| Objective The aim of the present study was to compare propofol, etomidate, and propofol-etomidate on the basis of their effects on median effective dose(ED50) of rocuronium for rapid tracheal intubation, onset time of rocuronium, intubation condition, complications of endotracheal intubation and hemodynamic.Methods In the first part of this experiment, patients were divided into 4 groups, such as male prpofol group(P1 group), female propofol group(P2 group), male propofol-etomidate group(PE1 group) and female propofol-etomidate group(PE2 group). Anesthesia was induced with target-controlled infusion(TCI) of remifentanil with a target effect-site concentration of 5 ng·ml-1. P1 and P2 group patients received TCI of propofol with the target plasma concentration 3.0μg·ml-1;PE1 and PE2 group patients received TCI of propofol and etomidate with the target plasma concentration 1.5μg·ml-1 and0.3μg·ml-1. When eyelash reflexes disapperar, apredetermined dose of rocuronium was administered in 5s. The neuromuscular block was monit, ored until the T1 dropped to 0,and then the tracheal catheter was inserted. The ratio of the two successive dose was 1.2. Modified Dixon’s up-and-down method was used to determine the ED50 of rocuronium. The satisfactory result was defined as excellent intubating condition. The ED50 and the 95% confidence interval(95% CI) of rocuronium were calculated. In the second part of this experiment, a group of 60 patients, scheduled for general anesthesia were divided into 3 groups,such as prpofol group(P group), etomidate group(E group) and propofol-etomidate group(PE group). Anesthesia was induced with TCI of remifentanil with a target effect-site concentration of 5 ng·ml-1. P group patients received TCI of propofol with the target plasma concentration 3.0μg·ml-1;E group patients received TCI of etomidate with the target plasma concentration 0.6μg·ml-1; PE group patients received TCI of propofol and etomidate with the target plasma concentration 1.5μg·ml-1 and 0.3μg·ml-1. When eyelash reflexes disapperar, 0.6 mg·kg-1 rocuronium was administered in 5s. Records of patients with general conditions, SP, DP, MAP, HR, and BIS. The data were collected within before anesthesia induction(T0), laryngoscope before put into immediate(T1), immediately after intubation(T2), 1 min(T3) and 3 min(T4) after intubation. Meanwhile, the intubation conditions according Cooper’s score, the onset time of rocuronium, intubation related complications were recorded.Results In the first part of this experiment, the ED50(95% CI) of rocuronium for rapid tracheal intubation following propofol in male and female were 0.41(0.37~0.46) mg·kg-1 and 0.32(0.29~0.34) mg·kg-1. The ED50(95% CI) of rocuronium following propofol-etomidate in male and female were 0.47(0.44~0.51) mg·kg-1 and 0.38(0.35~0.41) mg·kg-1. In the second part of this experiment, the MAP from T1 to T4 for group P was significantly(p<0.05) lower than MAP at T0. The MAP at T1 for group E was significantly(p<0.05) lower than MAP at T0 while the MAP from T2 to T4 was significantly(p<0.05) higher than MAP at T0. The MAP at T1 for group PE was significantly(p<0.05) lower than MAP at T0, the MAP at T2 was significantly(p<0.05) higher than MAP at T0, while there were no significant(p>0.05) differences from T3 to T4 and the point at T0. The comparison among groups: there were no significant(p>0.05) differences at T0 between the 3 groups.The MAP at T1 for group P was significantly(p<0.05) lower than that for groups E and PE, while the MAP from T2 to T4 for group E was significantly(p<0.05) higher than that for groups P and PE. The HR at T1 for group P was significantly(p<0.05) lower than that for groups E and PE. However, the HR from T2 to T4 for group E was significantly(p<0.05) higher than that for groups P and PE. The onset time of rocuronium for group P was significantly(p<0.05) longer than that for groups E and PE. However, there were no significant differences(p>0.05) between group E and PE.There was no significant(p>0.05) difference in BIS, intubation conditions according Cooper’s score, morbidity of sore-throat, cough and sputum between the 3 groups.Conclusion The ED50 of rocuronium for rapid tracheal intubation following propofol in male and female were 0.41 mg·kg-1 and 0.32 mg·kg-1. The ED50 of rocuronium following propofol-etomidate in male and female were 0.47 mg·kg-1 and 0.38 mg·kg-1. The dose of rocuronium for rapid tracheal intubation following propofol is larger than propofo-etomidate. Propofo-etomidate can maintain hemodynamic stability, shorten onset time of rocuronium, provide satisfactory intubating conditions, and there was no difference in morbidity of throat complications between 3 groups. |
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