Abstract
Purpose
Tracheal extubation causes hypertension and tachycardia, which may cause imbalance between myocardial oxygen demand and supply in patients at risk of coronary artery disease. We conducted a randomized, controlled study to evaluate the effects of 0.05 or 0.1 μg · kg−1 · min−1 prostaglandin E1, (PGE1) iv on haemodynamic variables occurring during tracheal extubation and emergence from anaesthesia and compared them in patients receiving either lidocaine or saline.
Methods
Eighty ASA physical status I patients undergoing elective surgery were enrolled in the current study. Anaesthesia was maintained with sevoflurane 1.0%–2.5% (ET concentration) and nitrous oxide 60% in oxygen. Muscle relaxation was achieved with vecuronium. The patients were randomly assigned to receive one of four treatments (n = 20 each): saline (control), 0.05 μg · kg−1 · min−1 PGE1, 0.1 μg · kg−1 · min−1 PGE1, or 1 mg · kg−1 lidocaine. PGE1 was infused from completion of surgery until five minutes after tracheal extubation. Changes in heart rate (HR) and blood pressure (BP) were measured during and after tracheal extubation.
Results
In the control group, the HR, systolic BP, and diastolic BP increased during tracheal extubation. Administration of 0.1 μg · kg−1 · min−1 PGE1 and 1 mg · kg−1 lidocaine attenuated the increases in BP although 0.05μg · kg−1 · min−1 PGE1 failed to do so. The inhibitory effect of the 0.1 μg · kg−1 · min−1 PGE1 on BP was similar to that of lidocaine 1 mg · kg−1 iv. The increase in HR was attenuated by lidocaine but not by PGE1.
Conclusion
The intravenous infusion of 0.1 μg · kg−1 · min−1 PGE1 given during emergence from anaesthesia and tracheal extubation is a useful method for attenuating the hypertension associated with noxious stimuli during this period.
Résumé
Objectif
L’intubation trachéale provoque de l’hypertension et de la tachycardie, sources de déséquilibre entre la demande et l’apport en oxygène chez les sujets à risque d’ischémie myocardique. Les auteurs ont mené une étude aléatoire contrôlée dans le but d’évaluer les effets de 0,05 ou 0,1 μg · kg−1 · min−1 de prostaglandine E1 (PGE1) iv sur les variables hémodynamiques mesurées à l’extubation et pendant le réveil postanesthésique et les comparer chez les patients recevant soit de la lidocaine soit du sol. physiologique.
Méthodes
L’étude présente incluait 84 patients ASA I programmés pour une chirurgie non urgente. L’anesthésie était maintenue avec du sévoflurane 1,0–2,5% (concentration télé-expiratoire) et du protoxyde d’azote 60% en oxygène. La curarisation était assurée par du vécuronium. Les patients étaient répartis pour recevoir une des quatre alternatives suivantes: sol. physiologique (contrôle), PGE1 0,05 μg · kg−1 min−1, PGE1 0,1 μg · kg−1 · min−1 ou lidocaine 1 mg · kg−1. La perfusion de PGE1 était commencée à la fin de la chirurgie et arrêtée cinq minutes après l’extubation. Les changements de la fréquence cardiaque (Fc) et de la pression artérielle (PA) étaient mesurés avant et après l’extubation.
Résultats
Dans le groupe contrôle, la Fc et la PA systolique et diastolique ont augmenté à l’extubation. L’administration de PGE1 0,1 μg · kg−1 · min−1 et de lidocaine I mg · kg−1 ont atténué l’augmentation de PA alors que la PGE1 0,005 μg · kg−1 · min−1 n’a pas eu cet effet. L’effet inhibiteur de PGE1 0,1 μg · kg−1 · min−1 sur la PA était identique à celui de la lidocaïne 1 mg · kg−1. L’augmentation de Fc a été atténuée par la lidocaine mais pas par la PGE1.
Conclusion
Une perfusion intraveineuse de PGE1 0,1 μg · kg−1 min−1, administrée au moment du réveil post-anesthésique et de l’extubation, constitue une méthode valable pour atténuer l’hypertension associée aux stimuli nociceptifs de cette période.
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Nishina, K., Mikawa, K., Shiga, M. et al. Prostaglandin E1 attenuates the hypertensive response to tracheal extubation. Can J Anesth 43, 678–683 (1996). https://doi.org/10.1007/BF03017950
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DOI: https://doi.org/10.1007/BF03017950