PROPHYLAXIS AGAINST THE SYSTEMIC HYPOTENSION INDUCED BY PROPOFOL DURING RAPID-SEQUENCE INTUBATION

The objective of this study was to determine the effectiveness of two prophylactic approaches against the anticipated hypotension induced by propofol during rapid-sequence intubation. Thirty-six male or female nonpremedicated ASA class I-II patients aged 21-60 yr undergoing elect ive outpatient surgery were included in the study. Patients were rando mly allocated to receive pre-induction ephedrine sulphate (70 mu g . k g(-1) iv), preinduction volume loading (12 ml . kg(-1) Ringer's lactat e) or no treatment. Rapid-sequence intubation with cricoid pressure wa s then performed with propofol (2.5 mg . kg(-1) and succinylcholine (1 .5 mg . kg(-1). The lungs were subsequently ventilated with 0.25-0.5% isoflurane in a 2:1 N2O/O-2 mixture. Vecuronium was given once neuromu scular function had recovered from the succinylcholine. Heart rate and systemic arterial blood pressure were measured non-invasively before induction, after propofol administration and every minute for ten minu tes after intubation. Pre-induction volume loading prevented the hypot ension observed before surgical stimulation in control and ephedrine g roups. Moreover pre-induction volume loading was not associated with i ncreases in heart rate after intubation as was ephedrine administratio n. The intubating conditions were excellent to satisfactory in most pa tients and the overall incidence of adverse events during induction wa s mainly due to pain during injection of propofol. The present study s howed that preoperative volume loading is more efficacious than preind uction administration of ephedrine sulphate in maintaining haemodynami c stability during rapid-sequence induction with propofol and succinyl choline. In addition propofol in combination with succinylcholine prov ides excellent conditions for rapid-sequence intubation.