Abstract
Endotracheal intubation has turned out to be a routine procedure in the modern-day anesthesia care by the middle of the last century. However, this procedure results in transient cardiovascular changes, which could result in potential complication in physiologically deranged population. We conducted this study to compare the effects of two drugs, namely lignocaine and diltiazem alone and in combination in attenuating the deleterious effect of intubation on cardiovascular system. The setting of this prospective comparative study was government medical college Thiruvananthapuram. We studied 45 cases of ASA Gr. I & II between age groups 20-65 years, involving both sexes coming for major elective surgical procedures. Each group consisted of 15 patients. Heart rate, systolic and diastolic blood pressures were monitored at different time points. We analyzed the data with stata IC 15 software. The outcome measures were compared with repeated measures ANOVA. The median age with inter quarter range of the patients was 36(28-45) years. There were more females in the study groups (80percent). Systolic and diastolic pressure varied at different time points in the groups studied, within the groups and across the groups. Systolic and mean arterial pressure showed initial rise and later a downward trend across the group. There was a statistically significant difference between the three groups studied (p<0.05. The study revealed that SBP, DBP and MAP increased briefly after tracheal intubation in all patients who had received lignocaine, diltiazem or diltiazem plus lignocaine before intubation.
Keywords: Blood Pressure, Heart Rate, Lignocaine, Diltiazem, Laryngoscopy, intubation, Prospective Studies, Anaesthesia.
References
- Göksu S, Sen E. History of Intubation. Journal of Academic Emergency Medicine 2015; 14(1): 35.
- Robinson DH, Toledo AH. Historical development of modern anesthesia. Journal of Investigative Surgery 2012; 25(3): 141-9.
- Baron SH, Kohlmoos HW. LXIX Laryngeal Sequelae of Endotracheal Anesthesia. Annals of Otology, Rhinology & Laryngology 1951; 60(3): 767-92.
- Haas CF, Eakin RM, Konkle MA, Blank R. Endotracheal Tubes: Old and NewDiscussion. Respiratory care 2014; 59(6): 933-55.
- Shribman A, Smith G, Achola K. Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation. BJA: British Journal of Anaesthesia 1987; 59(3): 295-9.
- UDELSMAN R, NORTON JA, JELENICH SE, et al. Responses of the hypothalamic-pituitary-adrenal and renin-angiotensin axes and the sympathetic system during controlled surgical and anesthetic stress. The Journal of Clinical Endocrinology & Metabolism 1987; 64(5): 986-94.
- Kayhan Z, Aldemir D, Mutlu H, Öğüş E. Which is responsible for the haemodynamic response due to laryngoscopy and endotracheal intubation? Catecholamines, vasopressin or angiotensin? European journal of anaesthesiology 2005; 22(10): 780-5.
- Govindaiah MH, Suryanarayana VG, Vas P, Vlk JL, Chandra SBC. Can calcium and sodium channel blockers attenuate hemodynamic responses to endotracheal intubation? European Journal of General Medicine 2008; 5(4).
- Forbes AM, Dally FG. Acute hypertension during induction of anaesthesia and endotracheal intubation in normotensive man. Br J Anaesth 1970; 42(7): 618-24.
- Kovac AL. Controlling the hemodynamic response to laryngoscopy and endotracheal intubation. Journal of Clinical Anesthesia 1996; 8(1): 63-79.
- Mort TC. Complications of emergency tracheal intubation: hemodynamic alterations-Part I. Journal of intensive care medicine 2007; 22(3): 157-65.
- Kihara S, Brimacombe J, Yaguchi Y, Watanabe S, Taguchi N, Komatsuzaki T. Hemodynamic responses among three tracheal intubation devices in normotens-ive and hypertensive patients. Anesthesia & Analgesia 2003; 96(3): 890-5.
- Fox EJ, Sklar GS, Hill CH, Villanueva R, King BD. Complications related to the pressor response to endotracheal intubation. Anesthesiology 1977; 47(6): 524-5.
- Abou-Madi M, Keszler H, Yacoub O. A method for prevention of cardiovascular reactions to laryngoscopy and intubation. Canadian Anaesthetists' Society journal 1975; 22(3): 316-29.
- Stoelting RK. Circulatory response to laryngoscopy and tracheal intubation with or without prior oropharyngeal viscous lidocaine. Anesth Analg 1977; 56(5): 618-21.
- DAVIES MJ, CRONIN KD, COWIE RW. The prevention of hypertension at intuba-tion. Anaesthesia 1981; 36(2): 147-51.
- Mikawa K, Nishina K, Maekawa N, Obara H. Comparison of nicardipine, diltiazem and verapamil for controlling the cardiova-scular responses to tracheal intubation. Br J Anaesth 1996; 76(2): 221-6.
- Chen CC, Tsai PS, Yang LC, Jawan B, Lee JH. The comparative potency of intravenous nicardipine and verapamil on the cardiovascular response to tracheal intubation. Acta Anaesthesiol Sin 1996; 34(4): 197-202.
- Mikawa K, Obara H, Kusunoki M. Effect of nicardipine on the cardiovascular response to tracheal intubation. Br J Anaesth 1990; 64(2): 240-2.
- Fujii Y, Saitoh Y, Takahashi S, Toyooka H. Combined diltiazem and lidocaine reduces cardiovascular responses to tracheal extubation and anesthesia emergence in hypertensive patients. Canadian journal of anaesthesia = Journal canadien d'anesthésie 1999; 46(10): 952-6.
Corresponding Author
Dr Sugandha
Associate Professor, Department of Anesthesiology
Gokulam Medical College, Trivandrum