Comparative effects of lidocaine, esmolol, and nitroglycerin in modifying the hemodynamic response to laryngoscopy and intubation

Singh, Harbhej; Vichitvejpaisal, Phongthara; Gaines, George Y.; White, Paul F.

doi:10.1016/0952-8180(95)90025-x

Cited by 12 publications

(16 citation statements)

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“…Esmolol is a rapid-onset, short-acting, cardioselective ␤-adrenergic receptor-site blocker that effectively mitigates the tachycardic response to intubation with an inconsistent effect on the hypertensive response. 41,42,54 -56 However, most studies, 41,54,56 but not all, 53 have indicated that esmolol is more effective than lidocaine or fentanyl in reducing the pres-sor response. The combined use of esmolol (2 mg/kg) and fentanyl (2 g/kg) has a synergistic effect for reducing both the tachycardia and hypertension associated with tracheal intubation and laryngeal manipulation.…”

Section: Preinduction Drugsmentioning

confidence: 99%

Airway Management of the Critically Ill Patient^*

Reynolds

Heffner²

2005

Chest

109

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Section: Preinduction Drugsmentioning

confidence: 99%

Airway Management of the Critically Ill Patient^*

Reynolds

Heffner²

2005

Chest

109

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“…Esmolol 1.4 mg/kg IV was more effective than either drugs in controlling the HR response to laryngoscopy and intubation. Esmolol also was signicantly more effective (12) than lidocaine in minimizing the increase in MAP N tomoki . et all shows that with a combination of anaesthesia induction midazolam-thiopental was effective in reducing hemod ynamic and cardiac autonomic nervous system responses to tracheal intubation in comparison with the conventional (13) induction with thiopental alone.…”

Section: Post-operative Complicationsmentioning

confidence: 92%

Role of Intravenous Midazolam, Esmolol and Their Combination in Attenuation of Cardiovascular Stress Response To Laryngoscopy and Intubation - A Comparative Clinical Study

Paul

Biswas

2019

Global Journal for Research Analysis

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BACKGROUND AND AIM: Laryngoscopy & intubation are associated with tachycardia & hypertension. These hemodynamic changes are temporary & do not cause any complication in healthy person. But these changes can be detrimental to the patient with history of coronary artery disease and can facilitate and accelerate the development of myocardial ischemia, arrhythmias, infraction and also heart failure. The present study was designed to evaluate and study the efciency of intravenous midazolam, esmolol and their combination in the attenuation of cardiovascular response to laryngoscopy and intubation in normotensive individuals. METHOD: This randomized prospective double-blind study was performed on 90 patients of ASA physical status I and II undergoing various elective abdominal surgeries under general anaesthesia with endotracheal intubation. Patients were randomized in three groups, Group M (midazolam) 0.05mg/kg I.V, Group E (esmolol) 2mg/kg I.V and Group M/E (midazolam 0.05mg/kg + Esmolol 2mg/kg I.V) with 30 patients in each group. Hemodynamic parameters were recorded before the study drug and at specied intervals. RESULT:- All three groups showed less rise in heart rate and blood pressure during laryngoscopy and intubation. Haemodynamic parameters were signicantly less in Group-M/E than Group M and E alone just after intubation and 1 and 2 minutes intervals. CONCLUSION: Combination of both midazolam and esmolol effectively attenuated the cardiovascular stress response associated with laryngoscopy & intubation than single drug therapy with esmolol or midazolam.

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“…Statistical Analysis: Based on an estimated variance of (20) [2] , a power of 90%, and an a of 0.05, a total 63 patients were required to detect a difference of 20 mmHg in MAP between either of the intervention groups and the control group. The trial, however, was stopped after a preplanned interim analysis, which was performed after enrolling 75% of the study patients.…”

Section: Anaesthetic Technique and Measurementsmentioning

confidence: 99%

“…Although such a response would likely be tolerated by healthy patients, it might not be tolerated well by those with significant coronary artery or cerebrovascular disease. For this reason, numerous drugs have been used to attenuate the circulatory response to tracheal intubation [2][3][4] . However, the success rate of these drugs have been variable [2] , and the long duration of action of some of them has been of concern.…”

Section: Introductionmentioning

confidence: 99%

“…For this reason, numerous drugs have been used to attenuate the circulatory response to tracheal intubation [2][3][4] . However, the success rate of these drugs have been variable [2] , and the long duration of action of some of them has been of concern. Furthermore, there is limitation to the use of certain drugs despite their effectiveness in attenuating the circulatory response to tracheal intubation.…”

Section: Introductionmentioning

confidence: 99%

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Effects of Upper Airway Anaesthesia on the Hyperdynamic Response to Tracheal Intubation

Alhashemi¹

2002

med

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Tracheal intubation is associated with a hyperdynamic response characterized by hypertension and tachycardia. Several drugs have been used to attenuate this response; however, anaesthetizing the superior laryngeal nerves of this purpose has not been formally studied. This study was designed to determine the effects of bilateral superior laryngeal nerve block and those of nebulized lidocaine on the hyperdynamic response to tracheal intubation. Forty-six patients were randomized, in a prospective, placebo-controlled, single blind trial, to receive bilateral superior laryngeal nerve block (SLN), nebulized lidocaine (NBL), or no intervention (CON). Blinding was achieved by placing a band-aid on the neck bilaterally all patients. A standard anaesthesia protocol was followed in all patients. Measurements of mean arterial pressure (MAP, systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were obtained pre-induction, at induction, and every minute for 10 minutes after tracheal intubation. Opioids and surgical stimuli were withheld during the study period. Tracheal intubation resulted in comparable increases in MAP, SBP, DBP, and HR among all patient groups. The maxium increases in these parameters were observed at 1-2 minutes following intubation. Although other haemodynamic variables returned to baseline, all patients continued to be tachycardiac 10 minutes after airway instrumentation. This study demonstrated that upper airway anaesthesia with either bilateral SLN block or nebulized lidocaine was ineffective by itself in attenuating the hyperdynamic response to tracheal intubation.

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Comparative effects of lidocaine, esmolol, and nitroglycerin in modifying the hemodynamic response to laryngoscopy and intubation

Cited by 12 publications

References 0 publications

Airway Management of the Critically Ill Patient^*

Airway Management of the Critically Ill Patient^*

Role of Intravenous Midazolam, Esmolol and Their Combination in Attenuation of Cardiovascular Stress Response To Laryngoscopy and Intubation - A Comparative Clinical Study

Effects of Upper Airway Anaesthesia on the Hyperdynamic Response to Tracheal Intubation

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Comparative effects of lidocaine, esmolol, and nitroglycerin in modifying the hemodynamic response to laryngoscopy and intubation

Cited by 12 publications

References 0 publications

Airway Management of the Critically Ill Patient*

Airway Management of the Critically Ill Patient*

Role of Intravenous Midazolam, Esmolol and Their Combination in Attenuation of Cardiovascular Stress Response To Laryngoscopy and Intubation - A Comparative Clinical Study

Effects of Upper Airway Anaesthesia on the Hyperdynamic Response to Tracheal Intubation

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Airway Management of the Critically Ill Patient^*

Airway Management of the Critically Ill Patient^*