Which is responsible for the haemodynamic response due to laryngoscopy and endotracheal intubation? Catecholamines, vasopressin or angiotensin?

Kayhan, Zeynep; Aldemir, Derya; Mutlu, Hülya Savaş; Öğüş, Ersin

doi:10.1017/s0265021505001298

Cited by 61 publications

(49 citation statements)

References 19 publications

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“…10 These responses may produce myocardial ischemia or infarction in susceptible patients. Alpha-2-Adrenergic Receptor (AR) agonists decrease the sympathetic outflows and noradrenergic activity, thereby counteracting haemodynamic fluctuations occurring at the time of intubation.…”

Section: Discussionmentioning

confidence: 99%

Effect of Dexmedetomidine on Haemodynamic and Recovery Responses During Tracheal Extubation: A Randomized Comparative Study

Vankayalapati¹,

Ramsali²,

Dumpala³

et al. 2016

jemds

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This study was undertaken to evaluate the effect of a bolus dose of dexmedetomidine on haemodynamic, recovery responses and airway reflexes during extubation. MATERIAL AND METHODSSixty patients aged 20-45 yrs. of either sex of ASA grade I/II scheduled for elective general surgical, ENT, orthopaedics and gynaecological surgeries were studied after randomisation into two groups; 5 minutes before anticipated end of surgery, group A and B received either dexmedetomidine 0.5 µg/kg or placebo (Saline) respectively intravenously over 2 minutes. Anaesthesia technique was standardised for both groups. Heart rate, systolic, diastolic, mean arterial pressures were recorded at the start of a bolus drug injection and thereafter 1, 2 and 3 minutes after injection during extubation; at 1, 3, 5 minutes after extubation for 15 minutes. Quality of extubation was evaluated immediately after extubation based on cough using a 5-point rating score. Postoperative sedation was evaluated on a 6-point scale (Ramsay sedation scale). Side effects like laryngospasm, bronchospasm, respiratory depression, desaturation, vomiting, hypotension, bradycardia and undue sedation were noted. RESULTSHeart rate, systolic, diastolic, mean arterial pressure were significantly lower in study group. Extubation quality score in majority of cases was score 1 in study group and score 3 in control group. Sedation score in most of the cases was 3 in study group and 2 in control group. Bradycardia and hypotension were more in study group. Vomiting incidence was comparable in both the groups. CONCLUSIONOur study concludes that single dose of dexmedetomidine 0.5 µg/kg administered 5 minutes before extubation attenuates the haemodynamic and airway reflexes during emergence from anaesthesia without causing undue sedation. KEYWORDSDexmedetomidine, Haemodynamic Responses, Airway Reflexes, Extubation. HOW TO CITE THIS ARTICLE:Vankayalapati SD, Ramsali MV, Dumpala S, et al. Effect of dexmedetomidine on haemodynamic and recovery responses during tracheal extubation: a randomized comparative study.

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Section: Discussionmentioning

confidence: 99%

Effect of Dexmedetomidine on Haemodynamic and Recovery Responses During Tracheal Extubation: A Randomized Comparative Study

Vankayalapati¹,

Ramsali²,

Dumpala³

et al. 2016

jemds

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“…9 Although the mechanism of changes occurring in the cardiovascular system during extubation remains to be elucidated, it is associated with increased release of catecholamines as a result of the stress response. 10 In this study, we compared the hemodynamic changes and adverse events with sublingual NTG during extubation and upto twenty min thereafter .We found that after NTG, mean blood pressure were under control during and after extubation and it remained close to baseline, whereas in control group, mean arterial blood pressure were found to be persistently high during extubation, coming to baseline after ten minutes of extubation. However, increase in heart rate was comparable in both groups.…”

Section: Parametersmentioning

confidence: 88%

“…10 The drug has also been used by several authors during tracheal intubation with favorable haemodynamic effects. S. Kamra et al 11 examined the effects of 2% nitroglycerin ointment rubbed on the forehead prior to intubation and found that the rise in systolic arterial pressure was significantly lower as compared to the control group (p<0.001).…”

Section: Parametersmentioning

confidence: 99%

The Effects of Nitroglycerine (Ntg) Sublingual Spray to Blunt the Haemodynamic Response to Endotracheal Extubation in Lumbar Disc Surgery

