Efficacy Of Sufentanil And Esmolol In The Prevention Of Cardiovascular Response To Laryngoscopy And Endotracheal Intubation

Objective:To evaluate the effect of sufentanil and esmolol in small doses in preventing cardiovascular response due to laryngoscopy and endotracheal intubation.Methods:60 ASA class and Mallampti classⅠ～Ⅱpatients of 20～55 years old,booked for elective non-cardiac surgery were studied.Patients ASA physical statusâ…¢,having a HR<50bpm,SBP<100mmHg,chronic obstructive lung disease(especially bronchial asthma ), past history of cardiac diseases,chronic hypertension,chronic use of medication such as opioid analgesic agents,β-blockers,alcohol,and history of allergic reactions to any of the study medications,menstruation at the time of surgery and obesity(50%above ideal body weight) were excluded from the study.They were randomly allocated into three groups.All patients received 10 ml solution i.v.in a double blind manner.All patients were transferred to the operating theatre.A 20 gauge intravenous catheter was inserted and LR(Lactate Ringer's Injection) was infused,complete monitoring was established before induction,non-invasive blood pressure(NIBP) monitor,SpO₂ and ECG.All patients received premedication with Midazolam 0.03mg/kg,followed by 0.02 mg/kg Penehyclidine Hydrochloride(PHC) in 10～15min before anaesthesia.Then obtain baseline values(B₀).Depending on their group allocation patients received 1mg/kg esmolol(Group E,n=20),0.5μg/kg sufentanil(GroupS,n=20),or 0.5mg/kg esmolol and 0.25μg/kg sufentanil(Group E+S,n=20) in 10 ml of saline as a bolus over 1 min.And then anaesthesia was subsequently induced with Midazolam 0.03mg/kg, Etomidate 0.3mg/kg,Vecuronium 0.1mg/ kg followed by 10 ml solution investigated.Direct laryngoscopy and tracheal intubation were performed after 2 min.Time from administration of esmolol to tracheal intubation was approximately two minutes.During this time oxygen/air mixture(FiO₂:3.0L/min) was administered via a face mask,normocarbia was maintained. Patients were excluded from the study if there was difficulty in intubation,or multiple attempts were required.Following intubation,the lungs were ventilated,with 1L/min oxygen and routine anaesthetic maintenance(TIVA).For the next ten minutes,all surgical stimuli were avoided during the study.All data were collected after given premedication(B₀),just before direct laryngoscopy(To),1-2-3-4-5-7-10 minutes after intubation(T₁,T₂,T₃,T₄,T₅,T₇,T₁₀).At T₁₀ the study finished and general anaesthesia was continued.Statistical analysis was performed using Systat ver 17.0(SPSS Inc.USA).Continuous variables are presented as mean±standard deviation.Norminal variables are presented as numbers.Statistical analysis was performed using general linear model analysis of variance for repeated measures(with treatment groups and time as between- and within-group factors).The data collected were analysed using 't' tests for comparing scores at various time intervals within each group.The results were considered significant when P<0.05.Results:Patient characteristics,baseline haemodynamic variables(SAP,DBP,MAP,HR), RPP and physical examinations were similar among groups(P>0.05).Parameters'changes:There were no significant differences in these parameters at B₀ among groups.There were significant changes between Group S,Group E+S and Group E in these parameters at any other time point except B₀(P<0.05).There were no significant differences between Group S and Group E+S in these parameters(P>0.05).There were significant changes among groups in SBP,DBP,MAP, HR,RPP betweenT₀ and T₁(P>0.05).The increases in SBP,DBP,MAP were sustained for 3-5 min with HR for 2min after intubation in the esmolol group and for 1-2 min in Group S and Group E+S.There were no incidences of bradycardia.Five patients in Group E and two patients in Group E+S were allergic with erythra.There were two patients with movements and one person coughing.Conclusion:Esmolol combined with sufentanil is more effective than esmolol or sufentanil in blunting the haemodynamic responses due to laryngoscopy and tracheal intubation.