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KMID : 0356920080540020160
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Korean Journal of Anesthesiology
2008 Volume.54 No. 2 p.160 ~ p.166
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Hemodynamic and Catecholamine Responses to Laryngoscopy and Endotracheal Intubation in Paraplegic Patients: Time Course and Relation to the Affected Level
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Yoo Kyung-Yeon
Jeong Sung-Tae
Kim Seok-Jae
Kim Woong-Mo
Jeong Cheol-Won
Hong Jin-Wook
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Abstract
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Background:We determined whether the cardiovascular responses to endotracheal intubation change as a function of the time elapsed after injury and the level of injury in patients with spinal cord injury.
Methods:One-hundred-eighty six patients with complete cord injury were grouped into 3 according to the level of injury:high- (T1?T4, n = 34), mid- (T5?T10, n = 47) and low paraplegics (＜ T10, n = 105).They were further divided into 5 according to the time elapsed since injury:＜ 4 wks, 4 wks?1 yr, 1?5 yrs, 5?10 yrs, and ＞ 10 yrs.Twenty-five patients with no cord injury served as controls.Systolic arterial blood pressure (SAP), heart rate (HR), and plasma catecholamine concentrations were measured.
Results:The intubation caused an increase of SAP and norepinephrine concentrations in every group.However, the magnitude of their peak increases was less in high paraplegics compared with all other groups (P ＜ 0.05).HR was similarly increased in all groups (P ＜ 0.01).Pressure but not either HR or norepinephrine response was enhanced in mid- and low-paraplegics whose injury elapsed more than 10 yrs compared with controls (P ＜ 0.05).The incidence of arrhythmias did not differ among the groups.
Conclusion:The pressure and plasma catecholamine changes associated with endotracheal intubation may be attenuated in high-paraplegics, and the pressure changes may be enhanced over time in mid- and low-paraplegics.(Korean J Anesthesiol 2008; 54: 160∼6)
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KEYWORD
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catecholamine, hypertension, intubation, spinal cord injury, tachycardia
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