Abstract
High concentrations of inhaled isoflurane can increase heart rate and/or arterial pressure. The purpose of this study was to determine whether fentanyl has a prophylactic effect on the isoflurane-induced circulatory response in adult patients. Thirty patients due to undergo elective surgery were randomly allocated to one of three groups of ten patients. Prior to surgery, one group inhaled 2.5% isoflurane, another inhaled 5.0% isoflurane, and the third group inhaled 5.0% isoflurane and were given fentanyl 2 μg · kg−1 iv two minutes before induction of anaesthesia. Anaesthesia was induced with thiamylal followed by vecuronium. The lungs were ventilated with 100% oxygen and either 2.5% or 5.0% isoflurane via face mask. Ventilation was continued for five minutes. Heart rate (HR) and mean arterial pressure (MAP) were recorded at two minutes before induction of anaesthesia (baseline), immediately before the induction of anaesthesia, and at three and five minutes after induction, respectively. It was found that 5.0% isoflurane caused an increase in HR compared with baseline (P < 0.01) and with the 2.5% isoflurane (P < 0.05): 2.5% isoflurane did not elicit this response. An increase was also noted in MAP, compared with the 2.5% isoflurane (P < 0.01): 2.5% isoflurane did not elicit this increase. Fentanyl pretreatment attenuated the increases in HR and in MAP that occurred with 5.0% isoflurane (P < 0.01). These results suggest that fentanyl attenuates the enhancement of both HR and MAP from face mask inhalation of a high concentration of isoflurane.
Résumé
L’inhalation de fortes concentrations d’isoflurane peut augmenter la fréquence cardiaque et la pression artérielle. Cette étude a pour objectif de déterminer si le fentanyl protège le sujet adulte de ces réponses circulatoires induites par l’isoflurane. Trente patients programmés pour une chirurgie non urgente sont répartis au hasard en trois groupes égaux. Avant la chirurgie, un groupe inspire de l’isoflurane à 2,5%, le deuxième de l’isoflurane à 5%, et le troisième de l’isoflurane à 5% et reçoit du fentanyl 2 μg · kg−1 iv deux minutes avant l’induction de l’anesthésie. L’anesthésie est induite avec du thiamylal suivi de vécuronium au masque facial. Les poumons sont ventilés avec de l’oxygène à 100% associé à l’isoflurane 2,5% ou 5%. La ventilation est continuée pendant cinq minutes. La fréquence cardiaque (FC) et la pression artérielle moyenne (PAM) sont enregistrées deux minutes avant l’induction (mesure initiale), immédiatement avant l’induction de l’anesthésie et trois et cinq minutes après l’induction. Les résultats montrent que l’isoflurane à 5% produit une augmentation de FC comparativement à la mesure initiale (P < 0,01): mais que l’isoflurane à 2,5% ne provoque pas cette réponse (P < 0,05). Une augmentation de la MAP est aussi notée comparativement à l’isoflurane 2,5% (P < 0,01):l’isoflurane 2,5% ne provoque pas cette augmentation. Le prétraitement au fentanyl diminue l’augmentation de la FC et de la MAP qui survient avec l’isoflurane 5% (P < 0,01). Ces résultats suggèrent que le fentanyl atténue l’augmentation à la fois de la FC et de la MAP pendant l’administration au masque de concentrations élevées d’isoflurane.
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Kinoshita, H., Wakamatsu, H., Taira, Y. et al. Fentanyl pretreatment attenuates the haemodynamic response to sudden inhalation of 5% isoflurane. Can J Anaesth 42, 204–208 (1995). https://doi.org/10.1007/BF03010677
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DOI: https://doi.org/10.1007/BF03010677