scholarly journals Comparison between two techniques of endotracheal intubation on blood pressure and heart rate in patient undergoing general anesthesia for elective surgery

2018 ◽  
Author(s):  
Frederick D'Aragon
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
General Anesthesia ◽  
Endotracheal Intubation ◽  
Elective Surgery

scholarly journals A randomized comparative study of preloading with Ringers lactate and intravenous Ephedrine for the prevention of hypotension due to propofol during induction of general anesthesia

2016 ◽  
Vol 3 (1) ◽  
pp. 22-27 ◽  
Author(s):  
Manisha Pradhan ◽  
Brahma Dev Jha
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Systolic Blood Pressure ◽  
General Anesthesia ◽  
Diastolic Blood Pressure ◽  
Endotracheal Intubation ◽  
Physical Status ◽  
Volume Loading

Background: The ideal method to prevent hypotension due to intravenous propofol for induction of anesthesia is still debatable. The aim of the study was to compare the hemodynamic response of ephedrine and volume loading with ringer lactate in preventing the hypotension caused by propofol as inducing agent in patients scheduled for elective surgeries requiring general anesthesia with endotracheal intubation.Methods: This was prospective randomized study conducted in 40 patients of ASA physical status I, aged 20-50 years, scheduled for elective surgeries requiring general anesthesia with endotracheal intubation. Group I received intravenous ephedrine sulphate (70 mcg/kg) just before induction of anaesthesia, and patients assigned to Group II received preloading with Ringer's lactate (12 ml/kg) over the 10-15 minutes before the administration of propofol. The variables compared were heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure following induction of anesthesia till 10 minutes after intubation of trachea.Results: We found that there were increase in systolic blood pressure, diastolic blood pressure and mean arterial pressure after induction in both the groups but the difference between the groups was not significant. The increase in heart rate was found to be significantly higher in ephedrine group in comparison to volume loading group.Conclusion: Our study showed that both the methods used were equally effective in preventing hypotension induced by propofol in the adult ASA physical status I patients requiring general anesthesia with endotracheal intubation. However, the heart rate was significantly higher in patients receiving ephedrine in comparison to volume loading group.

scholarly journals Comparison of non-invasive haemodynamic monitors of stress response to endo-tracheal intubation with perfusion index in patients undergoing elective surgery

2020 ◽  
Vol 23 (2) ◽  
pp. 9-13
Author(s):  
Sushila Lama Moktan ◽  
Manan Karki
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Stress Response ◽  
Tracheal Intubation ◽  
Endotracheal Tube ◽  
Diastolic Blood Pressure ◽  
Endotracheal Intubation ◽  
Elective Surgery ◽  
Perfusion Index ◽  
Non Invasive

Introduction: Laryngoscopy and intubation is always associated with a short term reflex sympathetic pressor response. The perfusion index is an indirect, non-invasive, and continuous measure of peripheral perfusion by pulse oximeter which can detect the stress response to intubation similar to heart rate, systolic blood pressure and diastolic blood pressure. Methods: This prospective observational study enrolled sixty-five normotensive patients of American society of anesthesiologists physical status grade I and II scheduled for elective surgery under general anaesthesia. Tracheal intubation was performed after induction with intravenous fentanyl, propofol and vecuronium. Heart rate, Systolic and Diastolic Blood Pressure and Perfusion Index were measured before induction of anesthesia, before intubation and one minute, three minutes, five minutes after the insertion of the endotracheal tube. Increase in heart rate by ?10 beats per minute, systolic and diastolic blood pressure by ?15 millimeters of mercury and decrease in Perfusion index ?10% after endotracheal intubation as compared to preintubationvalue were considered positive haemodynamic changes. Results: Endotracheal intubation produced a significant increase in heart rate and blood pressure whereas perfusion index decreased significantly. Our study showed that perfusion index response criterion achieved 97.7% (Confidence interval 97.58-97.86) sensitivity in detecting the stress response to insertion of endotracheal tube whereas systolic and diastolic blood pressure achieved sensitivity of 90% and 92% respectively. Conclusion: Perfusion Index is easier, reliable and non-invasive alternative to conventional haemodynamic criteria for detection of stress response to endotracheal intubation.

scholarly journals Dexmedetomidine vs Fentanyl in Attenuating the Sympathetic Surge During Endotracheal Intubation: A Scoping Review

2021 ◽  
Author(s):  
Alexandra Schwieger ◽  
Kaelee Shrewsbury ◽  
Paul Shaver
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Systolic Blood Pressure ◽  
General Anesthesia ◽  
Diastolic Blood Pressure ◽  
Endotracheal Intubation ◽  
Scoping Review ◽  
Hemodynamic Stability

