在用全剂量或减少剂量的诱导剂进行快速序列输管后,输管后低血压
Alicia E Mattson1, Caitlin S Brown1, Benjamin J Sandefur2
1Department of Pharmacy Services, Mayo Clinic Rochester, Rochester, MN, USA.
概括
在ED中用于快速序列输管 (RSI) 的全剂量胺与更高的输管后低血压 (PIH) 率有关,特别是在血动力学基线较差的患者中. 结果不支持广泛使用降低剂量诱导剂.
科学领域:
- 紧急医疗 紧急医疗
- 麻醉学 麻醉学
- 关键的护理关键的护理
背景情况:
- 快速序列输管 (RSI) 是一个关键的急诊室 (ED) 程序.
- 输管后低血压 (PIH) 是RSI的一个常见并发症.
- 诱导剂选择和剂量对PIH风险的影响需要澄清.
研究的目的:
- 为了确定在经历RSI的ED患者中PIH的发病率.
- 为了比较全剂量和减少剂量诱导剂 (乙胺和胺) 之间的PIH率.
主要方法:
- 追溯性,整个卫生系统的队列研究.
- 包括成人患者 (≥18岁) 从2018年7月至2020年12月接受ETOMIDATE或胺治疗RSI.
- 定义的减少剂量为胺≤1.25 mg/kg或埃托米达≤0.2 mg/kg.
主要成果:
- 分析了909名患者,84%接受了埃托米达,16%接受了胺.
- 胺组的平均输入前冲击指数 (P ≤ 0.001) 较高.
- 全剂量胺与PIH率最高 (36.5%) 相关,明显高于减少剂量胺 (16.7%) 和全剂量埃托米达 (22.8%).
结论:
- 全剂量的胺与PIH增加有关,但基线血液动力学混了解释.
- 研究结果不支持减少剂量诱导剂在RSI的广泛使用.
- 需要进一步的研究来优化诱导剂的选择,以尽量减少PIH风险.
相关概念视频
Parenteral Anesthetics: Overview
114
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
114
Endotracheal Intubation I: Procedure
1.0K
Endotracheal or ET intubation is a critical medical procedure used to secure a patient's airway, often in acute respiratory distress, apnea, upper airway obstruction, ineffective clearance of secretions, high risk for aspiration, or during general anesthesia.
The ET tube comprises various components, including a standard adaptor to attach a bag-valve-mask (BVM) or ventilator, a cuff, a pilot balloon, and radiopaque markings along its length to measure the insertion distance. The tube sizes...
The ET tube comprises various components, including a standard adaptor to attach a bag-valve-mask (BVM) or ventilator, a cuff, a pilot balloon, and radiopaque markings along its length to measure the insertion distance. The tube sizes...
1.0K
Endotracheal Intubation II: Nursing Management
550
Endotracheal intubation is a critical procedure that can be lifesaving for many patients with respiratory distress or failure. The role of nursing in managing endotracheal tubes is pivotal, as it involves pre-intubation preparation, assisting during the procedure, and post-extubation care.
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...
550
Inhalational Anesthetics: Overview
242
Inhalation anesthetics are drugs that induce general anesthesia upon inhalation. They work by increasing the sensitivity of GABAA receptors or inhibiting NMDA receptors, leading to a decrease in central nervous system activity. The depth of anesthesia can be rapidly adjusted by changing the concentration of the inhaled gas. Some common examples of inhalational anesthetics include volatile liquids like isoflurane, desflurane, sevoflurane and gases like xenon and nitrous oxide. Isoflurane, a...
242
Endotracheal Tube Extubation
549
Endotracheal tube extubation is a critical procedure in weaning patients from mechanical ventilation. It involves physically removing the oral or nasal endotracheal (ET) tube, marking the final step in liberating a patient from ventilatory support.
Procedure
Extubation removes the endotracheal tube (ETT) from the patient on mechanical ventilation. It requires a well-coordinated, multidisciplinary approach involving physicians, nurses, respiratory therapists, and other healthcare professionals....
Procedure
Extubation removes the endotracheal tube (ETT) from the patient on mechanical ventilation. It requires a well-coordinated, multidisciplinary approach involving physicians, nurses, respiratory therapists, and other healthcare professionals....
549
Stages of General Anesthesia
409
Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
409


