[Effect of different doses of sufentanil on stress responses to tracheal intubation in patients undergoing heart valve replacement surgery].

OBJECTIVE: To determine the effect of different doses of sufentanil on stress responses to tracheal intubation in patients undergoing heart valve replacement surgery.

METHODS: Sixty patients undergoing heart valve replacement surgery were randomly divided into 4 groups (n=15). Before the tracheal intubation, patients received 10microg/kg fentanyl (Group A), 1microg/kg sufentanil (Group B ), 1.5micro/kg sufentanil (Group C), and 1.5microg/kg sufentanil (Group D), respectively, with midazolum and vecuronium intravenous injection. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded before the induction of anesthesia(T(0)), after the induction of anesthesia(T(1)), and at 1(T(2)), 3(T(3)), 5(T(4)), and 10 min after the tracheal intubation(T(5)). Rate-pressure product was derived from SBP and HR. Blood sugar was monitored at T(0), T(2) and T5.

RESULTS: The SBP,DBP,MAP, HR and RPP at T(0) were not significantly different among the 4 groups (P>0.05). These parameters at T(1) were significantly lower than those at T(0) (P<0.01), but there was not significant difference among the 4 groups. The SBP, DBP, MAP in Group A increased significantly at T(2) and T(3) than those at T(1)(P<0.01 approximately 0.05), but were not significantly different than those at T(0)(P>0.05). The SBP,MAP in Group B,C,D at T(2) and T(3) were significantly lower than those in Group A (P<0.01 approximately 0.05 ). The SBP and MAP in Group D at T(4) were still lower than those in Group A (P<0.05). The HR at T(2) in Group A increased compared with that at T(1)(P<0.05),but was still lower than that at T(0). The HR at T(2) in Group B, C, and D was not significantly changed. The HR decreased significantly at T(2) in Group D compared with that in Group A(P<0.05), and the HR at T5 in Group A and D significantly decreased compared with that in Group B(P<0.05). The RPP at T(1) to T5 in Group B, C, and D significantly decreased compared with that at T(0)(P<0.01). The RPP at T(2) in Group A increased significantly compared with those in Group B, C, and D(P<0.01). The cases of using atropine during the induction and intubation in Group A,B,C, and D were 5(33.3%),0(0%),4(26.7%),5(33.3%),respectively, and the cases in Group B were significantly different compared with those in Group A and D(P<0.05). The change of blood sugar in Group A,B,C, and D was not significantly different(P>0.05).

CONCLUSION: Three doses of sufentanil may effectively control the stress responses to the tracheal intubation in patients undergoing heart valve replacement surgery, and the hemodynamics during the intubation at 1microg/kg is much more stable.