Can intravenous atropine prevent bradycardia and hypotension during induction of total intravenous anesthesia with propofol and remifentanil?
Can intravenous atropine prevent bradycardia and hypotension during induction of total intravenous anesthesia with propofol and remifentanil?
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DOI：
10.1007/s00540-009-0860-2
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发表时间：
2010-04-01
影响因子：
2.8
通讯作者：
Hayashida, Masakazu
中科院分区：
文献类型：
--
作者：
Maruyama, Koichi;Nishikawa, Yuki;Hayashida, Masakazu
本研究以前瞻性随机安慰剂对照的方式研究静脉注射阿托品预处理是否可以预防丙泊酚和瑞芬太尼全静脉麻醉诱导期间的心动过缓和低血压。70例患者，年龄24-78岁，随机分为两组，在瑞芬太尼0.4 μ g/kg/min、丙泊酚3 μ g/ml和维库溴铵1.5 mg/kg静脉麻醉诱导前1 min给予阿托品0.5 mg或安慰剂生理盐水。气管插管后立即将瑞芬太尼的输注速率和丙泊酚的靶浓度分别降低至0.1 μ g/kg/min和2 μ g/ml，并保持10 min。每分钟测量并记录无创血压（BP）和心率（HR）。静脉注射阿托品可以防止HR下降，但不能防止BP下降，在我们的给药方案中使用丙泊酚和瑞芬太尼静脉麻醉诱导期间。我们的数据表明，丙泊酚-瑞芬太尼麻醉引起的HR下降主要是由丙泊酚和瑞芬太尼的中枢介导的交感神经阻滞和/或迷走神经张力作用引起的，而BP下降主要是其直接血管舒张作用的结果。
This study was conducted to examine whether pretreatment with intravenous atropine could prevent bradycardia and hypotension during induction of total intravenous anesthesia with propofol and remifentanil in a prospective randomized placebo-controlled manner. Seventy patients, aged 24-78 years, were randomly divided into two groups, and received 0.5 mg atropine or placebo saline 1 min before induction of intravenous anesthesia with remifentanil at 0.4 mu g/kg/min, propofol at a target blood concentration of 3 mu g/ml, and vecuronium 1.5 mg/kg. Immediately after tracheal intubation, the infusion rate of remfentanil and the target concentration of propofol were reduced to and kept at 0.1 mu g/kg/min and 2 mu g/ml, respectively, for 10 min. Noninvasive blood pressure (BP) and heartrate (HR) were measured and recorded every minute. Intravenous atropine could prevent a fall in HR, but not a fall in BP, during induction of intravenous anesthesia with propofol and remifentanil of our dosing regimen. Our data suggested that a fall in HR induced by propofol-remifentanil anesthesia was mainly caused by centrally mediated sympatholytic and/or vagotonic actions of propofol and remifentanil, whereas a fall in BP was mainly the result of their direct vasodilating actions.