Attenuation of the Pressor Response to Tracheal Intubation in Severe Preeclampsia: Relative Efficacies of Nitroglycerine Infusion, Sublingual Nifedipine, and Intravenous Hydralazine

Abstract

A B S T R A C T Background:The pressor response to laryngoscopy is known to be exaggerated in patients with severe preeclampsia. Objectives: The aim of the present study was to compare the efficacies of continuous intravenous (IV) infusion of nitroglycerine, IV hydralazine, or sublingual nifedipine in modifying cardiovascular responses to endotracheal intubation, in women with severe preeclampsia undergoing cesarean delivery under general anesthesia. Patients and Methods: A total of 120 patients undergoing cesarean delivery were randomly divided into 3 groups, each receiving one of the following drugs before intubation: 5 µg/min nitroglycerine administered by continuous IV infusion (Group NTG, n = 40); a 10-mg capsule of nifedipine deposited sublingually (Group NIF, n = 40); or 5-10 mg hydralazine intravenously (Group H, n = 40). Heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and mean arterial pressure (MAP) were simultaneously recorded in the mother at pre-induction, pre-intubation, and at 1, 3, 5, and 10 min after intubation. Results: In contrast to those in group NIF and group H, the patients in group NTG showed no significant increases in HR, SAP, DAP, or MAP after intubation, compared to baseline. The incidence of hypotension was significantly greater in group NIF than in group H or group NTG [15 (37. 5%) vs. 8 (20%) vs. 5 (12. 5%) respectively, P = 0. 025]. Conclusions: In patients with severe preeclampsia undergoing cesarean delivery, a continuous IV infusion of nitroglycerine was able to attenuate the cardiovascular response to intubation to a greater extent than the use of sublingual nifedipine or IV hydralazine, without significant adverse effects on the newborn.

Comparison of Remifentanil and Fentanyl Regarding Hemodynamic Changes Due to Endotracheal Intubation in Preeclamptic Parturient Candidate for Cesarean Delivery

“…Opioids was also used in epidural space in pregnant women for cesarean section without significant difference in maternal complications and Apgar scores (21). Safavi M et al showed that some drugs such as Nitroglycerin are effective in attenuating the pressor response to tracheal intubation in severe preeclampsia and could be used instead of opioids to control hemodynamic responses (22). Remifentanil and fentanyl were also used effectively in endotracheal intubation without use of neuromuscular blocking drugs (23,24).…”

Investigating the Effects of Fentanyl and Nitroglycerin on Hemodynamic Changes During Laryngoscopy: A Randomized Trial

“…Laryngoscopy, known as an invasive procedure in the anesthesia process, that by sympathetic nervous system stimulation causes an increase in the release of catecholamines and increase in blood pressure and heart rate, and arrhythmia, which can have dangerous consequences in patients with a history of cardiovascular diseases (1)(2)(3). A safe anesthesia for the patient and less stress for anesthesiologists is obtained due to interventions to reduce anesthesia complications.…”

Fentanyl and fentanyl plus lidocaine on attenuation of haemodynamic stress response to laryngoscopy: a comparative study in controlled hypertensive patients posted for laparoscopic cholecystectomy

“…This sympathetic stimulation results in tachycardia and elevation of blood pressure. [1][2][3][4][5][6][7] Thus different drugs such as local anesthetics, opioids, calcium channel blockers, short acting β-adrenergic blockers, and their combinations have been used to prevent this hemodynamic responses but none was found to be most effective. [8][9][10][11][12][13][14] Fentanyl, a commonly used opioid along with hypnotic agents have been used to diminish hemodynamic responses to tracheal intubation.…”