Abstract
The haemodynamic response to anaesthetic induction and tracheal intubation was studied in 29 patients undergoing elective myocardial revascularization surgery. All patients included in the study were anaesthetized with etomidate, 0.3 mg · kg−1. The patients were randomized to three groups: Group I received fentanyl, 2.5 μg · kg−1; Group II received fentanyl, 5 μg · kg−1; and Group III received fentanyl, 10 μg · kg−1. Haemodynamic variables were measured at baseline (awake), after anaesthetic induction, and at one, three, five, and ten minutes after tracheal intubation. The number of patients with haemodynamic responses to intubation (>20% increase in heart rate or mean arterial pressure) was greater (P < 0.05) in Group I than in Groups II and III. Statistically significant, but clinically minor, decreases in mean arterial pressure and cardiac output occurred in all groups at the last three study times. The frequency of involuntary muscle movements was 14%, and all of these events occurred in patients in Group I. In conclusion, the authors recommend using fentanyl, 5–10 μg · kg−1 to blunt the haemodynamic response to tracheal intubation following anaesthetic induction with etomidate, 0.3 mg · kg−1.
Résumé
Chez 29 patients programmés pour une revascularisation chirurgicale du myocarde, on évalue la réponse hémodynamique provoquée par l’induction de l’anesthésie et de l’intubation endotrachéale. Tous les patients inclus dans l’étude sont anesthésiés à l’étomidate 0,3 m · kg−1. Par randomisation, on les distribue dans un des trois groupes suivants: le groupe I reçoit du fentanyl 2,5 μg · kg−1; le groupe II, 5 μg · kg−1; le groupe III, fentanyl 10 μg · kg−1. Les variables hémo-dynamiques de départ sont mesurées à l’état de veille, après l’induction de l’anesthésie, à une, trois, cinq et dix minutes après l’intubation endotrachéale. Le nombre de patients qui ont montré une réponse hémodynamique à l’intubation définie comme une augmentation de 20% de la fréquence cardiaque ou de la tension artérielle moyenne, est plus élevé dans le groupe I que dans les groupes II et III. Une diminution statistiquement significative mais cliniquement sans importance de la pression artérielle moyenne et du débit cardiaque survient dans les trois groupes aux trois derniers moments d’étude. La fréquence des mouvements musculaires involontaires est de 14% et tous ces épisodes surviennent chez les patients du groupe I. En conclusion, les auteurs recommandent l’utilisation de 5 à 10 μg · kg−1 pour atténuer la réponse hémodynamique à l’intuba-tion endotrachéal avec l’induction à l’étomidate 0,3 mg · kg−1.
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Weiss-Bloom, L.J., Reich, D.L. Haemodynamic responses to tracheal intubation following etomidate and fentanyl for anaesthetic induction. Can J Anaesth 39, 780–785 (1992). https://doi.org/10.1007/BF03008288
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DOI: https://doi.org/10.1007/BF03008288