Abstract
A randomized clinical trial was conducted in 14 women, aged 24–60 years, to compare the effects of rapid-sequence induction of anaesthesia and elective induction on heart rate, blood pressure and left ventricular ejection fraction (LVEF). None of the patients sufferedfrom heart or lung diseases, and all were scheduled for hysterectomy. Cuff blood pressure was measured repeatedly by an automatic recording device, and heart rate and LVEF were monitored by a portable nonimaging nuclear probe. In seven patients, a rapid-sequence induction was performed following preoxygenation and with simultaneous injection of thiopentone (5mg.kg1) and succinylcholine, without starting manual ventilation until the airway was secured with the endotracheal tube. In another seven patients, elective induction was carried out by sequential administration of the same drugs.
Forty seconds after laryngoscopy and intubation mean blood pressure had increased by 38 per cent and heart rate by 29 per cent from preintubalion values in the rapid-sequence induction group, compared to 30 and 12 per cent respectively, in the elective induction group (p < 0.05). Similar decreases in LVEF was observed in both groups, from 0.60 to 0.42 in the elective induction group, and from 0.60 to 0.41 in the rapid-sequence induction group. The equal depression of LVEF indicates that laryngoscopy and intubation produce, with both induction regimens, sudden impairment of cardiac function. The more pronounced hypertension and tachycardia observed during rapid-sequence induction suggests a higher myocardial oxygen consumption which may represent a serious additional burden for the poorly perfused heart.
Résumé
Une étude clinique randomisée a été faite chez 14 femmes âgées de 24 à 60 ans afin de comparer les effets de la séquence rapide d’induction de l’anesthésie et de l’induction élective sur la fréquence cardiaque, la pression artérielle, et la fraction d’éjection du ventricule gauche (LVEF). Aucune des patientes souffraient de maladie cardiaque ou pulmonaire et toutes étaient cédulées pour hystérectomie. La mesure de la tension artérielle par brassard était répétée par un appareil automatique et la fréquence cardiaque et le LVEF étaient surveillés par un probe portatif nucléaire non imagé. Chez sept patientes, une séquence rapide d’induction était faite après préoxygénation et injections simultanées de thiopentone (5 mg.kg-1) et succinylcholine sans ventilation manuelle jusqu’à l’intubation. Chez sept autres patientes, l’induction élective était faite par l’administration séquentielle des mêmes médicaments. Quarante secondes après laryngoscopie et intubation la pression artérielle moyenne augmenta de 38 pour cent et la fréquence cardiaque de 29 pour cent des valeurs préintubation pour le groupe à séquence d’induction rapide, comparativement à 30 et 12 pour cent respectivement pour le groupe à induction élective (p < 0.05). Une diminution similaire du LVEF a été observée dans les deux groupes de 0.60 à 0.42 pour le groupe à induction élective et de 0.60 à 0.41 pour le groupe à induction rapide.
La dépression indentique dans les deux groupes du LVEF nous indique que la laryngoscopie et l’intubation produisent une détérioration soudaine de la fonction cardiaque avec les deux méthodes d’induction. L’hypertension plus prononcée et la tachycardie observée lors de la séquence rapide d’induction suggère une plus grande consommation d’oxygène qui pourra représenter une surcharge additionnelle sérieuse pour le cœur mat perfusé.
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References
Chraemmer-Jørgensen B, Høilund-Carlsen PF, Marving J, Pedersen JF. Left ventricular performance monitored by radionuclide cardiography during induction of anesthesia. Anesthesiology 1985; 62:278–866.
Callahan RJ, Froelich JW, McKusick KA, Leppo J, Strauss HW. A modified method for the in vivo labeling of red blood cells with Tc-99m. J Nucl Med 1982; 23:315–88.
Høilund-Carlsen PF, Marving J, Jensen G. Accuracy of left ventricular ejection fraction determined by the nuclear stethoscope. Int J Cardiol 1982; 2:237–466.
Rahe AJ. Tables of critical values for the Pratt matched pair signed rank statistic. J Am Stat Assoc 1974; 69:638–733.
Smelting RK. Endotracheal intubation. In:Miller RD (ed): Anesthesia. New York, Churchill Livingstone, 1981, pp 247–51.
Moir DD. Cimelidine, antacids, and pulmonary aspiration. Anesthesiology 1983; 59:81–33.
