Attenuation of hypertensive response to tracheal intubation with nitroglycerin

Mikawa, Katsuya; Hasegawa, M.; Suzuki, Takeshi; Maekawa, Nobuhiro; Kaetsu, Hiroshi; Goto, Ryokichi; Yaku, Hideaki; Obara, Hidefumi

doi:10.1016/0952-8180(92)90157-v

Cited by 23 publications

(23 citation statements)

References 12 publications

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“…13 Studies conducted by Mikawa K et al, Grover VK et al and Fassoulaki A and Kaniaris P have also documented that NTG does not attenuate the rise in heart rate following laryngoscopy and endotracheal intubation which can be attributed to reflex tachycardia produced by vasodilatation. 15,18,19 When intravenous Fentanyl was used along with Nitroglycerin sublingual spray in group 3 (F+NTG), it resulted in more optimal control of tachycardia produced by laryngoscopy and intubation. In the group 3, baseline heart rate came down just before intubation and then rose to maximum at 1 minute after intubation followed by gradual fall at 3 rd and 5 th minutes bellow the baseline value.…”

Section: Haemodynamic Variablesmentioning

confidence: 99%

Attenuation of stress response to laryngoscopy and intubation: sublingual nitroglycerin spray vs intravenous fentanyl and sublingual nitroglycerin spray

Pegu

Dutta

Pathak

et al. 2017

Int J Basic Clin Pharmacol

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INTRODUCTIONLaryngoscopy and tracheal intubation are mandatory for most patients undergoing operations under general anaesthesia, which invariably is associated with certain cardiovascular changes such as tachycardia, rise in blood pressure and a wide variety of cardiac arrhythmias.1 The hemodynamic response to laryngoscopy and intubation was first described by Reid and Brace in 1940. A typical pressor response can leads to an average increase in blood pressure by 40-50% and heart rate by 20% and an elevation of both epinephrine and norepinephrine levels.These effects are generally well tolerated by overall healthy patients but can be lethal to patients with preexisting conditions such as coronary artery disease, recent myocardial infarction, hypertension, geriatric population pre-eclampsia, and cerebrovascular pathology such as tumours, aneurysms or increased intracranial pressure etc., and are at increased risk of morbidity and mortality. 2Geriatric and elderly patients which make up an increasingly large percentage of both the inpatient and outpatient hospital population, have an increased ABSTRACT Background: Laryngoscopy and tracheal intubation is invariably associated with certain cardiovascular changes such as tachycardia, rise in blood pressure and a wide variety of cardiac arrhythmias. 1 Such complications are highly detrimental in patients with limited cardiovascular reserve specially in geriatric and elderly population. Various pharmacological agents have been used to attenuate these stress responses but none has yet been considered ideal. Therefore, purpose of this study is to investigate the efficacy of sublingual Nitroglycerine spray alone and sublingual Nitroglycerine spray with intravenous Fentanyl to attenuate the pressor response to laryngoscopy and intubation in normotensive patients. Methods: A total of 120 ASA I and II patients of age group 18-60 years scheduled for elective surgical procedure under general anesthesia were randomly divided into 3 groups of 40 in each group. Group 1 control group, Group 2, received NTG sub-lingual spray (0.4mg/spray) two min. before induction, and Group 3 received inj. Fentanyl (2µg/kg) 5min before + NTG sublingual spray (0.4 mg/spray) 2min before induction. Vital parameters before and after induction and thereafter at specified time interval following laryngoscopy and intubation were recorded for comparison. Results: Demographic characteristics and baseline vital parameters in both the groups were comparable. Significant differences in mean arterial pressure (MAP) and heart rate (HR) were observed in between the groups during postintubation period. Conclusions: Combination of intravenous Fentanyl plus Nitroglycerin spray is more effective than NTG alone in attenuating the stress response following laryngoscopy and intubation.

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Section: Haemodynamic Variablesmentioning

confidence: 99%

Attenuation of stress response to laryngoscopy and intubation: sublingual nitroglycerin spray vs intravenous fentanyl and sublingual nitroglycerin spray

Pegu

Dutta

Pathak

et al. 2017

Int J Basic Clin Pharmacol

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“…Perioperative myocardial ischaemia has been associated with postoperative myocardial infarction, and a causal relationship has been postulated. [8,10] Therefore, elimination of ischaemia at the time of intubation might prevent infarction. Modification of the haemodynamic response to intubaton is a laudable objective and is clearly indicated in a small subgroup of patients in whom a single hyper-dynamic episode may cause a catastrophe.…”

Section: Discussionmentioning

confidence: 99%

“…[1-,3] Various agents, including anaesthetics, analgesics, adrenergic blocking agents and vasodilators effectively attenuate this response. [6][7][8][9][10][11][12] This has been a fertile area for clinical investigation, spawning numerous studies of the various techniques which might be expected to modify the haemodynamic response to intubation. Even a transient hyper-dynamic response may cause serious complication in patients with symptomatic aortic aneurysm, recent myocardial infarction, cerebral aneurysm, or intracranial hypertension, known or suspected ischaemic heart disease is by far the most common indication for modifying the haemodynamic response to intubation.…”

