불안정 고혈압 환자에서 후두경하 기관내 삽관시 Propofol 혹은 Thiopental Sodium-Esmolol이 혈역학 및 혈중 Catecholamine치에 미치는 영향

초록

Background: Endotracheal intubation under the laryngoscopy is one of the most potent stimuli that increase in heart rate and blood pressure and following cardiac complication such as arrhythmia, myocardial ischemia and infarction can lead to fatal situation. This study was designed to evaluate the effects of propofol and esmolol-thiopental sodium on cardiovascular system and catecholamine change to tracheal intubation in labile hypertensive patients. Methods: Thirty six hypertensive patients, ASA class 1 or 2, scheduled for elective surgery were selected randomly. They were divided into two groups. (Group 1: propofol 3.0 ㎎/㎏, Group 2: esmolol 0.5 ㎎/㎏ + thiopental sodium 5 ㎎/㎏, n = 18 in each group). Induction of anesthesia was started with propofol 3.0 ㎎/㎏ (Group 1), esmolol 0.5 ㎎/㎏ + thiopental sodium 5 ㎎/㎏ (Group 2), and succinylcholine (1 ㎎/㎏). After tracheal intubation under the routine laryngoscopic technique, vecuronium 0.08-0.1 ㎎/㎏ was injected, 50% nitrous oxide in oxygen and 2% enflurane were inhaled. Using noninvasive automatic blood pressure monitor (CRITICON DINAMAP^TM 1846SX, USA), blood pressure (systolic, diastolic and mean arterial pressure) and heart rate were measured at 7 points; ① on arrival to operating room, ② just before intubation, ③ just after intubation, ④ 1 minute after intubation, ⑤ 2 minutes after intubation, ⑥ 5 minutes after intubation, ⑦ 10 minutes after intubation. Results: There was a significant attenuation in systolic and diastolic arterial pressure after tracheal intubation in Group 1 compared to Group 2. Heart rate was significantly blunted in Group 2 than Group 1. The catecholamine level was normal range all the time in bath group. Conclusions: We suggest that 3.0 ㎎/㎏ of propofol as a induction dose of anesthesia could be a good choice for blunting hemodynamic changes caused by laryngoscopy and endotracheal intubation in labile hypertensive patients.

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