Cardiovascular and Plasma Catecholamine Responses at Tracheal Extubation

Abstract

The haemodynamic responses to tracheal extubation at the end of surgery were compared with those occurring at tracheal intubation in 12 patients undergoing major elective surgery. Arterial cannulation was performed and heart rate (HR), systolic arterial pressure (SAP) and diastolic arterial pressure (DAP) were measured before induction of anaesthesia, before tracheal intubation, at the end of surgery and 1, 3 and 5 min after tracheal extubation. Laryngoscopy was avoided at the end of surgery. At all but the first of these stages, venous blood was obtained for measurement of plasma concentrations of adrenaline and noradrenaline. Rate-pressure product (RPP) was derived from SAP x HR. After tracheal intubation there were significant (P less than 0.05) increases in HR, DAP, RPP and in plasma concentrations of both adrenaline and noradrenaline. After extubation, only HR and adrenaline concentration at 5 min after extubation increased significantly compared with measurements at the end of surgery.

Efficacy of sublingual nitroglycerine spray in attenuation of hemodynamics to tracheal extubation

“…Actually, nitroglycerine in higher doses has been used to treat perioperative laryngospasm successfully though we have not come across such observation. 5,13 Limitations of this study use of invasive arterial line would have been more accurate method for measurement of blood pressure. However, this was not needed for the type of procedures that these patients underwent and hence such additional invasive monitoring was not justified.…”

Comparative study on Haemodynamic response to extubation: Attenuation with Lignocaine, Esmolol, Propofol

“…It often provokes hypertension and tachycardia due to reflex sympathetic discharge caused by pharyngeal and laryngeal stimulation. This stimulation is associated with increase in plasma epinephrine concentration 3 . The haemodynamic responses to tracheal extubation are probably of little consequence in healthy individuals, but may be more severe and more hazardous in hypertensive patients.…”

Attenuation of hemodynamic responses to endotracheal extubation: A prospective randomised controlled study between two different doses of Verapamil

“…[1][2][3][4][5][6] High degree of sympathetic stimulation, as evidenced by tachycardia, hypertension and increased levels of circulating catecholamines during extubation may prove to be detrimental to their health or to the successful outcome of surgery.Hypertensive subjects exhibit an exaggerated response to laryngoscopy and intubation as well as to awakening and extubation compared to normotensive patients. 7,13,45 Increase in BP, HR and RPP which is a multiple of SBP and HR increases the cardiac workload and the oxygen demand of the myocardium; increasing the risk of developing a fresh episode of myocardial ischemia and infarction in known patients of ischemic heart disease due to a fixed coronary blood flow, along with fall in cardiac index and ejection fraction. [3][4][10][11][12]16 Therefore, perioperative measurement of RPP is of vital importance.…”

“…Postoperative extubation of trachea is an important event in the course of general anaesthesia which causes a modest (10% to 30%) and transient (lasting approximately 5 to 15 minutes) increase in the HR and BP. [1][2][3][4][5][6][7] Normally these responses are transient in nature hence well tolerated by normotensive healthy subjects.…”

“…[7][8][9][10] Acute hemodynamic changes during extubation can lead to dangerous arrhythmias, 2-4 myocardial ischemia, [3][4]7,[10][11][12][13] acute cardiac failure, 2,5,12 pulmonary edema 8 or cerebrovascular haemorrhage 14 in susceptible individuals. These responses can turn catastrophic in several situations like; ocular surgeries leading to dangerous increase in intraocular pressure; 15 patients with cardiac disease [3][4][10][11][12]16 or intracranial surgeries with raised intracranial pressure or for aneurysm surgeries 14 or with essential hypertension who show an exaggerated response to this stressful event.…”