使用Alfentanil降低插管時循環反應的最佳時機

The Optimal Injection Time of Alfentanil for Blunting Circulatory Responses to Tracheal Intubation

背景：本研究探討在麻醉誘導期給予alfentanil以減低由喉頭鏡和氣管插管所引起循環反應的最隹時機。方法：75個ASA為一或二的病人隨機分成五組。第一組給予安慰劑，第二、三、四、五組則 分別在插管前五、三、一分鐘及三十秒前給予每公斤體重10微克的alfentanil靜脈注射。插管 後，用氧氣-笑氣各每分鐘2公升混合並用1.5% 的isoflurane來維持麻醉。紀錄全部病人的血液 動力學資料，包括心率、血壓以及副作用的出現，並加以比較。結果=各組病人之基本資料及插管時間並無統計差異。第二，三，四組病人在插管後的前三分 鐘和第一組比較，均可明顯地降低心跳速率。而在血壓與心率-血壓乘積方面，第二、三、 四、五組的病人在插管後的前兩分鐘和第一組比較上則有顯著的差異。93%的第二和第三組 病人在給藥後覺得暈眩。在第二組中，有一個病人在給藥後覺得噁心而另一個則是有缺氧的 情況發生。結論：此研究顯示，在插管前一分鐘時，使用每公斤10微克的alfentanil會在插管期間有較穩 定的血屢、心率和較少的副作用發生。

Background: The aim of this study is to investigate the optimal injection time of alfentanil during induction of anesthesia to blunt the circulatory responses induced by laryngoscopy and tracheal intubation. Methods: Seventy-five percent of ASA class I or II were randomly assigned to five groups. Group I was the placebo group in which the patients received normal saline 2 ml just before induction. Patients in groups II, III, IV amd V received alfentanil 10 mg/kg at 5, 3, 1 and 0.5 min before intubation respectively. Anesthesia was main-tained with 1.5% isoflurane and nitrous oxid in 50% oxygen (2:2 L/min). The patients' heart rate and blood pressure before and after intubation were documented and compared. The occurrence of adversr effects was also recorded. Results: Patients' demographic data, baseline hemodynamic profile and the laryngoscopic time did not differ among the five groups. The patients in groups II, III and IVshowed decreased heart rate compared with group I within 3 min after intubation. The patients in group V like those in group I did not show a reduction in heart rate 1 min after incubation. The patients in groups II, III, IV and V all showed reduced systolic blood pressure and rate-pressure product (RPP) 2 min after intubation. The occurrence of hypotension and bradycardia was not different among the five groups; hypertension and high RPP were less in groups II, III and IV as compared with group I. Ninety-three percent patients in group IIand group III suffered from dizziness after alfentanil administration. One patient in group II had nausea and another one patient displayed hypoxemia after alfentanil administration. Conclustion: Consudering equal effectiveness and fewer side effects, one minute before intubation is the optimal injection time of alfentanil to blunt the circulatory responses induced by laryngoscopy and tracheal intubation.