This study compares four different anesthesia induction regimens to see which one provides the most stable blood pressure and heart rate during rapid sequence intubation. A total of 172 patients undergoing elective surgery will receive one of four combinations of propofol and opioids (alfentanil or sufentanil). The main outcomes are hypotension (low blood pressure), inadequate blunting of the stress response to intubation, and intubating conditions. The study aims to determine whether a lower dose of propofol combined with a higher dose of alfentanil can improve hemodynamic stability without compromising the quality of tracheal intubation.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
172
Propofol is a short-acting intravenous hypnotic agent used for induction of general anesthesia. In this study, it is administered at 1 mg/kg in Group A and 2 mg/kg in Groups B, C, and D.
Alfentanil is a short-acting synthetic opioid with rapid blood-brain equilibration (t½ke0 ≈ 1.0-1.5 min). It is administered at 50 μg/kg in Groups A and D, and 30 μg/kg in Group B, all by intravenous injection over 10 seconds.
Sufentanil is a synthetic opioid with slower equilibration compared to alfentanil. It is administered at 0.5 μg/kg by intravenous injection over 30 seconds in Group C only, followed by 4 minutes of mask ventilation before propofol induction
Rocuronium is a non-depolarizing neuromuscular blocking agent. It is administered at 0.6 mg/kg intravenously in all four treatment groups to facilitate tracheal intubation.
Aoyang Hospital Affiliated to Jiangsu University
Zhangjiagang, Jiangsu, China
Post-induction hypotension
Mean arterial pressure (MAP) \< 60 mmHg for at least 2 consecutive time points during T1-T5. MAP \< 50 mmHg at any time point is recorded separately as severe hypotension.
Time frame: T1 to T5 (from immediately before intubation to 5 minutes after tracheal intubation).
Substantial heart rate decline
Maximum decrease in heart rate (HR) ≥ 20% from the baseline value (T0) during T1-T5.
Time frame: T1 to T5 (from immediately before intubation to 5 minutes after tracheal intubation).
Inadequate blunting of intubation response
Meeting either of the following criteria at T2: (a) HR \> T0 × 1.2 and MAP ≥ T0 × 0.85 (i.e., MAP decline \<15%), excluding reflex tachycardia secondary to hypotension; or (b) MAP \> T0 × 1.2.
Time frame: Measured at T2 (immediately after intubation).
Intubating conditions
Intubating conditions assessed by the Steyn modified Helbo-Hansen score, range 5 to 20, with 5 representing optimal conditions.
Time frame: Assessed at the time of tracheal intubation.
Use of vasoactive agents
Use of vasoactive agents (e.g., atropine, urapidil) during the observation period T1-T5.
Time frame: T1 to T5 (from immediately before intubation to 5 minutes after tracheal intubation).
Other adverse events
Adverse events reported descriptively, including hypertensive response to intubation (systolic blood pressure at T2 elevated by \>30% above T0), body movement, coughing, lacrimation, and vagal reflexes.
Time frame: T1 to T5 (from immediately before intubation to 5 minutes after tracheal intubation).
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