2 research outputs found
The Effects of Trimethaphan on Responses of the Cardiovascular System During Endotracheal Intubation
μνκ³Ό/μμ¬[μλ¬Έ]
[νκΈ]
μ μ λ§μ·¨ νμμ μ§μ νλκ²½μ½μ
κ³Ό κΈ°κ΄λ΄ μ½κ΄μ μ μνμμμ μ¬νκ΄κ³μ μκ·Ήμ κ°
νμ¬μ λλ§₯νμκ³Ό μ¬λ°λμμ μ¦κ°λ₯Ό κ°μ Έμ€λλ°(Reid λ° Brace 1940: Burstein λ± 1950
: King λ± 1951: Take-shimaλ± 1964: Forbes λ° Dally 1970) μ΄λ κΈ°λμ κΈ°κ³μ μκ·Ήμ
μν κ²½λΆμ μμ¬μ± κ΅κ°μ κ²½μ¬μ μ κΈ°λ₯νμ§μΌλ‘ μΈν΄ μΌμ΄λλ€κ³ νλ©°(Tomori λ° Widdi
combe 1969) λν κΈ°κ΄λ΄ μ½κ΄μμλ λ―Έμ£Όμ κ²½ μκ·ΉμΌλ‘ κ°μ’
μ¬λΆμ λ§₯μ μΌμΌν¬ μ μκ³
(Burstein λ± 1950: King λ± 1951: Forbes λ° Dally1070) κ²½μ°μ λ°λΌμλ μ¬μ μ§κΉμ§ μΌ
μΌν¬ μ μλ κ²μΌλ‘ μλ €μ Έ μλ€(Burstein λ± 1950: Dwyer 1953: Raffan 1954: Lander
λ° Mayer 1965). νΉν κ³ νμ νμλ νμ§λ Vasopressive responseλ₯Ό λνλ΄λ―λ‘ κΈκ²©ν
νμ μμΉμ μ’μ¬μ€λΆμ κ³Ό λμΆνλ±μ μνμ μ΄λν μ μκ³ λν μλͺ
μ μνμ μ£Όλ
μ¬λΆμ λ§₯λ λνλ μ μλ€ (Dingle 1966: Masson 1964). μ΄λ¬ν νμ λ° μ¬λ°λμμ μ
μΉκ³Ό λΆμ λ§₯μ μΆνμ μ€μ΄κΈ° μν μ¬λ¬ κ°μ§ μ½λ¦¬μ μΈ μλκ° νν΄μ Έ μμΌλ νμ¬κΉμ§
λ§μ‘±ν λ§ν μμ ν λ°©λ²μ λ°κ²¬λμ§ μμλ€. μ μλ 1979λ
8μλΆν° 9μ μ¬μ΄μ μ°μΈλν
κ΅ μκ³Όλν λΆμ μΈλΈλμ€ λ³μμμ κΈ°κ΄λ΄μ½κ΄μ μν μ μ λ§μ·¨νμ μμ μ λ°λ μ±μΈ
νμ μ€ μ μ νμνμ 40λͺ
κ³Ό κ³ νμνμ 20λͺ
μ 무μμ μ ννμ¬ κ°κ°μ λμ‘°κ΅°κ³Ό trim
ethaphan camphosulfonas ν¬μ¬κ΅°μΌλ‘ λΆλ₯νμ¬ κΈ°κ΄λ΄μ½μ
κ΄μμ νμκ³Ό μ¬λ°λμμ λ³λ
λ° λΆμ λ§₯μ μΆνμ λΉκ΅ κ²ν νμ¬ λ€μκ³Ό κ°μ κ²°κ³Όλ₯Ό κ΄μ°°νμλ€.
1. μ μ νμκ΅°μμλ λμ‘°κ΅°μ λΉν΄ trimethaphanν¬μ¬κ΅°μ νμμμΉμ΄ μ½κ° μ΅μ λμ
μ§λ§ ν΅κ³νμ μΈ μμλ μμλ€. κ·Έλ¬λ κ³ νμκ΅°μμλ trimethaphanν¬μ¬κ΅°μ νμμμΉ
μ΅μ κ° ν΅κ³μ μΌλ‘ μμ μκ² λνλ¬λ€(P<0.05).
