Intranasal Administration of Nitroglycerine Attenuates the Pressor Response to Laryngoscopy and Intubation of the Trachea

Fassoulaki, Argyro; Kaniaris, P; Moffitt, Emerson A.

doi:10.1097/00132586-198310000-00036

Cited by 49 publications

(47 citation statements)

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“…19 Kumari I et al used sublingual Nitroglycerin in two doses (0.4mg and 0.8mg) Kamra S et al used 2% topical Nitroglycerin ointment equivalent to 30 mg Nitroglycerin. 13,14 Fassoulaki A and Kaniaris P used Nitroglycerin intranasally in a dose of 60 mg. 15 Anant and Waghray used intranasal NTG spray for attenuation of pressor response to intubation. 16 All these studies cited above revealed conflicting results.…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…12 Despite the efficacy demonstrated in previous studies, indepth analysis and ideal dose combination of Fentanyl and Nitroglycerine required to suppress the hemodynamic response to endotracheal intubation has not yet been determined. [13][14][15][16] Therefore, the 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.…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Haemodynamic Variablesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…The hypertensive patients were receiving nifedipine (1 3 patients), nicardipine (lo), diltiazem (6), enalapril (4) or metoprolol (3). No patient had a history of angina or congestive heart failure.…”

Section: Resultsmentioning

confidence: 99%

Effects of nicardipine on the circulatory responses to tracheal intubation in normotensive and hypertensive patients

et al. 1992

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“…cerebrovascular accident, acute left ventricular failure and pulmonary oedema [4]. Various pharmacological methods have been used to attenuate this reflex cardiovascular response to laryngoscopy and intubation with variable results [5][6][7][8][9][10].…”

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confidence: 99%

Variable Rate Iv Infusion of Morphine and Haemodynamic Response to Laryngoscopy and Tracheal Intubation

Velankar¹,

Sahi

1994

Medical Journal Armed Forces India

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Lt Col PM VELANKAR*. Surg Lt Cdr MS SAlfi+. Brig SP MEHTA (Retd)' ABSTRAcr Haemodynamic response. to laryngoscopy and tracheal intubation was studied in two groups of 45 patients each. Group I patients received variable rate infusion of morphine for 30 minutes followed by intravenous (IV) bolus dose of diazepam. Group n patients received intramuscular morphine as preanaesthetic premedication and preinduction IV bolus dose of diazepam. The method of fnductien of GA was same in both the groups. Systolic and diastolic blood pressure (SBP and DBP) mean arterial pressure and pulse-rate were recorded at intubatiDn and at different time intervals upto 10 minutes after intubation. In group I patients, there was no statistically significant increase in pulse-rate and SBP fDllowing Intubation but transient significant increase in DBP.In group n patients. there was statistically significant increase in pulse-rate. SBP and DBP upto 3 minutes post-intubation. Thus IV infusion of merpbtne in combination with IV bDlus dose ef diazepam proved more effective in attenuating haemDdynamic response to tracheal intubatiDn.

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Intranasal Administration of Nitroglycerine Attenuates the Pressor Response to Laryngoscopy and Intubation of the Trachea

Cited by 49 publications

References 0 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

Effects of nicardipine on the circulatory responses to tracheal intubation in normotensive and hypertensive patients

Variable Rate Iv Infusion of Morphine and Haemodynamic Response to Laryngoscopy and Tracheal Intubation

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