Background Laryngoscopy and tracheal intubation are strong stimuli that cause a reflex increase in blood pressure (BP), heart rate (HR), and serum catecholamine level. These can lead to myocardial infarction or cerebrovascular accidents. The purpose of this study is to compare the efficacy of dexmedetomidine and lidocaine combined with propofol in attenuating the hemodynamic response following laryngoscopy and endotracheal intubation. Methods This study was a randomized controlled study and adhered to the CONSORT guidelines. One-hundred and six patients undergoing elective general anesthesia with endotracheal intubation were divided randomly into two groups. Group D received dexmedetomidine (1 μg kg− 1) before induction. Group LP received lidocaine (1.5 mg kg− 1) before induction with additional propofol (0.5 mg kg− 1) before laryngoscopy. The primary endpoint was hemodynamic including systolic (S) BP, diastolic (D) BP, mean arterial blood pressure (MAP) and HR measured before and after induction and ≤ 10 min after intubation. Secondary outcome was complications/adverse effects. Results After induction, the mean SBP, DBP, MAP and HR decreased significantly from baseline in both groups except for mean HR in group LP at 1 min. Differences in mean values of SBP, DBP, and MAP were significantly lower in group D after intubation at 4–10 min (P <  0.05). Group LP had a non-inferior effect in blunting BP at all time points except 1 and 2 min after induction, and 2 min after intubation. The mean difference in HR in group D was significantly lower than that in group LP at all time points (P <  0.001). Group D had significantly more episodes of bradycardia (18.87% vs. 0%, P = 0.001) and hypotension (52.83% vs. 15.09%, P < 0.001) than did group LP. Conclusion Lidocaine (1.5 mg kg− 1) with additional propofol (0.5 mg kg− 1) had a non-inferior effect compared with dexmedetomidine (1 μg kg− 1) in attenuating the hemodynamic response following laryngoscopy and endotracheal intubation, and had fewer adverse effects. Trial registration Thai Clinical Trial Registry, (TRTC20190206002). Retrospectively registered 4 February 2019.

Background: Fluid resuscitation is essential for patients with sepsis and septic shock; however, the response of blood pressure to fluids is still challenging. Dynamic arterial elastance (Eadyn), defined as the ratio between pulse pressure variation (PPV) and stroke volume variation (SVV), is one of the parameters that has been proposed to predict mean arterial pressure (MAP) response to fluid administration. PPV and SVV are obtained from the heart-lung interaction concepts, in which spontaneous breathing is an important limitation. In this study, we evaluate the accuracy (sensitivity and specificity) of Eadyn in predicting the MAP response after fluid administration in predicted fluid responsive, spontaneously breathing septic patients. Methods: Spontaneously breathing patients with sepsis or septic shock and acute circulatory failure who were predicted to be fluid responders by the passive leg raising test or the mini-fluid challenge test were enrolled. PPV, SVV, Eadyn and the other hemodynamic parameters were measured by an arterial catheter connected to FloTracTM sensor integrated with the HemoSphereTM platform before and after a fluid challenge. Patients were classified according to the increase in MAP after fluid administration into 2 groups: MAP-responders (MAP increase ≥ 10%) and MAP-nonresponders (MAP increase < 10%). Hypothesis: In predicted fluid responders and spontaneously breathing septic patients, Eadyn should have predicted blood responsiveness. Ethics and dissemination: The Ramathibodi Human Research Ethics Committee has approved the trial. The findings plan to be presented in peer-reviewed publications and conferences in critical care medicine.

Background Total intravenous anesthesia (TIVA) is widely used as an anesthetic technique in patients undergoing colonoscopy. Lidocaine can reduce inflammation and visceral pain and potentiates the ventilatory responses to carbon dioxide. This study aimed to evaluate the efficacy and safety of lidocaine combined with propofol during a colonoscopy procedure. Methods The study had a prospective randomized controlled design and adhered to the CONSORT guidelines. Sixty-one patients underwent elective colonoscopy under TIVA with intravenous fentanyl 0.5 µg/kg and a loading dose of propofol 1 mg/kg followed by 2 mg/kg/h as a maintenance infusion with titration as needed. The patients were also randomized to receive 1.5 mg/kg of intravenous lidocaine followed by 2 mg/kg/h (L group) or 0.3 mL/kg of intravenous normal saline followed by 0.4 mL/kg/h (N group). The primary outcome was the total dose of propofol used during the colonoscopy. The secondary outcomes were complications and adverse events. Results Data for 60 patients were available for analysis. There was no statistically significant difference in the median total dose of propofol used between the L group and the N group (180 mg [interquartile range 150–270] vs 200 mg [interquartile range 150–250]) or in episodes of apnea (P ≥ 0.999) and desaturation (P = 0.547). The mean difference in mean arterial pressure at 5 minutes after scope insertion was significantly smaller in the N group than in the L group (P = 0.033). There was no statistically significant between-group difference in decrease in heart rate from baseline, number of episodes of hypotension or bradycardia, or any other adverse events. Conclusion Addition of intravenous lidocaine 1.5 mg/kg as a loading dose followed by lidocaine 2 mg/kg/h as a maintenance infusion did not decrease the dose of intravenous propofol used during a colonoscopy procedure. However, it was able to reduce the risk of hypotension in the early induction phase. Trial registration: The trial was registered retrospectively in the Thai Clinical Trial Registry (https://www.thaiclinicaltrials.org/show/TCTR20210902012) on 2 September 2021.