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

Author(s):  
Ninad Deepak Chodankar ◽  
Bhagyashree Shivde

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.

2016 ◽  
Vol 29 (3) ◽  
pp. 543-552
Author(s):  
João Douglas Alves ◽  
Jorge Luiz de Brito Gomes ◽  
Caio Victor Coutinho de Oliveira ◽  
José Victor de Miranda Henriques Alves ◽  
Fabiana Ranielle de Siqueira Nogueira ◽  
...  

Abstract Introduction: Tai-Chi-Chuan and Yoga have becoming popular practices. However is unclear the cardiovascular effects, and if they present similar behavior to aerobic and resistance sessions. Objective: To evaluate the cardiovascular responses during the session and post-exercise hypotension (PEH) of Tai Chi Chuan (TS) and Yoga (YS) in comparison to aerobic (AS) and resistance (SR) exercises. Methods: Fourteen young women (22.3 ± 2 years) apparently healthy performed four sessions (AS, RS, TS and YS). The heart rate (HR), systolic (SBP) and diastolic blood pressure (DBP) were recorded at resting, during (every 10 minutes) and until 50 minutes of recovery. Results: AS, RS, TS e YS showed significant increase in HR compared to resting.AS at 10, 30 e 50 minutes in relation to RS, TS e YS. The RS in relation to TS and YS at 10, 30 and 50 minutes. No significant difference between TS and YS. SBP was significantly increased in AS, RS, TS e YS at 10, 30 e 50 minutes during the session, in relation to rest. AS was significantly higher at 30 e 50 minutes than RS and higher than TS and YS at 10, 30 e 50 minutes. No significant difference in DBP. For PEH, AS, RS and TS significantly reduced at 10, 30 and 50 minutes. YS reduced at 50 minutes. No significant diastolic PEH. Conclusion: TS and YS showed as safe alternatives of exercising in the normotensive young adult woman, despite having lower values, they promote similar hemodynamic behavior to AS and RS.


2021 ◽  
Vol 5 (4) ◽  
pp. 220-224
Author(s):  
Chengxi Chi ◽  
Mengmeng Zhao ◽  
Jiajing He ◽  
Yanli Wang

Objective: To investigate and analyze the anesthetic effect of compound artevacaine hydrochloride in patients undergoing oral implantation. Methods: In this study, 60 patients receiving oral implant surgery in our hospital were selected as the research subjects, and the operation time was from July 2019 to March 2021. Patients were randomly selected and divided into groups for the study. 30 patients receiving lidocaine hydrochloride anesthesia were used as the control group, and 30 patients receiving compound artevacaine hydrochloride anesthesia were used as the research group. The anesthetic effect and safety of the two groups were compared and analyzed. Results: The anesthetic effect of the study group was significantly better than that of the control group (P < 0.05). The blood pressure and heart rate in the study group were significantly lower than those in the control group (P < 0.05). There was no significant difference in blood pressure and heart rate between the two groups before anesthesia (P > 0.05). There was no significant difference in the incidence of ADR between the two groups (P > 0.05). Conclusions: For patients undergoing oral implant surgery, choosing compound artevacaine hydrochloride as anesthetic drug has obvious anesthetic effect and can stabilize patients' life indexes. The anesthetic effect is obvious, and there is no obvious adverse reaction, and the clinical value is obvious.


2015 ◽  
Vol 1 (1) ◽  
pp. 29-35
Author(s):  
Anil Shrestha ◽  
Subhash Prasad Acharya ◽  
Roshna Amatya

Background: Laryngoscopy and tracheal intubation induces cardiovascular stress response characterized by tachycardia and hypertension, which are well tolerated in normotensive individuals but are of greater significance in patients with cardiovascular and cerebrovascular disorders. The quest for an effective suppression of these responses continues.Materials and Methods: A randomized, prospective, double blind, placebo controlled study was conducted in which the efficacy of Lignocaine 1.5 mg/kg and Esmolol 1.5 mg/kg were compared in attenuating the cardiovascular response to laryngoscopy and tracheal intubation in sixty patients undergoing elective surgery under general endotracheal anaesthesia. Patients were divided into three groups receiving Lignocaine, Esmolol or Normal saline (control). Anaesthesia was induced with intravenous Thiopental Sodium 5 mg/kg and intubation was facilitated with Vecuronium 0.12 mg/kg after administering the study drug. Blood pressure and heart rate were compared among the three groups.Results: The increase in Systolic blood pressure was not significant, but Diastolic and Mean Arterial Pressures increased significantly in control group whereas it was attenuated more effectively in Esmolol group (p<0.05) compared to lignocaine group. The increase in HR was significantly lower (p<0.05) in Esmolol group compared with lignocaine and control group.Conclusion: Esmolol is more effective than lignocaine in attenuating cardiovascular response to laryngoscopy and tracheal intubationJournal of Society of Anesthesiologists 2014 1(1): 29-35


2020 ◽  
Vol 23 (2) ◽  
pp. 9-13
Author(s):  
Sushila Lama Moktan ◽  
Manan Karki

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.


