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Category: Volume 06 Issue 10 October 2018
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Title: Alterations in Hemodynamic Response to Laryngoscopy and Intubation by Lidocaine, Esmolol, and Nitroglycerin-A comparative study

Author: Dr Ramesh Pendela

 DOI: https://dx.doi.org/10.18535/jmscr/v6i10.179

Abstract

Background: The pressure response to laryngoscopy and endotracheal intubation has been recognized since long, resulting a rise in pulse and blood pressure.

Aims and Objectives: To compare the safety and efficacy of standard IV bolus doses of lidocaine, esmolol, and nitroglycerin in modifying the acute hemodynamic response to laryngoscopy and tracheal intubation.

Materials and Methods: The study sample of 60 normotensive patients were categorized in to 4 groups. Group 1 = saline 5 ml IV at time 0 minutes; Group 2 = lidocaine 1.5 mgikg IV at time 1 minute; Group 3 = esmolol 1.4 mglkg IV at time 2 minutes and Group 4 = nitroglycerin 2 µg/kg IV at time 3 minutes. The parameters measured were Mean arterial pressure and Heart Rate.

Results:  MAP increased significantly following tracheal intubation in all four groups (control 47%±20%, lidocaine 53% ± 27%, esmolol 24%±12%, nitroglycerin 43% ±22%) compared with preinduction baseline values. in the esmolol group, the increase in HR was significantly lower than in the other three groups.

Conclusion: Esmolol was significantly more effective than either lidocaine or nitroglycerin in controlling the increase in HR, and in minimizing the increase in MAP following tracheal intubation.

Keywords: Esmolol, Hemodynamic Response, Intubation, Laryngoscopy, Lidocaine, Nitroglycerin.

References

  1. Harbhej Singh, Phongthara Vichitvejpaisal, George Y. Gaines, Paul F. White Comparative Effects of Lidocaine, Esmolol, And Nitroglycerin In Modifying The Hemodynamic Response To Laryngoscopy And Intubation. Journal of Clinical Anesthesia 1995;7:5-8.
  2. Neha Sharma, Hetal Parikh. A comparative study of hemodynamic responses to intubation: fentanyl versus nalbuphine. Gujarat Medical Journal 2014;69 (2):48-53.
  3. Volkan Hancı et al. Effects of esmolol, lidocaine and fentanyl on P wave dispersion, QT, QTc intervals and hemodynamic responses to endotracheal intubation during propofol induction: a comparative study. Rev Bras Anestesiol. 2013;63(3):235-244.
  4. Nasrullah Khan, Muhammad Aslam, Najma Naz, Muhammad Rashid Khan. Comparative Effects of Lidocaine and Esmolol in Modifying the Hemodynamic Response to Laryngoscopy and Intubation. P J M H S 2013;7 (2):301-306.
  5. Thomson IR - The hemodynamic response to intubation: a perspective. Can J Anaesth. 1989; 36:367-369.
  6. Kovac AL - Controlling the hemodynamic response to laryngoscopy and endotracheal intubation. J Clin Anesth. 1996; 8:63-79.
  7. Prasad SR, Matam UM, Ojili GP. Comparison of intravenous lignocaine and intravenous dexmedetomidine for attenuation of hemodynamic stress response to laryngoscopy and endotracheal intubation. J NTR Univ Health Sci 2015;4:86-90.
  8. Miller CD, Warren SJ. IV lignocaine fails to attenuate the cardiovascular response to laryngoscopy and tracheal intubation. Br J Anaesth 1990;65:216-9.
  9. Wilson IG, Meiklejohn BH, Smith G. Intravenous lignocaine and sympathoadrenal responses to laryngoscopy and intubation. The effect of varying time of injection. Anaesthesia 1991;46:177-80.
  10. Splinter WM, Cervenko F. Haemodynamic responses to laryngoscopy and tracheal intubation in geriatric patients: Effects of fentanyl, lidocaine and thiopentone. Can J Anaesth 1989;36:370-6.
  11. Abou-Madi MN, Keszler H, Yacoub JM. Cardiovascular reactions to laryngoscopy and tracheal intubation following small and large intravenous doses of lidocaine. Can Anaesth Soc J 1977;24:12-9.
  12. Tam S, Chung F, Campbell M. Intravenous lidocaine: optimal time of injection before tracheal intubation. Anesth Analg 1987;66:1036-8.
  13. Longmire S, Leduc L, Jones MM, Hawkins JL, Joyce TH 3d, Cotton DB: The hemodynamic effects of intubation during nitroglycerin infusion in severe preeclampsia. Am J Obstet Gynecol 1991;164:551-6.
  14. Mikawa K, Hasegawa M, Suzuki T, et al: Attenuation of hypertensive response to tracheal intubation with nitrog1ycerin.J Clin Anesth 1992;4:367-71.
  15. Vucevic M, Purdy GM, Ellis FR: Esmolol hydrochloride for management of the cardiovascular stress responses to laryngoscopy and tracheal intubation. BrJ Anaesth 1992;68:529-30.
  16. Parnass SM, Rothenberg DM, Kerchberger JP, lvankovich AD: A single bolus dose of esmolol in the prevention of intubation- induced tachycardia and hypertension in an ambulatory surgery unit. J Clin Anesth 1990;2:232-7.
  17. Miller DR, Martineau RJ, Wynands JE, Hill J: Bolus administration of esmolol for controlling the haemodynamic response to tracheal intubation: the Canadian Multicentre Trial. CanJ Anaesth 1991;38:849-58.

Corresponding Author

Dr Ramesh Pendela

Assistant Professor, Prathima Institute of Medical Sciences, Karimnagar, Telangana, India