The Influence of Fentanyl and Tracheal Intubation on the Hemodynamic Effects of Anesthesia Induction with Propofol/N2O in Humans
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서 론 최근 목표농도조절주입의 개발로 혈장농도 또는 효과처농 도를 목표로 약물의 조절주입이 가능하며, propofol의 효과처 농도 조절주입이 약물의 혈장농도와 효과처농도의 빠른 평 형을 가능하게 하여 저혈압의 위험이 없이 더 빠른 의식소 실을 이룰 수 있어 임상에서 안전하게 사용될 수 있다. 1,2)Propofol은 용량과 혈장농도에 비례하여 혈관확장과 심근 억제를 초래하여 혈압의 감소를 일으키며, 혈관확장 효과는 교감신경 활성도 감소와 평활근 세포내 칼슘이온 이동에 대한 직접적인 효과에
Bispectral index
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Objective: To compare and assess the intubating conditi on s and hemodynamic changes after anesthesia induction with propofol and remifenta nnil or fentanyl. Methods:Fortypatients wereallocated int o 2 groups.After 2 minutes ,tracheal intubation was performed .We measured meanarterial pressure(MAP) and heart rate(HR) before anesthesia induction, 1 minuteafter induction, and 2 minutes after intubation.Tracheal intubating conditions w ere graded by operater. Results:Intubation was successful in100% patients of both groups.Intubating conditions were regarded as acceptable i n 80% of group I and 75% of group II .The MAP and HR after induction were lowerthan baseline(P0.05). After intubation, MAP was signifcantly different betw een the 2 groups(P0.05). Conclusion:The intubating condi tions were similar after anesthesia induction with propofol and remifentanil orfentanyl. Furthermore,the control of cardiovascular responses to tracheal intuba tion with remifenanil is more effective than that with fentanyl.
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Objective: To study the influence of propofol induction with improved manually-controlled infusion on hemodynamic response to tracheal intubation.Method: 40 ASA I～II adult patients undergoing elective surgery were randomly divided into two groups(n=20 each).Anesthesia was induced with midazolam 0.2 mg/kg,fentanyl 4μg/kg,vecuronium 0.1mg/kg and propofol 2 mg/kg.Propofol was administered as a bolus and the intubation was performed 3 minutes later in mannually-controlled infusion technique(groupⅠ);1/3 propofol was administered first,then 2/3 propofol was administered after 2 minutes and the intubation was performed 1 minute later in improved mannually-controlled infusion technique(groupⅡ).SBP,DBP and HR were recorded before anesthetic induction and intubation,at 1,3 and 5 minutes after intubation.Result: The value of SBP,DBP and HR decreased significantly before intubation in two groups compared with that before anesthetic induction(P0.05),but the value of SBP and DBP in groupⅠ were lower than that in groupⅡ(P0.05).SBP and DBP increased significantly at 1 minute after intubation but no significant differences compared with before intubation.HR increased significantly at 1 minute after intubation and there were significantly differences compared with before intubation(P0.05).The value of SBP,DBP and HR at 5 minutes after intubation were lower than that before anesthetic induction(P0.05),but no significant changes between two groups.Conclusion: The hemodynamic response to tracheal intubation was more stable in improved mannually-controlled infusion technique.
Midazolam
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Objective Using impedance cardiography to monitor the hemodynamic changes during anesthesia induction using midazolam or propofol.Methods Fifty patients,ASA Ⅰ or Ⅱ,were randomly allocated into two groups with each group 25 cases. In group A and group B patients received induction of general anesthesia with propofol 1.5 mg/kg and midazolam 0.2 mg/kg respectively,followed by vecuronium 0.1 mg/kg,fentanyl 3 μg/kg. Results There was no significant difference between two groups in SVR,LCW,CO,HR and SBP during induction of general anesthesia. HR is faster before intubation(T1),during intubation(T2),at 3 min(T4) and 5 min(T5) after intubation in group B than those in group A(P0.05). Conclusion Midazolam as well as propofol has the similar hemodynamic effects during induction of general anesthesia.
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We examined the effectiveness of avoiding laryngoscopy in reducing the hemodynamic responses to orotracheal intubation during the induction of anesthesia. One hundred surgical patients who required orotracheal intubation were randomly allocated into four groups. The first and third groups underwent fiberoptic intubation, in which an anesthesiologist inserted the endotracheal tube into the trachea under TV monitoring through a bronchoscope, and the second and fourth groups underwent conventional orotracheal intubation using a rigid laryngoscope. The third and fourth groups were pretreated with 2 μg/kg fentanyl IV immediately before the induction of anesthesia. Blood pressure and heart rate were measured noninvasively. A significant reduction in hemodynamic response was seen in only the group treated with fentanyl and intubated using the fiberoptic technique. Without fentanyl, there was no significant difference in hemodynamic changes between the groups. We conclude that the administration of fentanyl suppresses the hemodynamic responses to endotracheal intubation more than it does to laryngoscopy. There was no significant difference in the hemodynamic responses to orotracheal intubation by fiberscopy and laryngoscopy without fentanyl pretreatment, whereas 2 μg/kg fentanyl significantly reduced the hemodynamic responses in the group intubated by fiberscopy.
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Objective: To observe the prevention of haemodynamic response by propofol during intubation and extubation of general anaesthesia.Methods: 24 ASA Ⅰ～Ⅱ patients, scheduled for elective operations, were divided randomly into two groups. The control group were induced with valium, fentanyl and relaxant without using sedative extubation of anaesthesia. Induced with propofol, fentanyl and relaxant, the propofol group were given single bolus dose of propofol before extubation.Results: There is no significant different in haemodynamic response during intubation period between the two groups. The haemodynamic response parameters of the control group increased significantly during the extubation period, compared with those before extubation (P0.05). No change of haemodynamic response was found in the propofol group during the period.Conclusion: It is concluded that propofol could depress the cardiovascular response during extubation of anaesthesia effectively.
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Elective surgery
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