Inhaled Fenoterol Pretreatment Attenuates Airway Resistance Response to Endotracheal Intubation

預先吸入Fenoterol在氣管內插管時對呼吸系統阻力之影響

吳世銓(Rick Sai-Chuen Wu) ； 吳憬全(King Chuen Wu) ； 蔡螢煌(Ying Huang Tsai) ； 鄭嘉遜(Robin Ka-Shun Cheng) ； 譚培炯(Peter P.C. Tan)

《Acta Anaesthesiologica Sinica》 33卷1期 (1995/03) Pp. 7-14

摘要

Background: Endotracheal intubation may induce vagal mediated bronchoconstriction. As fenoterol possesses bronchodilation effects, we studied the efficacy of fenoterol pretreatment on the increased resistance of total respiratory system (Rrs) caused by reflex bronchoconstriction in endotracheal intubation. Methods: Fifty patients were randomly allocated into two groups; group A (n=25) with fenoterol inhaled and group B (n=25) with placebo inhaled 10 min before induction. Patients were induced with sodium thiopental and vecuronium and resistance was measured 2 and 5 min after intubation with a Bicore pulmonary function monitor. Suctioning of the airway was performed 1 min before each measurement. Patients were further categorized into four conditions by smoking history and the presence of sputum in the suctionings. Condition I included patients that were smokers with no sputum collected. Condition II had non-smokers with no sputum collected. Condition III had patients with sputum collected but with no smoking history and condition IV were patients who had sputum collected and had a smoking history. Results: Patient who received fenoterol have significant lower total respiratory after intubation than those receiving placebo. There were no significant differences in post-intubation Rrs between smokers and non-smokers. Patients with sputum had the highest resistance after intubation with the placebo group. Heart rate and blood pressure were augmented in both groups. Conclusions: Fenoterol pretreatment produced lower post-intubation Rrs after intubation when compared with the placebo group suggesting of a protective effect in vagal mediated bronchoconstriction.

關鍵字

Beta-adrenergic agents: fenoterol hydrobromide ； Anesthetic techniques: endotracheal intubation ； Lung Mechanics: total respiratory resistance

並列摘要

背景：氣管內管插管術可刺激迷走神經而產生支氣管收縮現象。吸入性fenoterol乃一種能使支氣管擴張的藥物。本研究在探討預先給予吸入性fenoterol在氣管內管插管時對呼吸系統阻力之影響。方法：50位病人被隨機分成A，B組兩大組，每組25人。A組在麻醉插管前10分鐘先吸入600 μg fenoterol，B組則只給予安慰劑。麻醉誘導是以sodium thiopental及vecuronium進行。在插管2分鐘及5分鐘後以Bicore肺功能監測器測量呼吸系統阻力。在每測量前1分鐘，均給予氣管內管抽痰，以確保呼吸道之暢通及觀察當時氣道內之痰量。我們以病人的吸煙習慣及痰量多少的結果，再將病人細分為四個狀況來加以研究。狀況I病人有吸煙習慣，但沒有痰。狀況Ⅱ病人無吸煙習慣也沒有痰。狀況Ⅲ病人沒有吸煙習慣可是有痰。狀況Ⅳ病人有吸煙習慣也有痰。結果：結果顯示預先吸入fenoterol的病人之插管後呼吸系統阻力遠低於吸入安慰劑的。吸煙者與無吸煙者間卻無明顯呼吸系統阻力上之差異。B組帶痰病人插管後呼吸系統阻力為所有病人中之最高。A組帶痰病人插管後呼吸系統阻力則明顯低於B組。病人血壓與心跳在兩大組中均有增加的現象。結論：病人在置入氣管內管前吸入fenoterol要比吸入安慰劑有較低的呼吸系統阻力，顯示fenoteral對神經反射性氣管收縮有良好的保護效果。