Enflurane, 아산화질소, Thiopental과 소량의 Fentanyl을 이용한 마취유도시 기관삽관에 의한 빈맥과 수축기고혈압을 막기위한 Esmolol의 ED95

Background: Esmolol has been used combined with small dose of fentanyl to prevent tachycardia and hypertension induced by tracheal intubation, but there has been few studies about the appropriate doses of esmolol when used combined with fentanyl. Methods: According to esmolol dose, 140 patients were randomly allocated to 7 groups of 20 patients. After 2 μg/kg of fentanyl, 4 mg/kg of thiopental and 0.12 mg/kg of vecuronium were intravenously administered, mask ventilation for 3 minutes with enflurane, nitrous oxide and oxygen was followed. Then one of the doses of esmolol, 0, 0.2, 0.3, 0.45, 0.6, 0.8 or 1.0 mg/kg was administered. Ninty seconds later, tracheal intubation by direct laryngoscopy was performed. After then heart rate was monitored continuously and blood pressure was measured 5 times with 1 minute interval. The highest heart rate and systolic blood pressure were recorded. We calculated the doses of esmolol which reduce the incidence of tachycardia (increased above 100 bpm or by more than 40% of preinduction level) and systolic hypertension (increased above 170 mmHg or by more than 40% of preinduction level) below 5% respectively. Results: The ED95 of esmolol for prevention of tachycardia induced by tracheal intubation was 0.56 mg/kg (95% CI: 0.44∼0.81 mg/kg). But the incidence of systolic hypertension was so low even without esmolol injection that the esmolol dose was not significant factor. Conclusions: In anesthetic induction and tracheal intubation with enflurane, nitrous oxide, thiopental, vecuronium, and fentanyl 2 μg/kg, esmolol 0.56 mg/kg was ED95 of preventing tachycardia. But the incidence of systolic hypertension was acceptably low even without esmolol injection. (Korean J Anesthesiol 1999; 36: 225∼231)