Intubating conditions and haemodynamic changes following thiopentone or propofol for early tracheal intubation
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Abstract
Intubating conditions and haemodynamic changes were studied 30 sec after a fixed induction dose of thiopentone or propofol in patients scheduled for elective surgery. The hypnotic agent was preceded by the administration of papaveretum 10 mg three minutes before induction and alcuronium 0.2 mg·kg−1 at induction. Ease of intubation was graded and the study conducted in a randomised double-blind fashion. In the thiopentone group (n=30) intubation was very easy in 73% compared with 79% in the propofol group (n=29). In two patients in the propofol group the tracheas were moderately difficult to intubate but there were no failed intubations in either group. No patients recalled the intubation period on subsequent postoperative questioning. The immediate post-induction average systolic pressure in the thiopentone group decreased by 0.7% (range 15.9% increase to 25.3% decrease) whilst the post-intubation systolic pressure increased by 6.3% (range −31.5% increase to 24.2% decrease). In the propofol group there was a decrease in systolic pressure after induction (average 14.4%; range 15.5% increase to 41.4% decrease, P < 0.05) but the subsequent pressor response to intubation was markedly attenuated compared with baseline (average systolic pressure decreased 15.5% (range 22.4% increase to 42.7% decrease)). Following intubation and maintenance, ventilation with nitrous oxide 70% and halothane 1% the systolic pressure decreased markedly in both groups with a greater reduction in the propofol group (P < 0.05). Compared with baseline there were increases (P < 0.0001) in heart rate in both groups from induction of anaesthesia to the end of study. The results show that early tracheal intubation can be undertaken following thiopentone and is accompanied by haemodynamic stability. Comparable intubating conditions are associated with propofol but the dose used resulted in a considerable decrease in systolic blood pressure after induction.
Key words
Anaesthetics, Intravenous: thiopentone, propofol Iinubation, Tracheal: technique, cardiovascular responsesRésumé
Chez des patients programmés pour chirurgie non-urgente, les auteurs évaluent les conditions d’intubation et les changements hémodynamiques après l’injection d’une dose d’induction fixe de thiopental ou de propofol. L’administration de l’hypnotique est précédée de papavérétum 10 mg, trois minutes avant l’induction, et d’alcuronium 0,2 mg·kg−1 lors de l’induction. La facilité d’intubation est cotée et l’étude randomisée et à double insu. Dans le groupe thiopental (n=30), l’intubation est facile dans 73% des cas comparativement à 79% dans le groupe propofol (n=29). L’intubation endotrachéale est de difficulté moyenne chez deux patients mais elle est toujours réussie dans les deux groupes. Aucun patient ne se souvient de l’intubation. En moyenne, la pression systolique immédiatement après l’induction diminue dans le groupe thiopental de 0,7% (écart de +15,9% à −25,3%) de 6,3%. Dans le groupe propofol, on a noté une baisse de la pression systolique après l’induction (moyenne 14,4%; écart: de +15,5% à −41,4% P < 0.05). Dans ce groupe, le réponse tensionnelle à l’intubation est considérablement atténuée comparativement à la valeur initiale: la pression systolique en moyenne diminue de 15,5% (écart: de +22,4% à −42,7%). Après l’intubation et pendant le maintien de l’anesthésie avec ventilation sous protoxyde d’azote 70% en halothane 1%, la pression systolique a diminué considérablement dans les deux groupes avec une baisse plus importante dans le groupe propofol (P < 0,05). Si on réfère aux valeurs initiales, on note des augmentations importantes (P<0,0001) de la fréquence cardiaque dans les deux groupes du début de l’anesthésie à la fin de l’étude. Ces résultats montrent qu’une intubation précoce réalisée après thiopental s’accompagne d’une hémodynamique stable. Des condition d’intubation comparables sont associées au propofol mais la dose utilisée ici provoque une diminution importante de la pression systolique après l’induction.
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