Nicardipine versus lidocaine for attenuating the cardiovascular response to endotracheal intubation

Charuluxananan, Somrat; Kyokong, Oranuch; Somboonviboon, Wanna; Balmongkon, B.; Chaisomboonpan, S.

doi:10.1007/s005400050071

Cited by 23 publications

(18 citation statements)

References 34 publications

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“…[8][9][10][11][12] Various drug regimens and techniques have been used from time to time for attenuating the stress response to laryngoscopy and intubation, including opioids, barbiturates, benzodiazepines, beta blockers, calcium channel blockers and vasodilators etc. [13][14][15][16][17] Although the corresponding increases in blood pressure and heart rate are transitory and variable, they are more pronounced and unpredictable in patients with 19 % maximum increase in the heart rate after one minute of intubation and it was further decreased by 1.24% from the baseline.While patients of group B showed a 12% initial rise in pulse rate(at the first minof intubation) which did not return to the baseline even after ten minutes The maximum percentage increase in the SBP in Group B was 4%, while patients of Group A showed maximum percentage increase of only 0.29%.Dexmedetomidine group of patients also showed later a percentage decrease which was maximum at the third and fourth minutes (-0.61 %) raised intracranial tension, cardiovascular disease like hypertension following laryngoscopy. Consequently, lifethreatening complications such as pulmonary oedema, cerebrovascular hemorrhage and myocardial infarction are more likely to develop in these groups of patients.…”

Section: Discussionmentioning

confidence: 99%

A comparative evaluation of dexmedetomidine and fentanyl to attenuate hemodynamic response to laryngoscopy and intubation

et al. 2018

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A B S T R A C TBackground: Laryngoscopy and intubation are associated with a sympathetically mediated circulatory response due to irritation of respiratory tract which is associated with increase in pulse rate and blood pressure that may be dangerous. Aims and Objectives: The aim of the present study was to determine and compare the efficacy of dexmedetomidine and fentanyl in attenuating the hemodynamic response to laryngoscopy and intubation and to detect any complication or side effect as a result of these drugs. Materials and Methods: Following approval by ethical committee, 60 ASA grade I and II patients of either sex undergoing general anaesthesia for elective surgery were included in this study. Patients were randomly divided into two groups of 30 patients each. Dexmedetomidine in a dose of 1µg/kg was given to Group A patients and Fentanyl 2 µg/kg was given to Group B patients. Both the drugs were diluted with normal saline solution to make 10ml and were administered slow intravenous 10 min before induction.The hemodynamic parameters were recorded, demographic data was analyzed using unpaired t-test and hemodynamic variables were analyzed by using unpaired and paired t-test. Side effects were analyzed using chi square test. Result: The two groups were comparable in their demographic profiles. Dexmedetomidine proved itself to be an excellent drug when given intravenously as a premedicant in dose of 1µg/kg to attenuate hemodynamic response to laryngoscopy and intubation. It blunted the hemodynamic response to laryngoscopy and intubation to a greater magnitude than fentanylin a dose of 2µg/kg intravenously as a premedicant. Conclusion: We conclude that fentanyl 2µg/kg i.v. given ten minutes prior to airway instrumentation shows an inconsistent response to laryngoscopy and intubation. Between the two drugs under study, the use of dexmedetomidine 1µg/kg i.v. is satisfactory and produces a more favorable hemodynamic profile while fentanyl 2µg/kg is found to be non-dependable and less effective for the attenuation of the pressor response to laryngoscopy and endotracheal intubation. However, further larger studies are required to strengthen these conclusions.

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Section: Discussionmentioning

confidence: 99%

A comparative evaluation of dexmedetomidine and fentanyl to attenuate hemodynamic response to laryngoscopy and intubation

et al. 2018

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“…To date numerous efforts have been made to make the procedure safe, full proof and devoid of any complications.Attenuation and blunting of pressor response during laryngoscopy and intubation has been one of the most researched topics in anaesthesia, but with only a few positive established outcome [1][2][3][4][5]. Numerous drugs and their combinations have been tried in the past and studies have highlighted the use of these drugs in varying doses for suppression of stress response but not without the significant incidence of quite a few side-effects, especially with higher doses of opioids [5][6][7][8][9][10].Cardiovascular responses viz. changes in heart rate, blood pressure and wide variety of cardiac arrhythmias can occur because of afferent stimulation of vagus and a sympatho-adrenal response.…”

Section: Discussionmentioning

confidence: 99%

“…The pressor response, which is part of a huge spectrum of stress response, results from the increase in sympathetic and sympathoadrenal activity, as evidenced by increased plasma catecholamines concentrations in patients undergoing surgery under general anaesthesia [1][2][3][4][5].Various drug regimens and techniques have been used from time to time for attenuating the stress response to laryngoscopy and intubation, including opioids, barbiturates, ______________________________ *Correspondence Dr. Amarjeet Dnyandeo Patil Assistant Professor, MGM Medical College and Hospital, MGMUHS, Navi Mumbai,India E Mail: amarjeetpatil999@yahoo.co.in benzodiazepines, beta blockers, calcium channel blockers, vasodilators, etc [6][7][8][9][10]. The dose of opioids required for effective attenuation of stress response is fairly high and numerous drugs have been used as adjuncts in decreasing the dose of opioids with a varied level of success, but are not absolutely free from sideeffects [10][11][12].Alpha-2 agonists like clonidine has been used extensively in the past for attenuation of sympathoadrenal stimulation caused by tracheal intubation and surgery [4,13].…”

