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(94)00013-t

Cited by 91 publications

(39 citation statements)

References 17 publications

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“…This controversy may be referred to the importance of timing of the lidocaine administration. Considering the mechanism of lidocaine, inhibiting the sympathetic response associated with tracheal stimulation appears to result from an increased threshold for airway stimulation, central inhibition of sympathetic transmission, and direct depression of cardiovascular responses (27). …”

Section: Discussionmentioning

confidence: 99%

The Effect of Intravenous Magnesium Sulfate and Lidocaine in Hemodynamic Responses to Endotracheal Intubation in Elective Coronary Artery Bypass Grafting: a Randomized Controlled Clinical Trial

et al. 2014

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Background:There have been many concerns about alteration in hemodynamic parameters within and shortly after endotracheal intubation (ETI) in patients scheduled for elective coronary artery bypass grafting (CABG).Objectives:We compared the attenuation effect of magnesium sulfate and lidocaine on hemodynamic responses after ETI, in patients undergoing CABG.Patients and Methods:In this randomized controlled trial 150 patients undergoing elective CABG were enrolled. Included patients were randomly allocated to three groups and received lidocaine (1.5 mg/kg), magnesium sulfate (50 mg/kg within five minute), or normal saline, 90 seconds before ETI. Baseline hemodynamic parameters including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded immediately before anesthesia induction, before intubation, immediately after intubation, and at second and fifth minutes after intubation.Results:The baseline hemodynamic variables had no deference among the three groups. HR between intubation and five minute after intubation was significantly lower in two groups received lidocaine or magnesium sulfate in comparison with placebo group. Lidocaine induced more than 20% decrease in HR and MAP immediately after intubation; hence, lidocaine group showed significant MAP reduction in comparison with the two other groups.Conclusions:Lidocaine induced hemodynamic instability but premedication of magnesium sulfate maintained hemodynamic stability after intubation. Therefore, in patients undergoing CABG who received high-dose intravenous analgesic for general anesthesia, the administration of magnesium sulfate might result in maintaining hemodynamic stability after ETI in comparison with lidocaine.

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Section: Discussionmentioning

confidence: 99%

The Effect of Intravenous Magnesium Sulfate and Lidocaine in Hemodynamic Responses to Endotracheal Intubation in Elective Coronary Artery Bypass Grafting: a Randomized Controlled Clinical Trial

et al. 2014

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“…These hemodynamic changes can be detrimental in elderly and hemodynamically compromised patients. [45] More recently, Aronson and Fontes found that among the various component of blood pressure, preoperative pulse pressure was independently and significantly associated with postoperative stroke, renal failure, and mortality in patients undergoing coronary artery bypass. Rise in pulse pressure as few as 10 mmHg in both normotensive and hypertensive individual is associated with 20% or more increased risk of renal, coronary, and cerebral events.…”

Section: Discussionmentioning

confidence: 99%

Pregabalin premedication - A new treatment option for hemodynamic stability during general anesthesia: A prospective study

et al. 2011

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Background:Hemodynamic responses of laryngoscopy, intubation, and pain are powerful noxious stimulus which should be attenuated by the appropriate premedication, smooth induction, and rapid intubation.Context:The oral pregabalin may attenuate the hemodynamic pressor response with intraoperative hemodynamic stability.Aims:The present study was designed to evaluate the clinical efficacy and safety of oral pregabalin for hemodynamic stability.Settings and Design:This is a prospective blind randomized controlled cohort observation study.Materials and Methods:The 80 adult consented patients of ASA grade I and II of either gender aged 24–54 years who met the inclusion criteria were randomized to receive oral pregabalin 150 mg or placebo capsule, given 60–75 min before surgery. Patients were premedicated with metoclopramide (10 mg), glycopyrrolate (0.2 mg), and fentanyl (1 μg/kg). Anesthesia was induced with propofol and rocuronium and maintained with isoflurane, nitrous oxide, and oxygen. Both groups were assessed for preoperative sedation and changes in heart rate and mean arterial blood pressure before and after the induction and 1, 3, 5, and 10 min after laryngoscopy and intubation, then at 5 min intervals till end of surgery along with postoperative complications.Statistical Analysis:The hemodynamic variables were analyzed by using analysis of variance (ANOVA), Student's t test, and chi square test as appropriate.Results:Preoperative sedation was higher with pregabalin with no significant change in heart rate. The mean arterial pressure was attenuated with oral pregabalin to statistically significant value (P<0.007). The requirement of analgesic drug was reduced with no postoperative respiratory depression, nausea, or vomiting and hemodynamic parameters remained stabilized perioperatively.Conclusions:Oral pregabalin premedication effectively leads to sedation and analgesia with successful attenuation of the adverse and deleterious hemodynamic pressor response.

