The cardiovascular responses to double lumen endobronchial intubation and the effect of esmolol

Abstract

SummaryThis study compared the quality of anaesthesia and surgical access afforded by two techniques for the administration of anaesthesia during paediatric chair dental procedures. A total of 50 ASA 1 paediatric day case patients were randomly assigned to receive anaesthesia through either the traditional Goldman nasal mask or through a nasopharyngeal airway. Patients in the nasal mask group were judged to have significantly worse airway patency (p = 0.0001) and significantly more episodes of airway obstruction (14 vs. 4; p = 0.0032) than those in the nasopharygeal airway group. Anaesthetic, surgical and oxygen saturation data did not differ significantly between the two groups. Operating conditions were universally graded as excellent in the nasopharyngeal airway group, while those in the nasal mask group were graded as excellent/good in only 79% of cases (p < 0.0001). These results suggest that better quality anaesthesia and operating conditions can be achieved by using a nasopharyngeal airway rather than the traditional nasal mask for the administration of anaesthesia to paediatric chair dental patients.Keywords Anaesthesia; dental. Equipment; nasopharyngeal airway, tracheal tube, nasal mask.. ..................................................................................... Correspondence to: Dr O. Bagshaw Accepted: 3 February 1997 Paediatric chair dental surgery is a challenge to both the anaesthetist and the surgeon. The children are outpatients, not previously assessed by an anaesthetist, unpremedicated and often frightened and uncooperative. The anaesthetist and the surgeon have to share the airway and the problems of airway obstruction, oxygen desaturation and poor surgical access are common [1, 2].The technique of using a nasopharyngeal airway for both the maintainance of airway patency and the administration of general anaesthesia is historically well described [3][4][5], but there have been no recent reports of its usefulness as an alternative to the nasal mask. Traditionally, the nasopharyngeal airway has been made from rubber and was of a fixed length, which varied depending on the size of the airway selected. Recently, we have been using this technique substituting disposable tracheal tubes for the rubber airway. These have the advantages of being single-use, the length can be readily altered and they can be easily connected to a standard anaesthetic breathing system. The aim of this study was to compare the quality of anaesthesia and surgical access afforded by these two techniques and to note any associated morbidity. MethodsLocal Ethics Committee approval for the study was obtained. The majority of children presenting for daycase chair dental surgery were eligible for inclusion in the study. Children requiring tracheal intubation for conservation work were not studied. Informed consent was obtained from a parent.A total of 50 ASA 1 children were randomly assigned to either the Nasal Mask group or the Nasopharyngeal 786ᮊ 1997 Blackwell Science Ltd Airway group. All patients were unprem...

Ketamine eliminates propofol pain but does not affect hemodynamics during induction with double-lumen tubes

“…However, neither 0.5 nor 1.0 mg kg -1 ketamine administration increased mean arterial pressure or heart rate significantly during DLT handling, which can increase heart rate and arterial blood pressure more severely [23][24][25]. In contrast, propofol also has side effects that include a large decrease in arterial pressure and occasional severe bradycardia when used to induce anesthesia.…”

“…However, ketamine has unfavorable adverse effects, including increased secretion production and sympathetic stimulation leading to increased arterial pressure and heart rate [17][18][19][20][21][22]. For lung surgery, a double-lumen endobronchial tube (DLT) is required to perform surgical procedures, with which intubation and placement of the tube are accompanied by increased heart rate and arterial blood pressure [23][24][25]. Therefore, ketamine could enhance cardiovascular responses during DLT handling.…”

“…Therefore, ketamine could enhance cardiovascular responses during DLT handling. Patients presenting for lung surgery usually have a high risk for cardiovascular disease; therefore, marked hemodynamic responses would be undesirable [23,26]. In addition, increased secretion production might expose the patients to impaired respiratory conditions during one lung ventilation (OLV).…”

Esmolol attenuates hepatic blood flow responses during sodium nitroprusside-induced hypotension in dogs

“…Although MAP recovered after induced hypotension was terminated, there were significant reductions in RBF in the ES groups. The possible explanation is that RBF reductions may be mediated by increases in plasma catecholamine concentrations and by augmentation of sympathetic nervous activity which may produce vasoconstriction of the renal arteries, because esmolol has been reported to increase plasma norepinephrine concentrations 26,27 and beta-adrenergic receptor antagonist slows the clearance of norepinephrine from plasma. 28,29 In conclusion, during sevoflurane anesthesia the reductions in HBF during SNP-induced hypotension with esmolol were due to the decrease in CO caused by the reductions in cardiac contractility.…”

Hemodynamic and Humoral Response to Intubation with Double-lumen Endotracheal Tubes Versus Single-lumen Tubes Combined with an Endobronchial Blocker: A Randomized Clinical Trial

“…However, double-lumen tubes are larger and relatively inflexible than conventional single-lumen tubes; therefore insertion is more difficult and may trigger an increased hemodynamic response and stimulate the sympathetic nervous system exceedingly [3,4]. A consequence is perioperative tachycardia and hypertension, with consequent risk of myocardial ischemia and infarction [5,6].…”