The effects of lidocaine, fentanyl, nicardipine, and esmolol on hemodynamic and bispectral index responses during induction with thiopental sodium

Abstract

The laryngoscopy and tracheal intubation may accompany with undesirable side effects such as hypertension, tachycardia, arrhythmia, and awareness. The aim of this study was to investigate whether the correlation between the hemodynamics and BIS changes after tracheal intubation following the administration of various agjuvants to attenuate tracheal response exists or not. The patients were randomly assigned to one of five groups (control, lidocaine, fentanyl, nicardipine, or esmolol) and the drugs were administered at preselected time before tracheal intubation. The heart rate (HR), blood pressure, rate-pressure product (RPP), bispectral index (BIS) and the episode of BIS more than 65 (BIS≥65) were measured. There were significant defferences in the mean arterial pressure and RPP between control group and other groups. The HR was the most attenuated in esmolol group. The HR and RPP was the most increased in nicardipine group except control group. There was no significant difference in the maximal BIS among the five groups. The BIS≥65 were 50% in control group and 0.3% in nicardipine group. All the adjuvant drugs in the study attenuated with a various degree of the tracheal responses. However, there was no correlation between the changes of hemodynamics and BIS after the administration of various adjuvants following tracheal intubation. 전신마취 시 후두경 조작이나 기관 내 삽관은 고혈압, 빈맥, 부정맥, 각성 등의 부작용을 동반한다. 이 연구에서는 이러한 부작용을 방지하기 위해서 사용하는 보조약제의 혈역학적 안정성 및 BIS의 변화를 알아보고자 한다. 백오십 명의 환자는 임의로 다섯 그룹(control, lidocaine, fentanyl, nicardipine, esmolol) 으로 나누고 심박수, 혈압, RPP, BIS, BIS 65 이상의 환자 수를 측정 및 관찰하였다. 혈압과 RPP값은 보조약제 사용 시 대조군에 비해 안정화 되었고 BIS값의 변화는 유의한 차이가 없었다. BIS 65이상의 환자는 대조군에서 50%, nicardipine 군에서 0.3% 이었다. 모든 보조약제는 다양한 정도로 기관 반응을 성공적으로 억제 시켰다. 그러나 약제의 사용으로 인한 혈역학적 변화와 BIS값 변화의 상관관계는 찾기 어려웠다.