Effectiveness of a Manually; Controlled Infusion Scheme of Propofol and Alfentanil Mixture for Endotracheal Intubation in Hypertensive Patients: In Comparison with Thiamylal and Nifedipine Plus Thiamylal

於高血壓病患持續合併注射Propofol與Alfentanil麻醉對氣管插管之影響：與Thiamylal及Nifedipine合併Thiamylal之比較

魏志濤(Tze-Taur Wei) ； 林志福(Chih-Fu Lin)

《Acta Anaesthesiologica Sinica》 34卷1期 (1996/03) Pp. 9-16

https://doi.org/10.6955/AAS.199603.0009

摘要

Background: Bolus administration of propofol for induction causes hypotension, especially in elderly hypertensive patient. Carefully titrated infusion of propofol minimizes adverse effects, such as hypotension, and permits a rapid recovery of its central effects. The objective of this study was to investigate the effect of a manually controlled infusion scheme of propofol and alfentanil mixture on hemodynamic stability during induction and endotracheal intubation for hypertensive patient. At the same time, the effectiveness of this scheme was compared with two other induction regimens (thiamylal or nifedipine plus thiamylal). Methods: Sixty hypertensive patients undergoing orthopedic surgery were randomized into 3 groups (n = 20 per each group), None of the patients received premedication. Anesthesia was induced in group 1 (G1) with alfentanil 10 μg/kg. 30 s later, manual infusion of a mixture of propofol (10-12 mg/kg/h) and alfentanil (25 μg/kg/h) was performed for 2 min, followed by atracurium (5 mg) and propofol (1-1.5 mg/kg) as a bolus induction dose over 20 s, and then Suxamethonium (1.5 mg/kg) at 30-40 s later. Intubation was done while giving a continuous infusion of propofol and alfentanil. After intubation, the infusion rate was adjusted according to the blood pressure (BP) variation. Group 2 patients (G2) were induced with fentanyl (2 μg/kg), thiamylal (4-5 mg/kg), atracurium (5 mg) and succinylcholine (1.5 mg/kg), Induction of anesthesia in group 3 patients (G3) was the same as for G2, with additional sublingual nifedipine (1/2 capsule) 10 min prior to induction. Extra bolus dose of propofol (20 mg) or thiamylal (20 mg) was given at every 15 s if the systolic BP was still higher than 160 mmHg after induction by the above 3 regimens. The radial arterial pressure and electrocardiogram were continuously recorded for evaluation of hemodynamic changes. Results: Post-intubation peak mean arterial pressure (MAP) in G1 and G3 were below to awake baseline values, while MAP of G2 was significantly higher than over awake baseline level (p ＜ 0.001). The lowest MAP of G3 at post-intubation period before surgical stimulation were significantly lower than those of G1 and G2 (p ＜ 0.001). Peak tachycardiac response to intubation in G2 was significantly higher than G1 (p ＜ 0.05). After intubation, the peak rate pressure product were significantly higher in G2 compared with that in G1 (p ＜ 0.05) and G3 (p ＜ 0.001). Conclusions: The proposed manual infusion scheme of propofol and alfentanil mixture performed during induction and intubation attenuated the subsequent peak pressor response to intubation and reduced the hypotensive effect, in comparison to thiamylal or thiamylal plus nifedipine treatment, during post-intubation period. The same infusion scheme also attenuated the tachycardiac response to intubation.

關鍵字

Intubation: intratracheal ； Hypertension ； Anesthesia, intravenous: propofol, thiamylal ； Narcotic: alfentanil ； Infusion: intravenous

並列摘要

背景：單次足量之propofol於麻醉誘導時，常導致插管後血壓降低，此情形尤常發生於高血壓之老年病患。今以連續輸液方式合用propofol與alfentanil以探討維持血動力學穩定之可能性，並與thiamylal，及thiamylal併用nifedipine做比較。方法：將六十名高血壓患者分成三組，第一組先靜注alfentanil 10 mg/kg，30秒後開始給予propofol（10-12 mg/kg/h）及alfentanil（25 mg/kg/h）連續滴注2分鐘，随即以propofol 1-1.5 mg/kg及suxamethonium 1.5 mg/kg插管，（連續滴注仍繼續進行）。第二組以fentanyl 2 mg/kg及thiamylal 4-5 mg/kg誘導。第三組與第二組同，惟事前10分鐘先舌下给予nifedipine 5 mg。所有病人於收縮壓超過160 mmHg時每15秒鐘分別給予propofol 20 mg或thiamylal 20 mg。各組皆持續測量其橈動脈壓。結果：第一、三組插管後之MAP比原來低，第二組則增加11％（p ＜ 0.001）。而插管後之最低MAP第三組比第一、二組明顯降低（p ＜0.001）。第二組心跳增加明顯高於第一組（p ＜0.05）。插管後rate pressure product之增加則以第二組最大（與第一組、與第三組p ＜0.001）。結論：以連續輸液方式併用propofol及alfentanil為高血壓病患作插管，確可減低高血壓之反應，而且還可比thiamylal及thiamylal併用nifedipine所引起的低血壓更早回復正常。並可有效減少心跳過速。

並列關鍵字

插管：氣管內 ； 高血壓 ； 靜脈麻醉：propofol，thiamylal ； 成癮性止痛劑：alfentanil靜脈灌注