Effect Of Nalbuphine On The Inhibition Of Transnasal Tracheal Intubation Response To Sufentanil During Induction Of General Anesthesia

Objective:To investigate the effect of the opioid receptor agonist-antagonist nalbuphine on the inhibition of transnasal tracheal intubation response to sufentanil during the induction period of general anesthesia.Methods:Sixty patients,of any gender,aged 20-65 years,ASA I-II,with no difficult airway assessed preoperatively,were selected for general anesthesia transnasal tracheal intubation required for surgery at Guangxi Medical University Stomatology Hospital.The 60 patients were divided into two groups:experimental group（Group N）and control group（Group C）,with 30 cases in each group,using the random number table method.After admission to the room,the vein was opened,cardiac monitoring was connected,and the dorsalis pedis artery was punctured and cannulated using 1%lidocaine local infiltration anesthesia.At 10 min before induction of anesthesia,nalbuphine 0.2 mg/kg was injected intravenously in group N,and an equal volume of saline was injected intravenously in group C for control observation,while oxygen was administered by face mask.The induction protocol was the same in both groups:0.05 mg/kg midazolam,0.05 mg pentoxifylline,0.3 mg/kg etomidate,sufentanil TCI 0.25 ng/ml,cisatracurium 0.25 mg/kg was given after the patient fell asleep,and transnasal tracheal intubation was performed under the assistance of visual laryngoscope after muscle relaxation,and intubation was performed by experienced anesthesiologists,select the more open side of nasal cavity for intubation,and the intubation was successful once.After confirming the successful intubation by listening to the respiratory sounds of both lungs,the anesthesia machine was connected for artificial respiration.The systolic blood pressure（SBP）,diastolic blood pressure（DBP）,heart rate（HR）were observed and recorded after the patient entered the room quietly（T₀）,before induction（T₁）,before intubation（T₂）,immediately after intubation（T₃）,3 min after intubation（T₄）,5 min after intubation（T₅）and 10 min after intubation（T₆）,and3 ml of arterial blood was drawn at T₀,T₃and T₅.The fingertip blood glucose concentration was also measured with an electronic blood glucose meter at T₀,T₃and T₅time points.The incidence of adverse effects such as respiratory depression and hypotension during the induction of anesthesia was recorded in both groups.Results:There was no statistically significant difference in the comparison of age,gender,BMI,and ASA classification between the two groups（P>0.05）.（1）Changes in hemodynamic indexes:at T₀and T₁time points,there were no significant differences in blood pressure and heart rate between the two groups（P>0.05）.At T₂time point,SBP and DBP in both groups decreased compared with T₀（P<0.05）,HR did not change significantly compared with T₀time point,and there was no significant difference between the above indexes（P>0.05）.After intubation,at the time point of T₃,SBP,DBP and HR in group N increased compared with T₂,which was comparable to the time point of T₀,and the difference was not statistically significant（P>0.05）,while SBP,DBP and HR in group C increased about 15%compared with T₀（P<0.05）,and the above indexes were higher in group C than in group N（P<0.05）.At time point T₄,SBP and DBP in group N decreased compared with T₀（P<0.05）,HR did not change significantly compared with T₀（P>0.05）,and the above indexes in group C did not differ compared with T₀（P>0.05）,and the SBP in group C was still higher than that in group N（P<0.05）,and the rest indexes did not differ compared between the two groups（P>0.05）.The comparison between the two groups at T₅and T₆time points was the same as that at T₂time points.（2）Changes in COR and Glu concentrations:There were no significant differences in COR and Glu values between the two groups at time point T₀（P>0.05）.Compared with the T₀time point,the COR values decreased significantly in group N at T₃and T₅time points（P<0.05）,while the COR values did not change significantly in group C at T₃and T₅time points（P>0.05）.In the T₅time point,the COR value of group N was lower than that of group C（P<0.05）,and in the T₃and T₅time points,the changes in Glu values of the two groups were not significantly different（P>0.05）.（3）Adverse effects:During the induction of anesthesia,the pulse oximetry（Sp O₂）decreased to 94%in one patient in group N,except for one patient in group N,who recovered after the administration of oxygen by mask pressure,and the Sp O₂remained above 96%in all patients.There was no statistical difference in the incidence of adverse effects such as respiratory depression,hypotension,bradycardia,and myocardial tremor between the two groups（P>0.05）.Conclusions:Compared with sufentanil alone,the addition of nalbuphine 0.2mg/kg at the induction of anesthesia enhanced the effect of sufentanil in suppressing the response to transnasal tracheal intubation,and its combined effect showed a synergistic effect with more stable hemodynamics during the peri-induction period,while not increasing significant adverse effects.