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 Efficacy of esmolol and magnesium sulphate in attenuation of haemodynamic response during laryngoscopy and intubation: a clinical comparative study

2018 ◽  
Vol 6 (6) ◽  
pp. 1986
Author(s):  
Arbind K. Ray ◽  
Babita Lahkar ◽  
Trina Sen ◽  
Hrishikesh Bharali
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Body Weight ◽  
Magnesium Sulphate ◽  
Elective Surgery ◽  
Hemodynamic Response ◽  
Saline Group ◽  
Significant Rise ◽  
Group I ◽  
Group Ii

Background: Hypertension and tachycardia accompanying laryngoscopy and tracheal intubation are deleterious, especially in patients with cardiovascular or intracranial diseases. The aim of the present study was to compare and evaluate the efficacy of magnesium sulphate and esmolol in attenuating the hemodynamic response to laryngoscopy and endotracheal intubation.Methods: A prospective study was conducted with ninety patients undergoing elective surgery under general anaesthesia who were randomized into three groups of thirty patients each. Group I received 10 ml of 0.9% normal saline, group II received magnesium sulphate 50mg/kg body weight and group III received esmolol 2mg/kg body weight. The study drugs were administered intravenously over 30 seconds, 3 minutes prior to laryngoscopy. Induction was done with sodium thiopentone and endotracheal intubation was performed after one minute of administration of succinylcholine 1.5mg/kg. Heart rate and blood pressure were recorded from preinduction up till 10 minutes after intubation.Results: There was a significant rise in heart rate and blood pressure in group II as compared to group I.Conclusions: Esmolol is a better agent than magnesium sulphate to attenuate hemodynamic response to laryngoscopy and 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 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 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.

Attenuation of Cardiovascular Response During Laryngoscopy and Endotracheal Intubation by Using Pethidine with Lignocaine

1970 ◽  
Vol 6 (2) ◽  
pp. 40-43 ◽  
Author(s):  
MT Mollick ◽  
MD Hossain ◽  
NP Ali
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Body Weight ◽  
General Anaesthesia ◽  
Endotracheal Intubation ◽  
Cardiovascular Response ◽  
Rate Pressure Product ◽  
Group I ◽  
Blood Pressures ◽  
Group Ii

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

scholarly journals Comparison between esmolol and verapamil in attenuation of cardiovascular stress response to laryngoscopy and endotracheal intubation in elective surgery

2021 ◽  
Vol 12 (7) ◽  
pp. 64-68
Author(s):  
Nitisha Chakraborty ◽  
Sankar Roy ◽  
Debajyoti Sur ◽  
Arunava Biswas ◽  
Dipasri Bhattacharya ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Body Weight ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Diastolic Blood Pressure ◽  
Endotracheal Intubation ◽  
Efficacy And Safety ◽  
Cardiovascular Stress ◽  
The Mean

Background: Cardiovascular stress due to reflex sympathetic over activity is a great concern during laryngoscopy and endotracheal intubation. Aims and Objectives: To compare the efficacy and safety of esmolol and verapamil for attenuation of hemodynamic effects (heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure) due to laryngoscopy and endotracheal intubation in elective surgical cases. Materials and Methods: A prospective, randomized, double blinded, controlled study was conducted on 60 patients divided equally into 30 each receiving esmolol (2 mg/kg body weight) and verapamil (0.1 mg/kg body weight) respectively. Heart rate, systolic and diastolic blood pressure and mean arterial pressure were recordedat pre-operative stage, after administration of the study drugs, immediately after intubation and at 1 ,3 ,5 minutes after intubation. Data collected were statistically analyzed. Results: The mean systolic blood pressure was lower in the esmolol group at all times of estimation compared with the verapamil group and the difference was at the time of intubation (p value <0.001).The mean diastolic blood pressure was lower in the esmolol group at all times of estimation compared to the verapamil group which was not statistically significant at any time of estimation. The mean arterial pressure was significantly lower at the time of immediately after intubation (p<0.001) in esmolol as compared to verapamil group. Adverse effects in both the study groups were insignificant. Conclusion: Esmololand Verapamil can effectively attenuate the cardiovascular stress to laryngoscopy and endotracheal intubation with the former appears to be a better alternative from efficacy and safety perspectives.

scholarly journals Hemodynamic response in laparoscopic cholecystectomy after magnesium sulphate versus clonidine administration

2018 ◽  
Vol 6 (10) ◽  
pp. 3239
Author(s):  
Vijaya P. Borkar Patil ◽  
Mayuri Ganeshrao Tambakhe ◽  
Sunil Shankarrao Lawhale ◽  
Jayshree J. Upadhye
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Magnesium Sulfate ◽  
Magnesium Sulphate ◽  
Hemodynamic Response ◽  
Double Blind Study ◽  
Double Blind ◽  
Vasopressin Release ◽  
Significant Difference ◽  
The Mean

Background: Magnesium and clonidine both inhibit catecholamine and vasopressin release. They also attenuate hemodynamic response to pneumoperitoneum.Methods: This randomized double-blind study was designed to assess which agent attenuates hemodynamic stress response to pneumoperitoneum better in 70 patients undergoing laparoscopic cholecystectomy.Results: After the administration of drug, heart rate in group M was mean 84.29 while in group C was mean 79.89. Thus, there was more fall in Heart rate in C group. After intubation, heart rate at 1min, 3 min, 5 min was 101.20, 96.69, 93.94 respectively in group M and in C group was 96.37, 85.83, 86.17 respectively with p values (0.12, 0.001, 0.008). After giving drug, there was fall in blood pressure in both groups but in C group, there was significant fall in systolic blood pressure. There was no significant difference in the mean diastolic BP in both the groups immediately at intubation (76.17±10.74 for group M and 78.86±10.48 for group C with p>0.05) as also at 3 min (63.29±8.76 for M group and 65.14±11.705 for clonidine with p>0.05) and 5 min (63.03±7.909 for magnesium sulphate and 67.69±13.588 for clonidine with p>0.05) following intubation. Thus, the rise in mean diastolic BP was statistically similar in both Group M and Group C. There was no significant difference in the mean for MAP in both the groups immediately at intubation (88.86±12.76 for magnesium sulphate and 91.74±11.59 for clonidine) as also at 3 min (73.17±10.019 for M and 75.80±12.849 for C group. But at 5 min (71.71±9.11 for magnesium sulphate and 77.66±13.715 for clonidine) following intubation with p<0.05 which is significant.Conclusions: Administration of magnesium sulfate or clonidine attenuates hemodynamic response to pneumoperitoneum. Although magnesium sulfate produces hemodynamic stability comparable to clonidine, clonidine blunts the hemodynamic response to pneumoperitoneum more effectively.

Hemodynamic and Catecholamine Responses to Laryngoscopy and Tracheal Intubation in Patients with Complete Spinal Cord Injuries

2001 ◽  
Vol 95 (3) ◽  
pp. 647-651 ◽  
Author(s):  
Kyung Y. Yoo ◽  
JongUn Lee ◽  
Hak S. Kim ◽  
Woong M. