Abstract
Purpose
To compare the ease of tracheal intubation without the use of muscle reiaxants following an alfentanil-lidocaine-propofol sequence vs a fentanyl-lidocaine-propofol sequence.
Clinical features
In 80 ASA I and II adult patients undergoing elective laparoscopic surgery, we compared the intubating conditions following alfentanil 20μg· kg−1, lidocaine 1.5 mg· kg−1, propofol 3 mg· kg−1 (Group I;n = 40) vs fentanyl 2 μg· kg−1, lidocaine 1.5 mg· kg−1, propofol 3 mg· kg−1 (Group II;n = 40). The intubating conditions were scored by jaw relaxation, vocal cord position and response to intubation, as well as by blood pressure and heart rate changes. The intubating conditions were good or excellent in 95% of patients in Group I vs 62.5% of patients in Group II (P < 0.05), Blood pressure decreased from a preinduction value of 86 ± 13 mmHg to 72 ± 28 mmHg and 74 ± 19 mmHg in Group I, and from 85 ± 12 mmHg to 78 ± 15 mmHg and 78 ± 12 mmHg in Group II, one and five minutes following intubation (P < 0.05), This drop in blood pressure was not different between the two groups.
Conclusion
An alfentanil-lidocaine-propofol sequence offers significantly better intubating conditions than a fentanyl-lidocaine-propofol sequence in healthy adult patients.
Résumé
Objectif
Comparer la facilité de l’intubation endotrachéale réalisée, sans recours aux myorelaxants, à la suite de l’administration de la séquence alfentanil-lidocaïne-propofol vs fentanyl-lidocaïne-propofol.
Éléments cliniques
Nous avons comparé, chez 80 adultes d’état physique ASA I et II devant subir une Intervention laparoscoplque réglée, les conditions d’intubation suivant l’administration de 20 μg· kg−1 d’alfentanil, 1,5 mg· kg−1 de lidocaine et 3 mg· kg−1 de propofol (Groupe I; n = 40) vs 2 μg· kg−1 de fentanyl, 1,5 mg· kg−1 de lidocdïne et 3 mg· kg−1 de propofol (Groupe II; n = 40). Les conditions d’intubation ont été cotées en fonction du relâchement de la mâchoire, de la position des cordes vocales et de la réponse à l’intubation, des changements de tension artérielle et de fréquence cardiaque. Ces conditions ont été bonnes ou excellentes chez 95% des patients du Groupe I vs 62,5 % du Groupe II (P < 0,05). Il y a eu une baisse de la tension artérielle, par rapport aux valeurs enregistrées avant l’induction de 86 ± 13 mmHg à 72 ± 28 mmHg et 74 ± 19 mmHg dans Se Groupe I, et de 85 ± 12 mmHg à 78 ± 15 mmHg à 78 ± 12 mmHg dans le Groupe II, une et cinq minutes après l’Intubation (P < 0,05). Cette chute de la tension artérielle ne présentait pas de différence intergroupe.
Conclusion
Une séquence d’alfentanll-lidocaïne-propofol offre des conditions slgnificativement meilleures qu’une séquence de fentanyl-lidocaïne-propofol chez des sujets adultes sains.
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Jabbour-Khoury, S.I., Dabbous, A.S., Rizk, L.B. et al. A combination of alfentanil-lidocaine-propofol provides better intubating conditions than fentanyl-lidocaine-propofol in the absence of muscle relaxants. Can J Anaesth 50, 116–120 (2003). https://doi.org/10.1007/BF03017841
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DOI: https://doi.org/10.1007/BF03017841