Remifentanil vs. Lignocaine for Attenuating the Haemodynamic Response during Rapid Sequence Induction Using Propofol: Double-Blind Randomised Clinical Trial

Abstract

This study was conducted to determine whether lignocaine or remifentanil effectively attenuate the response to endotracheal intubation during rapid sequence induction. Forty-eight patients were randomly divided into three groups: Group NS (n=16) received normal saline 0.1 ml/kg, Group L (n=16) received lignocaine 1.5 mg/kg, and Group R (n=16) received remifentanil 1 μg/kg. Anaesthesia was induced with propofol 2 mg/kg after glycopyrrolate 0.2 mg IV. Each study drug was given intravenously over 30 seconds after loss of consciousness. Cricoid pressure was applied until intubation. Succinylcholine 1.0 mg/kg was administered to facilitate tracheal intubation. After intubation, the patient's lungs were ventilated with sevoflurane 1% and nitrous oxide 50% in oxygen. Mean arterial pressure and heart rate were recorded before induction, at loss of consciousness, immediately before laryngoscopy and every minute after intubation for 10 minutes. Mean arterial pressure fell following propofol in all groups. The maximum increase in mean arterial pressure in Group NS and Group L were 46% and 38% respectively above the baseline value one minute after intubation, whereas the mean arterial pressure in Group R increased only back to the baseline value. Heart rate in Group NS and Group L were increased by 27% and 33% above baseline value respectively one minute after intubation, while that in Group R was increased only to the baseline value. The results indicate that remifentanil 1 μg/kg, but not lignocaine 1.5 mg/kg, effectively attenuates the haemodynamic response to endotracheal intubation during rapid sequence induction using propofol.

Intravenous lidocaine does not affect the anesthetic depth during rapid sequence induction and intubation as assessed by Bispectral Index monitoring: a randomized double blind study

“…We found that lidocaine was ineffective in blunting RSII hemodynamic responses. Our results are in agreement with those of previous studies reporting that IV lidocaine 1.5–2 mg/kg does not attenuate the tachycardia and hypertension associated with rapid sequence induction and intubation [2, 3, 14]. In our study, patients did not receive any anticholinergic premedication, in order to avoid any influence on the results.…”

“…A lidocaine dose of 1.5 mg/kg was preferred in our study, since it has been used in several trials as a preintubation adjuvant for rapid and conventional non-rapid sequence induction [3–5, 13, 14]. The rocuronium dose we used was 1 mg/kg, since this or higher doses are indicated in RSII in order to provide satisfactory intubation conditions in 1 min [19, 20].…”

Management of the airway without the use of neuromuscular blocking agents: the use of remifentanil

“…Remifentanil combined either with propofol or with inhaled anesthetic agents has been proved to provide acceptable intubating conditions. It is also known that it provides greater haemodynamic stability during inhaled or total intravenous anesthesia, compared to other opioids [15][16][17][18] in healthy adults, as well as in patients with cardiac disease [19] and in children [20,21]. Strong evidence exists that illuminates the usefulness of the drug in cases of difficult airway as well as in neuromuscular diseases.…”

“…In a very recent study, Cafiero et al recommended the use of remifentanil infusion (0.25 lg/kg/min) in patients with risk factors for dysrhythmias, as it prevents the increase in the QT (the distance between the beginning of the QRS wave and the end of the T wave in the electrocardiography) dispersion after intubation in comparison with fentanyl [14]. It is also known that it provides greater haemodynamic stability during inhaled or total intravenous anesthesia, compared to other opioids [15][16][17][18] in healthy adults, as well as in patients with cardiac disease [19] and in children [20,21]. Finally, as it concerns the use of remifentanil during pregnancy, a rapid transplacental transfer of the drug has been documented [22].…”

Effects of lignocaine on pressor response to laryngoscopy and endotracheal intubation during general anaesthesia in rigid suspension laryngoscopy

“…However, their use may delay the time to arousal and the return of protective reflexes. 14 However, in that study, opioid was not administered in the lignocaine group, and the trachea was intubated immediately after lignocaine injection, without waiting for 2 minutes. 5,10 It has been claimed that a 1.5 mg/kg dose of IV lignocaine can afford complete protection against cardiac arrhythmias of all types, and provide borderline protection against hypertension and tachycardia.…”