The Use of Esmolol, Nicardipine, or Their Combination to Blunt Hemodynamic Changes After Laryngoscopy and Tracheal Intubation

Abstract

Compared with no pretreatment before the IV induction of general anesthesia, the peak increase in blood pressure after laryngoscopy and tracheal intubation is best blunted by the combination of nicardipine and esmolol, compared with either drug alone. No single drug or combination in the doses tested opposed increased heart rate.

Assessment of the efficacy of esmolol on the haemodynamic changes induced by laryngoscopy and tracheal intubation: A meta‐analysis

“…We retrieved 72 trials but only 38 met our inclusion criteria (Table 1) (14–51). Of these, four were abstracts (20, 25, 27, 35) and five of the articles included in the overall analyses were excluded from the meta‐analysis of sub‐groups because we did not encounter a minimum of three studies evaluating the same dose and/or parameters (23, 39, 46, 47, 49).…”

“…Of the 38 studies finally included, 16 evaluated at least two different doses of esmolol versus placebo (18, 20, 21, 25, 26, 29, 34, 35, 38, 40–43, 49–51). In 14 studies esmolol was compared with placebo as well as with an alternative therapeutic agent (14, 15, 17, 19, 21, 23–26, 28, 29, 36, 44, 47). Eleven different esmolol regimens were tested including intravenous bolus, infusion or combination of both as well as fixed doses (full milligrams) and variable doses (micrograms per kilogram body weight).…”

“…Table 2 contains the percentage changes in the different variables in the 19 studies in which opiates had been administered either as pre‐medication or during the induction period [esmolol n=526; placebo n=316] (14, 15, 20, 26–32, 34–38, 42, 49, 51) compared to the 16 studies [esmolol n=368; placebo n=285] (16, 18, 23, 24, 33, 39–41, 43–48, 50) in which the patients did not receive opiates. Two studies were excluded (17, 21) because the administered opiates had not been a systematic aspect of the study protocol.…”

“…Curiously, the bolus dose of 1 mg · kg −1 did not result in an effective reduction in SBP. We would interpret this as being due to the study of Atlee et al (14) (containing the greatest number of patients within the respective meta‐analysis) in which the baseline values of the placebo group (121.9 mmHg) were significantly lower than the baseline values of the esmolol group (142.8 mmHg), thus distorting the data and the interpretation of the results. From the respective meta‐analyses (Tables 4 and 5) it can be deduced that the doses of 500 μg · kg −1 over a period of 1–4 min plus a continuous intravenous infusion of 200–300 μg · kg −1 · min −1 are those that best conform to our above hypothesis.…”

Effect of Age on Haemodynamic Response to Tracheal Intubation. A Comparison of Young, Middle-aged and Elderly Patients

“…Our study has some important clinical implications regarding the importance of age while studying the intubation response. Most studies on this subject group the young and middle-aged patients together 19,20 , or include all three age groups as a single entity 21 . It also has implications in differing approaches which should be taken in treating the hypertensive response in middle-aged and elderly patients.…”