scholarly journals Comparison of the hemodynamic response of dexmedetomidine versus additional intravenous lidocaine with propofol during tracheal intubation: a randomized controlled study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rattaphol Seangrung ◽  
Koravee Pasutharnchat ◽  
Subundit Injampa ◽  
Sirima Kumdang ◽  
Rojnarin Komonhirun
Keyword(s):  
Blood Pressure ◽  
Adverse Effects ◽  
Tracheal Intubation ◽  
Endotracheal Intubation ◽  
Hemodynamic Response ◽  
Controlled Study ◽  
Time Points ◽  
Randomized Controlled ◽  
The Mean ◽  
Group D

Abstract Background Laryngoscopy and tracheal intubation are strong stimuli that cause a reflex increase in blood pressure (BP), heart rate (HR), and serum catecholamine level. These can lead to myocardial infarction or cerebrovascular accidents. The purpose of this study is to compare the efficacy of dexmedetomidine and lidocaine combined with propofol in attenuating the hemodynamic response following laryngoscopy and endotracheal intubation. Methods This study was a randomized controlled study and adhered to the CONSORT guidelines. One-hundred and six patients undergoing elective general anesthesia with endotracheal intubation were divided randomly into two groups. Group D received dexmedetomidine (1 μg kg− 1) before induction. Group LP received lidocaine (1.5 mg kg− 1) before induction with additional propofol (0.5 mg kg− 1) before laryngoscopy. The primary endpoint was hemodynamic including systolic (S) BP, diastolic (D) BP, mean arterial blood pressure (MAP) and HR measured before and after induction and ≤ 10 min after intubation. Secondary outcome was complications/adverse effects. Results After induction, the mean SBP, DBP, MAP and HR decreased significantly from baseline in both groups except for mean HR in group LP at 1 min. Differences in mean values of SBP, DBP, and MAP were significantly lower in group D after intubation at 4–10 min (P <  0.05). Group LP had a non-inferior effect in blunting BP at all time points except 1 and 2 min after induction, and 2 min after intubation. The mean difference in HR in group D was significantly lower than that in group LP at all time points (P <  0.001). Group D had significantly more episodes of bradycardia (18.87% vs. 0%, P = 0.001) and hypotension (52.83% vs. 15.09%, P < 0.001) than did group LP. Conclusion Lidocaine (1.5 mg kg− 1) with additional propofol (0.5 mg kg− 1) had a non-inferior effect compared with dexmedetomidine (1 μg kg− 1) in attenuating the hemodynamic response following laryngoscopy and endotracheal intubation, and had fewer adverse effects. Trial registration Thai Clinical Trial Registry, (TRTC20190206002). Retrospectively registered 4 February 2019.

scholarly journals Attenuation of hemodynamic response to laryngoscopy and endotracheal intubation with dexmedetomidine: a randomized controlled trial

2016 ◽  
Vol 3 (1) ◽  
pp. 28-31
Author(s):  
Nabin Pokhrel ◽  
Uday Bajra Bajracharya
Keyword(s):  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Endotracheal Intubation ◽  
Controlled Trial ◽  
Hemodynamic Response ◽  
Saline Group ◽  
Controlled Study ◽  
Randomized Controlled ◽  
Group D

Background: Laryngoscopy and endotracheal intubation causes marked increase in heart rate and blood pressure. Even though various agent tried to blunt the hemodynamic response but none of them proved to be an ideal. The aim of the study was to compare dexmedetomidine and placebo in blunting the hemodynamic response to laryngoscopy and endotracheal intubation.Methods: A randomized placebo controlled study with total of 90 patients were included in the study of which 30 patients received dexmedetomidine (Group D) 10 minutes prior to endotracheal intubation and 30 patients received 3 ml Normal Saline (Group C) 10 minutes prior to endotracheal intubation. They were evaluated with change in heart rate and mean arterial pressure at 1, 3 and 5 minutes post laryngoscopy and endotracheal intubation. Any adverse effect of the drug was noted. Results: Age, gender, physical status and weight were comparable between the groups. Heart rate and mean arterial pressure attenuated significantly in dexmedetomidine group (p<0.001 in 1, 3 and 5 minute intervals respectively), whereas placebo failed to attenuate hemodynamic response after laryngoscopy and intubation in any measured interval. No complications were noted. Conclusions: Dexmedetomidine 1 mcg/kg given 10 min prior to endotracheal intubation significantly attenuates heart rate and mean arterial pressure at 1, 3 and 5 minutes compared to placebo.

