2013, 32(6): 723-726.
ABSTRACT Objective To compare the effects of different dosage of target controlled infusion (TCI) of sufentanil on stress response in awake nasotracheal fibreoptic (FOB) intubation. MethodsFortyfive patients ASA Ⅱ or Ⅲ, aged 18 to 60 years, scheduled for awake nasotracheal fiberoptic intubation, were randomly assigned into three groups (n＝15 for each group): group Ⅰ, sufentanil target plasma concentration (Cp) of 0.3 ng·mL－1; group Ⅱ, Cp of 0.5 ng·mL－1 and group Ⅲ, Cp of 0.8 ng·mL－1. HR, SBP, DBP, SpO2 and RPP were recorded 5 min after patients arriving at operation room (t0), when each group reached target plasma concentrations (t1), at the time of intubation and seeing the epiglottis (t2), 1 min after intubation (t3), and 3 min after intubation (t4). Arterial blood samples were taken to determine the plasma concentrations of epinephrine (E), norepinephrine (NE) and cortisol (Cor) at all time points. Adverse reactions throughout the process were recorded.ResultsHR at t2 and t3 was (81±11) and (78±11) times·min－1 in group Ⅱ and (78±18) and (76±19) times·min－1 in group III, respectively. HR in group Ⅱ and Ⅲ was significantly lower than that in groupⅠ (P＜0.05). SBP and DBP in group Ⅲ at t1t4 and group Ⅱ at t2, t3 were significantly lower than those in groupⅠof the corresponding time points (P＜0.05). RPP in group Ⅱ and Ⅲ at t1 was lower than that at t0, while the RPP in group Ⅰ at t2 and t3 was significantly higher than that at t0 (P＜0.05). SpO2 at t1 in group Ⅲ was (90±10)%, significantly lower than that in group Ⅰ and Ⅱ (P＜0.05). In group Ⅰ, NE and Cor were (3 668±716) and (4 356±107) pmol·L－1 at t3, and (3 025±365) and (3 517±696) pmol·L－1 at t4, which were significantly higher than those at t0 (P＜0.05). In group Ⅲ, two patients developed respiratory depression, which was alleviated by using oxygen mask. ConclusionThe plasma concentration of 0.5 ng·mL－1 TCI of sufentanil can effectively inhibit the stress response during awake nasotracheal FOB intubation without respiratory depression.