2019 ◽  
Author(s):  
Lianxiang Jiang ◽  
Shulin Qiu ◽  
Peng Zhang ◽  
Weidong Yao ◽  
Yan Chang ◽  
...  

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 ).


2020 ◽  
Vol 9 (12) ◽  
pp. 4062
Author(s):  
Ángela Río-González ◽  
Ester Cerezo-Téllez ◽  
Cristina Gala-Guirao ◽  
Laura González-Fernández ◽  
Raquel Díaz-Meco Conde ◽  
...  

The aim of this study is to describe the short-term effects of manual lymph drainage (MLD) isolated in supraclavicular area in healthy subjects. A 4-week cross-sectional, double-blinded randomized clinical trial was conducted. Participants: 24 healthy participants between 18 and 30 years old were recruited from Universidad Europea de Madrid from December 2018 to September 2019. A total of four groups were studied: control, placebo, Vodder, and Godoy. The order of the interventions was randomized. Resting Heart Rate and Oxygen Saturation, blood pressure, pressure pain threshold of trapezius muscle, respiratory rate, range of active cervical movements were measured before and after every intervention. All the participants fulfilled four different interventions with a one-week-wash-out period. No statistically significant differences were found between groups in descriptive data; neither in saturation of oxygen, diastolic blood pressure and cervical range of motion. Significant differences were found in favor of Vodder (p = 0.026) in heart rate diminution and in cardiac-rate-reduction. A significant difference in respiratory rate diminution is found in favor of the Godoy group in comparison with the control group (p = 0.020). A significant difference is found in favor of the Godoy group in systolic blood pressure decrease (p = 0.015) even in pressure pain threshold (p < 0.05). MLD decreases systolic blood pressure in healthy participants. However, it does not produce any changes in other physiologic outcomes maintaining physiologic values, which may suggest the safety of the technique in patients suffering from other pathologies.


2021 ◽  
Vol 12 (3) ◽  
pp. 33-37
Author(s):  
Sankar Roy ◽  
Bidyut Bikas Gharami ◽  
Paramita Pandit ◽  
Arunava Biswas ◽  
Dipasri Bhattacharya ◽  
...  

Background: Hemodynamic change takes place during procedures like laryngoscopy and endotracheal intubation due to reflex sympathetic discharge caused by epipharyngeal and laryngopharyngeal stimulation before a surgery under general anesthesia. Aims and Objectives: The aim of the study was to compare the effectiveness of oral clonidine and intravenous lignocaine as premedicant to obtund the stress response due to such mandatory maneuvers. Materials and Methods: A prospective, randomized, double-blind, double dummy-controlled study was undertaken for 11 months at a tertiary care hospital in the eastern part of India. A total (n=100) patient aged 30 to 50 years of either sex with ASA I and II waiting for elective abdominal surgery were randomized into two equal groups. Group C (n=50) received (4μg/kg) of oral clonidine 90 minute before laryngoscopy and Group L (n=50) received 1.5 mg/kg lignocaine 3 minute before laryngoscopy as active drugs and appropriate placebos were administered as double dummy technique. Comparable demographic and baseline parameters like heart rate, systolic blood pressure and diastolic blood pressure were recorded at various time intervals. Similar anesthesia technique applied was in both the study arm. Result: Attenuation of systolic blood pressure, diastolic blood pressure, heart rate and mean arterial pressure was statistically highly significant (p<0.0001) more in Group C as compared to Group L within first vital 10 minutes of intubation. Conclusion: Oral clonidine attenuates the stress response better than intravenous lignocaine during laryngoscopy and endotracheal intubation with minimum adverse effects.


2018 ◽  
Vol 10 (1) ◽  
pp. 7
Author(s):  
Hans-Joachim Trappe ◽  
Irini Maria Breker