Purpose/Background Direct laryngoscopy and endotracheal intubation after induction of anesthesia can cause a reflex sympathetic surge of catecholamines caused by airway stimulation. This may cause hypertension, tachycardia, and arrhythmias. This reflex can be detrimental in patients with poor cardiac reserve and can be poorly tolerated and lead to adverse events such as myocardial ischemia. Fentanyl, a potent opioid, with a rapid onset and short duration of action is given during induction to block the sympathetic response. With a rise in the opioid crisis and finding ways to change the practice in medicine to use less opioids, dexmedetomidine, an alpha 2 adrenergic agonist, can decrease the release of norepinephrine, has analgesic properties, and can lower the heart rate. Methods In this scoping review, studies published between 2009 and 2021 that compared fentanyl and dexmedetomidine during general anesthesia induction and endotracheal intubation of surgical patients over the age of 18 were included. Full text, peer-reviewed studies in English were included with no limit on country of study. The outcomes included post-operative reviews of decrease in pain medication usage and hemodynamic stability. Studies that were included focused on hemodynamic variables such as systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, and use of opioids post-surgery. Result Of 2,114 results from our search, 10 articles were selected based on multiple eligibility criteria of age greater than 18, patients undergoing endotracheal intubation after induction of general anesthesia, and required either a dose of dexmedetomidine or fentanyl to be given prior to intubation. Dexmedetomidine was shown to effectively attenuate the sympathetic surge during intubation over fentanyl. Dexmedetomidine showed a greater reduction in heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure than fentanyl, causing better hemodynamic stability in patients undergoing elective surgery.Implications for Nursing Practice Findings during this scoping review indicate that dexmedetomidine is a safe and effective alternative to fentanyl during induction of general anesthesia and endotracheal intubation in attenuating the hemodynamic response. It is also a safe choice for opioid-free anesthesia.

scholarly journals A randomized controlled study of intravenous esmolol to attenuate the cardiovascular responses to laryngoscopy and endotracheal intubation

2020 ◽  
Vol 8 (3) ◽  
pp. 1103
Author(s):  
Ninad Deepak Chodankar ◽  
Bhagyashree Shivde
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
General Anaesthesia ◽  
Endotracheal Intubation ◽  
Elective Surgery ◽  
Cardiovascular Responses ◽  
Controlled Study ◽  
Control Group ◽  
Significant Difference ◽  
Control Group Group

Background: Objective is to compare the efficacy of intravenous Esmolol to attenuate the cardiovascular responses to laryngoscopy and endotracheal intubation with control group.Methods: Study was done on 60 adults, ASA grade I or II normotensive patients, undergoing elective surgery under general anaesthesia and willing to participate. These patients where be randomly allocated in to either group C (Control) or E (Esmolol). Group ‘C’ Control group. Group ‘E’, patients were given intravenous Esmolol 1.5 mg/kg 2 minutes before start of laryngoscopy. All patients were premedicated, induced and intubated using Thiopentone and Succinyl Choline as per the protocol. Heart Rate (HR), SBP, DBP and MAP were recorded at baseline (taken half an hour prior to anaesthesia), Before sedation, After induction but before intubation, Immediately after endotracheal intubation and Thereafter at 1, 2, 3, 4, 5 and 10 minutes.Results: Heart rate was lower in Group E as compared to Group C, and there was statistically significant difference immediately after intubation till 4 minutes after intubation. While Blood pressure was lower in Group E as compared to Group C, and there was statistically significant difference only immediately after intubation.Conclusions: In Normotensive patients requiring general anaesthesia with laryngoscopy and intubation, authors conclude that intravenous Esmolol 1.5 mg/kg attenuated Heart rate response but fails to satisfactorily prevent rise in blood pressure.

scholarly journals Effect of intravenous oxycodone on the physiologic responses to extubation following general anesthesia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Menglu Jiang ◽  
Jiawei Ji ◽  
Xin Li ◽  
Zhenqing Liu
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
General Anesthesia ◽  
Control Group ◽  
Study Group ◽  
Clinical Trial Registry ◽  
Blood Oxygen Saturation ◽  
Blood Concentrations ◽  
Number Of Patients ◽  
Blood Hormones