scholarly journals “EFFECT ON HEMODYNAMIC RESPONSE TO LARYNGOSCOPY AND TRACHIAL INTUBATION AND THEIR ATTENUATION BY BOLUS ADMINISTRATION OF DEXMEDETOMIDINE”

2020 ◽  
pp. 34-36
Author(s):  
Rituraj Saini ◽  
Urmila Keshari
Keyword(s):  
Adverse Effects ◽  
Endotracheal Intubation ◽  
Outcome Measures ◽  
Hemodynamic Response ◽  
Secondary Outcome ◽  
Controlled Study ◽  
Bolus Administration ◽  
Double Blind ◽  
Significant Difference ◽  
Group D

Background and Aims- Laryngoscopic and endotracheal intubation are noxious stimuli causes tachycardia, arrhythmias and hypertension. The aim of this study was to compare dexmedetomidine with placebo to attenuate stress response during laryngoscopy and endotracheal intubation.Methods-It was a randomised, double-blind placebo-controlled study. After Institutional Ethical Committee clearance, 60 patients of ASA 1& 2 were enrolled and divided into 30 each. Group NS received normal saline and Group D received injection dexmedetomidine 1μg/kgas infusion over 10 min. The general anaesthesia technique was standardised for both groups. The primary outcome measures were haemodynamic response at 1, 2, 5 and 10 min after intubation. The secondary outcome measures were to note down any adverse effects associated with drugs. The statistical package used was SPSS version 15.Results- There was a statistically significant difference (P <0.05) between Group D and Group NS in heart rate, systolic, diastolic and mean arterial pressures after tracheal intubation with dexmedetomidine. Sedation scores were more with dexmedetomidine. None of the patients had any adverse effects. Conclusion-Dexmedetomidine 1 µg/kg as premedication can be used safely and effectively to attenuate hemodynamic response to laryngoscopy and endotracheal intubation.

scholarly journals A Comparison of the Effects of Dexmedetomidine and Propofol in Controlling the Hemodynamic Responses after Intubation: A Double-Blind, Randomized, Clinical Trial Study

2018 ◽  
Vol 6 (11) ◽  
pp. 2045-2050
Author(s):  
Alireza Kamali ◽  
Mehrdad Taghizadeh ◽  
Mohtaram Esfandiar ◽  
Amin Shams Akhtari
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Tracheal Intubation ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Endotracheal Intubation ◽  
Arterial Oxygen ◽  
Arterial Blood ◽  
The Mean ◽  
Group D

AIM: This study aimed to compare the effects of dexmedetomidine and propofol in controlling the hemodynamic response following intubation of patients’ candidate intubation in the emergency department METHODS: A total of 114 patients were randomly assigned to one of 2 groups to receive one of the following treatments: dexmedetomidine 0.4 µg/kg (Group D, n = 57) and propofol 1–1.5 mg/kg/h (Group P, n = 57). Hemodynamic data such as the systolic blood pressure, diastolic blood pressure, arterial oxygen saturation and heart rate (HR) were recorded from the entrance to operation room to 5, 10 and 15 min after tracheal intubation RESULTS: Compared with group D, group P exhibited increases in mean arterial blood pressure (MAP), and systolic blood pressure significantly at all times and immediately after the endotracheal intubation. Moreover, the mean diastolic blood pressure changes due to tracheal intubation in group P were significantly more than group D immediately after the intubation. Furthermore, the mean heart rate changes immediately and 5 min after tracheal intubation was significantly higher in group P CONCLUSION: Our data suggest that the benefits of dexmedetomidine more than propofol in hemodynamic stability because propofol was associated with more variability in systolic/diastolic blood pressure, HR and MAP after endotracheal intubation.

