Effect of Age on Haemodynamic Response to Tracheal Intubation. A Comparison of Young, Middle-aged and Elderly Patients

Ismail, Samina; Si, Azam; Fa, Khan

doi:10.1177/0310057x0203000511

Cited by 29 publications

(15 citation statements)

References 23 publications

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“…7 Marked fluctuations in haemodynamic response are often seen in geriatric patients. 8,9 In our study, we selected an optimal age range of 18 to 60 years.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Two Different Doses of Dexmedetomidine in Attenuating Hemodynamic Changes During Laryngoscopy

S¹,

Shukla²,

Sathesha³

et al. 2014

jemds

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The sequence of induction of anaesthesia, laryngoscopy and tracheal intubation are associated with marked hemodynamic changes and autonomic reflex activity which may be a cause of concern in many high risk patients. In this study, we compare the effects of two different doses of Dexmedetomidine, 1µg/kg and 0.5µg/kg with control group with respect to hemodynamic responses such as heart rate, blood pressure, attenuation of sympathetic responses to laryngoscopy and intubation and undesirable effects. METHODS: 90 ASA I and II status normotensive patients scheduled for elective surgical procedure were selected and randomly divided into three groups of 30 each. Group 1 patients received 0.5µg/kg in 10 minutes, group 2 patients received 1µg/kg in 10 minutes and group 3 patients received Normal Saline. 60 secs after the infusion, patient was induced with Inj Fentanyl 1-2µg/kg, Inj. propofol and Inj Vecuronium administered. Intubation was performed. Values of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR) and O2 saturation (SpO2) were recorded at baseline (T0), 60 sec after Dexmedetomidine infusion (T1), 60 sec after induction (T2), 60 sec after intubation (T3), 5 min after intubation (T4). RESULTS: It was found that SBP, DBP, MAP levels were significantly lower at T3 period in group 2 than in group 1 and group 3 (p<0.05, p<0.01, p<0.05). Also, HR levels were significantly lower at T3 in group 2 than in group 1 and group 3(p<0.01).There was no significant changes in SpO2 levels between the groups. CONCLUSION: Through this study, we empirically prove that Dexmedetomidine 1 μg.kg-1 is more effective than Dexmedetomidine 0.5 μg.kg-1 in controlling haemodynamic responses to tracheal intubation.

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“…7 Marked fluctuations in haemodynamic response are often seen in geriatric patients. 8,9 In our study, we selected an optimal age range of 18 to 60 years.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Two Different Doses of Dexmedetomidine in Attenuating Hemodynamic Changes During Laryngoscopy

S¹,

Shukla²,

Sathesha³

et al. 2014

jemds

View full text Add to dashboard Cite

show abstract

“…However, the hemodynamic response was not proportional to the increase in the patient's age. The hemodynamic change due to tracheal intubation is greatest if the patient's age is between 40 and 50, according to Ismail et al [18], or 35 to 50, according to Bullington et al [19]. We chose age 45 as the dividing mark for the 2 ages groups after carefully reviewing Sun et al's report on anxiety and Ismail et al and Bullington et al's reports on hemodynamic responses.…”

Section: Discussionmentioning

confidence: 99%

Availability of preoperative anxiety scale as a predictive factor for hemodynamic changes during induction of anesthesia

Kim

Byeon

Song

et al. 2010

Korean J Anesthesiol

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BackgroundThe current study evaluated whether the level of preoperative anxiety assessed by the state-trait anxiety inventory (STAI) affects cardiovascular response during anesthetic induction. Furthermore, we evaluated the utility of the preoperative anxiety scale as a predictive factor for hemodynamic changes.MethodsOne hundred twenty patients who were scheduled to undergo elective surgery under general anesthesia were enrolled in this prospective study. The patients were asked to fill out STAI questionnaires the night before the day of surgery. For 5 minutes after tracheal intubation, changes in vital signs were recorded. The correlation between STAI scores and the percent changes in vital signs during the induction of anesthesia for each subgroup was assessed. In addition, the predictability of the 20% change in vital signs by STAI scores was analyzed using receiver operating characteristics curves.ResultsThe state anxiety scores of patients 45 years of age or older showed a significant correlation with percent changes in mean blood pressure and heart rate, whereas the state anxiety scores in other subgroups showed no significant correlation with changes in vital signs during the induction of anesthesia. Furthermore, the state anxiety scores in patients 45 years of age or older were shown to be useful in predicting a 20% change in vital signs during anesthetic induction.ConclusionsThe state anxiety scores of patients 45 years of age or above could be a useful tool for predicting changes in vital signs during anesthetic induction. Thus, physician should be mindful of preoperative anxiety.

