- 期刊
The Effect of Single Bolus Dose of Esmolol for Controlling the Tachycardia and Hypertension during Laryngoscopy and Tracheal Intubation
單一巨投注劑量的Esmolol在控制氣管插管後的心跳加快及血壓升高的效果
摘要
Tachycardia and hypertension usually accompany laryngoscopy and tracheal intubation. This response is undesirable, especially in patients with cardiovascular or intracranial diseases. Esmolol is a cardioselective, ultrashort-acting beta adrenergic blocking agent with a very short hail-life. The efficacy of holus dose of esmolol in blunting hemodynamic responses during laryngoscopy and tracheal intubation was evaluated. 45 patients (15 in each group) of ASA physical status I and II scheduled for elective non-cardiac surgery were included in this randomized, placebo-controlled study. At time zero, the study preparation (placebo, 100 or 200 mg of esmolol) was administered intravenously, followed by thiopentone 5 mg/kg and succinylcholine 1.5 mg/kg for induction. Tracheal intubation was performed 2 minutes after time zero. Anesthesia was maintained with 50% nitrous oxide and 1.0 MAC halothane in oxygen, and vecuronium 0.08 mg/kg. Heart rate (HR) and systolic blood pressure (SBP) were recorded every minute for 10 minutes. To compare with the placebo group, there was a significant decrease in either HR or SBP in 200 mg group in the 8 minutes course after intubation (p＜ 0.05). There was a significant decrease in HR in the 100 mg group at the 3rd, 4th, and 5th minutes when compared with the placebo group (p＜ 0.05). The differences in SBP between the 100 mg group and placebo group were significant at the 3rd and 4th minutes (p＜ 0.05). Both bolus dosages of esmolol could effectively attenuate the tachycardia and hypertension produced by laryngoscopy and tracheal intubation. Furthermore, esmolol 200 mg presented a better hemodynamic stability than esmolol 100 mg during induction of anesthesia.
並列摘要
氣管插管後的心跳加快及血壓升高可能造成嚴重的併發症，尤其在有心臟血管或顱內疾病的患者。本研究即在探討esmolol是否可以降低這些不良反應的發生。隨機選擇45位ASA體位I或II，欲進行非開心手術的病人，分成第I組：placebo；第2組：esmolol，100毫克；第3組：esmolol，200毫克。在第0分鐘時分別給予生理食鹽水20毫升，100或200毫克的esmolol，以thiopentone 5毫克／公斤和succinylcholine 1.5毫克／公斤作麻醉誘導。在第2分鐘時進行插管，之後以50%笑氣，1.0 MAC halothane, vecuronium 0.08毫克／公斤維持。記錄每分鐘各組心跳及收縮壓的變化，共記錄10分鐘，以Student t-test來進行統計分析。結果在插管後，第3組的心跳和血壓都比控制組低，在統計上有意義（p＜0.05）。第2組的心跳在第3, 4, 5分鐘；收縮壓在第3，4分鐘明顯較控制組低。我們的結論是單一巨投注劑量的esmolol的確可降低插管後的心跳加快及血壓升高。給200mg的病人，在麻醉誘導時對心跳和血壓可維持較佳的穩定度。