The Clinical Study Of Inhibiting Tracheal Intubated Cardiovascular Response

[Objective] Observation of a single intravenous injection of different dosage of fentanyl, sufentanil, remifentanil combined with the same dosage of midazolam, etomidate, intubation after induction of the hemodynamic changes. To study the suitable dosage of opioid reduce the stress response of intubation[Methods] By ASAI—Ⅱ,120 patients accepted abdominal with general anesthetics,male 60 cases, female60 cases, aged 20-60 years old,no hypertension,heart-lung and liver-renal disease, estimated no intubation difficulties. The patients were randomly divided into three groups with fentanyl, sufentanil, remifentanil group. Fentanyl group was divided into fentanyl group 1 (Fl group, N= 20 patients), fentanyl group 2(F2 group, N= 20 cases), sufentanil group was divided into sufentanil Group 1 (SFl group, N= 20 cases), sufentanil group 2 (SF2 group, N= 20cases), remifentanil group was divided into remifentanil group 1 (RF1 group, N= 20 cases), remifentanil group 2 (RF2 group, N= 20 cases). Each group was introduced with midazolam (0.1mg/kg), vecuronium (0.15mg/kg), etomidate (0.35mg/kg). intravenous injection. After 1 minute intravenous injection of drugs were:F1 Group intravenous fentanyl 2μg/kg, F2 group intravenous fentanyl 4μg/kg; SF1 group intravenous sufentanil 0.2μg/kg, SF2 Group intravenous sufentanil 0.4μg/kg; RF1 group intravenous remifentanil 1.0μg/kg, RF2 group intravenous remifentanil 1.0μg/kg.3 minutes after the injection of muscle relaxant then tracheal intubation. Continuous monitoring and recording before anesthesia (baseline= T0), after intubation lmin (T1), after intubation 3min (T3), after intubation 5min (T5), after intubation 9min (T9) the time of systolic blood pressure (SBP), heart rate (HR).[Results]1.The Systolic blood pressure (SBP) compared before and after tracheal intubationcompared in groups T1 time compared with T0:F1,SF1, RF1 groups were significantly higher blood pressure, there was statistically significant (P<0.05), T3 time compared with T0:F1,SF1, RF1 groups blood pressure were significantly higher, there was statistically significant (P<0.05), compared all of the 6 groups onT5 time and T9 time,there was not statistically significant (P>0.05)compared among groups At T1time,RF2group blood pressure decreased significantly,compared with other five groups there was statistically significant (P<0.05);SF2 compared with F1,SF1,SF2,RFlgroup,four was statistically significant (P<0.05);RF2 group compared with other five groups onT3 time,there was statistically significant (P<0.05),F2,SF2 group compared with F1, SF1, RF1 group,there was statistically significant (P<0.05),compared all of the 6 groups onT5 time and T9 time,there was not statistically significant (P>0.05)2.The heart rate (HR)compared before and after tracheal intubationcompared in groups T1 time compared with T0:The heart rate significantly higher in F1, F2, SF1, RF1 four groups,there was statistically difference(P<0.05);heart rate significantly decreased in RF2 group,there was statistically significant (P<0.05).T3 time compared with T0:heart rate was significantly accelerated,inF1,SF1,RF1 three groups,there was statistically significant (P<0.05);heart rate significantly decreased in RF2 group,there was statistically significant (P<0.05). compared all of the 6 groups onT5 time,T9 time and TO time,there was not statistically significant (P>0.05)compared among groups At T1 time,RF2 group heart rate was significantly slower compared with other five groups,there was statistically significant(P<0.05).SF2 group compared with F1,SF1,RFlgroups,heart rate significantly decreased(P<0.05).At T3 time,the heart rate was most significant decrease in RF2 group,heart rate was significantly lower than other five groups (P<0.01).F2,SF2 groups compared with F1,SF1,RF1 groups,heart rate were significantly decreased,there was statistically significant(P<0.05),Compared all of six groups at T5,T9 time,there was not statistically significant (P> 0.05).[Conclusion]1. Fentanyl,sufentanil, remifentanil three drugs could inhibit tracheal intubation cardiovascular responses. But remifentanil was better efficient in this respect2. Intravenous fentanyl more than 4μg/kg, sufentanil 0.4μg/kg or remifentanil 2.0μg/kg before tracheal intubation, the inhibition of tracheal intubation cardiovascular responses was better.