Lignocaine and Esmolol on Stress Response to Laryngoscopy and Intubation

Rajbhandari, Pradeep

doi:10.31729/jnma.2729

Cited by 6 publications

(4 citation statements)

References 12 publications

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“…Intraoperative hypotension may lead to negative outcomes such as myocardial injury, stroke, acute kidney injury, and death [ 6 – 10 ]. Conversely, laryngoscopy and tracheal intubation often cause hypertension [ 11 – 15 ]. Hypertension associated with intubation may cause negative outcomes such as myocardial infarction, heart failure, pulmonary edema, and cerebral and subarachnoid hemorrhage [ 16 – 18 ].…”

Section: Introductionmentioning

confidence: 99%

Prediction of hemodynamic fluctuations after induction of general anesthesia using propofol in non-cardiac surgery: a retrospective cohort study

et al. 2018

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BackgroundAlthough propofol is a common anesthetic agent for the induction of general anesthesia, hemodynamic fluctuations are occasionally prominent during induction/intubation. The aims of this study were to determine the influential factors on enhanced hemodynamic fluctuation and to establish a prediction formula to quickly determine the dose of propofol to protect against hemodynamic fluctuations.MethodsThis retrospective cohort study patients (n = 2097) were 18 years or older. They underwent general anesthesia induction using propofol and orotracheal intubation for non-cardiac surgery at Kyushu University Hospital during April 2015 to March 2016. Preoperative patient clinical information was collected from anesthesia preoperative evaluation records. Intraoperative data were obtained from computerized anesthesia records. If patients’ post-induction mean arterial blood pressure (MAP) decreased or increased 30% or more from their pre-induction MAP, they were determined to have enhanced hemodynamic fluctuations. Unconditional logistic regression was used to assess the adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Structural equation modeling (SEM) was conducted to simultaneously examine the direct and indirect effect (path coefficient = r) of potential variables.ResultsIn the SEM analysis, age was significantly associated with enhanced hemodynamic fluctuations (adjusted odds ratio = 1.008, 95% CI = 1.001–1.015, P = 0.03). Age (path coefficient (r) = − 0.0113, 95% CI = − 0.0126–0.010, P < 0.001), American Society of Anesthesiologists physical status (ASA-PS) (r = − 0.0788, 95% CI = − 0.1431–0.0145, P = 0.02), sex (r = 0.057, 95% CI = 0.0149–0.9906, P = 0.01), and fentanyl dose (r = 0.1087, 95% CI = 0.0707–0.1467, P < 0.001) influenced the dose of propofol in induction. The prediction formula of “Propofol dose (mg) = [2.374 – 0.0113 × age (year) – 0.0788 (if ASA-PS 3 or 4) + 0.057 (if female) + 0.1087 × fentanyl dose (μg/kg)] × body weight (kg)” was derived.ConclusionsAge was associated with hemodynamic fluctuations in induction. Although the prediction formula is considered to be acceptable, future studies validating whether it can decrease patients’ risk of enhanced hemodynamic fluctuations in clinical situations are necessary.

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Section: Introductionmentioning

confidence: 99%

Prediction of hemodynamic fluctuations after induction of general anesthesia using propofol in non-cardiac surgery: a retrospective cohort study

et al. 2018

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“…Esmolol is a beta-blocker that is generally used to lower the heart rate after intubation or surgical stimulation. [28,29] In this study, esmolol was administered not only on awakening but also during induction. However, we believe that esmolol administered at the time of induction would exert only a minimal effect; the mean operating time was only 30 min, and the peak effect of esmolol occurs within 5 to 10 min and lasts for only 10 to 20 min.…”

Section: Discussionmentioning

confidence: 99%

Effect of esmolol and lidocaine on agitation in awake phase of anesthesia among children

