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

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.

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A Comparative Study between Two Different Doses of Dexmedetomidine for Attenuation of Hemodynamic Response to Laryngoscopy and Tracheal Intubation.

Nepal Medical College Journal ◽

10.3126/nmcj.v21i3.26444 ◽

2019 ◽

Vol 21 (3) ◽

pp. 178-183

Author(s):

Chitra Thapa ◽

S. Gauchan

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Mean Arterial Pressure ◽

Tracheal Intubation ◽

Arterial Pressure ◽

Systolic Blood Pressure ◽

Study Drug ◽

Hemodynamic Response ◽

Group A ◽

Group B

Laryngoscopy and end tracheal intubation are stressful situation for the patients, as these procedures are capable of producing tachycardia, hypertension and arrhythmias. This study was conducted with the objective of arriving at an optimal dose of dexmedetomidine that can attenuate the hemodynamic response to laryngoscopy and intubation with minimal side effects. The current study was conducted in 60 patients, posted for elective surgery under general anesthesia withendotracheal intubation. The patients were divided into two groups: Group A and Group B. Group A received dexmedetomidine 0.5 μg/kg and group B received dexmedetomidine 1 μg/kg intravenously over 10 min prior to induction of anesthesia. The anesthesia technique was standardized in both the groups. Heart rate, systolic, diastolic and mean arterial pressure were monitored and recorded at 5min and 10 min of completion of infusion of study drug, after induction, and at 1 min, 2 min, 5 min after intubation. The baseline heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were statistically similar in both the groups. After the infusion of the study drug the mean heart rate, mean systolic blood pressure, mean diastolic blood pressure, mean arterial pressure at all times were comparable in both the groups. Episodes of hypotension and bradycardia were also statistically similar in both the groups. Attenuation of hemodynamic response to laryngoscopy and intubation by dexmedetomidine is similar with the two doses: 0.5 μg/kg and 1 μg/kg. Both the doses of dexmedetomidine were devoid of any significant adverse effects.

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Variable versus fixed-rate infusion of phenylephrine during cesarean delivery: a randomized controlled trial

BMC Anesthesiology ◽

10.1186/s12871-019-0879-3 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Ahmed Hasanin ◽

Sara Habib ◽

Yaser Abdelwahab ◽

Mohamed Elsayad ◽

Maha Mostafa ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Systolic Blood Pressure ◽

Cesarean Delivery ◽

Controlled Trial ◽

Controlled Study ◽

Lower Systolic Blood Pressure ◽

Randomized Controlled ◽

Phenylephrine Infusion ◽

Infusion Regimen

Abstract Background Phenylephrine is the most commonly used vasopressor for prophylaxis against maternal hypotension during cesarean delivery; however, the best regimen for its administration is not well established. Although variable infusion protocols had been suggested for phenylephrine infusion, evidence-based evaluation of variable infusion regimens are lacking. The aim of this work is to compare variable infusion, fixed on-and-off infusion, and intermittent boluses of phenylephrine for prophylaxis against maternal hypotension during cesarean delivery. Methods A randomized controlled study was conducted, including full-term pregnant women scheduled for elective cesarean delivery. Participants were divided into three groups which received phenylephrine by either intermittent boluses (1.5 mcg/Kg phenylephrine), fixed on-and-off infusion (with a dose of 0.75 mcg/Kg/min), or variable infusion (with a starting dose of 0.75 mcg/Kg/min). The three groups were compared with regard to frequency of: maternal hypotension (primary outcome), second episode hypotension, reactive hypertension, and bradycardia. Other outcomes included heart rate, systolic blood pressure, physician interventions, and neonatal outcomes. Results Two-hundred and seventeen mothers were available for final analysis. The 2 infusion groups showed less incidence of maternal hypotension {26/70 (37%), 22/71 (31%), and (51/76 (67%)} and higher incidence of reactive hypertension compared to the intermittent boluses group without significant differences between the two former groups. The number of physician interventions was highest in the variable infusion group compared to the other two groups. The intermittent boluses group showed lower systolic blood pressure and higher heart rate compared to the two infusion groups; whilst the two later groups were comparable. Conclusion Both phenylephrine infusion regimens equally prevented maternal hypotension during cesarean delivery compared to intermittent boluses regimen. Due to higher number of physician interventions in the variable infusion regimen, the current recommendations which favor this regimen over fixed infusion regimen might need re-evaluation.

