Increased Cerebrospinal Fluid Pressure During Laryngoscopy and Intubation for Induction of Anesthesia

Burney, Robert G.; Winn, Robert K.

doi:10.1213/00000539-197509000-00028

Cited by 69 publications

(19 citation statements)

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“…In a study of 12 neurosurgical patients [6-tumors, 3-metastasis, 3-aneurysm], all patients had rise in ICP; therefore, patients with subtle ICP issues or pre-existing raised ICP may experience a dramatic rise in ICP leading to a Cushing reflex [11]. This reflex may lead to severe hemodynamic changes including bradycardia and asystole.…”

Section: Discussionmentioning

confidence: 99%

Asystole During Airway Manipulation in Neurosurgical Patient:Causes and Management

Chowdhury¹,

Cenkowski²,

Cappellani³

2013

IJAR

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Section: Discussionmentioning

confidence: 99%

Asystole During Airway Manipulation in Neurosurgical Patient:Causes and Management

Chowdhury¹,

Cenkowski²,

Cappellani³

2013

IJAR

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“…'j Complications of the pressor response that follows laryngoscopy include myocardial ischaemia,2s14 cardiac failure,' intracranial haemorrhage and increases flow and improved myocardial oxygen balance.2 I Rcin intracranial pressure. 16 Studies of hypertcnsivc flex tachycardia may, however. accompany the use of patients have shown that the pressor response to nitroglycerine and thls can offset the beneficial effects laryngoscopy is exaggerated in these patients and on myocardial oxygen balance.…”

Section: Discussionmentioning

confidence: 99%

Intranasal nitroglycerine attenuates pressor response to tracheal intubation in beta‐blocker treated hypertensive patients

et al. 1987

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Key wordsAnu (,v[iit,tir t~c h n i y u~.~: tracheal intubation Phurmucolugy: nitroglycerine.Tachycardia and hypertension are well-documented reflex cardiovascular effects of laryngoscopy and tracheal intubation in normotensive subjects.' The extent of these reflexes is more marked in both treated and untreated hypertensive patients.2 Intranasal nitroglycerine has been shown to attenuate the pressor response to laryngoscopy and intubation in normotensive p a t~e n t s .~ Its use in hypertensive patients has not heen reported so far. The present study was undertaken to assess the effect of nitroglyccrine solution administered intranasally before laryngoscopy, to prevent the cardiovascular changes associated with laryngoscopy and tracheal intubation..Mii/ericd utid n7efhotl.sThe study was carried out in a double-blind manner. Forty, mild to moderately hypertensive patients (pretreatment diastolic arterial pressure 10G130 mmHg) rccciving therapy in the form of beta-blocking drugs alone. or in addition to a diuretic, were selected.Patients with obstructive lung disease. a history of angina or previous myocardial infarction. congestive cardiac failure or 2nd and 3rd degree AV block, were excluded from the study. All the patients were scheduled for short surgical procedures.The day before surgery, the purpose of the atudy and the proccdurc to bc undertaken were explained to the patients and informed consent was obtained. The antihypertensive medication was continued until the morning of surgery. All the patients were placed first on the operation list. so that the interval between the morning dose of antihypertensivc medication and induction of anaesthesia was about 2 hours. Premedication was with morphine 0.1 mg:kg and protnethazine 0.4 mgjkg intramuscularly. one hour before anaesthesia. Patients were allocated to one of two groups (20 in each group) with the help of a randomisation chart.The arterial blood pressure was measured after a resting period of 10 minutes, subsequent to arrival of Forum 885 the patient in the operating theatre. Basal heart rate readings were recorded after a continuous display of heart rate and ECG had been established on an oscilloscope using ECG leads in the CMS position. Depending upon the allocation of paticnts to a particular group, they received either 1.5 ml normal saline (group I ) or 1.5 ml nitroglycerine solution (group 2). The nitroglycerine solution was prepared by dissolving two crushed tablets of 0.5 mg each in 2 ml saline, by a worker who was not associated with the monitoring of blood pressure and heart rate. The same worker loaded I .5 ml of saline or nitroglyccrinc solution in a 5-ml syringe (taped to prevent recognition on the basis ofcolour) and instilled i t intranasally with an opaque intravenous cannula (Angiocath).Anaesthesia was induced 30 seconds after the administration of the solution, with a sleep dose of sodium thiopentone 4 6 mg/kg followed by suxamethonium 1.5 mg/kg. The induction drugs were administered within 40 -50 seconds. Laryngoscopy and tracheal intuba...

