Comparison of the effects of intravenous alfentanil and esmolol on the cardiovascular response to double‐lumen endobronchial intubation

Abstract

SummaryWe compared the effect of alfentanil 10 mg.kg 21 and esmolol 1.5 mg.kg 21 on the cardiovascular responses to laryngoscopy and double-lumen endobronchial intubation in two groups of 20 ASA 2±3 patients undergoing pulmonary surgery, in a randomised double-blind study. Arterial pressure and heart rate decreased after induction of anaesthesia and increased after intubation in both groups (p , 0.05) but remained at or below baseline values, and changes were comparable in both groups. Plasma catecholamine concentrations decreased after induction of anaesthesia in both groups (p , 0.05). Epinephrine concentrations increased in the esmolol group after intubation (p , 0.05) but remained below baseline in the alfentanil group (p , 0.05). Norepinephrine concentrations increased significantly in both groups after intubation but were higher in the esmolol group (p , 0.05). Although both esmolol 1.5 mg.kg 21 and alfentanil 10 mg.kg 21 similarly attenuated the arterial pressure and heart rate response to endobronchial intubation, plasma catecholamine concentrations increased in the esmolol group to values greater than previously reported after tracheal intubation. Laryngoscopy and intubation with a double-lumen endobronchial tube is accompanied by increased heart rate, arterial blood pressure and plasma catecholamine concentrations [1], mediated by increased sympathetic nervous activity [2,3]. The increases in heart rate and arterial pressure are of similar magnitude and duration to the well-described responses to laryngoscopy and tracheal intubation, i.e. mean increases of 15±20 beats.min 21 and 30±40 mmHg, respectively, for approximately 5±6 min. These responses may result in myocardial ischaemia in susceptible individuals [4], and patients presenting for surgery which requires double-lumen endobronchial intubation (mostly pulmonary surgery) are a high-risk group for coexisting ischaemic heart disease. We have previously shown that the haemodynamic changes to double-lumen endobronchial intubation were attenuated by the administration of intravenous esmolol 1.5 mg.kg 21 [1]. However, plasma norepinephrine concentrations were significantly increased after intubation in those who received esmolol compared with control subjects, suggesting that although esmolol diminished the endorgan response to intubation, sympathetic nervous system activity was increased. This may be because esmolol, by decreasing the haemodynamic changes, prevented a baroreflex-mediated inhibition of central sympathetic activity, which occurred in the control group.Several drugs have been shown to attenuate the cardiovascular responses to laryngoscopy and intubation [3] and intravenous opioids, e.g. alfentanil [5,6]

The Effect of Prophylactic Dexmedetomidine on Hemodynamic Disturbances to Double-Lumen Endotracheal Intubation: A Prospective, Randomized, Double-Blind, and Placebo-Controlled Trial

“…The incidences of hypotension (a decrease in SBP > 25% of baseline or SBP < 90 mmHg) and bradycardia (a decrease in HR > 25% of baseline or HR < 50 beats per minute) were also noted. Rescue medication was comprised of ephedrine 3 mg increments for hypotension (SBP < 90 mmHg for 60 seconds), nicardipine 0.5 mg increments for hypertension (SBP > 200 mmHg or DBP > 120 mmHg for 60 seconds) [2, 14, 15], and atropine 0.3 mg increments for bradycardia (HR < 50 beats per minute). The flow diagram of the study, recommended by the Consolidated Standards of Reporting Trials, is presented in Figure 1.…”

Hemodynamic Responses to Tracheal Intubation in Elderly Patients: Intravenous or Spray of Lidocaine versus Fentanyl

“…These complications are more likely to occur in the presence of coronary or cerebral disease or preexisting hypertension. The present study was conducted to study the efficacy of intravenous infusions of nitroglycerin and esmolol in attenuating these responses ( 4 , 8 , 9 ).…”

Effects of landiolol on QT interval and QT dispersion during induction of anesthesia using computerized measurement

“…They attenuate the unexpected increase in HR. Therefore, β-adrenoceptor antagonists, such as esmolol or labetalol, have been used to prevent hyperdynamic responses induced by laryngoscopy and tracheal intubation [3][4][5][6][7]25]. Landiolol, a newer, ultra-short-acting β 1 -adrenoceptor antagonist, has been proposed as an alternative drug to avoid adverse hemodynamic effects caused by intubation [1,8].…”

“…Many studies have been performed to prevent hyperdynamic responses induced by tracheal intubation [1][2][3][4][5][6][7][8]. Of the various classes of drugs, β-adrenoceptor antagonists have frequently been used to prevent such detrimental events.…”