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| 題 名 | Tracheal Intubation after Anesthetic Induction with Thiopental, Fentanyl and Lidocaine Without Muscle Relaxants=應用Fentanyl, Lidocaine及Thiopental誘導麻醉(無肌肉鬆弛劑)作氣管內插管 |
|---|---|
| 作 者 | 黃兆德; 蘇翔; 徐智星; 葉富欽; | 書刊名 | 慈濟醫學 |
| 卷 期 | 11:2 1999.06[民88.06] |
| 頁 次 | 頁125-130 |
| 分類號 | 416.5 |
| 關鍵詞 | 氣管插管; Tracheal intubation; Fentanyl; Lidocaine; Thiopental; |
| 語 文 | 英文(English) |
| 中文摘要 | 目的:研究以fentanyl,lidocaine及thiopental來作麻醉誘導而不加肌肉鬆弛劑 來作氣管內插管。病人及方法:以 30 位健康狀況良好且無解剖學上可能困難插管之病患作 研究。 應用 fentany 1.5 μ.g/kg, lidocaine 1.5mg/kg 及 thiopental 4mg/kg 作麻醉 誘導。記錄之資料包括麻醉誘導前與後及氣管內插管後之動脈收縮壓、舒張壓及心率。另外 也評估下顎活動性、人工換氣容易性、喉頭視野、聲帶位置,及對氣管內管的忍受性。若有 必要則使用 succinylcholine 1 mg/kg 靜注來幫忙完成插管。 結果:動脈血壓及心率雖然 在給藥後有明顯下降,但插管後回升至給藥前的水平。所有病患之下顎活動性與人工換氣容 易性均良好,並可作直接喉頭鏡檢。喉頭視野有 2 位病患較差,須要 succinylcholine 來 幫忙完成插管。 22 位病患之聲帶位置為全開或半開狀。置放氣管內管後 l9 位病患對內管 忍受性良好。其他病患表現出多次咳嗽,有些更是合併有上肢運動現象。結論: 絕大多數無 解剖擊上可能困難插管之病患,若以 fentanyl、 lidocaine 及 thiopental 作麻醉誘導而 不加肌肉鬆弛劑,直接喉頭鏡檢及氣管內插管是可能完成的。尤其是在患有神經肌肉疾病患 者,肌肉鬆弛劑可能會有無法預測之作用這個方法應該是有助益的。 |
| 英文摘要 | Objective: To investigate the possibility and feasibility of performing tracheal intubation after anesthetic induction withfentanyt, lidocaine and thiopental without the simultaneous use of muscle relaxants. Patients and Methods: Thirty patients ofASA physical status I with favorable airway anatomy scheduled for elective surgery were studied. Fentanyl 5 p-g/kg, lidocaine 7.5 mg/kg and thiopental 4 mg/kg were given for anesthetic induction. Circulatory parameters including systolic and diastolic blood pressure, and heart rate were measured before (pre-induction) and after (post-induction) drug administration, and after tracheal intubation (post-intubation) . Variables including jaw mobility, ease of manual ventilation, exposure of the glottis, position of the vocal cords, and toleration of the tracheal tube were assessed during anesthetic induction and tracheal intubation. Succinylcholine I mg/kg intravenously was employed to complete tracheal intubation when needed. Results: Our data showed that systolic and diastolic blood pressure and heart rate decreased significantly after drug administration compared with pre-induction levels. After tracheal intubation, however, these circulatory parameters returned to preinduction levels. All patients had good jaw mobility and could be manually ventilated via mask. Direct laryngoscopy and intubation were possible in most patients. Exposure of the glottis was poor in 2 patients who were supplemented with succinlycholinefor tracheal intubation. Vocal cord position was favorable (open or midposition) in 22 patients. After tracheal intubation, 19 patients tolerated the tube well. The rest of the patients suffered from persistent cough with or without movement of the upper extremities. Conclusion: Direct laryngoscopy and tracheal intubation after induction of anesthesia may be accomplished in most patients with favorable airway anatomy using a combination of thiopental, fentanyl, and lidocaine without muscle relaxants. |
本系統中英文摘要資訊取自各篇刊載內容。