Tracheal Intubation after Anesthetic Induction with Thiopental, Fentanyl and Lidocaine without Muscle Relaxants

應用Fentanyl,Lidocaine及Thiopental誘導麻醉(無肌肉鬆弛劑)作氣管內插管

黃兆德(Siu-Tak Huang) ； 蘇翔(Edmund C. So) ； 徐智星(Chi-Sing Hsu) ； 葉富欽(Fuh-Cheng Yeh)

《慈濟醫學雜誌》 11卷2期 (1999/06) Pp. 125-130

https://doi.org/10.6440/TZUCMJ.199906.0125

摘要

目的：研究以fentanyl，lidocaine及thiopental來作麻醉誘導而不加肌肉鬆弛劑來作氣管內插管。病人及方法：以30位健康狀況良好且無解剖學上可能困難插管之病患作研究。應用fentany 1.5µg/kg，lodocaine 1.5 mg/kg及thiopental 4 mg/kg作麻醉誘導。記錄之資料包括麻醉誘導前與後及氣管內插管後之動脈收縮、舒張壓及心率。另外也評估下顎活動性、人工換氣容易性、喉頭視野、聲帶位置，及對氣管內管的忍受性。若有必要則使用succinylcholine 1 mg/kg靜注來幫忙完成插管。結果：動脈血壓及心率雖然在給藥後有明顯下降，但插管後回升至給藥前的水平。所有病患之下顎活動性與人工換氣容易性均良好，並可作直接喉頭鏡檢。喉頭視野有2位病患較差，須要succinylcholine來幫忙完成插管。22位病患之聲帶位置為全開或半開狀。置放氣管內管後19位病患對內管忍受性良好。其他病患表現出多次咳嗽，有些更是合併有上肢運動現象。結論：絕大多數無解剖學上可能困難插管之病患，若以fentanyl、lidocaine及thiopental作麻醉誘導而不加肌肉鬆弛劑，直接喉頭鏡檢及氣管內插管是可能完成的。尤其是在患有神經肌肉疾病患者，肌肉鬆弛劑可能會有無法預測之作用這個方法應該是有助益的。

關鍵字

氣管插管 ； fentanyl ； lidocaine ； thiopental

並列摘要

Objective: To investigate the possibility and feasibility of performing tracheal intubation after anesthetic induction with fentanyl, lidocaine and thiopental without the simultaneous use of muscle relaxants. Patients and Methods: Thirty patients of ASA physical status I with favorable airway anatomy scheduled for elective surgery were studied. Fentanyl 5 ug/kg, lidocaine 1.5 mg/kg and thiopental 4 mg/kg were given for anesthetic induction. Circulatory parameters including systolic and diastolic blood pressure, and heart rte were measured before (pre-induction) and after (post-induction) drug administration, and after tracheal intubation (post-intubation). Variables including jaw mobility, ease of manual ventilation, exposure of the glottis, position of the vocal cords, and toleration of the treacheal tube were assessed during anesthetic induction and tracheal intubation. Succinylcholine 1 mg/kg intravenously was employed to complete tracheal intubation when needed. Results: Our data showed that systolic and diastolic blood pressure and heart rate decreased significantly after drug administration compared with pre-induction levels. After tracheal intubation, however, these circulatory parameters returned to pre-induction levels. All patients had good jaw mobility and could be manually ventilated via mask. Direct laryngoscopy and intubation were possible in most patients.Exposure of the glottis was poor in 2 patients who were supplemented with succinlycholine for tracheal intubation. Vocal cord position was favorable (open or midpostion) in 22 patients. After tracheal intubation, 19 patients tolerated the tbue well. The rest of the patients suffered from persistent cough with or without movement of the upper extremities. Conclusion: Direct laryngoscopy and tracheal intubation after induction of anesthesia may be accomplished in mos patients with favorable airway anatomy using a combination of thiopental, fentanyl, and lidocaine without muscle relaxants.

並列關鍵字

tracheal intubation ； fentanyl ； lidocaine ； thiopental