Abstract Background Endotracheal intubation and extubation may cause undesirable hemodynamic changes. Intravenous oxycodone has recently been introduced and used for relieving hemodynamic alterations in response to intubation, but there is insufficient information regarding its application in stabilizing hemodynamics during extubation in the patients emerging from general anesthesia. Methods One hundred patients, who had undergone assorted laparoscopic surgeries under general anesthesia, were randomly assigned to Control group (saline injection, 50 cases) and Study group (intravenous injection of 0.08 mg/kg oxycodone immediately after completion of the surgical procedure, 50 cases). Blood pressure, heart rate, blood oxygen saturation (SpO2) as well as blood concentrations of epinephrine, norepinephrine, and cortisol were recorded or measured immediately before extubation (T0), during extubation (T1), as well as one minute (T2), 5 min (T3), and 10 min after extubation (T4). In addition, coughing and restlessness, time of eye-opening, and duration from completing surgery to extubation as well as Ramsay Sedation Scale were analyzed. Results Blood pressure and heart rate as well as blood concentrations of epinephrine, norepinephrine, and cortisol were significantly higher in the Control group compared with the Study group at the time of extubation as well as 1, 5, and 10 min after extubation (P < 0.05). When the patients emerged from general anesthesia, 70 % of the Control group had cough, which was significantly higher than that of Study group (40 %, P < 0.05). Significantly higher number of patients manifested restlessness in the Control group before (40 %) and after extubation (20 %) compared with that in the Study group (20 and 2 %, respectively, P < 0.05). In addition, patients of Control group had lower Ramsay score at extubation (1.7 ± 0.7) as well as 30 min after extubation (2.4 ± 0.9) compared to that of the patients of Study group (2.2 ± 0.9, and 3.0 ± 0.8, respectively, P = 0.003 and 0.001). Conclusions Intravenous oxycodone attenuated alterations of hemodynamics and blood hormones associated with extubation during emergence from general anesthesia. Trial registration Chinese Clinical Trial Registry: ChiCTR2000040370 (registration date: 11-28-2020) “‘retrospectively registered”.

scholarly journals Observer’s Assessment of Alertness/Sedation-based titration reduces propofol consumption and incidence of hypotension during general anesthesia induction: A randomized controlled trial

2021 ◽  
Vol 104 (4) ◽  
pp. 003685042110523
Author(s):  
Lihong Chen ◽  
Kun Lu ◽  
Tongfeng Luo ◽  
Huiming Liang ◽  
Yuqin Gui ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
General Anesthesia ◽  
Diastolic Blood Pressure ◽  
Elective Surgery ◽  
Controlled Trial ◽  
Mean Blood Pressure ◽  
Conventional Group ◽  
Anesthesia Induction ◽  
Post Intubation

Administration of a single propofol bolus dose for anesthesia induction causes hypotension. We included 160 patients (74 males and 86 females; mean age, 42.4 ± 10.7 [range: 18–60] years) with the American Society of Anesthesiologists status I–II undergoing elective surgery under general anesthesia. Using simple randomization, the patients were divided into a conventional group ( n = 80; received 2 mg/kg propofol at a rate of 250 mg/min) and titrated group ( n = 80; received propofol at a rate of 1 mg/kg/min until the Observer's Assessment of Alertness/Sedation scale score reached 1 point). Fentanyl (4 µg/kg) and cisatracurium (0.2 mg/kg) were administered, as appropriate. Systolic blood pressure, diastolic blood pressure, mean blood pressure, and heart rate were recorded at different time points. Propofol consumption, hypotension, and other adverse events were recorded. All the patients were intubated without awareness. Compared with the conventional group, the titrated group showed more stable blood pressure ( p < 0.05), as well as a lower decrease in systolic blood pressure, mean blood pressure at 1 and 3 min, and diastolic blood pressure at 1 min after propofol administration ( p < 0.01). Moreover, compared with the conventional group, the titrated group showed a lower post-intubation hypotension incidence (9 vs. 19 cases; p = 0.04), as well as lower total propofol dosage and propofol dose per kilogram of body weight (93.57 ± 14.40 mg vs. 116.80 ± 22.37 mg and 1.73 ± 0.27 mg/kg vs. 2.02 ± 0.08 mg/kg, respectively, p < 0.01). Compared with conventional propofol usage, titrated propofol administration can reduce the incidence of hypotension and propofol consumption during anesthesia induction.

