Abstract
The objective of this study was to determine the effectiveness of two prophylactic approaches against the anticipated hypotension induced by propofol during rapid-sequence intubation. Thirty-six male or female nonpremedicated ASA class I-II patients aged 21– 60 yr undergoing elective outpatient surgery were included in the study. Patients were randomly allocated to receive pre-induction ephedrine sulphate (70 μg · kg− 1 iv), preinduction volume loading (12 ml · kg− 1 Ringer’s lactate) or no treatment. Rapid-sequence intubation with cricoid pressure was then performed with propofol (2.5 mg · kg− 1) and succinylcholine (1.5 mg · kg− 1). The lungs were subsequently ventilated with 0.25– 0.5% isoflurane in a 2:1 N2O/O2 mixture. Vecuronium was given once neuromuscular function had recovered from the succinylcholine. Heart rate and systemic arterial blood pressure were measured non-invasively before induction, after propofol administration and every minute for ten minutes after intubation. Pre-induction volume loading prevented the hypotension observed before surgical stimulation in control and ephedrine groups. Moreover, pre-induction volume loading was not associated with increases in heart rate after intubation as was ephedrine administration. The intubating conditions were excellent to satisfactory in most patients and the overall incidence of adverse events during induction was mainly due to pain during injection of propofol. The present study showed that preoperative volume loading is more efficacious than preinduction administration of ephedrine sulphate in maintaining haemodynamic stability during rapid-sequence induction with propofol and succinylcholine. In addition, propofol in combination with succinylcholine provides excellent conditions for rapid-sequence intubation.
Résumé
Cette étude a pour objet de déterminer l’efficacité de deux approches visant à prévenir l’hypotension induite par le propofol pendant l’induction en séquence rapide. Trente-six patients des deux sexes non prémédiqués de classe ASA I et II âgés de 21 à 60 ans programmés en chirurgie ambulatoire font partie de l’étude. Les patients sont répartis au hasard pour recevoir du sulfate d’éphédrine (70 μg · kg− 1 iv) avec une charge liquidienne (12 ml · kg− 1 de lactate de Ringer) ou aucun traitement. L’intubation en séquence rapide avec pression cricoïdienne est exécutée sous propofol (2,5 mg · kg− 1) et succinylcholine (1,5 mg · kg− 1). La ventilation mécanique est ensuite initiée avec de l’isoflurane 0,25 à 0,5% dans une mélange N2O/O2 2:1. Du vécuronium est administré après récupération de la succinylcholine. La fréquence cardiaque et la pression artérielle systémique sont mesurées avant l’induction et à toutes les minutes pendant dix minutes. La charge liquidienne préinduction prévient l’hypotension observée avant la stimulation chirurgicale dans les groupes contrôles et éphédrine. En outre, la charge liquidienne préinduction n’est pas associée à une augmentation de la fréquence cardiaque après l’intubation comme l’est l’éphédrine. Les conditions d’intubation sont excellentes dans la plupart des cas et les complications se limitent presque totalement à de la douleur au moment de l’injection du propofol. La présente étude montre que la charge liquidienne préinduction est plus efficace que l’administration de sulfate d’éphédrine pour maintenir la stabilité hémodynamique pendant l’induction à séquence rapide avec le propofol et la succinylcholine. D’ailleurs, l’association de propofol et de succinylcholine procure d’excellentes conditions pour l’intubation en séquence rapide.
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El-Beheiry, H., Kim, J., Milne, B. et al. Prophylaxis against the systemic hypotension induced by propofol during rapid-sequence intubation. Can J Anaesth 42, 875–878 (1995). https://doi.org/10.1007/BF03011034
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DOI: https://doi.org/10.1007/BF03011034