scholarly journals EFFECT OF LABETALOL AND ESMOLOL ON ONSET OF ACTION OF ROCURONIUM: A PROSPECTIVE DOUBLE-BLINDED RANDOMIZED CONTROLLED TRIAL

2018 ◽  
Vol 11 (6) ◽  
pp. 133
Author(s):  
Ranjita Acharya ◽  
Shakti Bedanta Mishra ◽  
Arun Rath ◽  
Bhabani Sankara Pati ◽  
Kalyani Bala Nayak
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Tracheal Intubation ◽  
Systolic Blood Pressure ◽  
Controlled Trial ◽  
Hemodynamic Response ◽  
Controlled Study ◽  
Onset Of Action ◽  
Group B ◽  
Time To Onset

Objective: Labetalol is a non-selective beta blocker which is used for the treatment of hypertension. Its role in controlling the hemodynamic response to tracheal intubation is established. This comparative controlled study was carried out to verify its effects on time to onset of action of rocuronium in comparison to esmolol.Methods: We randomized patients into two groups. Group A receiving injection labetalol 0.25 mg/kg diluted to 10 ml with 0.9% saline and Group B receiving 0.5 mg/kg of esmolol in 10 ml 0.9% saline before surgery. The time to onset of action of rocuronium, systolic blood pressure, and heart rate were recorded. The adverse reactions were observed in the post-operative period.Results: A total of 60 patients were randomized into two groups. At the time of intubation, the systolic blood pressure and heart rate were similar between the two groups. The onset of action of rocuronium was decreased significantly in the labetalol group.Conclusion: Labetalol attenuates the hemodynamic response to tracheal intubation both during intubation. It also slightly decreases the time to onset of action of rocuronium.

scholarly journals The midline approach for endotracheal intubation using GlideScope video laryngoscopy could provide better glottis exposure in adults： A randomized controlled trial

2019 ◽  
Author(s):  
Lianxiang Jiang ◽  
Shulin Qiu ◽  
Peng Zhang ◽  
Weidong Yao ◽  
Yan Chang ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Endotracheal Intubation ◽  
Elective Surgery ◽  
Controlled Trial ◽  
Video Laryngoscopy ◽  
Controlled Study ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Midline Approach ◽  
Approach Group

Abstract Background: Previous studies have demonstrated that the common laryngoscopic approach (right-sided) and midline approach are both used for endotracheal intubation by direct laryngoscopy. Although the midline approach is commonly recommended for video laryngoscopy (VL) in the clinic, there is a lack of published evidences to support this practice. This study aimed to evaluate the effects of different video laryngoscopic approaches on intubation. Methods: Two hundred sixty-two patients aged 18 years who underwent elective surgery under general anaesthesia and required endotracheal intubation were included in the present prospective, randomized, controlled study. The participants were randomly and equally allocated to the right approach (Group R) or midline approach (Group M). All the intubations were conducted by experienced anaesthetists using GlideScope video laryngoscopy. The primary outcomes were Cormack-Lehane laryngoscopic views (CLVs) and first-pass success (FPS) rates. The secondary outcomes were the time to glottis exposure, time to tracheal intubation, haemodynamic responses and other adverse events. Comparative analysis was performed between the groups. Results: Finally, 262 patients completed the study, and all the tracheas were successfully intubated. No significant differences were observed in the patient characteristics and airway assessments ( P >0.05). Compared with Group R, Group M had a better CLV ( χ2 =14.706, P =0.001) and shorter times to glottis exposure (8.82±2.04 vs 12.38±1.81; t =14.94; P <0.001) and tracheal intubation (37.19±5.01 vs 45.23±4.81; t =13.25; P <0.001), but no difference was found in the FPS rate (70.2% vs 71.8%; χ2 =0.074; P =0.446) and intubation procedure time (29.86±2.56 vs 30.46±2.97, t =1.75, P =0.081). Between the groups, the rates of hoarseness or sore throat, minor injury, hypoxemia and changes in SBP and HR showed no significant difference ( P >0.05). Conclusion: Although the FPS rate did not differ based on the laryngoscopic approach, the midline approach could provide better glottis exposure and shorter times to glottis exposure and intubation. The midline approach should be recommended for teaching in VL-assisted endotracheal intubation. Trial registration: The study was registered in the Chinese Clinical Trial Registry ( ChiCTR-RNC-1900023252 ).

