| objective: Hydromorphone,a semi-synthetic opioid, one of morphine derivatives,provides analgesia through μ-agonist activity.Since it has rapid onset,strong sedation,short half-life,no sealing effect,no histamine release,less adverse reactions.Hydromorphone has been widely administrated for postoperative analgesia,acute pain and chronic pain,but the hydromorphone is less used for induction of anesthesia.This research aims at exploring the feasibility of different doses of hydromorphone used for induction of anesthesia though observing BP,HR,blood glucose,intubation response and adverse reaction and the effect on postoperative pain.Methods:88 patients scheduled for elective abdominal surgery,aged 40-65 years,ASA I-II,body mass index18-29kg/m2,were allocated randomly into four groups:Q1 group(hydromorphone 0.02 mg/kg),Q2 group(hydromorphone 0.025 mg/kg),Q3group(hydromorphone 0.03 mg/kg),F group(fentanyl 3ug/kg),22 cases in each group.After entering Operation room,venous access was established,8ml/kg of lactated Ringer’s solution was infused.HR,MAP,SBP,DBP,Sp O2,BIS were monitored.Arterial catheter was inserted to monitor arterial blood pressure.Penehyclidine hydrochloride 0.01mg/kg,midazolam 0.02mg/kg were injected intravenously,then all patients were pre-oxygeneted using 6-8ml/min oxygen with mask for 5min.Q1 group:hydromorphone 0.02mg/kg,Q2group:hydromorphone 0.025mg/kg,Q3 group:hydromorphone 0.03 mg/kg,F Group:fentanyl-3ug/kg were injected intravenously(the time of injection was longer than 60s),five minutes later propofol 1.5 mg/kg was injected,then cisatracurium besilate 0.2 mg/kg was injected,when the BIS was under 55 and the muscle relaxation completely,tracheal intubation was performed.All tracheal intubation were completed by a same anesthesiologist who successfully finished intubation within 30 s.All patients were received mechanical ventilation:tidal volume 8-12ml/kg, frequency 10-15 times/min,oxygen flow1.5-2L/min,Pet CO2 maintained in 35-45 mm Hg,sevoflurane(0.7-1.3MAC)was used to maintain the depth of anesthesia with bispectral index between45-55.Operating room environment is maintained relatively quiet,with no any irritating,eg urethral catheterization,disinfection,shop sterile surgical towels,et al.HR,MAP,SBP,DBP,Sp O2 BIS were recorded at the time of base value(T0);after induction(T1);1min(T2),5min(T3),10min(T4) after intubation.Plasma noradrenaline concentration,endothelin-1 concentration were detected by radioimmunoassay method and blood sugar levels were detected at all points.Intubation response and adverse reactions were recorded in four groups.Steward score was used to evaluate the awareness of patients 10 minutes after extubation. Postoperative pain was evaluated by numerical rating scale(NRS)after extubation 10 min,30min,2h,4h,6h,12 h,24h.PCA compression times and the additional number of tramadol were recorded 24 h after extubation.Results:1.88 cases were finished this study,and into statistics,there were no statistical differences in the diseases, age,sex and weight among four groups(P>0.05).2.The BIS value of four groups at the point of T1,T2,T3,T4 were significantly lower than that of T0(P > 0.05).3.BP and HR:F group:MAP,SBP,DBP,HR at the point of T1,T4 and HR at the point of T3 were lower than T0(P<0.05);MAP,SBP,DBP,HR at the point of T2,T3 were higher than T1(P<0.05).Q1 group:MAP,SBP,DBP,HR at the point of T1 and HR at the point of T4 were lower than T0(P<0.05),MAP,SBP,DBP at the point of T2 were higher than T0(P<0.05);MAP,SBP,DBP,HR at the point of T2,T3 were higher than T1(P<0.05);MAP,SBP,DBP,HR at the point of T4,T3 were lower than T2(P<0.05).Q2 group:MAP,SBP,DBP,HR at the point of T1 and HR at the point of T4 were lower than T0(P<0.05);MAP,SBP,DBP,HR at the point of T2 were higher than T1(P<0.05);MAP,SBP,DBP,HR at the point of T4 were lower than T2(P<0.05).Q3 group:MAP,SBP,DBP,HR at the point of T1 and SBP,HR at the point of T4 were lower than T0(P<0.05);MAP,SBP,DBP,HR at the point of T2 were higher than T1(P<0.05).MAP,SBP,DBP,HR of Q1 group were higher than that of F group,Q3 group at T2 point(P<0.05).4.Plasma NE and ET-1concentration: plasma NE concentration:Compared with T1 point,F group was higher at point T2(P<0.05);Compared with T0 point,T1 point,Q1 group were higher at T2 point,T3 point,T4 point(P<0.05).Compared with T1 point, Q2 group was higher at point T2(P<0.05);Compared with T2 point,Q2 group was lower at point T4(P<0.05).Comparison among groups:Compared with Q1 group,the plasma NE concentration of Q2 group,Q3 group,F group were lower at T2 point,T3 point,T4 point(P<0.05).Plasma ET-1 concentration:Compared with T0 point,the plasma NE concentration of Q1 group,Q2 group,Q3 group,F group were lower at T1 point,T3 point,T4 point(P<0.05);Compared with T1 point,the plasma NE concentration of Q1 group,Q2 group,F group were higher at T2 point(P< 0.05);Compared with T2 point,the plasma NE concentration of Q1 group,F group were lower at T3 point,T4 point(P<0.05);the plasma NE concentration of Q2 group,Q3 group were lower at T4point(P<0.05).Comparison among groups:the plasma NE concentration of Q2 group,Q3 group,F group were lower than that of Q1 group at T2point(P<0.05).5. Blood glucose concentration:the blood glucose level of four groups at T1 point were lower than that at T0 point(P<0.05);the blood glucose level of Q1 group,Q2 group,F group at T2 point were higher than that at T1 point(P<0.05);the blood glucose level of Q1 group at T3,T4 point were lower than that at T2 point(P<0.05);the blood glucose level of Q1 group was higher than that of F group,Q3 group at T2 point(P<0.05).6.Comparison of postoperative NRS, the additional number of tramadol and PCA compression times: The NRS score of F group was higher than that of Q1 group,Q2 group and Q3 group after extubation 2h(P<0.05);The NRS score of F group,Q1 group were higher than that of Q2 group and Q3 group after extubation4h(P<0.05);The NRS score of F group was higher than that of Q2 group and Q3 group after extubation 6h(P<0.05).The additional number of tramadol:additional number of tramadol in Q2 group and Q3 group was less than that in F group(P<0.05).The number of PCA compression times:The total number of PCA compression times in Q2 group,Q3 group was lessr than that in F group and Q1 group(P<0.05).7.Steward score of patients was no statistical difference after extubation 10 minutes(P>0.05).8.There was no statistical significance(P>0.05)in the intubation response and adverse reaction in the four groups.Conclusions:1.The selected dose of Hydromorphone could be used safely in induction of general anesthesia, and it has postoperative analgesic effect.2.The inhibitory effect of 0.03mg/kg Hydromorphone on the stress response was stronger than that of 0.02mg/kg,0.025mg/kg Hydromorphone and3ug/kg fentanyl,and its hemodynamic was more stable,with no influence on postoperative recovery of patients. |
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