Attenuation of the pressor response to laryngoscopy and tracheal intubation with intravenous verapamil

Abstract

This study was undertaken in surgical patients in order to evaluate the effects of intravenous verapamil on the circulatory responses to laryngoscopy and tracheal intubation. Laryngoscopy for tracheal intubation was initiated 1 min after thiamylal 5 mg.kg-1 and succinylcholine 1.5 mg.kg-1 in the control group (n = 21). The verapamil group (n = 23) received intravenous verapamil 0.1 mg.kg-1 immediately after thiamylal-succinylcholine administration. The resulting changes in mean arterial pressure (MAP) and heart rate (HR) were continuously measured. Compared with the control group, MAP increased less in response to laryngoscopy and tracheal intubation (56 +/- 13% versus 25 +/- 15% above baselines, P less than 0.01) and returned toward baseline sooner in patients receiving verapamil. For hypertensive patients, MAP increases from baseline after intubation were 18 +/- 9% in the verapamil group, and 53 +/- 14% in the control group, respectively (P less than 0.001). Increases in HR response to laryngoscopy for intubation were comparable in both groups. We conclude that intravenous verapamil is effective in reducing pressor responses during endotracheal intubation, especially in hypertensive patients.

Tracheal lidocaine attenuates the cardiovascular response to endotracheal intubation

“…These hemodynamic changes may be associated with myocardial ischemia, myocardial failure and cerebral hemorrhage in critically ill [3][4][5] beta-adrenergic blockers, 6,7 iv lidocaine 8 and narcotics 6 have been used in an attempt to prevent the cardiovascular responses to endotracheal intubation. Intratracheal administration of lidocaine (tracheal lidocaine) is also widely used for the attenuation of those cardiovascular responses.…”

Nicardipine and verapamil attenuate the pressor response to laryngoscopy and intubation

“…However, when used with inhalational agents it may cause excessive hypotension. 24 Puri et al (1986), using higher doses of morphine (0.2 mg-kg -t) and thiopentone (5.5 rag-kg-t), achieved better control of heart rate responses using verapamil 0.1 mg" kg -~/v one rain before induction, t t Nishikawa and Namiki (1989), on the other hand, using the same dose of verapamil after succinylcholine could not control hypertension and tachycardia, t2 This could' have been due FIGURE 3 Changes in mean blood pressure. FIGURE 4 Changes in heart rate.…”

Use of the fibreoptic stylet scope (Styletscope™) reduces the hemodynamic response to intubation in normotensive and hypertensive patients

“…These procedures are associated with hemodynamic changes. [1][2][3] One of the reasons for the smaller hemodynamic changes following tracheal intubation using a stylet scope was, probably, less stimulus to the perilaryngeal area. Similar investigations using a lightwand (Trachlight™, Laerdal Medical, Armonk, NY, USA) technique have been conducted, 9,10 since this method of intubation requires neither elevation of the epiglottis by the laryngoscope blade nor exposure of the glottic opening.…”