scholarly journals The midline approach for endotracheal intubation using GlideScope video laryngoscopy could provide better glottis exposure in adults： A randomized controlled trial

2019 ◽  
Author(s):  
Lianxiang Jiang ◽  
Shulin Qiu ◽  
Peng Zhang ◽  
Weidong Yao ◽  
Yan Chang ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Endotracheal Intubation ◽  
Elective Surgery ◽  
Controlled Trial ◽  
Video Laryngoscopy ◽  
Controlled Study ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Midline Approach ◽  
Approach Group

Abstract Background: Previous studies have demonstrated that the common laryngoscopic approach (right-sided) and midline approach are both used for endotracheal intubation by direct laryngoscopy. Although the midline approach is commonly recommended for video laryngoscopy (VL) in the clinic, there is a lack of published evidences to support this practice. This study aimed to evaluate the effects of different video laryngoscopic approaches on intubation. Methods: Two hundred sixty-two patients aged 18 years who underwent elective surgery under general anaesthesia and required endotracheal intubation were included in the present prospective, randomized, controlled study. The participants were randomly and equally allocated to the right approach (Group R) or midline approach (Group M). All the intubations were conducted by experienced anaesthetists using GlideScope video laryngoscopy. The primary outcomes were Cormack-Lehane laryngoscopic views (CLVs) and first-pass success (FPS) rates. The secondary outcomes were the time to glottis exposure, time to tracheal intubation, haemodynamic responses and other adverse events. Comparative analysis was performed between the groups. Results: Finally, 262 patients completed the study, and all the tracheas were successfully intubated. No significant differences were observed in the patient characteristics and airway assessments ( P >0.05). Compared with Group R, Group M had a better CLV ( χ2 =14.706, P =0.001) and shorter times to glottis exposure (8.82±2.04 vs 12.38±1.81; t =14.94; P <0.001) and tracheal intubation (37.19±5.01 vs 45.23±4.81; t =13.25; P <0.001), but no difference was found in the FPS rate (70.2% vs 71.8%; χ2 =0.074; P =0.446) and intubation procedure time (29.86±2.56 vs 30.46±2.97, t =1.75, P =0.081). Between the groups, the rates of hoarseness or sore throat, minor injury, hypoxemia and changes in SBP and HR showed no significant difference ( P >0.05). Conclusion: Although the FPS rate did not differ based on the laryngoscopic approach, the midline approach could provide better glottis exposure and shorter times to glottis exposure and intubation. The midline approach should be recommended for teaching in VL-assisted endotracheal intubation. Trial registration: The study was registered on May 18, 2019 in the Chinese Clinical Trial Registry (ChiCTR1900023252).

scholarly journals The midline approach for endotracheal intubation using GlideScope video laryngoscopy could provide better glottis exposure in adults: a randomized controlled trial

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Lianxiang Jiang ◽  
Shulin Qiu ◽  
Peng Zhang ◽  
Weidong Yao ◽  
Yan Chang ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Endotracheal Intubation ◽  
Elective Surgery ◽  
Controlled Trial ◽  
Video Laryngoscopy ◽  
Controlled Study ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Midline Approach ◽  
Approach Group