Effectiveness Comparison of Dexmedetomidine and Remifentanil for Perioperative Management in Patients Undergoing Endoscopic Sinus Surgery

2020 ◽  
Vol 34 (6) ◽  
pp. 751-758
Author(s):  
Hyub Huh ◽  
Jeong Jun Park ◽  
Hyun Young Seong ◽  
Sang Hag Lee ◽  
Seung Zhoo Yoon ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Endotracheal Intubation ◽  
Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Hemodynamic Responses ◽  
Hemodynamic Variables ◽  
Intraoperative Period ◽  
Postanesthetic Care Unit ◽  
Remifentanil Group

Background For patients undergoing endoscopic sinus surgery, intranasal injection of epinephrine can cause acute increases in heart rate and blood pressure. Objective Among the drugs for reducing hyperdynamic effects, dexmedetomidine and remifentanil are expected to blunt the acute hemodynamic responses after intranasal injection of epinephrine. Our study compared a difference in the 2 drugs in their abilities to blunt the hemodynamic responses in intraoperative period and postoperative profile. Methods In this study, the patients were randomly divided into the dexmedetomidine and remifentanil groups. During the intraoperative period, the hemodynamic values were recorded. The surgical condition was assessed by a single surgeon. During the postoperative period, hemodynamic values, sedation scale score, and pain score were recorded. Result No significant differences in hemodynamic variables were found between the groups before and after intranasal injection of epinephrine. Comparison of the group mean values before endotracheal intubation revealed that the blood pressure values in the remifentanil group were significantly lower than those in the dexmedetomidine group. At 2 minutes after endotracheal intubation, blood pressure and heart rate values in the remifentanil group were significantly lower than those in the dexmedetomidine group. The sedation score was significantly lower in the dexmedetomidine group on arrival and at 30 minutes after arrival at the postanesthetic care unit ( P < .001 and P = .001, respectively). At 30 and 60 minutes after the operation, the pain scores were significantly lower in the dexmedetomidine group ( P = .015 and P = .001, respectively). Conclusion Dexmedetomidine had better postoperative sedative and analgesic effects than remifentanil for patients undergoing endoscopic sinus surgery in this study. Remifentanil and dexmedetomidine attenuated acute hemodynamic responses to be within normal ranges after intranasal injection of epinephrine, and no significant differences in terms of hemodynamic variables. Remifentanil was superior to dexmedetomidine in inducing hypotension during endotracheal intubation.

A Comparative Study Between Efficacy Of Esmolol And Lignocaine For Attenuating Haemodynamics Response Due To Laryngoscopy And Endotracheal Intubation

1970 ◽  
Vol 5 (1) ◽  
pp. 25-28 ◽  
Author(s):  
M Begum ◽  
P Akter ◽  
MM Hossain ◽  
SMA Alim ◽  
UHS Khatun ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Endotracheal Intubation ◽  
Anaesthetic Management ◽  
Management Plan ◽  
Mean Blood Pressure ◽  
Rate Pressure Product ◽  
Plasma Norepinephrine ◽  
Mean Values ◽  
The Mean

Haemodynamic stability is an integral and essential goal of any anaesthetic management plan. Laryngoscopy and intubation can cause striking changes in haemodynamics. Increase in blood pressure and heart rate occurs most commonly from reflex sympathetic and vagal discharge in response to laryngotracheal stimulation, which in turn leads to increased plasma norepinephrine concentration. This study was designed to compare efficacy of esmolol and lignocaine for attenuating haemodynamics response due to laryngoscopy and endotracheal intubation. The aim of this study was to compare the effects of Esmolol with that of Lignocaine to attenuate the detrimental rise in heart rate and blood pressure during laryngoscopy and tracheal intubation. One hundred and twenty adult patients randomized into group-L and group-E, were received lignocaine 1.5 mg/kg and Esmolol 1.5 mg/kg I.V. respectively. Heart rate and blood pressure in each minutes for the 10 minutes after intubation was recorded. Time span around intubation up to 4 minutes has been looked specifically to isolate the effect of the study drugs at the time of intubation. For statistical analysis Student's 't' test was used for comparing means of quantitative data and chi-square test was used for qualitative data. Difference was considered statistically significant if p<0.05. The mean heart rate, systolic, diastolic, and mean blood pressure, and rate-pressure product before starting anesthesia were similar in group-L (Lignocaine group) and in group-E (Esmolol group) (p>0.05). The mean values of heart rate, systolic, diastolic, and mean blood pressure, and rate-pressure product at 2, 3 and 4 minutes after intubation were significantly lower in group-E than group-L (p<0.05). In conclusion, esmolol 1.5 mg/kg is superior to lignocaine (1.5 mg/kg) for attenuation of haemodynamic response to laryngoscopy and endotracheal intubation. Key words: Haemodynamics; heart rate; intubation; esmolol; lignocaine DOI: 10.3329/fmcj.v5i1.6810Faridpur Med. Coll. J. 2010;5(1):25-28

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