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“…Reflex circulatory responses after three stages of nasotracheal intubation and two stages of orotracheal intubation: A comparative study significant, though transient, hypertension, tachycardia, arrhythmia and also an increase in intracranial pressure 4 . Although these haemodynamic responses are probably of little consequences in young healthy individuals, they may be more severe and more hazardous in hypertensive and elderly patients which may lead to myocardial ischaemia 5 as well as cerebrovascular accidents 6 .…”

Section: Introductionmentioning

confidence: 99%

“…The majority of studies treated laryngoscopy and intubation as a single stimulus though actually they are not. 4 It has been shown that different phases of intubation 7,8 and passage of endotracheal tube through different parts of airway 9 causes different degrees of cardiovascular responses. Nasotracheal intubation can stimulate the nasal cavity and nasopharynx which does not occur during orotracheal intubation.…”

Section: Introductionmentioning

confidence: 99%

Reflex circulatory responses after three stages of nasotracheal intubation and two stages of orotracheal intubation: A comparative study

et al. 2017

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Background: Endotracheal intubation has become the mainstay of modern anaesthesia. Stimulation of upper respiratory tract during tracheal intubation under general anaesthesia causes activation of sympatho-adrenal system and results in increased serum catecholamines. Aims and Objectives: To identify and compare the hemodynamic responses contributed by each stage of nasotracheal with that of orotracheal intubation. Material and Methods: About 125 patients in the age group 18-50 years, ASA physical status I-II of either sex, scheduled to undergo various elective surgical procedures requiring nasotracheal or orotracheal intubation were evaluated in the present study.After 4 minutes of ventilation, patients requiring nasal intubation (n=75) were allocated to three groups-nasopharyngeal intubation group (NPI), nasopharyngeal intubation with laryngoscopy group (NPIL) and nasotracheal intubation group (NTI). Those requiring oral intubation (n=50) were allocated to two groups namely-laryngoscopy only group (L) and laryngoscopy followed by orotracheal intubation group (OTI). Haemodynamic parameters like heart rate and blood pressure, SpO2, ECG, ETCO 2 were monitored continuously and data were recorded before induction, just after induction and after intubation at one minute interval for five minutes. Results: The pre-induction and pre-procedure values of systolic, diastolic and mean arterial pressures and also heart rate were similar in each group (P<0.05). Induction of anaesthesia caused a significant decrease in systolic, diastolic and mean arterial pressures in all groups compared to their pre-induction values (P<0.0012). Our study showed that systolic, diastolic and mean arterial pressures were significantly increased after intubation procedures in all the five groups compared to pre-procedure values. Conclusion: All the procedures evoked cardiovascular responses characterized by increases in heart rate and blood pressure. NTI produced a significant rise in blood pressure.

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Increased Cerebrospinal Fluid Pressure During Laryngoscopy and Intubation for Induction of Anesthesia

Cited by 69 publications

References 0 publications

Asystole During Airway Manipulation in Neurosurgical Patient:Causes and Management

Asystole During Airway Manipulation in Neurosurgical Patient:Causes and Management

Intranasal nitroglycerine attenuates pressor response to tracheal intubation in beta‐blocker treated hypertensive patients

Reflex circulatory responses after three stages of nasotracheal intubation and two stages of orotracheal intubation: A comparative study

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