| Abstract: | 目的：在不使用肌肉鬆弛劑時，成功且平順的喉頭罩放置需要病人下巴足夠放鬆以及盡量減少呼吸道的反射。Fentanyl可以有效的減少呼吸道反射，但是我們發現使用etomidate誘導合併注射Fentanyl時的時間選擇會影響喉頭罩放置的成功率。在這篇研究中，在不使用肌肉鬆弛劑的情形下，我們比較了以Etomidate誘導之後兩組不同的Fentanyl注射時間來評估成功率。方法：總共九十位病人被隨機分為三組。第一組只使用etomidate 0.3 mg/kg誘導，第二組在接受Fentanyl 2 ug/kg的同時注射etomidate 0.3 mg/kg，第三組給予Fentanyl 2 ug/kg兩分鐘之後注射etomidate 0.3 mg/kg。所有的病人都給予Atropine 0.01 mg/kg，給予etomidate之後開始計時，記錄下巴足夠放鬆的時間。在六十秒時第一次檢查，之後每三十秒檢查一次直到兩百四十秒為止。當發現下巴放鬆時執行喉頭罩置放。喉頭罩放置之後檢查是否有呼吸道刺激。結果：三組病人之間的基本資料沒有顯著差異。使用Fentanyl可以有效的增加下巴放鬆的比率，縮短置放喉頭罩所需的時間。Etomidate誘導前兩分鐘先給予Fentanyl比單獨使用etomidate或是同時給予fentanyl及etomidate更顯著有效的減少放置喉頭罩時的躁動及呼吸道反射。Etomidate誘導前兩分鐘先給予Fentanyl可以顯著的增加喉頭罩放置的成功率。結論：在不使用肌肉鬆弛劑時，單獨使用etomidate來實行喉頭罩置放不是一個好選擇。Fentanyl可以有效的增加下巴放鬆的比率。Etomidate誘導前兩分鐘給予Fentanyl 2 ug/kg可以有效的減少呼吸道反射，增加喉頭罩置放的成功率。
Purpose: Without the use of a muscle relaxant, smooth insertion of a laryngeal mask airway (LMA) requires attenuation of airway reflexes to prevent gagging, coughing, or laryngospasm. Since fentanyl is a potent depressant of the upper airway reflex, the timing of fentanyl administration during etomidate induction may be an important factor in the successful insertion of a laryngeal mask airway. We compared the success rates of LMA insertion with various injection times of fentanyl given during etomidate induction. Methods: Ninety adult patients who were scheduled for general anesthesia were placed into one of the following groups: Group 1 (n=30), etomidate 0.3 mg/kg; Group 2 (n=30), fentanyl 2 pg/kg with immediate etomidate 0.3 mg/kg administration (n=30); or Group 3 (n=30), fentanyl 2 p/kg two minutes prior to etomidate 0.3 mg/kg administration during induction. After premedication with atropine 0.01 mg/kg, the time needed for jaw relaxation from the beginning of etomidate administration was calculated and recorded. The first check began 60 sec after etomidate administration, Subsequent checks were performed at 30 sec intervals up to 240 sec. Laryngeal mask airway was inserted when jaw relaxation was sufficient. After LMA insertion, any sign of airway irritation (e.g., coughing, swallowing, gagging, biting, hiccupping, and tongue movement) were noted. Results: There was no significant difference among the three groups with regard to demographic data, Inadequate jaw relaxation occurred in each group. Fentanyl given 2 mm before etomidate injection significantly reduced airway reflex better than etomidate alone or fentanyl administration immediately before etomidate injection. Among the three groups, fentanyl 2 pg/kg given 2 mm before etomidate injection had a significant greater success rate of LMA insertion than the other two groups. Conclusions: Without a muscle relaxant, etomidate is not a good induction agent for the insertion of LMA. The addition of fentanyl can decrease the time to LMA insertion as well as produce better jaw relaxation. Administration of fentanyl 2 pg/kg given 2 mm before etomidate injection could decrease airway reflex and increase the success rate of LMA insertion. |
