The Effect Of Sufentanil And Different Doses Of Remifentanil Combination On Circulatory Function During Tracheal Intubation

Background The ideal induction of anesthesia is to reduce the stress response to tracheal intubation while maintaining circulatory stability by reducing hemodynamic fluctuations.The combination of medium-and long-acting opioid sufentanil and short-acting opioid remifentanil can reduce the dose of a single drug used,reduce the side effects of the drug,and better maintain circulatory stability,and the choice of its appropriate dose in the induction of anesthesia is unclear.Objective By observing the effects of different doses of remifentanil and sufentanil combined induction of anesthesia on the stress response and hemodynamics of general anesthesia tracheal intubation,we provide a safer anesthesia induction protocol for patients.Methods One hundred and five patients who voluntarily received elective general anesthesia from May 2021 to May 2022 at the Three Gorges Central People’s Hospital in Yichang City were selected as the study population.The patients were divided into 3 groups according to the random number table method: group R1,0.4 μg/kg of sufentanil and 1 μg/kg of remifentanil;group R2,0.4 μg/kg of sufentanil and 2 μg/kg of remifentanil;group R3,0.4μg/kg of sufentanil and 3 μg/kg of remifentanil,35 cases in each group.Patients’ vital signs and depth of anesthesia were monitored throughout;the mean arterial pressure(MAP)and heart rate(HR)were recorded before induction of anesthesia(T0),before intubation(T1),immediately after intubation(T2),capsule inflation(T3),1 min after intubation(T4),3 min after intubation(T5),and 5 min after intubation(T6);the incidence of cardiovascular events and ephedrine,propofol,scopolamine The incidence of cardiovascular events and the dosage of ephedrine,propofol,scopolamine,esmolol,and uradil were recorded;the occurrence of adverse reactions was also recorded.Results The positive response to tracheal intubation in the R1 group was higher than that in the R3 group,which was statistically different(P < 0.05),and all three groups were able to inhibit the generation of strong stress response.MAP in all three groups decreased at T1 and increased significantly at T3 to reach the post-induction peak(P < 0.05);MAP in the R1 group had a significant trend of growth at T2 and T3,and MAP growth regressed to no statistically significant difference from T0 at T3 and T4 moments(P > 0.05),and the overall trend of MAP at T4-T6 moments showed a slow decrease and tended to be stable(P > 0.05);R2 group T3-T5 moment and R3 group T4-T6 moment MAP did not change significantly fluctuation(P> 0.05);MAP in R1 group was higher than R3 group at T1-T6,which was statistically significant(P<0.05),and MAP in R2 group was higher than R3 group at T1,T4 and T5(P < 0.05).The HR of all three groups decreased at T1,and HR reached the post-induction peak at T3;T5 and T6 still had a slowly decreasing trend of HR(P < 0.05).HR in the R1 group increased at T2,and a significant difference was seen between T1 and T2(P <0.05),and T2 returned to its initial value that was not significantly different from the moment of T0(P > 0.05),and HR continued to increase from T2 to T3 with a statistical difference(P <0.05),and returned to the same level as T0 HR at T4;the HR of R2 and R3 groups did not fluctuate much between T1 and T2 moments,and the HR increased from T2 to T3 with statistical difference(P < 0.05);the HR of R1 group was higher than that of R2 group at T2,T3 and T4,with statistical significance(P < 0.05);the HR of R1 group was higher than that of R3 group at T1-T6 moments,with statistical significance(P < 0.05);HR was not statistically different in the R2 group compared with the R3 group.The incidence of hypocapnic events was lower in the R1 group than in the R3 group(P < 0.05).scopolamine use was statistically lower in both the R1 and R2 groups than in the R3 group(P < 0.05),and there was no statistically significant difference in the incidence of hypotensive events in the three groups after induction(P > 0.05).Conclusion(1)The combination of sufentanil and remifentanil for anesthesia induction can suppress the strong stress response caused by tracheal intubation;(2)A single dose of 0.4μg/kg sufentanil was combined with 1 μg/kg,2 μg/kg and 3 μg/kg of remifentanil for induction,respectively,the 1 μg/kg and 2 μg/kg remifentanil anesthesia induction regimen has a lower incidence of cardiovascular events and can maintain smoother hemodynamics,which was conducive to circulatory stability.