The effects of low-dose ephedrine on intubating conditions following low-dose priming with cisatracurium.
OBJECTIVE
To determine whether low-dose ephedrine plus priming with low-dose cisatracurium improves intubating conditions.


METHODS
Prospective, randomized, double-blinded study.


METHODS
Operating room.


METHODS
124 ASA physical status I and II patients scheduled for elective surgery.


METHODS
Patients were randomly assigned to 4 groups (n = 31): Group PE (priming + ephedrine), Group P (priming), Group E (ephedrine), and Group NPE (no priming, no ephedrine). All patients were induced with propofol two mg/kg and sulfentanil 0.15 μg/kg. In the priming groups, 0.005 mg/kg (10% ED(95)) cisatracurium was given, followed three minutes later by 0.145 mg/kg of cisatracurium. In Groups E and NPE, a single dose of 0.15 mg/kg cisatracurium was given. Intravenous ephedrine 70 μg/kg was given in Groups PE and E. Tracheal intubation was attempted 60 seconds after the intubating dose of cisatracurium and was considered successful only if performed within 20 seconds.


METHODS
Intubating conditions were graded. Heart rate and non-invasive blood pressure, at one-minute intervals, were recorded during and 5 minutes after induction.


RESULTS
The tracheas of all patients in Group PE were successfully intubated within 20 seconds versus 74% in Group P, 77% in Group E, and 64% in Group NPE (P < 0.001 vs. Group PE). Intubating conditions were graded good to excellent in all PE patients, but in only 52% of Groups P and E, and 48% of NPE patients (P < 0.001). Hemodynamic variables were comparable among groups (P = ns).


CONCLUSIONS
Low-dose ephedrine plus priming with low-dose cisatracurium before an intubating dose, significantly improved clinical intubating conditions at 60 seconds.
Leykin
Yigal
Y
Department of Anaesthesia and Intensive Care, Santa Maria degli Angeli Hospital, 33170 Pordenone, Italy; University of Trieste, Trieste 34127, Italy. yigal.leykin@aopn.fvg.it
Dalsasso
Massimiliano
M
Setti
Tomasso
T
Pellis
Tommaso
T
D000328:Adult; D000768:Anesthesia, General / Q000379:methods; D001279:Atracurium / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology; D001794:Blood Pressure / Q000187:drug effects; D004311:Double-Blind Method; D017558:Elective Surgical Procedures / Q000379:methods; D004809:Ephedrine / Q000008:administration & dosage / Q000494:pharmacology*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage / Q000494:pharmacology*; D011446:Prospective Studies; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000494:pharmacology; D055815:Young Adult
D009466:Neuromuscular Blocking Agents; D014662:Vasoconstrictor Agents; D001279:Atracurium; D004809:Ephedrine; C101584:cisatracurium