Section: Discussionmentioning

confidence: 99%

“…Omitting cholinergic premedication, pre-treatment with beta blockers, [6] calcium channel blockers, [7] nitroglycerine, [8] opioids, [9] gabapentin, [10] dexmedetomidine, [11] and clonidine [12] are common practices with variable results. Efficacy of oral pregabalin postoperative analgesia and reduction of parenteral analgesics has been demonstrated in several studies.…”

Section: Name and Address Of Corresponding Authormentioning

confidence: 99%

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Pre-emptive Use of Oral Pregabalin Attenuates the Pressor Response of Laryngoscopy and Endotracheal Intubation: A Double Blind Randomized Placebo Controlled Study

2016

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Background: Laryngoscopy and intubation may cause undesirable increase in blood pressure and heart rate. The aim of the present study was to investigate the effect of Pregabalin premedication on hemodynamic responses to laryngoscopy and intubation. Methods: Sixty ASA physical status I or II patients undergoing elective surgery under general anesthesia were randomly allocated into two equal groups who received either oral Pregabalin 150 mg (Group PB)or placebo (Group PL)1 hour prior to surgery. Heart rate, Systolic, Diastolic and Mean arterial blood pressures were recorded preoperative, at laryngoscopy and 0,1,3,5 and 10 minutes after tracheal intubation. Results: Demographic data and base-line values for Heart rate, Systolic, Diastolic and Mean arterial blood pressures were comparable between groups. During laryngoscopy and intubation there was significant attenuation of SBP, DBP and MBP in PB group as compared to PL group. Although increase in heart rate was less in pregabalin group during laryngoscopy and intubation but it was not statistically significant. Conclusion:In the present study design, oral Pregabalin premedication at a dose of 150 mg one hour prior to surgery attenuates pressor response associated with laryngoscopy and endotracheal intubation but not the tachycardia significantly.

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“…On the contrary, magnesium sulfate and lidocaine did not have any effect on the hemodynamic changes following intubation. Further, in a study by Mikawak et al (33), it was shown that administration of a single dose of intravenous nitroglycerine was a safe and effective method for attenuation of the hypertensive response following intubation. In a study performed in Greece (34,35) women were enrolled to receive nitroglycerine before induction of anesthesia, and it was found that nitroglycerine effectively attenuated the increase in BP after laryngoscopy.…”

Section: Attenuation Of Cardiovascular Response In Severe Preeclampsiamentioning

confidence: 99%

Attenuation of the Pressor Response to Tracheal Intubation in Severe Preeclampsia: Relative Efficacies of Nitroglycerine Infusion, Sublingual Nifedipine, and Intravenous Hydralazine

2011

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A B S T R A C T Background:The pressor response to laryngoscopy is known to be exaggerated in patients with severe preeclampsia. Objectives: The aim of the present study was to compare the efficacies of continuous intravenous (IV) infusion of nitroglycerine, IV hydralazine, or sublingual nifedipine in modifying cardiovascular responses to endotracheal intubation, in women with severe preeclampsia undergoing cesarean delivery under general anesthesia. Patients and Methods: A total of 120 patients undergoing cesarean delivery were randomly divided into 3 groups, each receiving one of the following drugs before intubation: 5 µg/min nitroglycerine administered by continuous IV infusion (Group NTG, n = 40); a 10-mg capsule of nifedipine deposited sublingually (Group NIF, n = 40); or 5-10 mg hydralazine intravenously (Group H, n = 40). Heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and mean arterial pressure (MAP) were simultaneously recorded in the mother at pre-induction, pre-intubation, and at 1, 3, 5, and 10 min after intubation. Results: In contrast to those in group NIF and group H, the patients in group NTG showed no significant increases in HR, SAP, DAP, or MAP after intubation, compared to baseline. The incidence of hypotension was significantly greater in group NIF than in group H or group NTG [15 (37. 5%) vs. 8 (20%) vs. 5 (12. 5%) respectively, P = 0. 025]. Conclusions: In patients with severe preeclampsia undergoing cesarean delivery, a continuous IV infusion of nitroglycerine was able to attenuate the cardiovascular response to intubation to a greater extent than the use of sublingual nifedipine or IV hydralazine, without significant adverse effects on the newborn.

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Attenuation of hypertensive response to tracheal intubation with nitroglycerin

Cited by 23 publications

References 12 publications

Attenuation of stress response to laryngoscopy and intubation: sublingual nitroglycerin spray vs intravenous fentanyl and sublingual nitroglycerin spray

Attenuation of stress response to laryngoscopy and intubation: sublingual nitroglycerin spray vs intravenous fentanyl and sublingual nitroglycerin spray

Pre-emptive Use of Oral Pregabalin Attenuates the Pressor Response of Laryngoscopy and Endotracheal Intubation: A Double Blind Randomized Placebo Controlled Study

Attenuation of the Pressor Response to Tracheal Intubation in Severe Preeclampsia: Relative Efficacies of Nitroglycerine Infusion, Sublingual Nifedipine, and Intravenous Hydralazine

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