Abstract
The purpose of this randomized, double-blind study was to compare the ability of a combination of fentanyl and esmolol to blunt the haemodynamic effects of intubation with that of either agent alone. Patients received fentanyl or saline four minutes before, and esmolol or saline two minutes before rapid-sequence induction of anaesthesia. The F2 group (n = 24) received fentanyl 2 μg · kg−1, the E2 group (n = 24) received esmolol 2 mg · kg−1, the F2/E2 group (n = 25) received a combination of fentanyl 2 μg · kg−1 and esmolol 2 mg · kg−1, and the F5 group (n = 26) received fentanyl 5 μg · kg−1. Following tracheal intubation, the maximum percent change from baseline heart rate was less in the F2/E2 and F5 groups (12% and 16% respectively) than in the E2 group (34%)(P < 0.05). The maximum percent changes from baseline systolic blood pressure in the F2/E2 and F5 groups (15% and 6% respectively) were less than in the F2 and E2 groups (24% and 33% respectively) (P < 0.05). The combination of a low dose of fentanyl and esmolol provides an alternative to a higher dose of fentanyl for blunting the haemodynamic responses to laryngoscopy and tracheal intubation during rapidsequence induction in healthy patients.
Résumé
Cette étude randomisée, à double insu, compare la capacité de blocage de la réponse hémodynamique à l’intubation de l’association fentanyl/esmolol avec celle des deux agents utilisés séparément. Les patients reçoivent soit du fentanyl ou du soluté physiologique, soit de l’esmolol ou du soluté physiologique, respectivement à quatre minutes et à deux minutes de l’induction d’une anesthésie à séquence rapide. Le groupe F2 (n = 24) reçoit fentanyl 2 μg · kg−1, le groupe E2 (n = 24) reçoit esmolol 2 mg · kg−1, le groupe F2/E2 (n = 25) reçoit une association de 2 μg · kg−1 de fentanyl et d’esmolol 2 mg · kg−1 et le groupe F5 (n = 26) reçoit fentanyl 5 μg · kg−1. Après l’intubation endotrachéale, le pourcentage maximal de variation de la fréquence cardiaque initiale est moindre pour les groupes F2/E2 et F5 (respectivement 15% et 16%) que pour le groupe E2 (34%) (P < 0,05). Le pourcentage maximal de variation de la tension systolique initiale pour les groupes F2/E2 et F5 (respectivement 15% et 6%) est moindre que pour les groupes F2 et E2 (respectivement 24% et 33%) (P < 0,05). L’association d’une faible dose de fentanyl et d’esmolol constitue une alternative valable aux doses élevées de fentanyl pour atténuer les effets hémodynamiques de la laryngoscopie directe et de l’intubation endotrachéale lors de l’induction à sequence rapide de l’anesthésie chez des sujets en bonne santé.
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Supported in part by a research grant from DuPont Pharmaceuticals, U.S.A.
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Chung, K.S., Sinatra, R.S., Halevy, J.D. et al. A comparison of fentanyl, esmolol, and their combination for blunting the haemodynamic responses during rapid-sequence induction. Can J Anaesth 39, 774–779 (1992). https://doi.org/10.1007/BF03008287
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DOI: https://doi.org/10.1007/BF03008287