| Part one:Effect of different doses of sufentanil combined with lidocaine on cardiovascular response induced by tracheal intubationObjective:To compare the effect of different doses of sufentanil on hemodynamics during general anesthesia endotracheal intubation when combined with 1.5mg/kg lidocaine,and to investigate the appropriate induction dose of sufentanil for general anesthesia.Methods:120 patients(ASA grade I~II,BMI for 18~25 kg/m~2,aging 35~55 years)undergoing radical mastectomy under general anesthesia were enrolled into this part of study.The patients were randomly divided into four groups(n=30):group LS1(1.5mg/kg lidocaine+0.1?g/kg sufentanil),group LS2(1.5mg/kg lidocaine+0.2?g/kg sufentanil),group LS3(1.5mg/kg lidocaine+0.3?g/kg sufentanil),and group LS4(1.5mg/kg lidocaine+0.4?g/kg sufentanil).All patients were received 1.5mg/kg lidocaine by the non-operated side peripheral vein before anesthesia induction,then they were injected different preset doses of sufentanil(>60s),1.0~1.5mg/kg propofol(adjust the dose according to the entropy index monitoring,>60s),then the patients were injected0.2mg/kg cisatracurium after they lost conscious.Three minutes after the injection of cisatracurium,tracheal intubation was performed if the state entropy(SE)were kept40~60 for 5 seconds.Systolic blood pressur(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),and heart rate(HR)were recorded at lie quietly for 10 minutes after entering the room(T0,baseline),immediately before tracheal intubation(T1),1 min after endotracheal intubation(T2)and 5 min after endotracheal intubation(T3).The incidence of cardiovascular adverse events and lidocaine poisoning were counted in each group.Results:1.Comparison of general conditions:There were no statistically significant differences in patient characteristics between the four groups(P>0.05).2.Comparison of hemodynamic parameters:(1)Comparison between groups:At T0,there was no significant differences in SBP,DBP,MAP and HR between the four groups(P>0.05).At T1,SBP,MAP and HR in group LS4 were lower than those in group LS1,group LS2 and group LS3(P<0.05).SBP and MAP in group LS1,group LS2 and group LS3were not significantly different(P>0.05).At T2,SBP,MAP and HR in group LS1 were higher than those in group LS2,group LS3 and group LS4(P<0.05).SBP,MAP and HR in group LS4 were lower than those in group LS1,group LS2 and group LS3(P<0.05).SBP,MAP and HR in group LS2 were not significantly different from those in group LS3(P>0.05).At T3,SBP in group LS1 and group LS2 were higher than that in group LS3 and group LS4(P<0.05).There was no statistically significant difference in SBP between group LS1 and group LS2,and between group LS3 and group LS4(P<0.05).MAP and HR in group LS4 were lower than that in group LS1,group LS2 and group LS3(P<0.05).HR in group LS1 was higher than that in group LS2,group LS3 and group LS4(P<0.05).There was no significant difference in HR between group LS2 and group LS3(P>0.05).(2)Comparison within groups:At T1,SBP,MAP in all groups were lower than baseline(P<0.05).HR in group LS1 was not significantly different than baseline(P>0.05),while HR in group LS2,group LS3 and group LS4 were lower than baseline(P<0.05).At T2,SBP,MAP and HR in group LS1 were higher than baseline(P<0.05),SBP,MAP and HR in group LS2 and group LS3 were not significantly different than baseline(P>0.05),SBP,MAP and HR in group LS4 were lower than baseline(P<0.05).At T3,SBP,MAP and HR in group LS1 were not significantly different than baseline(P>0.05),while SBP,MAP and HR in group LS2,group LS3 and group LS4were lower than baseline(P<0.05).3.Four groups of patients induced adverse events:(1)The incidence of hypertension and tachycardia in group LS1 were higher than those in group LS2,group LS3 and group LS4(P<0.05).The incidence of hypertension and tachycardia in group LS2,group LS3 and group LS4 were no significantly different(P>0.05).(2)The incidence of hypotension in group LS4 was higher than that in group LS1,group LS2 and group LS3(P<0.05).The incidence of hypotension in group LS1,group LS2 and group LS3 was no significantly different(P>0.05).(3)The incidence of bradycardia in the four groups was no significantly different(P>0.05).(4)None of the patients had lidocaine poisoning.Conclusion:With 1.5mg/kg of preoperative lidocaine,0.2?g/kg or 0.3?g/kg of sufentanil would be appropriate for induction of anesthesia which can maintain the hemodynamic stability during the induction period with no obvious adverse reactions.Part Two: Sequential method for determination of ED50 of sufentanil in blunting cardiovascular response to tracheal intubation with lidocaineObjective: To determine the median effective dose(ED50)of sufentanil in blunting cardiovascular responses induced by endotracheal intubation when combined with 1.5mg/kg lidocaine by Sequential methods,so as to provide reference for anesthesia induction.Methods: According to the request of sequential method,25 patients(ASA grade I~II,BMI for 18~24 kg/m2,aging 35~55 years)undergoing radical mastectomy under general anesthesia were enrolled into this part of study.All patients were received intravenous injection of lidocaine(1.5mg/kg)by the non-operated side peripheral vein before anesthesia induction.Then they were injected different preset doses of sufentanil(>60s),1.0~1.5mg/kg propofol(adjust the dose according to the entropy index monitoring,>60s)at the beginning of induction,then the patients were injected 0.2mg/kg cisatracurium after they lost conscious.Three minutes after the injection of cisatracurium,tracheal intubation was performed if the state entropy(SE)were kept 40~60 for 5 seconds.When the state entropy(SE)were kept as 40~60 for 5s,and three minutes after the injection of cisatracurium tracheal intubation was performed.The dose of sufentanil was determine by the “up-and-down”sequential allocation method.The first patient received a dose of 0.2?g/kg sufentani.The ratio of each adjacent dose was 1:2 and the difference between the logarithm of each adjacent dose is 0.1.If a patient developed cardiovascular response to tracheal intubation,which meas either his HR or MAP increased more than 20% of the baseline within 5 minutes after tracheal intubation,the next patients would receive a increased dose of sufentani,otherwise,they would receive a reduced dose of sufentani.The trial would be completed upon the appearance of the sixth turning point.Systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),and heart rate(HR)were recorded at lie quietly for 10 minutes after entering the room(T0,baseline),immediately before tracheal intubation(T1),1 min after endotracheal intubation(T2)and 5 min after endotracheal intubation(T3).Results: 25 cases of patients were recruited in this part of the study,and there were 12 positive cases and 13 negative cases.1.There was no significant difference in the general condition and the basic value of the hemodynamic indexes between the two groups(P>0.05).2.The median effective dose(ED50)of sufentanil blunting cardiovascular responses to endotracheal intubation when combined with 1.5mg/kg lidocaine was 0.21?g/kg by Dixon and Mood estimator,and the 95% confidence interval was(0.19,0.22)?g/kg.3.In Probit analysis,the median effective dose(ED50)of sufentanil blunting cardiovascular responses to endotracheal intubation when combined with 1.5mg/kg lidocaine was 0.21?g/kg,and the 95% confidence interval was(0.18,0.26)?g/kg.Conclusion: The median effective dose(ED50)of sufentanil blunting cardiovascular responses to endotracheal intubation when combined with 1.5mg/kg of lidocaine was 0.21?g/kg. |
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