2. μ μ λ§μ·¨ νμ μ§μ νλκ²½μ½μ
μ μ¬λ°λμμ λν μλμ .trimethaphanμ ν¨κ³Όλ
ν΅κ³μ λ³ μμκ° μμλ€.
3. λΉμ μμ¬μ λ μ견μ κ³ νμκ΅°μμ λμ‘°κ΅°μ λΉν΄ trimethaphan ν¬μ¬κ΅°μ΄ μ κ² λ
νλ¬λ€.
μ΄μμ κ²°κ³Όλ₯Ό μ’
ν©νλ©΄ μ μ λ§μ·¨ νμ μ§μ νλκ²½μ½μ
μ κ³ νμ νμμμ trimethaph
anμ μλ(0.1γ/γ) μ μ£Όνλ©΄ μνν hypertensive crisisλ₯Ό λ§μ μ μλ ν λ°©λ²μΌλ‘
μ¬μ©ν μ μμ κ²μΌλ‘ μ¬λ£λλ€.
The Effect of Trimethaphan on Responses of the Cardiovascular System During
Endotracheal Intubation
Sang Ki Paik
Department of Medical Science, The Graduate School, Yonsei University
(Directed by Prof. Kwang Won Park, M.D.)
Tachycardia and hypertension are well documented complications of laryngoscopy
and tracheal intubation in normal patients(Reid and Brace, 1940; Burstein et al,
1950; King et al 1951; Takeshima et al, 1964; Forbes and Dally, 1970). This
phenomenon has been studied in detail in cats by Tomori and Widdicombe(1969), who
found it to be associated with an increased impulse traffic in the cervical
sympathetic efferent fibers. This nervous activeity was especially increased by
stimulation of the epipharyngeal and laryngopharyngeal regions, and was accompanied
by the largest hypertensive response(Takki et al, 1972). Also various arrhythmias
were elicityed by vagal stimulation during endotracheal intubation (Burstein et al,
1950; King et al, 1951; forbes et al, 1970), and it has been known that cardiac
arrest could be observed in severe cases(Burstein et al, 1950; Dwyer, 1953; Raffan,
1954; Lander and Mayer, 1965).
That hypertension during induction of anesthesia in critically ill patients may
be harmful is substantiated by reports of cerebral hemorrhage, left ventiricular
failure and life threatening cardiac arrhythmia(Forbes and Dally, 1970; Dingle,
1966; Masson, 1964; Katz and Bigger, 1970).
Pharmacologic attempts to attenuate these blood pressure and heart rate
elevations and appearances of arrhythmia have been tried but these approaches have
been only partially successful.
We selected at random 60 adult patients who had received operation under the
general anesthesia with intubation at Severance Hospital from August to September,
1979. They were divided into 4 groups. Group β
was normotensive without
trimethaphan(n=20), Group β
‘ was normotensive with trimethaphan(n=20), Group β
’ was
hypertensive without trimethaphan(n=10) and Group β
£ was hypertensive with
trimethaphan(n=10).
The changes of arterial blood pressure and pulse rate, and appearance of
arrhythmia were analyzed and data were compared between groups.
The results were as follows;
1. In the trimethaphan injected group, during induction attenuation of increase
in blood pressure was not significant in the normotensive group but was
statistically significant in the ypertensive group.
2. The effects of trimethaphan on changes of pulse rate were not significant
during laryngoscopic insertion under general anesthesia.
3. On EKG of hypertensive patients the trimethaphan injected group revealed fewer
abnormal EKG findings than the control group.
It is suggested from the above results that intravenous injection of a small
amout(0.1mg/kg) of trimethaphan in a hypertensive patient just before endotracheal
intubation can be used as one method to prevent a dangerous hypertensive crisis.restrictio