Effect Of Propofol And Etomidate United Target Controlled Infusion Induction On Hypertensive Patients

Objective:This research applied the mindray noninvasive hemodynamic monitoring system and the BIS monitor and three inducing methods of propofol, etomidate emulsion and two combinations of the50%target controlled infusion to observe the change of hemodynamic and the depth of anesthesia for patients with hypertension during induction of general anesthesia, in order to evaluate the applications of these three inducing methods in patients with hypertension. The single-blind randomized design was adopted in the present study.Methods:This study was approved by the hospital ethics committee. ASA Ⅱ level and a history of hypertension undergoing elective general anesthesia surgery of60patients with laparoscopic cholecystectomy were selected and divided randomly into3groups with20cases each:propofol group (P group), etomidate group (E group), combination group (PE group). The propofol, etomidate and their combination were used3ug/ml,0.6ug/ml and50%each to induce plasma concentration of target controlled infusion, respectively, and applied before anesthesia induction (T0, fundamental value), laryngoscope before put into immediate (T1), immediately after intubation (T2),1min (T3) and5min (T4) after intubation. The heart rate, mean arterial pressure, systolic blood pressure, diastolic blood pressure and change of the BIS value and stroke volume, cardiac index and systemic vascular resistance index were observed for patients. Meanwhile, the adverse reactions of patients with injection pain and muscle clonus, and the time period from injection of drugs to the disappearance of eyelash reflex were recorded.Results:1.Generally three groups of patients’ height, weight, age, and mean arterial pressure, systolic blood pressure, cardiac output, stroke volume, systemic vascular resistance index and heart rate before the induction (TO) did not achieve statistical significance (P>0.05).2. The comparison of the time period from intravenous sedative hypnotics to the disappearance of eyelid reflex for three groups of patients showed that PE group was obviously shorter than the P and E group (P<0.05).3. The comparisons of hemodynamic changes for patients during induction of general anesthesia showed that①there were significant difference (P<0.05) in heart rate placing laryngoscope instantly for the groups P, E and PE, although that for group P was low relative to the groups E and PE. The heart rate before immediate intubation and after intubation for group E was significantly (P<0.05) higher than that for groups P and PE. However, there were no significant differences (P>0.05) in heart rate for group PE before the laryngoscope and after intubation.②The mean arterial pressure during and after intubation (T1-T4) for group P was significantly (.P<0.05) lower than that for groups E and PE, while the mean arterial pressure in the immediate intubation (T2) for group E was significantly (P<0.05) higher than that for groups P and PE.③The systolic blood Three groups of patients with systolic blood pressure comparison:in group E, placed immediately to intubation laryngoscope (T1～T4) systolic blood pressure higher than that of P group and PE group, there was significant difference.④The diastolic blood pressure during placing laryngoscope instantly to intubation (T1～T4) for group P was significantly (P<0.05) lower than that for groups E and PE.⑤The SV during placing laryngoscope instantly to intubation (T1～T4) for group P was significant (P<0.05) lower than that for groups E and PE. There were no significant (P>0.05) differences in heart rate before the laryngoscope placement (T1) and intubation (T2) for group PE.⑥The heart index before placing laryngoscope and after intubation (T1～T4) for group P was significant (P<0.05) lower than that for groups E and PE. Compared with groups PE and E, group P showed the significant differences in heart index before the laryngoscope placement (T1) and intubation (T2).⑦The peripheral vascular resistance index before placing laryngoscope and after intubation (T1～T4) for group P was significant lower than that for groups E and PE(P<0.05).⑧The cycle fluctuation for group P was significant higher than that for groups PE(P<0.05).4. The comparisons of depth of anesthesia showed that there were no difference of statistics (P>0.05)in BIS value before induction, before and after intubation (T0～T4) during anesthesia induction for three groups of patients.5. The comparisons of side effects showed that①there were considerable differences (P<0.05) in the incidence of injection pain for the three groups of patients. The incidence of injection pain for P group was higher than that of PE group (P<0.05).②the differences of incidence of myoclonus for three groups of patients were also significant (P<0.05). The incidence of myoclonus for P and PE group was lower than that of E group (P<0.05).Conclusion:Relative to the use of propofol or etomidate emulsion alone, the use of their joint target controlled infusion for patients with hypertension during anesthesia induction could obtain relatively stable hemodynamic feature, and reduce the side effects of intravenous anesthetics pain and myoclonus. Therefore, the propofol and etomidate united can be a good general anesthesia induction method for hypertensive patients.