【摘要】 目的 观察右星状神经节阻滞（R-SGB）对全身麻醉气管内插管期心血管反应的影响。 方法 2009年10-12月选取60例美国麻醉医师协会（ASA）Ⅰ、Ⅱ级择期全麻手术患者，随机分为3组。研究组于全麻诱导前15 min用1%利多卡因10 mL经颈6入路行R-SGB，对照组1诱导前同法注射10 mL生理盐水，对照组2诱导前肌注2%利多卡因5 mL。观察气管插管前后收缩压（SBP）、舒张压（DBP）、平均动脉压（MBP）、心率（HR）、心电图（ECG）、氧饱和度（SpO2）和心率收缩压乘积（RPP）的变化。 结果 研究组各时点与进入手术室时的基础值比较，仅诱导后SBP、DBP、MBP显著降低，窥喉时HR和RPP显著升高（Plt;0.01）；在插管3 min后已恢复至基础值。对照组1和对照组2诱导后SBP、DBP、MBP显著降低（Plt;0.01）；窥喉时SBP、DBP、MBP、HR、RPP均显著升高（Plt;0.01），并持续至插管后5 min。两对照组升高的程度均显著高于研究组（Plt;0.05或Plt;0.01）。 结论 R-SGB对全麻气管插管期的心血管反应有一定抑制作用，可用于调控全麻插管期心血管不良反应。【Abstract】 Objective To explore the effect of right stellate ganglion block (R-SGB) on cardiovascular response during endotracheal intubation under the general anesthesia. Methods Sixty ASAⅠ-Ⅱpatients who underwent general anaesthesia between October to December 2009 were randomly divided into three groups. The patients in the trial group accepted R-SGB by C6 route with 1% lidocaine (10 mL) 15 minutes before induction of general anesthesia; the patients in control group 1 were injected with 10 mL physiological saline in the same way before the induction; the patients in control group 2 underwent the intramuscular injection of 2% lidocaine (5 mL) before the induction. The changes of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), hear rate (HR), electrocardiogram (ECG), oxygen saturation (SpO2) and heart rate-systolic blood pressure product (RPP) before and after endotracheal intubation were observed and recorded. Results In the trial group, SBP, MAP, and DBP decreased significantly after the induction; HR and RPP increased evidently at the laryngeal exposure compared with the baseline values (Plt;0.01) and recovered three minutes after the intubation. In the control group 1 and 2, SBP, MAP, and DBP decreased significantly after induction (Plt;0.01); SBP, MAP, DBP, HR and RPP increased apparently at the laryngeal exposure compared with the baseline values (Plt;0.01), and the raise continued until five minutes after endotracheal intubation. The difference in the raise between the control groups and the trial group was significant (Plt;0.05 or Plt;0.01). Conclusion R-SGB may effectively inhibit the cardiovascular response during endotracheal intubation under the general anesthesia and can be used to control the negative reaction during the induction.
Objective To investigate the effective dose of remimazolam benzenesulfonate to suppress cardiovascular responses to laryngeal mask placement in elderly patients. Methods Elderly patients undergoing laryngeal mask anesthesia between March and June 2023 were selected. Combined with sulfentanil 0.2 μg/kg, remimazolam was used as induction hypnotic. The first patient was given remizolam benzenesulfonate 0.16 mg/kg infused by pump for 1 min. The dose of remimazolam for the next patient was determined by the biased coin up-and-down method based on the patient’s response to the laryngeal mask placement. The score of Modified Observer’s Assessment of Alert/Sedation, vital signs and anesthesia depth index (AI) were recorded during induction. Probit analysis was used to calculate the half effective dose (ED50), 95% effective dose (ED95) and half effective AI (AI50). According to the statistical requirements, at least 45 negative patients were required. Results A total of 53 elderly patients were enrolled in the study until the end of the trial. The ED50 and ED95 of remimazolam benzenesulfonate for inhibiting cardiovascular responses to laryngeal mask insertion were 0.154 mg/kg [95% confidence interval (CI) (0.034, 0.170) mg/kg] and 0.207 mg/kg [95%CI (0.190, 0.614) mg/kg], respectively. AI decreased during induction, with an AI50 of 64.119 [95%CI (60.609, 69.984)]. Conclusion When combined with 0.2 μg/kg sufentanil, infusing 0.2 mg/kg remimazolam benzenesulfonate for 1 min is effective and safe for laryngeal mask anesthesia induction in elderly patients.