Which Drug Prevents Tachycardia and Hypertension Associated With Tracheal Intubation

Abstract

Eighty patients, ASA physical status II-IV, scheduled for noncardiac surgery, were randomly assigned in a double-blind, placebo-controlled manner to receive a preintubation dose of either placebo, 200 mg lidocaine, 200 micrograms fentanyl, or 150 mg esmolol. Induction of anesthesia was accomplished with 4-6 mg/kg thiopental IV followed immediately by the study drug; 1-1.5 mg/kg succinylcholine was given at minute 1. Laryngoscopy and intubation were performed at minute 2 with anesthesia thereafter maintained with 1 MAC (+/- 10%) isoflurane in 60% nitrous oxide in oxygen at a 5 L/min flow for 10 min. Heart rate was recorded every 15 s and blood pressure every minute from induction until 10 min after intubation. Maximum percent increases in heart rate (mean +/- SE) during and after intubation were similar in the placebo (44% +/- 6%), lidocaine (51% +/- 10%), and fentanyl (37% +/- 5%) groups, but lower in the esmolol (18% +/- 5%) group (P less than 0.05). Maximum systolic blood pressure percent increases were lower in the lidocaine (20% +/- 6%), fentanyl (12% +/- 3%), and esmolol (19% +/- 4%) groups than in the placebo (36% +/- 5%) group (P less than 0.05), but not different from each other (P greater than 0.05). Only esmolol provided consistent and reliable protection against increases in both heart rate and systolic blood pressure accompanying laryngoscopy and intubation.

Efeitos de esmolol, lidocaína e fentanil nos intervalos dispersão da onda P, QT, QTc e respostas hemodinâmicas à intubação endotraqueal durante indução com propofol: um estudo comparativo

“…In the current study, we determined that esmolol was the most effi cient agent to depress the refl ex response to laryngoscopy and tracheal intubation, in parallel with previous studies 27,32,33 . Prolonged QT interval may cause arrhythmias such as polymorphic ventricular tachycardia or ventricular fi brilation.…”

“…However, literature on this matter is confounding. Other studies demonstrated that lidocaine administration before intubation was unable to suppress the laryngoscopy and intubation-related sympathetic activity 27,32,33,38 . In addition, signifi cant MAP increases were observed in lidocaine groups after intubation in Owczuk et al's 17 study, which raises the possibility of insuffi cient lidocaine effi cacy in inhibiting sympathetic activation.…”

“…Prys-Roberts et al, has reported that refl ex tachycardia and hypertension secondary to two different but consecutive stimuli manifest themselves during laryngoscopy, increase with intubation and are rapidly resolved when the endotracheal tube is placed and laryngoscope is withdrawn; nonetheless, concominant arrhtymias continue 26 . Previous studies aiming to suppress hemodynamic responses accompanying laryngoscopy and tracheal intubation have defi ned utilization of glossopharyngeal and superior laryngeal nerve blocks, topical or systemic lidocaine, deep levels of anesthesia with intravenous or inhalational anesthesia, opioids 27,28 , magnesium sulphate, vasodilators 29 , calcium channel 30 , α or β adrenergic receptor blockers 27,29,31 . On the other hand, studies comparing lidocaine, fentanyl and esmolol to suppress hemodynamic responses to intubation are limited.…”

“…In their study, Helfman et al 27 had given 200 mg lidocaine, 200 μg or 150 mg esmolol before anesthesia and induced it with 4-6 mg.kg -1 thiopenthal, 1-1.5 mg.kg -1 succinylcholine. They concluded that all three drugs were effective to block the increase in systolic blood pressure when compared to placebo.…”

Comparison of esmolol versus combination of esmolol and fentanyl in preventing cardiovascular stress response to intubation

“…11 Central nervous system block is achieved by narcotics like Fentanyl, Alfentanil and Remifentanil. [12][13][14][15][16][17][18][19][20] These drugs are used for intraoperative analgesia; therefore there is no additional cost involved.…”