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“…They recommended a bolus injection of remifentanil of 1 μg/kg as more effective dose in reducing the pressor response during laryngoscopy and tracheal intubation (McAtamney et al, 1998; O’Hare et al, 1999). However, while the cardiovascular responses reaches a peak 1–2 min after laryngoscopy and intubation, and usually subsides within 5–6 min (Singh et al, 1995), the context-sensitive half-time of bolus remifentanil is only 3.2 min (Glass et al, 1993; Kapila et al, 1995). Therefore, remifentanil bolus alone is not enough to attenuate the responses and the use of a bolus-infusion regimen is required (McAtamney et al, 1998).…”

Section: Introductionmentioning

confidence: 99%

Intraoperative use of remifentanil and opioid induced hyperalgesia/acute opioid tolerance: systematic review

et al. 2014

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Introduction: The use of opioids has been increasing in operating room and intensive care unit to provide perioperative analgesia as well as stable hemodynamics. However, many authors have suggested that the use of opioids is associated with the expression of acute opioid tolerance (AOT) and opioid-induced hyperalgesia (OIH) in experimental studies and clinical observations in dose and/or time dependent exposure even when used within the clinically accepted doses. Recently, remifentanil has been used for pain management during anesthesia as well as in the intensive care units because of its rapid onset and offset.Objectives: Search of the available literature to assess remifentanil AOT and OIH based on available published data.Methods: We reviewed articles analyzing remifentanil AOT and OIH, and focused our literature search on evidence based information. Experimental and clinical studies were identified using electronic searches of Medline (PubMed, Ovid, Springer, and Elsevier, ClinicalKey).Results: Our results showed that the development of remifentanil AOT and OIH is a clinically significant phenomenon requiring further research.Discussions and Conclusions: AOT – defined as an increase in the required opioid dose to maintain adequate analgesia, and OIH – defined as decreased pain threshold after chronic opioid treatment, should be suspected with any unexplained pain report unassociated with the disease progression. The clinical significance of these findings was evaluated taking into account multiple methodological issues including the dose and duration of opioids administration, the different infusion mode, the co-administrated anesthetic drug’s effect, method assessing pain sensitivity, and the repetitive and potentially tissue damaging nature of the stimuli used to determine the threshold during opioid infusion. Future studies need to investigate the contribution of remifentanil induced hyperalgesia to chronic pain and the role of pharmacological modulation to reverse this process.

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

Cited by 91 publications

References 17 publications

The Effect of Intravenous Magnesium Sulfate and Lidocaine in Hemodynamic Responses to Endotracheal Intubation in Elective Coronary Artery Bypass Grafting: a Randomized Controlled Clinical Trial

The Effect of Intravenous Magnesium Sulfate and Lidocaine in Hemodynamic Responses to Endotracheal Intubation in Elective Coronary Artery Bypass Grafting: a Randomized Controlled Clinical Trial

Pregabalin premedication - A new treatment option for hemodynamic stability during general anesthesia: A prospective study

Intraoperative use of remifentanil and opioid induced hyperalgesia/acute opioid tolerance: systematic review

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