Peri-intubation hemodynamic changes during low dose fentanyl, remifentanil and sufentanil combined with etomidate for anesthetic induction  

作　　者：ZHANG Guo-hua SUN Li 

机构地区：[1]Department of Anesthesiology, Cancer Institute & Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China

出　　处：《Chinese Medical Journal》2009年第19期2330-2334,共5页中华医学杂志（英文版）

摘　　要：Background Although etomidate is associated with very few cardiovascular side-effects and minimal histamine release it has a less inhibitory effect on the pharyngolaryngeal reflex. Hence, blunting the responses to endotracheal intubation is more dependent of opioids for etomidate-based anesthetic induction. This prospective, randomized, double-blinded study was designed to investigate the effects of low dose remifentanil, fentanyl or sufentanil on etomidate induction with respect to hemodynamics, conscious level changes and drug consumption. Methods Ninety unpremedicated and normotensive patients with American Society of Anesthesiologists （ASA） physical status I or II undergoing elective major abdominal surgery were randomly assigned in a double blinded fashion to each of the three groups： groups F, R and S. A bolus dose of fentanyl 1μg/kg, sufentanil 0.1 μg/kg or remifentanil 1 1 μg/kg was given over 60 seconds in groups F, S and R, respectively. In each instance this loading dose was followed by a continuous infusion （0.1, 0.01 or 0.1 μg·kg^-1·min^-1 of fentanyl, sufentanil or remifentanil, respectively）. After 5 minutes from start of opioid infusion, etomidate was titrated at a rate of 20 mg/min to a decrease in bispectral index （BIS） to 50. The time from administration of etomidate to loss of eyelash reflex or to a decrease in BIS to 50 was recorded. The blood pressure and heart rate were also recorded at different five time points. The average maximum percent changes of systolic blood pressure （Imaximal or minimal measuring value-baselinel/baselinex100%） were calculated. Results The time and the dosage of etomidate necessary to loss consciousness were greater in group F （（70.0±15.6） seconds; （0.35±0.05） mg/kg） than in groups S （（52.3±15.9） seconds; （0.26±0.06） mg/kg） and R （（56.2±20.2） seconds; （0.27±0.07） mg/kg） （P 〈0.01）. The three groups took similar time and amount of etomidate to achieve an adequate depth anesthesia （BIS=50）. ThBackground Although etomidate is associated with very few cardiovascular side-effects and minimal histamine release it has a less inhibitory effect on the pharyngolaryngeal reflex. Hence, blunting the responses to endotracheal intubation is more dependent of opioids for etomidate-based anesthetic induction. This prospective, randomized, double-blinded study was designed to investigate the effects of low dose remifentanil, fentanyl or sufentanil on etomidate induction with respect to hemodynamics, conscious level changes and drug consumption. Methods Ninety unpremedicated and normotensive patients with American Society of Anesthesiologists （ASA） physical status I or II undergoing elective major abdominal surgery were randomly assigned in a double blinded fashion to each of the three groups： groups F, R and S. A bolus dose of fentanyl 1μg/kg, sufentanil 0.1 μg/kg or remifentanil 1 1 μg/kg was given over 60 seconds in groups F, S and R, respectively. In each instance this loading dose was followed by a continuous infusion （0.1, 0.01 or 0.1 μg·kg^-1·min^-1 of fentanyl, sufentanil or remifentanil, respectively）. After 5 minutes from start of opioid infusion, etomidate was titrated at a rate of 20 mg/min to a decrease in bispectral index （BIS） to 50. The time from administration of etomidate to loss of eyelash reflex or to a decrease in BIS to 50 was recorded. The blood pressure and heart rate were also recorded at different five time points. The average maximum percent changes of systolic blood pressure （Imaximal or minimal measuring value-baselinel/baselinex100%） were calculated. Results The time and the dosage of etomidate necessary to loss consciousness were greater in group F （（70.0±15.6） seconds; （0.35±0.05） mg/kg） than in groups S （（52.3±15.9） seconds; （0.26±0.06） mg/kg） and R （（56.2±20.2） seconds; （0.27±0.07） mg/kg） （P 〈0.01）. The three groups took similar time and amount of etomidate to achieve an adequate depth anesthesia （BIS=50）. Th

关 键 词：etomidafe response to endotracheal intubation bispectral index OPIOIDS 

分 类 号：R[医药卫生]