Bolus doses of esmolol for the prevention of perioperative hyper-tension and tachycardia

The effectiveness of esmolol, an ultra short-acting cardioselective beta blocker, in the prevention and treatment of post-intubation haemodynamic perturbations, was investigated. Forty-eight ASA physical status I and II patients undergoing hysterectomy were randomly assigned to receive a single intravenous bolus of placebo, esmolol 100 mg, or esmolol 200 mg in a double-blind fashion. This was administered over 15 sec, and immediately followed by thiopentone 3-5 mg.kg-1, succinylcholine 1.5 mg.kg-1, and tracheal intubation 90 sec later. The heart rate following induction of anaesthesia was lower in the esmolol 200 mg group (P less than 0.01); following intubation, the increase in heart rate in the placebo group was greater than in the esmolol groups (P less than 0.05). The systolic blood pressure post-induction was lower in the esmolol 200 mg group (P less than 0.05); following intubation, however, no significant differences were seen among groups in systolic, diastolic, or mean blood pressures. Following tracheal intubation, the incidence of ventricular arrhythmias was lower in the esmolol groups (P less than 0.05). In summary, esmolol in 100 mg and 200 mg doses was effective in mitigating the haemodynamic response following tracheal intubation.     

尼卡地平预防双腔支气管导管插管反应的观察

目的　观察应用尼卡地平预防双腔支气管导管插管心血管反应的效果。　方法　肺、食道择期手术病人 40例 ,随机分为 2组 ,每组 2 0例。咪唑安定 0 .0 4mg/kg、异丙酚 1.5mg/kg、芬太尼 4μg/kg、维库溴铵 0 .12mg/kg静脉诱导后 ,甲组给予尼卡地平 4μg/kg ,乙组给予生理盐水 3ml作为对照。分别于诱导前、后 ,插管后即刻及 1、3、5min监测收缩压 (SBP)、舒张压 (DBP)、心率 (HR) ,并计算心率收缩压乘积 (RPP)。　结果　A组插管后血压无明显升高 ,心率较诱导前无明显增快 ,B组插管后血压明显升高。　结论　尼卡地平可抑制双腔支气管导管插管时的心血管副反应。     

直视下行大鼠气管插管的改良方法

目的 提高大鼠气管插管的成功率;方法 对比传统闭式法与改良直视法的成功率;结果传统闭式法的成功率为50％,改良直视法的成功率为100％。结论 改良直视法优于传统闭式法,值得推广应用。     

硬膜外麻醉对老年人气管插管时心血管反应抑制作用的临床观察

观察胸部硬膜外麻醉对老年人全麻气管内插管时心血管反应的抑制作用。方法：利用胸部硬膜外麻醉对４０例老年择期全麻手术病人进行分组对比研究,观察全麻气管内插管时血流动力学,心肌耗氧及应激性激素的变化。结果：实验组气管内插管时血流动力学和心肌耗氧指标及ＲＮ、ＡⅡ显著低于对照组并在围插管斯保持平稳。纣胸部硬膜外麻醉可抑制老年手术患者全麻气管内插管时血浆儿茶酚胺分泌,保持插管期间血流动力学的稳定。     

The relaxant action of osthole isolated from Angelica pubescens in guinea-pig trachea

The effect of osthole, isolated from Angelica pubescens, on the contraction of guinea-pig trachea was studied. Osthole (25–100 mol/l), theophylline (10–1000 mol/l) and higher concentrations of nifedipine (0.1–100 mol/l) suppressed the contraction response curves of tracheal smooth muscle caused by carbachol, prostaglandin F₂ (PGF₂), U46619 (thromboxane A₂ analogue) and leukotriene C₄ (LTC₄) in a concentration-dependent manner. The contraction caused by high K⁺ (120 mmol/1) and cumulative concentrations of CaCl₂ (0.03–3 mmol/1) was also inhibited concentration-dependently by osthole (25–100 mol/l), theophyl line(10–1000 mol/l) and lower concentrations of nifedipine (0.01–0.1 mol/l). The relaxant actions of osthole were not affected by propranolol (1 mol/l), glibenclamide (10 mol/l) or removal of tracheal epithelium. Osthole (100 mol/l) was still effective in causing tracheal relaxation in the presence of nifedipine (1 mol/l). In Ca²⁺-free- and EGTA (0.2 mmol/1)-containing medium, the relaxing effect of osthole was more potent than in normal Krebs solution. Osthole (25 and 50 mol/l) caused 2.9 and 6.5, or 3.0 and 5.6 fold, respectively, increase in potency of forskolin or sodium nitroprusside in causing tracheal relaxation but did not affect that by cromakalim. Osthole (50 mol/l) enhanced the increase in tissue cAMP and cGMP levels induced by forskolin and sodium nitroprusside, respectively, and in higher concentrations (100 and 250 mol/l), itself increased markedly tissue cAMP and cGMP contents. Osthole (10–250 mol/l) inhibited the activity of cAMP and cGMP phosphodiesterases in a concentration-dependent manner. It is concluded that osthole exerts a nonspecific relaxant effect on the trachealis by inhibiting the cAMP and cGMP phosphodiesterases. Correspondence to: C. M. Teng at the above address     

Awake intubation of the adult trachea using the Bullard laryngo-scope

Awake intubation using the Bullard laryngoscope can be comfortably and easily performed in the adult. Five cases are presented in which tracheal intubation was performed under topical anaesthesia with light intravenous sedation. In each case, topical anaesthesia was performed by insertion of a Guedel oral airway, with lidocaine ointment applied to the inferior and posterior surfaces. In one case, Bullard intubation was successful where direct laryngoscopy and multiple attempts at bronchoscopic intubation by three different operators had failed. We conclude that the Bullard laryngoscope can be easily used in awake patients and may be a useful alternative where other methods for awake intubation have failed.     

艾司洛尔预防气管内插管心血管反应的临床观察

研究艾司洛尔静注预防气管插管时心血管反应的效果。将９０例ＡＳＡⅠ～Ⅱ级择期全麻下手术患者随机分为３组,Ａ组（ｎ＝３０）静注艾司洛尔１ｍｇ．ｋｇ－１,Ｂ组（ｎ＝３０）静注艾司洛尔２ｍｇ．ｋｇ－１,Ｃ组（ｎ＝３０）为对照组,静注同等容量的生理盐水。观察注药前、插管前及插管后１ｍｉｎ、２ｍｉｎ、３ｍｉｎ、５ｍｉｎ、１０ｍｉｎ时,心率、收缩压和舒张压的变化。结果显示：Ａ组和Ｂ组均能较好地缓解窥喉和气管插管时心率增快和血压升高的心血管反应,效果尤以Ｂ组为佳;３组中各有１例发生心动过缓和低血压,未见哮喘和过敏。研究提示：艾司洛尔能安全有效地减轻插管时的心血管反应。