A Method for Prevention of Cardiovascular Reactions to Laryngoscopy and Intubation

Abou-Madi, M.; Keszler, H; Yacoub, O.

doi:10.1097/00132586-197604000-00026

Cited by 6 publications

(9 citation statements)

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“…The readings approached baseline and started coming down at 2minutes postintubation. These results are similar to the results of Vijaylakshmi et al 10 and Anila D Malde etal 1 .However in some studies 11,12,13,14 where no opioid analgesic was used at the time of induction the rise in SBP, DBP & MAP is much more than that observed in our study.…”

Section: Resultssupporting

confidence: 92%

Clinical Efficacy Of Combination Of Diltiazem And Lidocaine In Attenuating Hemodynamic Changes During Tracheal Intubation And Comparing The Response When They Are Used Alone.

Gupta¹,

Dubey²,

Naithani³

et al. 2012

IJA

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Background: Tracheal intubation produces transient hemodynamic pressor responses which may be unpredictable. Diltiazemlidocaine combination is hypothesized to attenuate these responses better that when they are used alone.Aims: To compare the clinical efficacy and safety of diltiazem-lidocaine combination in attenuating pressor response to tracheal intubation with lidocaine and diltiazem alone.Settings and Design : prospective double blind, randomised clinical trial of efficacy and safetyMethods and Materials: 120 ASA grade I&II patients were randomly divided in to four groups (using a random sequence generator) of 30 each according to the drug given before intubation to attenuate the hemodynamic response to intubation: saline in control group, diltiazem in D group, lidocaine in L group and both diltiazem and lidocaine in DL group. The person A prepared the drugs, B injected the drug and C evaluated the response; B and C were thus unaware of the drug given.Statistical analysis used : Demographic profiles were evaluated statistically using CHI square test. Changes in haemodynamic parameters were compared using paired t test within the group. Inter group comparison were done by one way analysis of variance (ANOVA). Results: The attenuation of hemodynamic response occurred maximal in DL group followed by lidocaine and diltiazem group respectively (P value< 0.001 till 5 minutes postintubation for BP and HR). Lidocaine controlled both heart rate and blood pressure better than Diltiazem as there was reflex tachycardia to some extent in D group due to reflex sympathoadrenal stimulation. Diltiazem-Lidocaine combination controlled both these parameter to optimal levels.Conclusions : The primary outcome of the study is that Diltiazem-Lidocaine combination is safe and effective in attenuating pressor response to tracheal intubation. We recommend its routine used before intubation

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Section: Resultssupporting

confidence: 92%

Clinical Efficacy Of Combination Of Diltiazem And Lidocaine In Attenuating Hemodynamic Changes During Tracheal Intubation And Comparing The Response When They Are Used Alone.

Gupta¹,

Dubey²,

Naithani³

et al. 2012

IJA

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“…Lidocaine has received the most attention. While several studies have demonstrated its ability to decrease the cough reflex, 10,11 HR and BP increases, [12][13][14][15] and ICP increases [16][17][18][19] occurring with laryngoscopy, endotracheal intubation, and suctioning, other studies have suggested the lack of efficacy of lidocaine. [20][21][22][23][24][25] However, a current recommendation for patients who have suffered head trauma and require intubation is to include lidocaine as an intravenous bolus at 1.5-2.0 mg/kg 3 minutes prior to intubation.…”

mentioning

confidence: 99%

The Efficacy of Esmolol versus Lidocaine to Attenuate the Hemodynamic Response to Intubation in Isolated Head Trauma Patients

Levitt

Dresden

2001

Academic Emergency Medicine

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Abstract. Objective: To assess the effect of esmolol vs lidocaine to attenuate the detrimental rise in heart rate and blood pressure during intubation of patients with isolated head trauma. Methods: This was a prospective, double-blind, randomized study, performed at an urban, county teaching emergency department. Participants were 30 patients with isolated head trauma. Each underwent a standardized intubation protocol including esmolol or lidocaine, both at 2 mg/ kg. Results: Esmolol was used in 16 patients and lidocaine in 14. Mechanisms of injury included 12 assaults, 6 motor vehicle collisions, 6 falls, 4 auto-vspedestrian crashes, and 2 bicycle incidents. Mean ethanol level was 0.116 Ϯ 0.133 SD (range 0-0.482). Mean Glasgow Coma Scale (GCS) score was 7.9 Ϯ 4.0 SD. Cranial computed tomography (CT) hemorrhagic findings included 9 subdural/epidural hematomas, 6 cortex hemorrhages, and 2 multi-hemorrhages. Eleven patients received surgical intervention: 9 patients received a craniotomy, and 2 a ventricular catheter. The 2-minute time interval around intubation was used to assess each drug's efficacy. The mean difference change between groups for heart rate was 4.0 beats/min (95% CI = Ϫ17.7 to 9.7 beats/min), for systolic blood pressure was 1.3 mm Hg (95% CI = Ϫ27.8 to 30.4 mm Hg), and for diastolic blood pressure was 2.6 mm Hg (95% CI = Ϫ27.1 to 21.9 mm Hg). The power of this study was 90% to detect a 20-beat/min difference in heart rate, a 35-mm Hg difference in systolic blood pressure, and a 20-mm Hg difference in diastolic blood pressure. Conclusions: Esmolol and lidocaine have similar efficacies to attenuate moderate hemodynamic response to intubation of patients with isolated head trauma.

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“…Cardiovascular instability following laryngoscopy and tracheal intubation has been investigated extensively and different techniques have been used to prevent these effects: laryngeal and oropharyngeal local anaesthesia (Abou-Madi, Keszler and Yacoub, 1975), oropharyngeal viscous lignocaine before laryngoscopy (Stoelting, 1978), alpha-and betablocking agents (De Vault, Greifenstein and Harris, 1960;Prys-Roberts et al, 1973;Curran, Crowley and O'Sullivan, 1980;Werner et al, 1980). In all these techniques an anticholinergic premedicant was given routinely and the beta-blocking drugs were preceded by a generous dose of atropine to prevent bradycardia (Prys-Roberts et al, 1973;Werner etal., 1980).…”

Section: Discussionmentioning

confidence: 99%

Does Atropine Premedication Affect the Cardiovascular Response to Laryngoscopy and Intubation?

Fassoulaki

Kaniaris

1982

British Journal of Anaesthesia

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The effect of atropine premedication 1. v and i.m. on the cardiovascular changes resulting from laryngoscopy and tracheal intubation has been evaluated in 139 patients undergoing maior surgery. Atropine administered i.v. and i.m. did not affect the hypertensive response to laryngoscopy and tracheal intubation, but did augment the tachycardia and increased the frequency of cardiac arrhythmia observed during intubation of the trachea.

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A Method for Prevention of Cardiovascular Reactions to Laryngoscopy and Intubation

Cited by 6 publications

References 0 publications

Clinical Efficacy Of Combination Of Diltiazem And Lidocaine In Attenuating Hemodynamic Changes During Tracheal Intubation And Comparing The Response When They Are Used Alone.

Clinical Efficacy Of Combination Of Diltiazem And Lidocaine In Attenuating Hemodynamic Changes During Tracheal Intubation And Comparing The Response When They Are Used Alone.

The Efficacy of Esmolol versus Lidocaine to Attenuate the Hemodynamic Response to Intubation in Isolated Head Trauma Patients

Does Atropine Premedication Affect the Cardiovascular Response to Laryngoscopy and Intubation?

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