[Circulatory and respiratory repercussions to direct suspension laryngoscopy in the adult: value of a propofol-alfentanil combination].
The clinical effects of a propofol-alfentanil association were studied in fifteen patients ASA II (mean age 50.1 +/- 14.1) anaesthetized for E.N.T. endoscopy after informed consent. All the patients received an intramuscular premedication with 0.10 to 0.15 mg.kg-1 midazolam. Propofol 2.5 mg.kg-1 was injected in a peripheral venous line with alfentanil 10 micrograms.kg-1, followed by continuous automatic injection of propofol at a dose of 5 to 10 mg.kg.h-1 and alfentanil 5 micrograms.kg-1 given just before suspension. After induction and during maintenance of anaesthesia, the patients were allowed to breathe oxygen spontaneously O2 assisted when apneic. The following variables were studied before induction (to), after induction (t1), during suspension (t2) and when stopping the infusion (t3): haemodynamic parameters using an invasive method and blood gases. Statistical analysis was performed using the Student's test for paired samples. Surgical conditions and anaesthetic quality were good with early recovery of consciousness and return of all reflexes. After an initial period of cardio vascular depression, the haemodynamic parameters did not vary much during the anaesthesia and propofol-alfentanil appeared to limit considerably the hypertension due to laryngoscopy. However, there was a moderate degree of hypercapnia (p less than 0.001) in most patients, giving evidence of some respiratory depression and possibly a greater depth of anaesthesia than desirable. Indeed, the doses of alfentanil required seemed to be more important with propofol because of a probably interference between the two drugs; the doses of these drugs should therefore be modified according to the length of surgery.
Welfringer
P
P
Département d'Anesthésie-Réanimation, Hôpital Central, Nancy.
Taron
F
F
Bertrand
D
D
D000328:Adult; D015760:Alfentanil; D000771:Anesthesia, Intravenous; D000777:Anesthetics; D005260:Female; D005283:Fentanyl / Q000031:analogs & derivatives*; D006439:Hemodynamics; D006801:Humans; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D010636:Phenols; D015742:Propofol; D012119:Respiration
D000777:Anesthetics; D010636:Phenols; D015760:Alfentanil; D005283:Fentanyl; D015742:Propofol
Répercussions circulatories et ventilatoires de la laryngoscopie direct en suspension chez l'adulte: intérêt de l'association propofol-alfentanil.