- 期刊
A Comparison of Lidocaine, Fentanyl, and Esmolol for Attenuation of Cardiovascular Response to Laryngoscopy and Tracheal Intubation
比較Lidocaine, Fentanyl和Esmolol降低因喉頭鏡術及氣管插管引起的心臟血管反應
摘要
Background: Laryngoscopy and tracheal intubation are known to increase sympathetic activity that may be detrimental to patients with pre-existing ischemic or hypertensive heart diseases. In order to alter the hyperdynamic consequences resulting from intubation during induction of general anesthesia, we chose esmolol, an ultra-short acting cardioselective beta-adrenergic blocker, to attenuate the cardiovascular responses during tracheal intubation in patients undergoing elective surgery. The efficacy of esmolol in this regard was carefully evaluated. Methods: Eighty ASA physical status class I or II patients undergoing elective, non-cardiac procedures were included in a randomized, single-blinded study consisting of 4 groups with each group receiving a designated drug: group A received normal saline as control, while group B, group C and group D received lidocaine 2 mg/kg, fentanyl 3μg/kg and esmolol 2 mg/kg, respectively. Monitoring included EKG, pulse oximetry, capnometry and arterial pressure. All patients wert' premedicated with diazepam 0.1 mg/kg 30 min before induction of general anesthesia. Each designated drug was given upon induction of anesthesia (time zero). Anesthesia was induced with thiopental 5 mg/kg and succinylcholine 1.5 mg/kg, and maintained with N_2O, 1% isoflurane in 50% O_2 and vecuronium. Intubation was carried out 3 min after the designated drug was given. Heart rate (HR) and systolic arterial blood pressure (SBP) were obtained every min for 10 min after induction. Either chi-square test or analysis of variances (ANOVA) was used for statistical comparison. A p value less than 0.05 was considered statistically significant. Results: There was no difference in the demographic data among the four groups. After intubation, the incidence of tachycardia (HR ＞100/min) was found in 3 of 20 (15%) patients in esmolol group, significantly lower than 17 of 20 (85%) patients in the control group, 15 of 20 (75%) patients in lidocaine group, and 11 of 20 (55%) patients in fentanyl group, respectively (p ＜ 0.05). The incidence of hypertension(SBP ＞ 180 mmHg) was found in 4 of 20 (20%) patients in esmolol group, significantly lower than 16 of 20 (80%) patients in control group and 14 of 20 (70%) patients in lidocaine group, respectively (p ＜ 0.05), but not in 8 of 20 (40%) patients in fentanyl group. Besides, the incidence of hypertension in fentanyl group (40%) was significantly lower than control group (80%; p＜0.05), but not in lidocaine group (70%). Conclusions: Results of this study showed that only esmolol could reliably offer protection against the increase in both HR and SBP, low dose of fentanyl (3μg/kg) prevented hypertension but not tachycardia, and 2 mg/kg lidocaine had no effect to blunt adverse hemodynamic responses during laryngoscopy and tracheal intubation.
並列摘要
背景：在原有心臟缺氧成高血壓病變者，喉頭鏡術及氣管內管置放時可因導致交感神經亢奮而使病情加深。我們試圖以esmolol去緩解誘導插管其間之心臟循環亢進，並測試其效益。方法：經本院許可及病人同意後，以隨機單盲研究80位ASA體位分等第I或II級預計在全身麻醉下接受常規非心臟手術病人，分為四組：分別接受A組:食鹽水；B組：lidocaine2 mg/kg；C組fentanyl 3μg/kg，及D組：esmolol 2 mg/kg，監視系統有EKG,SPO_2, ETCO_2和直接動脈血壓測定。病人在手術前30分鐘以靜脈給予diazepam 0.1 mg/kg為麻醉前給藥，待血壓及心跳穩定後，立即（第零分鐘）給予各測試藥物，隨後給予thiopental 5 mg/kg, succinylcholine 1.5mg/kg，在第2分鐘末時進行氣管插管，麻醉維持以N_2O (2L), O_2(2L)及1% isofIurane及vecu-ronium0.08 mg/kg。我們在第0到第10分鐘，每分鐘分別記錄病人的血壓及心跳速率，並以變異數分析法(ANOYA)或chi-square test行統計分析，其p ＜0.05，視為有統計意義。結果：四組病人之基本資料並無統計差別，但插管後心跳大於100次/分鐘者，在A組20位中有17位(85%)，相似於B組的20位中有15位(75%)及C組的20位中有11位(55%)，但在D組20位中僅有3位(15%)，四組相比較，D組比率較低且有明顯的差異(p ＜ 0.05)動脈收縮壓大於180 mmHg者，在A組20位中有16位(80%)，相似於B組的20位中有14位(70%)，但C組20位中有8位(40%)，而D組20位中只有4位(20%)，D組和A組及B組比較，D組比率較低，且C組和A組比較，C組比率較低，且有明顯的差異(p ＜ 0.05)，但B，C組及C，D組相比較，雖各兩組後者比率較低，但無統計上差別。結論：由以上結果，我們可發現三種藥物中，以esmolol較明顯且有效地抑制因氣管插管所引起的心跳及血壓增加，而低劑量的fentanyl 3μg/kg只能抑制血壓增加，對心跳沒有抑制作用，2 mg/kg lidocaine卻無法有效的抑制因氣管插管所引起的心跳及血壓增加。