Abstract Background Previous studies have demonstrated that the common laryngoscopic approach (right-sided) and midline approach are both used for endotracheal intubation by direct laryngoscopy. Although the midline approach is commonly recommended for video laryngoscopy (VL) in the clinic, there is a lack of published evidences to support this practice. This study aimed to evaluate the effects of different video laryngoscopic approaches on intubation. Methods Two hundred sixty-two patients aged 18 years who underwent elective surgery under general anaesthesia and required endotracheal intubation were included in the present prospective, randomized, controlled study. The participants were randomly and equally allocated to the right approach (Group R) or midline approach (Group M). All the intubations were conducted by experienced anaesthetists using GlideScope video laryngoscopy. The primary outcomes were Cormack-Lehane laryngoscopic views (CLVs) and first-pass success (FPS) rates. The secondary outcomes were the time to glottis exposure, time to tracheal intubation, haemodynamic responses and other adverse events. Comparative analysis was performed between the groups. Results Finally, 262 patients completed the study, and all the tracheas were successfully intubated. No significant differences were observed in the patient characteristics and airway assessments (P > 0.05). Compared with Group R, Group M had a better CLV (χ2 = 14.706, P = 0.001) and shorter times to glottis exposure (8.82 ± 2.04 vs 12.38 ± 1.81; t = 14.94; P < 0.001) and tracheal intubation (37.19 ± 5.01 vs 45.23 ± 4.81; t = 13.25; P < 0.001), but no difference was found in the FPS rate (70.2% vs 71.8%; χ2 = 0.074; P = 0.446) and intubation procedure time (29.86 ± 2.56 vs 30.46 ± 2.97, t = 1.75, P = 0.081). Between the groups, the rates of hoarseness or sore throat, minor injury, hypoxemia and changes in SBP and HR showed no significant difference (P > 0.05). Conclusion Although the FPS rate did not differ based on the laryngoscopic approach, the midline approach could provide better glottis exposure and shorter times to glottis exposure and intubation. The midline approach should be recommended for teaching in VL-assisted endotracheal intubation. Trial registration The study was registered on May 18, 2019 in the Chinese Clinical Trial Registry (ChiCTR1900023252).

scholarly journals Comparison of acetaminophen and nalbuphine in attenuating hemodynamic response to tracheal intubation.

2020 ◽  
Vol 27 (02) ◽  
pp. 341-347
Author(s):  
Manzoor Ahmad Faridi ◽  
Sohail Nasir ◽  
Imran Haider ◽  
Inamullah Shah
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Body Weight ◽  
Tracheal Intubation ◽  
Endotracheal Intubation ◽  
Pressor Response ◽  
Hemodynamic Response ◽  
Significant Rise ◽  
Ethical Review ◽  
Double Blind

