DỰ PHÒNG TỤT HUYẾT ÁP SAU KHỞI MÊ BẰNG PROPOFOL Ở NGƯỜI BỆNH CAO TUỔI

Abstract

Objective: To evaluate the effectiveness of phenylephrine in combination with propofol for preventing hypotension during induction of anesthesia with a laryngeal mask airway (LMA) in elderly patients (EP) undergoing flap transfer surgery and debridement with skin grafting. Subjects and methods: This was a prospective, randomized controlled clinical trial involving 60 EP (> 60 years old) diagnosed with sacral pressure ulcers, indicated for flap transfer surgery or debridement with skin grafting under LMA anesthesia. Patients were randomly divided into two groups: Group 1 (n = 30) received propofol combined with 100 mcg phenylephrine for induction, while Group 2 (n = 30) received propofol alone for induction. We monitored heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) at various time points from induction until 5 minutes after LMA insertion. We also recorded the amount of vasopressor medication needed to treat hypotension in both groups. Results: Immediately after propofol induction until 1 minute after LMA insertion (Ts, T0, T1), SBP, DBP, and MAP decreased in both study groups. The incidence of hypotension in Group 1 was 43.3% compared to 83.3% in Group 2 (p=0.001). Among these, the incidence of hypotension requiring treatment was 23.3% in Group 1 versus 70% in Group 2 (p<0.001). Subsequently, blood pressure values increased again until 5 minutes after LMA insertion. The mean amount of phenylephrine used was 95.90±43.52 in Group 1 and 91.67±92.93 in Group 2 (p>0.05). Conclusion: Hypotension is a common complication after propofol induction in elderly patients. Combining propofol with 100 mcg of phenylephrine is effective in preventing hypotension during the induction phase in elderly patients.