A comparison of fentanyl, esmolol, and their combination for blunting the haemodynamic responses during rapid-sequence induction

Chung, K. Sam; Sinatra, Raymond S.; Halevy, Jonathan; Paige, Darcy; Silverman, David G.

doi:10.1007/bf03008287

Cited by 66 publications

(51 citation statements)

References 12 publications

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“…Although previous studies have also shown that esmolol blunted the hypertension and tachycardia associated with several perioperative pain stimuli, including intubation, [17][18][19][20] emergence and extubation, 2 1 Mean arterial blood pressure changes following saline (n=9), esmolol low (n=7) and esmolol high (n=9) in rats subjected to formalin injection. Data are expressed as actual changes from ST (mean ± SEM).…”

Section: Discussionmentioning

confidence: 89%

Antinociceptive and cardiovascular properties of esmolol following formalin injection in rats

Davidson¹,

Doursout²,

Szmuk³

et al. 2001

Can J Anesth/J Can Anesth

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Section: Discussionmentioning

confidence: 89%

Antinociceptive and cardiovascular properties of esmolol following formalin injection in rats

Davidson¹,

Doursout²,

Szmuk³

et al. 2001

Can J Anesth/J Can Anesth

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“…34 Chung et al interpreted that the combination of low dose Fentanyl (2 µg/kg) and Esmolol (2 mg/kg) is more effective than the same dose of either agent alone in blunting tachycardia and hypertensive response to laryngoscopy and intubation. 29 None of the patients in both groups had tachycardia, bradycardia or arrhythmia during intubation. Chung et al observed that one patient of Esmolol group and three patients of Esmolol and Fentanyl group experienced a decrease in heart rate to less than 50 beats/min prior to intubation.…”

Section: Discussionmentioning

confidence: 84%

“…29 Rathore et al found change in systolic blood pressure from baseline during intubation was 30 mmHg with 100 mg of Esmolol and 21mmHg with 150 mg of Esmolol (p <0.01). 31 Singh et al found 31mmHg increase in systolic blood pressure from baseline during intubation with 2 mg/kg of Esmolol.…”

Section: Discussionmentioning

confidence: 96%

“…Sam Chung found 12% change in heart rate in Esmolol group versus 34% in Esmolol and Fentanyl group and difference was statistically significant (p<0.05). 29 Rathore et al found change in mean heart rate immediately after intubation by 11.7 beats/min with 100mg of Esmolol versus 9.5 beats/min with 150 mg of Esmolol. 31 Sheppard et al found changes in mean heart rate immediately after intubation by 5 beats/min with 200mg of Esmolol.…”

Section: Discussionmentioning

confidence: 98%

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

Bhalke

Karale²,

Deshmukh³

2017

Int J Clin Trials

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Background: A number of cardiovascular responses occur during laryngoscopy and intubation which can have serious consequences during anaesthesia.We planned to conduct a study to evaluate effectiveness of intravenous Esmolol and intravenous Fentanyl in attenuating hemodynamic stress response to laryngoscopy and endotracheal intubation.Methods: A prospective, observational, randomized, double blind comparative clinical study, conducted on 60 cases of ASA grade I/II patients undergoing elective abdominal surgery under general anesthesia. The data obtained was divided in the two groups based on drug used 5 min prior to induction, Group 1 (I.V. Esmolol 2 mg/kg) and Group 2 (I.V. Esmolol 2 mg/kg & I.V. Fentanyl 2 µg/kg). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were measured at various time intervals.Results: There was no significant difference in HR, SBP, DBP, MAP after premedication and induction in both the groups. However at intubation, both groups showed an increase in HR, SBP, DBP and MAP but the rise was attenuated in both groups. Increase in HR was more in group 1 as compared to group 2 and it was statistically significant at 01 and 02 minutes post intubation. The increase in SBP was statistically significant at 00, 01 and 02 minutes post intubation. The increase in MAP was statistically significant immediately after induction, at 00, 01, 02, 05 and 10 minutes post intubation. Conclusions: Combination of intravenous Esmolol and intravenous Fentanyl is more effective in attenuating heart rate, systolic, diastolic and mean arterial pressure response to intubation than intravenous Esmolol alone.

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“…[13][14][15]17 The combination of esmolol and fentanyl provided the greatest sympatholysis and hemodynamic stability. 14,17 Despite the potential benefits of neuroprotective agents in patients undergoing RSI in the ED and their acceptance as standard of care, the actual use of these agents has not been evaluated at our centre. The purpose of this study was to determine the frequency with which neuroprotective agents are used for RSI in our ED when there are clear indications for use.…”

Section: Introductionmentioning

confidence: 99%

Use of lidocaine and fentanyl premedication for neuroprotective rapid sequence intubation in the emergency department

Kuzak

Harrison²,

Zed³

2006

CJEM

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Introduction:Autoregulation is dysfunctional in the injured brain. Increases in intracranial and arterial pressure may therefore result in extension of the primary injury. Rapid sequence intubation (RSI) is a well-known cause of surges in both arterial pressure and intracranial pressure. Neuroprotective agents, namely lidocaine and fentanyl, have the potential to minimize the pressure surges implicated in secondary brain injury. The purpose of this study was to determine the frequency with which neuroprotective agents were used for neuroprotective RSI in the emergency department. Methods: We conducted a retrospective chart review of all 139 patients intubated in the emergency department of Vancouver General Hospital between March and October 2003. Patients were eligible if there was an indication for neuroprotective agents defined as presumed intracranial pathology and a mean arterial pressure (MAP) > 85 mm Hg. Contraindications to fentanyl included MAP < 85 mm Hg or allergy to fentanyl. Results: Seventy-seven patients were intubated for primary neurological indications. Indication for intubation included non-traumatic causes (n = 37) (including cerebrovascular accident or intracranial hemorrhage) and closed head injury (n = 40). The mean age (± standard deviation) was 52.3 ± 20.4 years, and 31.4% were female. Fifty-seven (74.0%) patients had indications for neuroprotective agents, without contraindications. When neuroprotective agents were indicated, lidocaine was used in 84.2% (95% confidence interval [CI] 72.6%-91.5%) of patients while fentanyl was used in 33.3% (95%CI 22.4%-46.3%) of patients. Eleven percent of the intubations were performed with a fentanyl dose of ∆ 2 mcg/kg, which is the lower limit considered effective. Conclusions: Despite the potential benefit of using lidocaine and fentanyl in appropriate patients undergoing neuroprotective RSI in the emergency department, our study identified a significant underutilization of optimal premedication. The identification of barriers to use and the implementation of strategies to optimize use are necessary.

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A comparison of fentanyl, esmolol, and their combination for blunting the haemodynamic responses during rapid-sequence induction

Cited by 66 publications

References 12 publications

Antinociceptive and cardiovascular properties of esmolol following formalin injection in rats

Antinociceptive and cardiovascular properties of esmolol following formalin injection in rats

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

Use of lidocaine and fentanyl premedication for neuroprotective rapid sequence intubation in the emergency department

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