Effects Of Co-remifentanil Propofol TCI Induction On Hemodynamics In The Elderly And Patients With Hypertension

Objective: To investigate the hemodynamic effects of co-remifentanil propofolTarget Control infusion(TCI) induction in the elderly and patients with essentialhypertension, detect the difference of cardiovascular reactions and the possiblereasons in them, assess its value of clinical applications.Methods: 40 case elected to given co-remifentanil propofol Target Controlinfusion(TCI) induction, were randomly divided into four groups10 in each, according to the age and if hypertension(yes or no). Group A (middle-agedwith non-hypertension), aged from 36-57, ASAâ… ; group B(middle-aged withhypertension),aged from 36-57,ASAâ…¡, primary hypertension diagnosedPreoperatively (ECG showed changes in ST-T and suspicious myocardial ischemia,heart function 1-2); group C(Older, with non-hypertensive),aged from 61-84,ASAâ… ;group D (old aged with hypertension),aged from 64-84, ASAâ…¡, primaryhypertension diagnosed Preoperatively (ECG showed changes in ST-T, suspicious ofmyocardial ischemia, heart function 1-2). After venous channel established, all thepatients were transfused at a speed of 13ml·kg^-1·h^-1 to fill up the liquid lacking(crystal:colloid=1:1). Induction with midazolam 0.03-0.04mg·kg^-1. constant infusionof remifentanil (induce dose: 1ug·kg^-1, within 4min).maintenance: 0.2ug kg^-1.min^-1constant infusion. Propofol TCI4.0ug·ml^-1 (target plasma concentration 3.0ug·ml^-1,suspended lmin, then, re-infusion,to maintain constant target plasma concentrationwith 3.0ug·ml^-1).after asleep, patient was given esmeron 0.9mg·kg^-1 (3ED₉₅). Whenthe target organ concentration of propofol reached to 3.0ug·ml^-1 and muscle relaxantmet with requirement for tracheal intubation, trachea was intubated. Patient'sbreathing frequency, pulse-oxygen saturation and haemodynamic parameters (bloodpressure, heart rate, systemic vascular resistance, cardiac output, cardiac indexaccelerated etc.) were monitored by BS-PM-9000 and Bioz.com during induction.Record the parameters before induction (T1), after induction immediately (T2), glottisrevealed immediately (T3), after intubation immediately (T4), after intubation 1 min(T5), 3min (T6) 5min (T7), 10 min (T8), collecting monitoring parameters to preparefor analysis statistically.Results: During remifentanil and propofol TCI induction: Group A and Group B: At T1-T8moment, HR, SBP, DBP, MAP, CO, SVR, ACI, LCW, SV change is nosignificant differences (p＞0.05). Before induction, SBP, PP and SVR were higher ingroup B than in group A (all p＜0.05). After Induction, the cycle parameters betweengroups A and B is close and no significant differences (all p＞0.05). However, PP isstill increased at T4 in group B. Group A and group C:At T1～T8 moment, SBP,DBP, MAP, ACI, PP is no significant differences (all p＞0.05). CO, LCW, SV islower in group C than in group A (p＜0.05). CO is lower in group C than in group Aat T1, T2, T7 moment (p＜0.05). at T1 moment, SVR in Group C is higher thanin group A (p＜0.05). After induction, the differences in other groups disappear (p＞0.05), At T1, T4 moment, PP in group C is higher than in group A. At T2, T7moment, the difference disappear. LCW in group A is higher than in C group atall time (p＜0.01). Group B and groups D: At T1～T8 moment, CO, ACI, SV changeis no significant differences (all p＞0.05); SBP, DBP, MAP, LCW, SVR, PP in GroupD is higher than in group B (all p＜0.01). At T1 moment, MAP is no differencesbetween group B and group D (all p＞0.05); At T2, T4 and T7 moment, MAP ingroup B is lower than in group D (p＜0.05). At T1, T2, T4 and T7 moment, CO,SVR, LCW, ACI is no significant difference between group B and group D (all p＞0.05), PP in Group D is higher than in group B at T1, T4 moment, and at T2, T7moment the differences disappear. Group C and group D: At T1～T8 moment,SBP, DBP, MAP, LCW, PP in Group C were higher than in group D (p＜0.05). CO,ACI, SV is no significant differences (all p＞0.05). At T1, T2, T4 and T7 moment,MAP in Group D is higher than in group C (all p＜0.05). At T1, T2, T3, T4 moment,CO, SVR, LCW, ACI is no significant differences (all p＞0.05). At T1, T4moment, PP in Group D is higher than in Group C. At T2, T7 moment thedifferences disappear. Conclusion: Co-remifentanil and propofol TCI induction caneffectively inhibit stress responses and, reliable and safe for the elderly and patientswith hypertension. In order to improve safety during induction, it is recommend thatinduced period should be appropriate prolonged in the elderly patients withhypertension so as to reduce or avoid hemodynamic fluctuations,...