The Efficacy of Esmolol versus Lidocaine to Attenuate the Hemodynamic Response to Intubation in Isolated Head Trauma Patients

Abstract

Abstract. Objective: To assess the effect of esmolol vs lidocaine to attenuate the detrimental rise in heart rate and blood pressure during intubation of patients with isolated head trauma. Methods: This was a prospective, double-blind, randomized study, performed at an urban, county teaching emergency department. Participants were 30 patients with isolated head trauma. Each underwent a standardized intubation protocol including esmolol or lidocaine, both at 2 mg/ kg. Results: Esmolol was used in 16 patients and lidocaine in 14. Mechanisms of injury included 12 assaults, 6 motor vehicle collisions, 6 falls, 4 auto-vspedestrian crashes, and 2 bicycle incidents. Mean ethanol level was 0.116 Ϯ 0.133 SD (range 0-0.482). Mean Glasgow Coma Scale (GCS) score was 7.9 Ϯ 4.0 SD. Cranial computed tomography (CT) hemorrhagic findings included 9 subdural/epidural hematomas, 6 cortex hemorrhages, and 2 multi-hemorrhages. Eleven patients received surgical intervention: 9 patients received a craniotomy, and 2 a ventricular catheter. The 2-minute time interval around intubation was used to assess each drug's efficacy. The mean difference change between groups for heart rate was 4.0 beats/min (95% CI = Ϫ17.7 to 9.7 beats/min), for systolic blood pressure was 1.3 mm Hg (95% CI = Ϫ27.8 to 30.4 mm Hg), and for diastolic blood pressure was 2.6 mm Hg (95% CI = Ϫ27.1 to 21.9 mm Hg). The power of this study was 90% to detect a 20-beat/min difference in heart rate, a 35-mm Hg difference in systolic blood pressure, and a 20-mm Hg difference in diastolic blood pressure. Conclusions: Esmolol and lidocaine have similar efficacies to attenuate moderate hemodynamic response to intubation of patients with isolated head trauma.

Comparison of Fentanyl and Fentanyl Plus Lidocaine on Attenuation of Hemodynamic Responses to Tracheal Intubation in Controlled Hypertensive Patients Undergoing General Anesthesia

“…Moreover, another study by Ali et al in 2010 revealed that pre-treatment with xylocard improves intra- and post-operative hemodynamic stability during laparoscopic surgery without prolonging recovery (26). Our study was in line with some previous studies such as Shin et al that compared the effects of lidocaine, fentanyl, Nicardipine and Esmolol, on the hemodynamic response during intubation and that study revealed that all of these agents are effective in producing hemodynamic stability (27). Moreover, a study by Levitt et al found that Esmolol and lidocaine have similar efficacies to attenuate moderate hemodynamic responses to intubation in patients with isolated head trauma (28).…”

“…Our study was in line with some previous studies such as Shin et al that compared the effects of lidocaine, fentanyl, Nicardipine and Esmolol, on the hemodynamic response during intubation and that study revealed that all of these agents are effective in producing hemodynamic stability (27). Moreover, a study by Levitt et al found that Esmolol and lidocaine have similar efficacies to attenuate moderate hemodynamic responses to intubation in patients with isolated head trauma (28). Additionally, Malde and Sarode in a 2007 study compared lignocaine and fentanyl efficacy on hemodynamic stability and revealed that lignocaine and fentanyl both attenuated the rise in heart rate; however, fentanyl produced better results.…”

Airway Management of the Critically Ill Patient*

“…Lidocaine, a class 1B antiarrhythmic drug, has been used to diminish the hypertensive response, to reduce airway reactivity, to prevent intracranial hypertension, and to decrease the incidence of dysrrhythmias during intubation. 49 -51 Demonstrated effectiveness for these end points, however, has varied among reports, 50,52,53 and no evidence has clearly established that lidocaine improves outcomes in terms of a lower incidence of myocardial infarction or stroke. North American physicians use lidocaine more commonly as a preinduction agent for patients who are at risk of elevated intracranial pressure compared with physicians in Europe.…”

Fentanyl and fentanyl plus lidocaine on attenuation of haemodynamic stress response to laryngoscopy: a comparative study in controlled hypertensive patients posted for laparoscopic cholecystectomy

“…27 According to Levitt et al Esmolol and lidocaine have similar efficacies to attenuate moderate hemodynamic responses to intubation in patients with isolated head trauma. 28 Additionally, Malde and Sarode in a 2007 study compared lignocaine and fentanyl efficacy on hemodynamic stability and revealed that lignocaine and fentanyl both attenuated the rise in heart rate, however, fentanyl produced better results. Lignocaine attenuated the rise in blood pressure with intubation while fentanyl inhibits it totally.…”