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A prospective randomised study comparing intravenous magnesium sulphate and sublingual nitroglycerine spray in attenuating haemodynamic responses to laryngoscopy and intubation

International Journal of Clinical Trials ◽

10.18203/2349-3259.ijct20181396 ◽

2018 ◽

Vol 5 (2) ◽

pp. 90 ◽

Cited By ~ 1

Author(s):

Deepti M. Kotwani ◽

Manish B. Kotwani ◽

Amit Hiwarkar

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Tracheal Intubation ◽

Systolic Blood Pressure ◽

Stress Responses ◽

Magnesium Sulphate ◽

Study Drug ◽

Intravenous Magnesium ◽

Group A ◽

Group B

Background: Laryngoscopy and tracheal Intubation are invariably associated with certain stress responses due to the sympatho-adrenal stimulation. These cardiovascular and neurohumoral alterations may directly affect the physiology and increase the risk. So far, various drugs have been tried but none has been considered ideal for blunting this presser response. We therefore, planned this comparative study to evaluate and compare the efficacy of intravenous magnesium sulphate (30 mg/kg) versus sublingual nitroglycerine spray (0.4 mg/spray) in attenuating the presser response to Laryngoscopy and Tracheal Intubation.Methods: Fifty patients, aged 15–50 years, scheduled for elective surgery under general anaesthesia, were randomly assigned to one of the two groups of 25 each, Group A (magnesium group) and Group B (nitroglycerine group). Study drug was given 90-120 seconds before tracheal intubation. Heart rate, Systolic blood pressure and Rate pressure product were recorded at different intervals after administering the study drug till 3 minutes after intubation.Results: Mean heart rate was significantly higher from the baseline at all times after administering the study drug in both the groups. Increase in systolic blood pressure as a presser response was limited to 7.25% in Group A and 5.83% in Group B from the baseline after tracheal intubation. There was relative hypotension after administration of the study drug in both the groups.Conclusions: Intravenous magnesium or sublingual nitroglycerine pre-treatment is found to be effective in attenuating the presser response to laryngoscopy and intubation. These drugs may lead to rise in HR but it is transient and dose dependent. However, both the drugs can significantly control the hypertensive response after laryngoscopy and intubation.

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Comparative Study of Oral Clonidine Versus Gabapentin as Premedication for Anxiolysis, Sedation and Attenuation of Pressor Response to Laryngoscopy and Tracheal Intubation

Anwer Khan Modern Medical College Journal ◽

10.3329/akmmcj.v9i2.39209 ◽

2018 ◽

Vol 9 (2) ◽

pp. 131-136 ◽

Cited By ~ 1

Author(s):

Muhammad Sazzad Hossain ◽

Mohammad Mamunur Rashid ◽

Syed Ariful Islam ◽

Md Anisur Rahman Babu ◽

Devashis Saha ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Controlled Trial ◽

Hemodynamic Response ◽

Sedation Score ◽

Oral Clonidine

Background and Aims: We conducted a prospective, randomized, double-blind and controlled trial to compare the effects of oral clonidine and gabapentin as premedication in obtunding hemodynamic response to laryngoscopy and intubation in normotensive patients undergoing elective surgery. We also compared the preoperative anxiety and sedation status between these two drugs.Materials and Methods: A total of 60 patients of American Society of Anesthesiologists (ASA) physical status I, aged 20 -50 years of either sex enrolled in the study were randomly divided into two groups of 30 each. Group A patients received oral clonidine 200 mcg and Group B patients received oral gabapentin 900 mg, 90 minutes prior to induction of anesthesia. The heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were observed and recorded pre and post endotracheal intubation. Anxiety and sedation score were noted after 60 minutes of oral administration of drug as well as before induction of anesthesia.Results: Both groups were matched for age, sex, weight and intubation time. Anxiety score and sedation score before induction were significantly better in clonidine group as compared with gabapentin group. Also oral clonidine attenuated the increase in heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure better than oral gabapentin (p<0.05).Conclusion: Oral clonidine provided good attenuation of hemodynamic response to laryngoscopy and intubation as compared with oral gabapentin. Also clonidine is better agent as anxiolytic and sedative than gabapentin.Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 131-136

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COMPARISON STUDY OF IVABRADINE WITH METOPROLOL IN MANAGEMENT OF ACUTE CORONARY SYNDROME

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i9.2201 ◽

2021 ◽

Vol 5 (9) ◽

Author(s):

Rishman Tandi ◽

Tanvi Kumar ◽

Amritpal Singh Kahlon ◽

Aaftab Sethi

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Acute Coronary Syndrome ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Beta Blocker ◽

