Tracheal Intubation with Different Doses of Propofol - Haemodynamic Changes

Abstract

BACKGROUND Stress response to intubation produces marked hemodynamic changes during direct laryngoscopy using muscle relaxants. Since attenuation of hemodynamic response to laryngoscopy and tracheal intubation leads to better outcomes, a method for providing good intubating conditions rapidly without using muscle relaxants is being sought. The objective of the present study was to compare the hemodynamic changes occurring while intubating with 2 different doses of propofol. METHODS We compared heart rate, systolic blood pressure, diastolic pressure and mean arterial pressure changes during tracheal intubation with 2 different propofol doses without using muscle relaxants. Intravenous fentanyl inhibits the sympathetic nervous response to direct laryngoscopy and tracheal intubation in both groups of patients and acts as pre-emptive analgesia. RESULTS Comparison of the hemodynamic parameters revealed no statistically significant differences between the low dose propofol (PL) and high dose propofol (PH) groups with regard to heart rate or blood pressure changes at similar intervals postintubation. Both patient groups showed blood pressure fall along with a reflex increase in heart rate at 1 minute to 5 minutes post-intubation, returning to nearbaseline values 10 minutes post-intubation. None of these changes was either clinically detrimental or produced incidents of desaturation or arrhythmias in any study patient. CONCLUSIONS Low dose propofol may be useful in elderly or mildly hypovolemic patients, intolerant to a higher drug dosage whereas, the higher propofol dose may be particularly useful in the adult with a higher muscle mass in situations where muscle relaxant is to be restricted or avoided. KEY WORDS Tracheal Intubation, Hemodynamic Changes, Different Doses Propofol.