Park

Kim

et al. 2019

Chinese Medical Journal

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Background: Sevoflurane is widely used to anesthetize children because of its rapid action with minimal irritation of the airways. However, there is a high risk of agitation after emergence from anesthesia. Strabismus surgery, in particular, can trigger agitation because patients have their eyes covered in the postoperative period. The aim of this study was to determine whether or not esmolol and lidocaine could decrease emergence agitation in children. Methods: Eighty-four patients aged 3 to 9 years undergoing strabismus surgery were randomly assigned to a control group (saline only), a group that received intravenous lidocaine 1.5 mg/kg, and a group that received intravenous esmolol 0.5 mg/kg and lidocaine 1.5 mg/kg. Agitation was measured using the objective pain score, Cole 5-point score, and Richmond Agitation Sedation Scale score at the end of surgery, on arrival in the recovery room, and 10 and 30 min after arrival. Results: The group that received the combination of esmolol and lidocaine showed lower OPS and RASS scores than the other two groups when patients awoke from anesthesia (OPS = 0 (0–4), RASS = –4 [(–5)–1]) and were transferred to the recovery room (OPS = 0 (0–8), RASS = –1 [(–5)–3]) ( P < 0.05). There was no significant difference in the severity of agitation among the three groups at other time points ( P > 0.05). Conclusions: When pediatric strabismus surgery is accompanied by sevoflurane anesthesia, an intravenous injection of esmolol and lidocaine could alleviate agitation until arrival in the recovery room. Trial registration: Clinical Research Information Service, No. KCT0002925; https://cris.nih.go.kr/cris/en/search/search_result_st01.jsp?seq=11532

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“…Both fentanyl and sufentanil are wildly used to control cardiovascular responses induced by tracheal intubation. In healthy normotensive patients without cardiovascular disease, they showed a similar effect in blunting the cardiovascular changes after the process of tracheal intubation (9)(10)(11). However, the efficacy of fentanyl and sufentanil has not yet been compared in patients with abnormal cardiovascular function.…”

Section: Original Articlementioning

confidence: 99%

Sufentanil blunts the myocardial stress induced by tracheal intubation in older adult patients with coronary heart disease better than equipotent fentanyl

Yang¹,

Teng²,

Zhu³

2020

Ann Palliat Med

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Background: To evaluate the role of sufentanil and fentanyl in the prevention of cardiovascular responses to endotracheal intubation in elderly patients with coronary heart disease (CHD).Methods: Seventy-one CHD patients scheduled for surgery under general anesthesia were randomly divided into two groups to receive either 0.4 µg/kg of sufentanil (n=35) or 4 µg/kg of fentanyl (n=36) in a double-blind manner. Under local anesthesia, an invasive arterial catheter is used to monitor systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial blood pressure (MAP). Laryngoscopy and tracheal intubation were successfully performed within 30 seconds. MAP and heart rate (HR) were recorded before anesthesia induction, immediately before intubation, at intubation, and 1, 3, 5 min after tracheal intubation. Rate pressure product (RPP) is calculated by SBP multiple HR.Results: Patients in the fentanyl group showed a significant increase in MAP, HR, and RPP associated with tracheal intubation. However, the cardiovascular stimulation induced by tracheal intubation was attenuated in the sufentanil group.Conclusions: Laryngoscope and endotracheal intubation may cause adverse increases in blood pressure (BP) and HR in elderly patients with CHD, resulting in an imbalance of myocardial oxygen consumption and supply and myocardial ischemia. Anesthesia induction with sufentanil 0.4 µg/kg is more potential than fentanyl 4 µg/kg to attenuate the cardiovascular intubation response.

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Lignocaine and Esmolol on Stress Response to Laryngoscopy and Intubation

Cited by 6 publications

References 12 publications

Prediction of hemodynamic fluctuations after induction of general anesthesia using propofol in non-cardiac surgery: a retrospective cohort study

Prediction of hemodynamic fluctuations after induction of general anesthesia using propofol in non-cardiac surgery: a retrospective cohort study

Effect of esmolol and lidocaine on agitation in awake phase of anesthesia among children

Sufentanil blunts the myocardial stress induced by tracheal intubation in older adult patients with coronary heart disease better than equipotent fentanyl

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