Attenuation of Hemodynamic Responses to Laryngoscopy and Tracheal Intubation: Propacetamol versus Lidocaine—A Randomized Clinical Trial

Abstract

The purpose of this study is to assess the effects of propacetamol on attenuating hemodynamic responses subsequent laryngoscopy and tracheal intubation compared to lidocaine. In this randomized clinical trial, 62 patients with the American Anesthesiologists Society (ASA) class I/II who required laryngoscopy and tracheal intubation for elective surgery were assigned to receive propacetamol 2 g/I.V./infusion (group P) or lidocaine 1.5 mg/kg (group L) prior to laryngoscopy. Systolic and diastolic blood pressures (SBP, DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded at baseline, before laryngoscopy and within nine minutes after intubation. In both groups P and L, MAP increased after laryngoscopy and the changes were statistically significant (P < 0.001). There were significant changes of HR in both groups after intubation (P < 0.02), but the trend of changes was different between two groups (P < 0.001). In group L, HR increased after intubation and its change was statistically significant within 9 minutes after intubation (P < 0.001), while in group P, HR remained stable after intubation (P = 0.8). Propacetamol 2 gr one hour prior intubation attenuates heart rate responses after laryngoscopy but is not effective to prevent acute alterations in blood pressure after intubation.

Propacetamol poses a potential harm of adverse hypotension in male and older patients

“…In general, the administration of propacetamol to febrile patients results in vasoconstriction and then an increase in blood pressure in accordance with a decrease in body temperature. Regarding hemodynamic effects, several reports suggest that intravenous propacetamol injection results in significant decreases in either systolic, diastolic, or mean arterial blood pressure, as well as heart rates, compared to baseline values . However, the reason why some patients with propacetamol‐associated hypotension react to the drug differently still remains uncertain.…”

“…A prodrug of paracetamol, propacetamol shows additional benefits of being water soluble and convertible by plasma esterase for a more rapid acting painkiller than paracetamol upon oral administration . Propacetamol is primarily used for short‐term relief of pain and fever immediately after surgery or during intensive care.…”

Comparison of acetaminophen and nalbuphine in attenuating hemodynamic response to tracheal intubation.

“…These findings are contrary to a double-blind, randomized study by Ayatollahi V et al that showed intravenous acetaminophen to be efficaciousin blunting hemodynamic responses to tracheal intubation in comparison to placebo. 9 KordValeshabad et al 11 in a study proved that paracetamol one hour prior to intubation attenuates heart rate response after laryngoscopy but is not effective to prevent acute alterations in blood pressure after intubation. Results of our study are not in conformity with their findings as we found acetaminophen to be ineffective in controlling hemodynamic response.…”

“…Acetaminophen has also been compared with local anesthetic agents like lidocaine. 11 but the literature search did not yield any comparison with the widely used opioid analgesics like nalbuphine.…”

Comparative Study of Intraocular Pressure and Haemodynamic Changes Subsequent to Insertion of Laryngeal Mask Airway and Endotracheal Tube

“…There has been a growing trend to find an effective substitute to minimize the sympathoadrenal pressor response to endotracheal intubation. [13] One of the methods used to attenuate the pressor response and IOP changes subsequent to ETT intubation is use of LMA. Its insertion requires neither the visualization of vocal cords nor the penetration of larynx making the placement less stimulating than insertion of endotracheal tube and it may provoke less sympathetic response and catecholamine release.…”