Beta Blockers ◽

Coronary Syndrome ◽

Group A ◽

Group B

Introduction: Acute coronary syndrome remains as one of the most important causes for morbidity and mortality in developed countries. Therefore, evidence-based management strategy is required to offset the loss of health during an acute coronary syndrome. An effective approach includes both medical and surgical methods. This study was conducted to evaluate the medical method of management. Objective: To study blood pressure and heart rate variability after administration of Ivabradine or metoprolol in cases with acute coronary syndrome. Materials and methods: The study was a Prospective single center observational study conducted in patients attending Cardiology Intensive Care Unit in Nayyar Heart and Superspecialty Hospital, a tertiary care centre located in an urban area. All patients with Acute coronary syndrome admitted to the emergency or cardiac care unit were analysed with ECG as a preliminary diagnostic test and confirmed with troponin markers. They were either given Ivabradine or Metoprolol. Baseline evaluation and follow up was done and necessary data was collected and analysed. Results: 100 patients were included in the study out of which 50 were given Metoprolol (Group A) and 50 were given Ivabradine (Group B). Themean age of studied cases was found to be 66.54 years in group A and 68.69 years in group B. It was observed that there was a fall in heart rate by 26.8 beats per minute with beta blocker and 24.4 beats per minute with Ivabradine. In case of blood pressure measurement, in patients with beta blocker administration, there was a fall of 25 mm Hg in systolic blood pressure and 17 mm Hg in diastolic blood pressure However, with Ivabradine there was only a fall of 8mm Hg in systolic Blood pressure and 6 mm Hg in diastolic blood pressure. Conclusion: Although Metoprolol is the drug of choice to decrease heart rate and blood pressure in acute coronary syndrome, Ivabradine is being increasingly used in cases where beta blockers are contraindicated as it has similar efficacy in lowering heart rate without compromising contractility of cardiac muscle, thereby maintaining LVEF and blood pressure. Keywords: Acute coronary syndrome, Beta Blockers, Metoprolol, Ivabradine.

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A randomized trial to evaluate a modified tracheal catheter with upper and lower balloons for anesthetic administration: effect on the cardiovascular, stress response, and comfort in patients undergoing laparoscopic cholecystectomy

BMC Anesthesiology ◽

10.1186/s12871-019-0883-7 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Yuenong Zhang ◽

Zhiwen Zeng ◽

Guangwen Xiao ◽

Weiqiang Zhang ◽

Weixiong Lin ◽

...

Keyword(s):

Blood Pressure ◽

Clinical Trial ◽

Heart Rate ◽

Laparoscopic Cholecystectomy ◽

Stress Response ◽

Angiotensin Ii ◽

Tracheal Intubation ◽

Systolic Blood Pressure ◽

Group A ◽

Endotracheal Anesthesia

Abstract Background We aimed to evaluate a modified endotracheal tube containing upper and lower balloons for anesthetic administration among patients undergoing laparoscopic cholecystectomy. Methods Ninety patients scheduled to undergo laparoscopic cholecystectomy were randomly allocated to 3 equal groups: group A (conventional tracheal intubation without endotracheal anesthesia); B (conventional tracheal intubation with endotracheal anesthesia); and C (tracheal intubation using a modified catheter under study). Blood pressure, heart rate, angiotensin II level, blood glucose level, airway pressure before anesthesia (T1) were measured immediately after intubation (T2), 5 min after intubation (T3), and immediately after extubation (T4). The post-extubation pain experienced was evaluated using the Wong-Baker Face Pain scale. Adverse reactions within 30 min after extubation were recorded. Results Systolic blood pressure, diastolic blood pressure, angiotensin II, and blood sugar level in group C at T2, T3 and T4, and heart rate at T2 and T4 were significantly lower than those in group A (P < 0.05); systolic blood pressure and blood sugar at T4, and angiotensin II levels at T2, T3, and T4 were significantly lower than those in group B (P < 0.05). Patients in group C reported the lowest post-extubation pain (P < 0.05 vs. Group A), and the lowest incidence of adverse events such as nausea, vomiting, and sore throat than that in groups A and B (P < 0.05). Conclusion The modified endotracheal anesthesia tube under study is effective in reducing cardiovascular and tracheal stress response, and increasing patient comfort, without inducing an increase in airway resistance. Trial registration The clinical trial was retrospectively registered at the Chinese Clinical Trial Registry with the Registration Number ChiCTR1900020832 at January 20th 2019.

