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Is there an ideal approach for rapid-sequence induction in hypertensive patients?

Abstract：

STUDY OBJECTIVE:To compare 4 different anesthesia induction protocols, in a simulated model of rapid-sequence induction, in controlled hypertensive patients. DESIGN:Prospective, randomized, double-blind, clinical investigation. SETTING:Large metropolitan university hospital. PATIENTS:120 ASA II-III adult hypertensive patients. INTERVENTIONS:Patients were allocated to 4 groups at random. After preoxygenation for 3 minutes, induction and tracheal intubation was performed in a 30 degrees head-up position. Thiopental (5-7 mg/kg) was the induction agent. Study groups were as follows: group LS (n = 30), lidocaine (1.5 mg/kg) and succinylcholine (1 mg/kg); group LR (n = 30), lidocaine (1.5 mg/kg) and rocuronium (1 mg/kg); group RS (n = 30), remifentanil (1 microg/kg) and succinylcholine (1 mg/kg); group RR (n = 30), remifentanil (1 microg/kg) and rocuronium (1 mg/kg). Patients were intubated 60 seconds after administration of muscle relaxant. MEASUREMENTS:Hemodynamic data were obtained before induction (baseline), after induction, at intubation, and at 1, 3, 5, and 10 minutes after intubation. More than 20% change in blood pressure and heart rate was considered significant. MAIN RESULTS:Systolic and mean arterial blood pressures at intubation and 1 and 3 minutes after intubation were higher in group LS compared with groups RS and RR (P < 0.01). Mean arterial blood pressure decreased after induction in groups LS, LR, and RR, but increased at intubation and 1 minute after intubation in groups LS and LR (P < 0.01). Mean arterial blood pressure was similar at all measurement intervals in group RS. The median area under the systolic, mean, and diastolic blood pressure time curves was higher in groups LS and LR compared with groups RS and RR (P < 0.05 and P < 0.01). CONCLUSIONS:Remifentanil is a better adjunct for attenuation of the response to laryngoscopy and intubation compared with lidocaine, whereas remifentanil-succinylcholine combination appears to be more beneficial in terms of hemodynamic stability in hypertensive patients.

journal_name

J Clin Anesth

journal_title

Journal of clinical anesthesia

authors

Alanoğlu Z,Ateş Y,Yilmaz AA,Tüzüner F

doi

10.1016/j.jclinane.2005.06.006

subject

Has Abstract

pub_date

2006-02-01 00:00:00

pages

34-40

issue

eissn

0952-8180

issn

1873-4529

pii

S0952-8180(05)00329-6

journal_volume

pub_type

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Is there an ideal approach for rapid-sequence induction in hypertensive patients?