Induction of Anaesthesia in Patients with Coronary Artery Disease: A Comparison between Sevoflurane-Remifentanil and Fentanyl-Etomidate
Induction of Anaesthesia in Patients with Coronary Artery Disease: A Comparison between Sevoflurane-Remifentanil and Fentanyl-Etomidate
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DOI：
10.1177/0310057x9902700405
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发表时间：
1999-08
影响因子：
1.5
通讯作者：
J. Wang;S. Winship;S. D. Thomas;T. Gin;G. Russell
中科院分区：
文献类型：
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作者：
J. Wang;S. Winship;S. D. Thomas;T. Gin;G. Russell
在一项前瞻性随机研究中，比较了七氟醚-瑞芬太尼（SR组）与芬太尼-乙托咪酯（FE组）对缺血性心脏病患者的诱导麻醉效果。测量心血管稳定性、心率、平均动脉压、率压积、抢救用药及相关心肌缺血情况。SR组（n=20）采用5%七氟醚含氧肺活量呼吸诱导麻醉。在失去意识后，将吸入的七氟醚减少到3%，并在90秒内给予瑞芬太尼0.5 μg.kg - 1 （0.33 μg.kg - 1）。Min−1)，然后0.025 μg.kg−1。分钟−1输液。插管后，吸入七氟醚降至2%。FE组（n =20）：芬太尼10.5 μg.kg - 1，依托咪酯0.2 mg.kg - 1, 60秒后给予麻醉。在失去意识后给予1%异氟醚供氧。两组均给予罗库溴铵，2分钟后插管。七氟醚气体诱导是平稳的，心血管稳定性与芬太尼-乙咪酯相当。SR组服用β -阻断药物的患者明显增多（P<0.05），总体而言，SR组插管前HR和RPP较低。给予瑞芬太尼与3例严重心动过缓和4例心脏骤停相关。所有四名患者都在服用β -阻断药物，其中三人服用地尔硫卓。由于SR组心动过缓/停搏并发症发生率高，研究终止。
In a prospective, randomized study, sevoflurane-remifentanil (Group SR) was compared with fentanyl-etomidate (Group FE) for induction of anaesthesia in patients with ischaemic heart disease. Cardiovascular stability, heart rate, mean arterial pressure, rate pressure product, rescue medications and associated myocardial ischaemia were measured. For Group SR (n=20), anaesthesia was induced with vital capacity breaths of sevoflurane 5% in oxygen. After loss of consciousness, the inspired sevoflurane was reduced to 3% and remifentanil was administered as a 0.5 μg.kg−1 bolus over 90 seconds (0.33 μg.kg−1 .min−1) followed by a 0.025 μg.kg−1. min−1 infusion. After intubation, the inspired sevoflurane was reduced to 2%. For Group FE (n =20), anaesthesia was induced with fentanyl 10.5 μg.kg−1 and etomidate 0.2 mg.kg−1 given 60 seconds later. Isoflurane 1% in oxygen was administered after loss of consciousness. Both groups received rocuronium and the trachea was intubated two minutes later. Sevoflurane gaseous induction was smooth, with cardiovascular stability comparable to fentanyl-etomidate. Significantly more patients in Group SR (P<0.05) were on beta-blocking medication, and, overall, the HR and RPP was lower pre-intubation in Group SR. Remifentanil administration was associated with severe bradycardia in three patients and asystole in a fourth. All four patients were on beta-blocking medication and three of the four were on diltiazem. The study was terminated due to the high incidence of bradycardic/asystolic complications in Group SR.