Comparison of different rapid sequence anesthesia induction methods in hypertension patients

Objective: In this study, we aimed to compare the impacts of application of three different drugs during rapid sequence anesthesia induction in hypertensive patients on responses to laryngoscopy and intubation.
Method: The study was planned as a randomized prospective study. 90 patients aged between 18-79 years old from the American society of anesthesiologists (ASA) II-III group with hypertension were included in this study. Patients were randomly divided into 3 groups of 30 people. After 3 minutes of pre-oxygenation, the patients in Group R received 1µg/ kg remifenatnil+5 mg/kg sodium thiopental, the patients in Group L received 1 mg/kg lidocaine+5mg/kg sodium thiopental, and the patients in Group F received 2µg/kg fentanil+5 mg/kg sodium thiopental through induction. As myorelaxant, 1 mg/kg rocuronium bromide was injected and intubation was performed after 60 seconds. All patients underwent intubation scoring. Hemodynamic parameters of the patients were recorded before induction, during intubation and on the 1st, 3rd, 5th and 10th minutes after intubation.
Results: There was no significant difference between the groups in terms of demographic data and intubation scoring. Systolic arterial pressures 1st, 3rd and 5th minutes after intubation found significantly higher in Group L compared to Group F and Group R. Diastolic and mean arterial pressures after intubation of 1st and 3rd minutes were found to be highest in Group L. In Group R systolic, diastolic and mean arterial pressures up to 10 minutes after intubation were detected under basal values. The heart pulse rates in the 1st and 3rd minutes after intubation were the highest in Group L and the lowest in Group R.
Conclusion: Remifentanil seems to be a better choice than lidocaine and fentanyl to reduce hemodynamic response in patients and to ensure hemodynamic stabilization during prompt anesthesia induction in hypertension patients.

Hipertansiyon hastalarýnda deðiþik hýzlý seri anestezi indüksiyon yöntemle- rinin karþýlaþtýrýlmasý

Amaç: Çalýþmamýzda hipertansif hastalarda hýzlý seri anestezi indüksiyonu sýrasýnda üç farklý grup ilaç uygulamasýnýn, laringoskopi ve entübasyona hemodinamik cevap üzerine etkilerinin karþýlaþtýrýlmasý amaçlandý.
Yöntem: Çalýþmanýn randomize prospektif bir çalýþma olarak yapýlmasý planlandý. Çalýþmaya, hipertansiyonu olan American society of anesthesiologists (ASA) II-III grubu, 18-79 yaþ arasý 90 hasta dahil edildi. Hastalar randomize olarak 30’ar kiþilik 3 gruba ayrýldý. Üç dakikalýk preoksijenasyonu takiben Grup R’deki hastalara 1µg/ kg remifenatnil+ 5 mg/kg sodyum tiyopental, Grup L’deki hastalara 1 mg/kg lidokain+5mg/kg sodyum tiyopental, Grup F’deki hastalara 2µg/ kg fentanil+5 mg/kg sodyum tiyopental ile indüksüyon yapýldý. Kas gevsetici olarak 1 mg/kg roküronyum bromür IV enjekte edildi ve 60 sn sonunda entübasyon gerçekleþtirildi. Tüm hastalar için entübasyon skorlamasý yapýldý. Ýndüksiyon öncesinde, entübasyon sýrasýnda, entübasyonu takiben 1, 3, 5 ve 10. dakikalarda hastalarýn hemodinamik parametreleri kaydedildi.
Bulgular: Demografik veriler ve entübasyon skorlamasý açýsýndan gruplar arasý anlamlý fark bulunmadý. Sistolik arter basýnclarý entübasyon sonrasý, 1, 3 ve 5. dakikalarda Grup L’de, Grup F ve Grup R’ye göre anlamlý olarak yüksek bulundu. Diyastolik arter ve ortalama arter basýnclarý Grup L’de entübasyon sonrasý, 1 ve 3. dakikalarda en yüksek olarak tespit edildi. Grup R’de sistolik, diastolik ve ortalama arter basýnçlarý entübasyon sonrasý 10. dakikaya kadar bazal deðerlerin altýnda tespit edildi. Entübasyon sonrasý 1 ve 3. dakika kalp atým hýzý deðerleri açýsýndan Grup L en yüksek, Grup R’de en düþük olarak tespit edildi.
Sonuç: Remifentanil, laringoskopi ve entübasyona karþý geliþen hemodinamik yanýtýn azaltýlmasýnda lidokain ve fentanilden daha etkili ve hipertansiyon hastalarýnda hýzlý seri anestezi indüksiyonu sýrasýnda hemodinamik stabilizasyon saðlanmasý için daha iyi bir tercih olarak gözükmektedir.