study showed that preoperative volume loading is more efficacious than preinduction administration of ephedrine sulphate in maintaining haemodynamic stability during rapid-sequence induction with propofol and succinylcholine. In addition propofol in combination with succinylcholine provides excellent conditions for rapid-sequence intubation.