Singh¹,

Sundrani²,

Tagalpallewar³

et al. 2015

jemds

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OBJECTIVE:The aim of this study was to evaluate the effects of nitroglycerine (NTG) Sublingual Spray on prevention of haemodynamic responses to tracheal extubation in patients undergoing lumbar disc surgery. METHODS: With approval from the institutional ethical Committee, written consent, 30 patients between 20-60 years of age undergoing elective lumbar disc surgery were randomly placed in either the Group A (n=30) or the Group B Control (n=30).Anaesthesia was induced with 2mg kg-1 propofol, 0.5mg kg-1pentazocin, and 0.1mg kg-1 vecuronium bromide iv, and was maintained with 0.8-1 MAC isoflurane in oxygen-nitrous mixture (40:60). After dressing of the surgical wound, all anaesthetic agents were discontinued and the patients were ventilated with 100% oxygen. Two sublingual NTG sprays (0.8mg) was given to Group A (n=30), after regain of spontaneous respiratory attempts, while no drug given to Group B. Hemodynamic variables were noted before administering study drug, during extubation then at 1, 3, 5, 10, 15 and 20 min after the extubation. RESULTS: In the sublingual NTG group, mean arterial pressures decreased significantly after sublingual NTG Spray and were significantly lower than in the control group at exubation and 1,3 and 5min after extubation (p<0.05).The heart rate and Rate pressure product (RPP) were comparable in both groups (p>0.050). CONCLUSION: We concluded that 0.8mg (Two sprays) sublingual NTG before extubation can prevent hypertension caused by extubation in patients undergoing elective lumbar disc surgery without much affecting heart rate and RPP . KEYWORDS: Nitroglycerine (NTG), Subligual, Extubation, Lumbar disc surgery. INTRODUCTION:Recovery from general anesthesia and extubation is a period of intense physiological stress for patients. There are several physiological responses to postoperative stress, including increases in oxygen consumption, catecholamine blood levels, blood pressure and heart rate. In most cases blood pressure and heart rate increases gradually as patient awakens. Tracheal extubation causes additional transient increase by 10-30% in arterial pressure and heart rate lasting 5-15 min. 1 it is more hazardous in patients with hypertension, myocardial insufficiency or cerebral vascular diseases. Patient with coronary artery disease experience a 40-50% decrease in ejection fraction. 2 Therefore, attenuation of haemodynamic responses to tracheal extubation such as hypertension, tachycardia and arrhythmias is important for an anesthesiologist. In order to control haemodynamic changes during tracheal intubation and extubation, local anaesthetics, opioids, beta-blocking agents, and calcium channel blockers have been used with varying success rates. 3-6 all of them require time for preparation and administration.Nitroglycerine generates NO (Nitric oxide) in vascular smooth muscles which produce vasodilatation leading to decrease in blood pressure.

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“…However, the shape of the stylet may hinder its removal and cause longer intubation times. In addition, a recent study showed that intubation times with video laryngoscopes can be decreased with proper preparation of the stylet and tracheal tube (7,27 Various studies indicated that laryngoscopy may cause an undesirable increase in blood pressure and heart rate in anesthetized patients (29)(30)(31)(32)(33)(34)(35). Various video laryngoscopes have been studied to elucidate the hemodynamic changes during orotracheal intubation; however, there has been no study comparing the hemodynamic response to orotracheal intubation of the McGrath Series 5 video laryngoscope and the Macintosh laryngoscope (36)(37)(38)(39).…”

Section: Discussionmentioning

confidence: 99%

The McGrath Series 5 video laryngoscope versus the Macintosh laryngoscope: a randomized trial in obstetric patients

Aydın

Çakmakçı

2014

Turk J Med Sci

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The utilisation of whey is very important for preventing the waste of a protein-and lactose-rich dairy by product and protecting the environment. Therefore, the objective of this study was to investigate the effect of whey use in tel (wire) kadayıf (a Turkish dessert raw material) production on microbiological and technological properties and sensory characteristics of tel kadayıf. For this purpose, 3 experimental tel kadayıf samples were produced using different amounts (0%, 25%, and 50%) of fresh whey instead of water in the production of raw tel kadayıf. The samples were placed in plastic bags and vacuum packaging and stored in a refrigerator (4 °C). Storage period (1, 3, 5, and 7 days) analysis was performed. The results of the research showed that nutritional value and sweetness increased, while the baking time decreased with respect to increases in the amount of whey used in tel kadayıf. As a result of a collective evaluation of the study findings, it was concluded that a 25% whey addition and vacuum packaging would provide the most positive quality characteristics in tel kadayıf desserts.

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Which is responsible for the haemodynamic response due to laryngoscopy and endotracheal intubation? Catecholamines, vasopressin or angiotensin?

Abstract: Blood pressure, heart rate, plasma epinephrine, norepinephrine and vasopressin concentrations increased slightly in response to laryngoscopy and intubation, all returning to or below baseline 5 min later with no change in angiotensin converting enzyme activity in normotensive patients.

Cited by 61 publications

References 19 publications

Effect of Dexmedetomidine on Haemodynamic and Recovery Responses During Tracheal Extubation: A Randomized Comparative Study

Effect of Dexmedetomidine on Haemodynamic and Recovery Responses During Tracheal Extubation: A Randomized Comparative Study

The Effects of Nitroglycerine (Ntg) Sublingual Spray to Blunt the Haemodynamic Response to Endotracheal Extubation in Lumbar Disc Surgery

The McGrath Series 5 video laryngoscope versus the Macintosh laryngoscope: a randomized trial in obstetric patients

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