Abstract
Twenty-eight surgical patients aged 65–84 were randomly assigned to either a control group (12) induced with thiopentone alone, or a treatment group (16), induced with 3 μg·kg-1 fentanyl followed by thiopentone, to determine whether the use of fentanyl during induction would attenuate the cardiovascular response to laryngoscopy and intubation.
Patients in the fentanyl group required 47 per cent less thiopentone for induction. Increases in systolic (SBP) and diastolic (DBP) blood pressure were significantly smaller in the group receiving fentanyl at one minute post intubation. SBP rose by 56 mmHg in the control group, compared to 15 mmHg in the fentanyl group; DBP increased 42 mmHg compared to 20 mmHg, respectively. Increases in rate-pressure product were twice as great in the control group compared to the fentanyl group (72.2 vs 36.0 per cent, respectively).
Thus, fentanyl, as an adjunct to barbiturate induction, effectively lowered the thiopentone requirement and attenuated the pressor response to laryngoscopy and intubation.
Résumé
Vingt-huit patients âgés de 65 à 84 ans et subissant une intervention chirurgicale ont été répartis au hasard entre un groupe témoin (12 patients) recevant du thiopentone seul, et un groupe actif (16 patients) recevant 3 μg·kg-1 de fentanyl suivis de thiopentone. Le but de l’étude est de déterminer si l’utilisation du fentanyl pendant la période d’induction diminue la réponse cardiovasculaire observée durant la laryngoscopie et l’intubation.
Les patients du groupe recevant le fentanyl ont reçu47 pour cent de thiopentone en moins lors de I’induction. Dans le groupe recevant le fentanyl les augmentations de la pression artérielle systolique (PAS) et diastolique (PAD) ont été significativement moins importantes une minute après l’intubation. La PAS a augmenté de 56mmHg dans le groupe temoin et seulement de 15 mmHg dans le groupe traité au fentanyl. La PAD a augments de 42 mmHg et de 20 mmHg dans les deux groupes. Les augmentations du produit de la fréquence cardiaque par la pression arterielle ont été deux fois plus importantes dans le group témoin que dans le group recevant le fentanyl (72,2 et 36,0 pourcent respectivement). L’utilisation du fentanyl comme adjuvant lors de l’induction par les barbirutiques a dimunué les besoins en thiopentone et a atténué la réponse vasopressive observée lors de la laryngoscopie et de l’intubation.
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This study was supported by a grant from Janssen Pharmaceutica, Mississauga, Ontario.
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Chung, F., Evans, D. Low-dose fentanyl: Haemodynamic response during induction and intubation in geriatric patients. Can Anaesth Soc J 32, 622–628 (1985). https://doi.org/10.1007/BF03011409
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DOI: https://doi.org/10.1007/BF03011409