Nitrous Oxide Attenuates Pressor but Augments Norepinephrine Response to Laryngoscopy and Endotracheal Intubation

Yoo, Kyung Yeon; Jeong, Sung Tae; Ha, In Ho; Lee, Jong-Un

doi:10.1213/01.ane.0000058842.05373.e3

Cited by 5 publications

(3 citation statements)

References 2,012 publications

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“…Inhaled anesthetics including nitrous oxide have been shown to attenuate the activity of the sympathetic nervous system, which is responsible for pressor response. 17,18) Therefore, the discrepancy between two studies may be accounted for by differences in anesthetic technique. Furthermore, both studies used escape medication for hypertension (SAP ＞ 200 mmHg more than 60 s) occurred during intubation in 3 (30%) of 10 control patients in their study and 8 (40%) of 20 control patients in our study, so the untreated pressor responses may have been greater than those reported in these articles.…”

Section: Discussionmentioning

confidence: 99%

Effects of Remifentanil and Alfentanil on Cardiovascular Responses to Laryngoscopy and Double-lumen Endobronchial Intubation

Yoo

Park

Kim

et al. 2007

Korean J Anesthesiol

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Background: This study examined the cardiovascular responses to double-lumen endobronchial intubation during rapid sequence induction of anesthesia, and compared the effect of remifentanil and alfentanil in a randomized, double-blind, placebo-controlled study in three groups of 20 elderly patients each.Methods: Anesthesia was induced with intravenous thiopental (4-6 mg/kg) immediately followed by either remifentanil 2 μg/kg, alfentanil 30μg/kg, or saline (placebo) given over 30 sec. Succinylcholine 1.5 mg/kg was given for neuromuscular block.The laryngoscopy and intubation were performed 60 sec later.Results: The intubation significantly increased systolic arterial pressure (SAP) and heart rate (HR) in all groups. The maximum pressure changes in the remifentanil and alfentanil groups (36 ± 26 and 33 ± 30 mmHg, respectively) were significantly lower than the 83 ± 35 mmHg in the control group. The maximum HR in the remifentanil (77 ± 13 bpm) and alfentanil (80 ± 13 bpm) groups was lower when compared to controls (93 ± 11 bpm). The norepinephrine and epinephrine concentrations increased after intubation in the control group but remained unaltered in both the alfentanil and remifentanil groups. There were no significant differences between the remifentanil and alfentanil groups in HR, SAP or catecholamines at any time. Five patients in the remifentanil group and three in the alfentanil group received ephedrine for hypotension.Conclusions: Endobronchial intubation elicited a significant pressor response, and that both remifentanil and alfentanil similarly attenuated the pressor response. However, the incidence of hypotension confirms that both drugs should be used with caution in elderly patients.

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Section: Discussionmentioning

confidence: 99%

Effects of Remifentanil and Alfentanil on Cardiovascular Responses to Laryngoscopy and Double-lumen Endobronchial Intubation

Yoo

Park

Kim

et al. 2007

Korean J Anesthesiol

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“…Klinisch bedeutsam ist eine Beobachtung von Yoo et al, die an 100 gesunden Patienten zeigen konnten, dass N 2 O trotz Erhöhung der Norepinephrinspiegel im Plasma den Druckanstieg (nicht jedoch die Tachykardie) durch Laryngoskopie und Intubation unterdrücken konnte [175].…”

Section: Kardiovaskulärunclassified

Lachgas

Schönherr¹,

Hollmann

Graf³

2004

Anaesthesist

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Nitrous oxide has been used in addition to other volatile anaesthetics to provide general anaesthesia and short time sedation for more than 150 years. However, the exact mechanisms of action remain unclear. For decades nitrous oxide was considered to be the ideal anaesthetic because of his favourable physical properties and low cardiovascular side effects. However, the known side effects of nitrous oxide as well as the implementation of new anaesthetic agents and short acting opiates led to more and more criticism about the administration of this gas. Nitrous oxide is still frequently used for mask induction primarily in paediatric anaesthesia and gynaecology. However, recent studies have shown that omitting nitrous oxide can also be a risk factor because of an increased susceptibility to intraoperative awareness. Careful consideration of the illustrated contraindications and side effects as well as the available alternatives, shows that nitrous oxide is still an option in general anaesthesia.

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“…2 In two different studies which compared hemodynamic responses to three different intubating devices showed that laryngoscopic intubation has the greater response as compared with laryngeal mask airway especially in hypertensive patients 3,4 . There are many pharmacological agents which attenuates this response like nitrous oxide, 5 propofol 6 , remifentanil and alfentanil, 7 esmolol and nicardipine, 2 labetalol, 8 clonidine and gabapentin etc 9 .…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic Responses during Insertion of Laryngeal Mask Airway versus Conventional Intubation

Kumar¹,

Farooq²,

Malik³

et al. 2021

PJMHS

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Aim: To determine the hemodynamic response during insertion of laryngeal mask airway versus conventional intubation. Study design: Randomized controlled trial. Place and duration of study: Department of Anaesthesia, Jinnah Postgraduate Medical Centre, Karachi from 9th June 2016 to 10th December 2016. Methodology: One hundred and fifty-eight patients were enrolled, and they were divided in two groups; Group A (laryngeal mask airway) and patients falling in group B (conventional method). Baseline haemodynamic parameters were noted, and all patients were induced with propofol 2mg.kg 1. In group B, succinylcholine 1.5mg.kg-1 was used to facilitate intubation. After induction appropriate size endotracheal tube or laryngeal mask airway were inserted for airway control. For first five minutes after intervention, analgesics and any other stimulation were avoided, in order to prevent any haemodynamic alteration. All airway interventions were done by anaesthesiologist who had more than 5 years post fellowship experience. Mean arterial pressures were recorded. Initial haemodynamic parameters were measured when the patient enter the operating room and then second reading taken just after induction of anaesthesia, third reading recorded one minute and fourth reading 5 minutes after the intervention (i.e., after passing either endotracheal tube or laryngeal mask airway). Results: The average mean arterial pressure during process of intubation of patients in Group laryngeal mask airway group was 105.21±5.90 while in conventional group the average mean arterial pressure was 102.21±4.29 with P-value=0.001. Conclusion: Intubation through intubating laryngeal mask airway is accompanied by minimal cardiovascular responses than those associated with direct laryngoscopic tracheal intubation, so it can be used for patients in whom a marked pressor response would be deleterious. Keywords: Intubating laryngeal mask airway, Conventional laryngoscopy, Hemodynamic responses, Airway morbidity,

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Nitrous Oxide Attenuates Pressor but Augments Norepinephrine Response to Laryngoscopy and Endotracheal Intubation

Cited by 5 publications

References 2,012 publications

Effects of Remifentanil and Alfentanil on Cardiovascular Responses to Laryngoscopy and Double-lumen Endobronchial Intubation

Effects of Remifentanil and Alfentanil on Cardiovascular Responses to Laryngoscopy and Double-lumen Endobronchial Intubation

Lachgas

Hemodynamic Responses during Insertion of Laryngeal Mask Airway versus Conventional Intubation

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