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Spectral Analysis of Systolic Blood Pressure and Heart Rate after Heart Transplantation in Children

Clinical Science ◽

10.1042/cs0880095 ◽

1995 ◽

Vol 88 (1) ◽

pp. 95-102 ◽

Cited By ~ 18

Author(s):

Isabelle Constant ◽

Arlette Girard ◽

Jérôme Le Bidois ◽

Elizabeth Villain ◽

Dominique Laude ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Heart Rate Variability ◽

Heart Transplantation ◽

Systolic Blood Pressure ◽

High Frequency ◽

Power Spectra ◽

Critical Factor ◽

Group B ◽

Cardiac Afferents

1. The aim of the study was to examine the short-term variability in blood pressure and heart rate in 19 children who had received heart transplants and in eight normal control children. 2. Blood pressure was determined by a finger arterial pressure device. We examined the power spectra for heart rate and systolic blood pressure in the supine and tilted positions. In addition, we studied the acute changes in blood pressure and heart rate during active standing. 3. In the transplanted children we could distinguish two groups (groups A and B) in whom heart rate variability differed, although in both it was greatly reduced compared with controls (group C). In group A there were no significant fluctuations in the mid-frequency range for heart rate. The gain of the relationship between systolic blood pressure and heart rate was very low and there were virtually no heart rate changes associated with passive tilting. 4. By contrast, in group B transplant patients the heart rate variability, as assessed by standard deviation, was about half that of normal controls. The power spectra attenuation was greater in the high-frequency than in the mid-frequency bands. On passive tilting the latter became enhanced, but not the high-frequency variability. On active standing the tachycardic response was about half that of controls. The findings suggest some reinnervation involving cardiac sympathetic fibres to a greater degree than the fast-responding vagal fibres. 5. In both groups A and B the drop in systolic blood pressure observed early in active standing was about 4–6 times as great as in controls. One possible mechanism could be the loss of cardiac afferents. 6. Time since operation was a critical factor for reinnervation, since all subjects from group B were transplanted more than 44 months prior to the recording. 7. We conclude that in a proportion of children who have received heart transplantation there is a delayed reinnervation of the heart, which probably involves sympathetic effectors rather than the vagus.

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

BMC Anesthesiology ◽

10.1186/s12871-021-01484-6 ◽

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.

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Oral nifedipine versus intravenous labetalol for acute blood pressure control in hypertensive emergencies of pregnancy: a randomized controlled trial

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20191943 ◽

2019 ◽

Vol 8 (5) ◽

pp. 1921

Author(s):

Anjuman Alam ◽

S. M. A. Zakaria

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Urine Output ◽

Gestational Hypertension ◽

Controlled Trial ◽

Pressure Control ◽

Controlled Study ◽

Randomized Controlled ◽

Hypertensive Emergencies ◽

To Receive

Background: To compare intravenous labetalol with oral nifedipine in terms of rapidity at which they control blood pressure in acute hypertensive emergencies of pregnancy.Methods: A randomized controlled study. Pregnant women with severe gestational hypertension with BP ≥160/110 mmHg after ≥20 weeks of gestation were randomized with computer generated numbers, either to receive IV labetalol with an escalating dose of 20, 40, 80, 80 and 80 mg or nifedipine capsule orally in a dose of 10 mg every 15 minutes (upto 5 doses) until a BP of ≤150/100 mmHg is achieved. Crossover treatment was to be effected if initial treatment regimen was unsuccessful. Primary outcome was time taken and number of doses required to achieve the target BP of ≤150/100 mmHg. Secondary outcomes were volume of urine output, maternal heart rate changes, fetal heart rate abnormality, perinatal and maternal outcome and side effects.Results: Oral nifedipine achieved the target BP (≤150/100 mmHg) more rapidly in (26.25±12.60) minutes in comparison to (32.62±12.19) minutes with IV labetalol (p= 0.024). Nifedipine group also took less number of doses to achieve the target BP of (≤150/100 mmHg) mmHg than IV labetalol (1.75±0.840 vs. 2.18±0.83), p= 0.024. Volume of urine output was also significantly more in nifedipine group (94.90±1.84 ml) at 1 hour and thereafter till 24 hour of treatment in comparison to IV labetalol (41.28±2.14 ml), p= 0.000. Side effects are few and not serious. No patient required crossover treatment.Conclusions: Both the drugs are equally effective in controlling acute hypertensive emergencies of pregnancy, however oral nifedipine is more rapid in controlling severe hypertension and also it is associated with significantly increased urine output.

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A study on oral clonidine vis a vis intravenous lignocaine for attenuation of hemodynamic response to laryngoscopy and endotracheal intubation

Asian Journal of Medical Sciences ◽

10.3126/ajms.v12i3.31995 ◽

2021 ◽

Vol 12 (3) ◽

pp. 33-37

Author(s):

Sankar Roy ◽

Bidyut Bikas Gharami ◽

Paramita Pandit ◽

Arunava Biswas ◽

Dipasri Bhattacharya ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Stress Response ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Endotracheal Intubation ◽

Controlled Study ◽

Care Hospital ◽

Total N ◽

Oral Clonidine

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.

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