Burstein CL, LoPinto FJ, Newman W. Etectrocar-diographic studies during endotracheal intubation. I. Effects during usual routine technics. Anesthesiology 1950; 11:224–37.
King BD, Harris LC, Greifenstein FE, Elder JD, Dripps RD. Reflex circulatory responses to direct laryngoscopy and tracheal intubation performed during general anesthesia. Anesthesiology 1951; 12:556–666.
Takeshima K, Noda K, Higaki M. Cardiovascular response to rapid anesthesia induction and endotracheal intubation. Anesth Analg 1964; 43:201–88.
Forbes AM, Dally FG. Acute hypertension during induction of anesthesia and endotracheal intubation in normotensive man. Br J Anaesth 1970; 42:618–244.
Giles RW, Berger HJ, Barash PG et al. Continuous monitoring of left ventricular performance with the computerized nuclear probe during laryngoscopy and intubation before coronary artery bypass surgery. Am J Cardiol 1982; 50:735–411.
Fox EJ, Sktar GS, Hill CH, Villanueva R, King BD. Complications related to the pressor response to endotracheal intubation. Anesthesiology 1977; 47:524–55.
Roy WL.Edelist G, Gilbert B. Myocardial ischemia during non-cardiac surgical procedures in patients with coronary-artery disease. Anesthesiology 1979; 51:393–7.
Slogoff S, Keats AS. Does perioperative myocardial ischemia lead to postoperative myocardial infarction? Anesthesiology 1985; 62:107–14.
Tomori Z, Widdicombe JG. Muscular, bronchomotor and cardiovascular reflexes elicited by mechanical stimulation of the respiratory tract. J Physiol 1969; 200:25–49.
Russell WJ, Morris RG, Frewin DB, Drew SE. Changes in plasma catecholamine concentrations during endotracheal intubation. Br J Anaesth 1981; 53:837–9.
Nigrovic V, McCullough LS, Wajskol A, Levin JA, Martin JT. Succinylcholine-induced increases in plasma catecholamine levels in humans. Anesth Analg 1983; 62:627–32.
Cummings MF, Russell WJ, Frewin DB, Jonsson JR. The effects of suxamethonium and D-tubo-curarine on the pressor and plasma catecholamine responses to tracheal intubation. Anaesth Intensive Care 1983; 11:103–6.
Cummings MF, Russell WJ, Frewin DB. Effects of pancuronium and alcuronium on the changes in arterial pressure and plasma catecholamine concentrations during tracheal intubation. Br J Anaesth 1983; 55:619–23.
Smelting RK. Endotracheal intubation. In:Miller RD (ed) Anesthesia. New York, Churchill Livingstone, 1981, p 235–42.
Cork RC, Weiss JL.Hameroff SR, Bentley J. Fentanyl preloading for rapid-sequence induction of anesthesia. Anesth Analg 1984; 63:60–4.
Safwat AM, Fung DL, Bilton DC. The use of propranolol in rapid sequence anaesthetic induction: optimal time interval for pretreatment. Can Anaesth Soc J 1984; 31:638–41.
Foster C, AnholmJD, Hellman CK, Carpenter J, Pollock ML, Schmidt DH. Left ventricular function during sudden strenuous exercise. Circulation 1981; 63:592–6.
Kaplan JA. Hemodynamic monitoring. In:Kaplan JA (ed) Cardiac Anesthesia. New York, Grune and Stratton, Inc., 1979, p 109.
Smith RA. Respiratory care. In:Miller RD (ed) Anesthesia. New York, Churchill Livingstone, 1981, p 1425.
Hickey RF, Eger IIEl. Circulatory pharmacology of inhaled anesthetics. In:Miller RD (ed) Anesthesia. New York, Churchill Livingstone, 1981, pp 338–41.
Hug JRCC. Pharmacology — anesthetic drugs. In:Kaplan JA (ed) Cardiac Anesthesia. New York, Grune and Stratton, Inc., 1979, pp 5–7.
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Presented in part at the 8th World Congress of Anaesthesiologists, Manila, Philippines, January 1984.
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Chraemmer-jørgensen, B., Høilund-Carlsen, P.F., Marving, J. et al. Left ventricular ejection fraction during anaesthetic induction: comparison of rapid-sequence and elective induction. Can Anaesth Soc J 33, 754–759 (1986). https://doi.org/10.1007/BF03027126
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DOI: https://doi.org/10.1007/BF03027126