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“…Infants and children have been reported to have a more pronounced vagal response to laryngoscopy and intubation than adults [22]. The differences in the cardiovascular intubation responses between adults of different ages have also contributed to the age‐related changes in the sensitivity of cardiac beta receptor and elasticity of the major vessels [23, 24].…”

Section: Discussionmentioning

confidence: 99%

The circulatory responses to tracheal intubation in children: a comparison of the oral and nasal routes

Xue

Liao²,

Liu

et al. 2007

Anaesthesia

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SummaryThe circulatory responses to laryngoscopic tracheal intubation in 62 healthy children undergoing surgery requiring tracheal intubation were studied. They were randomly assigned to receive either the oral or nasal route for intubation. Baseline non-invasive blood pressure and heart rate were recorded following induction of anaesthesia, at intubation and then every minute for 5 min. The percentage changes of systolic blood pressure and heart rate during the measurement period were calculated. The results demonstrated that intubation time was significantly longer in the nasal group. Both oral and nasal intubation caused significant increases in blood pressure and heart rate compared to baseline and postinduction values. However, there were no significant differences found between the two groups in relation to blood pressure and heart rate. The two groups were similar with respect to the percentage changes of systolic blood pressure and heart rate during the observation period. It is concluded that oral and nasal intubation using a direct laryngoscopy can result in a similar circulatory response in anaesthetised children. Laryngoscopy and tracheal intubation in anaesthetised children is often associated with hypertension and tachycardia [1]. This may be the result of reflex sympathetic activation, perhaps involving the baroreceptor system provoked by airway nociceptive stimulus. It has been shown that different phases of the intubation process can cause different degrees of circulatory response [2,3], as indeed does mechanical stimulation of different sites in the airway [4]. Nasotracheal intubation can stimulate the nasal cavity and nasopharynx, which does not occur during orotracheal intubation. Previous studies in anaesthetised adults have demonstrated that simple nasopharyngeal intubation and insertion of a nasopharyngeal airway can produce significant hypertensive responses [5,6] and the circulatory responses to laryngoscopic nasal intubation are greater than those produced by oral intubation [7,8]. To the best of our knowledge, no previous study in children has compared the circulatory responses of these two intubation routes in a single clinical trial. Therefore, this randomised clinical study was designed to determine whether there was a clinically relevant difference between the circulatory responses produced by nasal and oral intubation performed by experienced practitioners in healthy anaesthetised children. MethodsFollowing institutional ethics committee approval and written informed parental consent, 62 ASA physical status 1 children, scheduled for elective plastic surgery requiring general anaesthesia with tracheal intubation were included in this study. Exclusion criteria included a history of reactive airway disease, gastro-esophageal reflux, morbid obesity, hypertension, and the use of medications known to affect blood pressure and heart rate. Children were randomly allocated to either the oral or the nasal group using a sealed envelope method.Prior to surgery, all children fasted overnight a...

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Effect of Age on Haemodynamic Response to Tracheal Intubation. A Comparison of Young, Middle-aged and Elderly Patients

Cited by 29 publications

References 23 publications

Comparison of Two Different Doses of Dexmedetomidine in Attenuating Hemodynamic Changes During Laryngoscopy

Comparison of Two Different Doses of Dexmedetomidine in Attenuating Hemodynamic Changes During Laryngoscopy

Availability of preoperative anxiety scale as a predictive factor for hemodynamic changes during induction of anesthesia

The circulatory responses to tracheal intubation in children: a comparison of the oral and nasal routes

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