Laryngoscopy and tracheal intubation causes sympathetic over activity in the form of increased heart rate and blood pressure, which may lead to deleterious effects. Opioid drugs like fentanyl and nalbuphine are routinely used to attenuate this response during intubation. A few studies have claimed that acetaminophen is efficacious for this purpose too. Various studies have explored its role in blunting of pressor response but none have compared it with nalbuphine. We compared these drugs with the purpose, if both drugs are equally effective; acetaminophen would be a better alternative to nalbuphine without adverse effects of an opioid. Objectives: The objective of this study was to compare the efficacy of acetaminophen and nalbuphine in attenuating hemodynamic response during tracheal intubation. Study Design: Randomized, double-blind clinical trial. Setting: Main operation theatre complex of Fauji Foundation Hospital Rawalpindi. Period: From August to December 2018. Material & Methods: After obtaining permission from institutional ethical review committee of Fauji Foundation Hospital Rawalpindi. 60 Patients of ASA physical status I and II, aged 30 to 55 years, undergoing abdominal surgical procedure of 1 to 3 hour duration were randomly divided into two groups. Patients in group N received nalbuphine hydrochloride 0.15 mg/kg body weight intravenously, 30 minutes before induction. Patients in group P received acetaminophen infusion (paracetamol) 15mg/kg body weight intravenously, 30 minutes before induction. Systolic and diastolic blood pressures were measured manually and heart rate by pulse oximeter. Observations were made before giving analgesics, during induction, 1 minute after intubation, then at every 1- minute intervals till first 5 minutes, and thereafter at 10 minutes and at 15 minutes after intubation. The descriptive statistics of data were expressed as mean and standard deviation. Independent samples t-test was used for comparison of mean values of the variables in both groups. The value of p< 0.05 was considered as statistically significant. Results: There was a significant rise in heart rate and blood pressure after laryngoscopy and endotracheal intubation with acetaminophen (P group) as compared to the N group in which nalbuphine effectively reduced the tachycardia and hypertension. Conclusion: Acetaminophen has no significant effect on the prevention of hemodynamic changes due to intubation. Nalbuphine effectively reduces tachycardia and hypertension associated with laryngoscopy and endotracheal intubation.

scholarly journals The midline approach for endotracheal intubation using GlideScope video laryngoscopy could provide better glottis exposure in adults： A randomized controlled trial

2019 ◽  
Author(s):  
Lianxiang Jiang ◽  
Shulin Qiu ◽  
Peng Zhang ◽  
Weidong Yao ◽  
Yan Chang ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Endotracheal Intubation ◽  
Elective Surgery ◽  
Controlled Trial ◽  
Video Laryngoscopy ◽  
Controlled Study ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Midline Approach ◽  
Approach Group

Abstract Background: Previous studies have demonstrated that the common laryngoscopic approach (right-sided) and midline approach are both used for endotracheal intubation by direct laryngoscopy. Although the midline approach is commonly recommended for video laryngoscopy (VL) in the clinic, there is a lack of published evidences to support this practice. This study aimed to evaluate the effects of different video laryngoscopic approaches on intubation. Methods: Two hundred sixty-two patients aged 18 years who underwent elective surgery under general anaesthesia and required endotracheal intubation were included in the present prospective, randomized, controlled study. The participants were randomly and equally allocated to the right approach (Group R) or midline approach (Group M). All the intubations were conducted by experienced anaesthetists using GlideScope video laryngoscopy. The primary outcomes were Cormack-Lehane laryngoscopic views (CLVs) and first-pass success (FPS) rates. The secondary outcomes were the time to glottis exposure, time to tracheal intubation, haemodynamic responses and other adverse events. Comparative analysis was performed between the groups. Results: Finally, 262 patients completed the study, and all the tracheas were successfully intubated. No significant differences were observed in the patient characteristics and airway assessments ( P >0.05). Compared with Group R, Group M had a better CLV ( χ2 =14.706, P =0.001) and shorter times to glottis exposure (8.82±2.04 vs 12.38±1.81; t =14.94; P <0.001) and tracheal intubation (37.19±5.01 vs 45.23±4.81; t =13.25; P <0.001), but no difference was found in the FPS rate (70.2% vs 71.8%; χ2 =0.074; P =0.446) and intubation procedure time (29.86±2.56 vs 30.46±2.97, t =1.75, P =0.081). Between the groups, the rates of hoarseness or sore throat, minor injury, hypoxemia and changes in SBP and HR showed no significant difference ( P >0.05). Conclusion: Although the FPS rate did not differ based on the laryngoscopic approach, the midline approach could provide better glottis exposure and shorter times to glottis exposure and intubation. The midline approach should be recommended for teaching in VL-assisted endotracheal intubation. Trial registration: The study was registered in the Chinese Clinical Trial Registry ( ChiCTR-RNC-1900023252 ).

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