Background There is little known whether music of different styles can directly alter blood pressure (BP) and heart rate (HR) in humans. We studied the potential effects of Bach’s orchestral Suite No. 3 in comparison to silence (S [“controls CO]) on BP and HR.Objective To analyse the effect of different music styles (intervention group) on BP, HR and C compared to S (control group).Methods 120 volunteers aged 25-75 years were randomly assigned in the intervention group (n=60) or to a control group (n=60). Interventional music styles were the different parts of Bach’s Suite No. 3, BWV 1068 [Ouverture, Air, Gavotte, Bourrée, Gigue]). Sixty healthy volunteers served as “control group” (CO): they underwent an identical study protocol but without music application.Results In studied volunteers, systolic, diastolic BP (mm Hg) and HR (min-1) decreased when Bach was played compared to CO (p<0.001). Prior to the study BPsyst was 128.3+11.3 mm Hg, BPdiast was 81.9+7.9 Hg and HR was 75.3+12.0 bpm. After sound exposure or in CO the following results were observed (table). *p<0.001, ap=0.01, bp=0.08                        BPsyst (mm Hg)                  BPdiast (mm Hg)                 HR (min-1)Ouverture        120.9+12.4*               76.9+8.8*                   69.8+11.2*Air                  121.1+12.4*               77.1+7.9*                   68.4+9.4*Gavotte           120.9+12.6*               77.0+8.9*                   68.5+9.8*Bourrée           120.6+13.7*               76.5+9.4*                   66.4+8.4*Gigue              120.4+15.2*               78.5+11.1*                 68.1+9.2*Controls          120.6+8.7a                  75.4+5.5b                    78.8+11.9*Conclusions The results provide clear evidence for the potential of Bach’ music styles to influence cardiovascular parameters. All parts of the Suite No. 3 lead to decreased values of BP and HR. In the control group we could not observe similar findings.Trial registration German Clinical Trials Register (DRKS00009835)Funding: None 


2017 ◽  
Vol 13 (4) ◽  
pp. 221
Author(s):  
Cyrus Motamed, MD ◽  
Juliette Audibert, MD ◽  
Aline Albi-Feldzer, MD ◽  
Gaelle Bouroche, MD ◽  
Christian Jayr, MD, PhD

Background: Opioid dependency is becoming increasingly common among surgical patients with cancer, and can lead to inadequate pain relief during the initial postoperative period. No guidelines are currently available for the management of perioperative and postoperative morphine administration in these patients. As a first approach, the authors assessed the opioid requirements of these patients during the early postoperative period.Methods: A group of 35 consecutive surgical patients with cancer on opioid therapy (opioid-dependent group) for cancer pain were compared to a matched group of 44 surgical opioid-naive patients (control group). All patients underwent major head and neck or abdominal surgery. The following parameters were recorded and compared: preoperative and postoperative morphine consumption, patient-controlled analgesia records and Visual Analog Scale scores, intraoperative remifentanil and desflurane consumption, Bispectral Index monitoring values, heart rate, and blood pressure.Results: Remifentanil requirements were significantly higher (1.4-fold) in the opioid-dependent group compared to the control group (p < 0.05). On postoperative day 1, morphine requirements were significantly higher in the opioid-dependent group (2.3-fold) compared to the control group (p < 0.05). Baseline heart rate was significantly higher in the opioid-dependent group and this difference remained significant during surgery, no significant difference in blood pressure was observed between the two groups.Conclusion: This study shows a 40 percent increase of intraoperative remifentanil requirements in opioid-dependent patients during cancer surgery. Morphine requirements during the postoperative period were increased by up to 140 percent.


1970 ◽  
Vol 6 (2) ◽  
pp. 40-43 ◽  
Author(s):  
MT Mollick ◽  
MD Hossain ◽  
NP Ali

A prospective comparative study was done on lignocaine versus lignocaine with pethidine to observe the effect on cardiovascular response to laryngoscopy and endotracheal intubation. One hundred such elective surgical patients of active age group (16 - 60 years) having American Society of Anaesthesiologist (ASA) physical status I & II irrespective of surgical procedure were randomly assigned to one of the two groups of 50 each. Group I received injection lignocaine 1 mg/kg intravenously 02 minutes before induction of general anaesthesia. Patients in group II received injection pethidine 1 mg/kg body weight and injection lignocaine 1 mg/kg body weight intravenously 02 minutes before induction of general anaesthesia. Haemodynamic parameter i.e. blood pressures (systolic blood pressure, diastolic blood pressure and mean blood pressure), heart rate, rate pressure product were monitored after 1st, 3rd, 5th minutes following intubation. There were statistically significant (p<0.001) increase in blood pressures, heart rate and rate pressure product in group I i.e. pretreatment with 1 mg/kg body weight intravenous lignocaine and remained so after 5 minutes. On the other hand there were no statistically significant (p>0.05) increase in heart rate, blood pressures and rate pressure product in group II, where pretreatment done with pethidine 1 mg/kg body weight with lignocaine 1 mg/kg body weight and the values returned control level before 5 minutes. The study showed that pethidine 1 mg/kg body weight with lignocaine 1 mg/kg body weight pretreatment suppresses the cardiovascular response due to laryngoscopy and intubation. Key words: Cardiovascular response; laryngoscopy; lignocaine with pethidine. DOI: 10.3329/jafmc.v6i2.7274JAFMC Bangladesh. Vol 6, No 2 (December) 2010 pp.40-43


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