Effects of Anesthetic Technique on the Hemodynamic Response to Microlaryngeal Surgery

Abstract

Our aim was to study the attenuation of the hemodynamic response to microlaryngeal surgery by beta-blocking agents used as support drugs to the anesthetic technique. The study was carried out in 30 patients randomly allocated to one of three groups. The control group received only anesthetic drugs. The second group received labetalol hydrochloride 0.3 mg/kg 3 minutes before induction and 0.15 mg/ kg 2 minutes prior to the start of suspension of the larynx. The third group received esmolol hydrochloride 500 micrograms/kg 3 minutes prior to induction and a continuous infusion of 300 micrograms/kg during the surgical procedure. Hemodynamic data in the three groups were compared by analysis of variance. A statistically significant difference (p < .05) was found in hemodynamic data among the two groups treated with blocking agents and the control group. The addition of beta-blocking agents to the anesthetic technique attenuates the hemodynamic response to suspension laryngoscopy.

Assessment of the efficacy of esmolol on the haemodynamic changes induced by laryngoscopy and tracheal intubation: A meta‐analysis

“…We retrieved 72 trials but only 38 met our inclusion criteria (Table 1) (14–51). Of these, four were abstracts (20, 25, 27, 35) and five of the articles included in the overall analyses were excluded from the meta‐analysis of sub‐groups because we did not encounter a minimum of three studies evaluating the same dose and/or parameters (23, 39, 46, 47, 49).…”

“…Of the 38 studies finally included, 16 evaluated at least two different doses of esmolol versus placebo (18, 20, 21, 25, 26, 29, 34, 35, 38, 40–43, 49–51). In 14 studies esmolol was compared with placebo as well as with an alternative therapeutic agent (14, 15, 17, 19, 21, 23–26, 28, 29, 36, 44, 47). Eleven different esmolol regimens were tested including intravenous bolus, infusion or combination of both as well as fixed doses (full milligrams) and variable doses (micrograms per kilogram body weight).…”

“…SBP was evaluated in 28 studies (Table 1). The mean baseline value for the groups treated with esmolol was 140 mmHg (range 114–185) (16, 26) and, for the placebo groups, 138 mmHg (range 117–171) (15, 16). Following anaesthesia induction, the SBP values decreased (with respect to the baseline values) by 6.1% in the 525 patients of the placebo groups.…”

Effects of 10% lidocaine spray on arterial pressure increase due to suspension laryngoscopy and cough during extubation

“…Thus, serious consideration by anesthesiologist should be given to the perioperative cardiovascular responses such as hypertension and tachycardia owing to suspension laryngoscopy. Opioids [10], α- and β-blockers [11], β-blockers [11] or α 2 agonists [12] have been used, but these drugs should be used with care because of delays in postoperative awakening and occurrence of complications in decline of cardiac function. Time interval from spray to airway stimulation is important for lidocaine spray to be effective in reducing hemodynamic responses caused by airway irritation.…”

Effect of sevoflurane versus propofol-based anesthesia on the hemodynamic response and recovery characteristics in patients undergoing microlaryngeal surgery

“…[1] The need for attenuation of cardiovascular responses and rapid emergence as well represent a dynamic clinical challenge for anesthesiologists. [23] Various anesthetic agents and a number of alternative anesthetic techniques have been tried with varying results. [4–6] The use of intravenous anesthesia with propofol during microlaryngeal surgery is in widespread clinical practice due to its rapidity and quality of awakening.…”