Section: Introductionmentioning

confidence: 99%

Attenuation of pressor response and dose sparing effect on opioids with the use of dexmedetomidine in spine surgeries

Patil¹,

Kagade²,

D’souza³

et al. 2017

APJHS

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Background:The pressor response, which is part of a huge spectrum of stress response, results from the increase in sympathetic and sympathoadrenal activity, as evidenced by increased plasma catecholamines concentrations in patients undergoing surgery under general anaesthesia. Various drug regimens and techniques have been used from time to time for attenuating the stress response to laryngoscopy and intubation, including opioids, barbiturates, benzodiazepines, beta blockers, calcium channel blockers, vasodilators, etc. The dose of opioids required for effective attenuation of stress response is fairly high and numerous drugs have been used as adjuncts in decreasing the dose of opioids with a varied level of success, but are not absolutely free from side-effects. This study was conducted to investigate the ability of pre-operative intravenous dexmedetomidine in decreasing the dose of opioids and anaesthetics for attenuation of haemodynamic responses during laryngoscopy and tracheal intubation in spine surgery.Methods: Fifty patients belonging to ASA I and II physical status were included in this study. Twenty five patients received 1μg/kg each of dexmedetomidine and Fentanyl pre-operatively (group D) and other twenty five patients received 2microg/kg of Fentanyl preoperatively (group F). Results:-Statistically significant changes in heart rate, blood pressure, sedation score, reduction in dose of induction agent, opioids demonstrated.Conclusion: Dexmedetomidine is not only an excellent drug for attenuation of pressor response to laryngoscopy and intubation and during extubation, but also decreases the dose of opioids and propofol in achieving an adequate analgesia and anaesthesia, respectively.

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“…10,11,12 Studies have been published regarding the attenuation of haemodynemic response by α-2 adrenoreceptor agonist clonidine. 4 Recently introduced, Dexmedetomidine, α-2 adrenoreceptor agonist, is gaining popularity for its sympatholytic, sedative, anaesthetic sparing and haemodynamic stabilizing properties without significant respiratory depression.…”

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confidence: 99%

Dexmedetomidine and Fentanyl for Endotracheal Intubation: A Comparative Study

Hiremath¹,

Gnanasekar²

2015

jemds

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Severe cardiovascular response in the form of tachycardia and hypertension occur during induction of general anaesthesia and endotracheal intubation. This can cause deleterious effects in hypertensive and other cardiovascular disease patients. Alpha-2 (α-2) agonists are increasingly used as adjuncts in anaesthesia. Nowadays, dexmedetomidine, α-2 adrenoreceptor agonist, is gaining popularity for its sympatholytic, sedative, anaesthetic sparing and haemodynamic stabilizing properties without significant respiratory depression. The stable hemodynamic and decreased oxygen consumption due to enhanced sympathoadrenal stability make dexmedetomidine very useful pharmacologic agent. The present study was undertaken to compare the effectiveness of dexmedetomidine and fentanyl in attenuating the response to laryngoscopy and endotracheal intubation during general anaesthesia. We enrolled 100 patients in age range 18-50 years of ASA I-II, and of either sex undergoing elective operation of short duration. Patients were randomly selected and allocated into two Groups. Group D: Received dexmedetomidine 1µg/kg intravenous (IV) bolus and Group F: received fentanyl 1µg/kg IV bolus 10min before induction. All patients were induced with thiopentone sodium and vecuronium. Patients in both the Groups were continuously monitored for heart rate, systolic, diastolic and mean arterial pressure (MAP) and data recorded. After induction and intubation HR, SBP, DBP and MAP were significantly lower in Group D than Group F (P<0.004, P=0.00, P<0.04, P<0.006 respectively). The need for thiopentone was decreased by 9% in the dexmedetomidine Group as compared to the fentanyl Group. Post-operative sedation and pain scores were comparably less in Group D than Group F. We conclude, Preoperative infusion of 1µg/kg of both dexmedetomidine and fentanyl are effective in attenuating the sympathetic responses to laryngoscopy and tracheal intubation however, dexmedetomidine blunts this response more effectively than fentanyl. In addition dexmedetomidine has significant anaesthetic sparing effect.

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Nicardipine versus lidocaine for attenuating the cardiovascular response to endotracheal intubation

Abstract: Nicardipine can be used as an alternative to lidocaine in attenuation of cardiovascular response to tracheal intubation in patients without ischemic heart disease.

Cited by 23 publications

References 34 publications

A comparative evaluation of dexmedetomidine and fentanyl to attenuate hemodynamic response to laryngoscopy and intubation

A comparative evaluation of dexmedetomidine and fentanyl to attenuate hemodynamic response to laryngoscopy and intubation

Attenuation of pressor response and dose sparing effect on opioids with the use of dexmedetomidine in spine surgeries

Dexmedetomidine and Fentanyl for Endotracheal Intubation: A Comparative Study

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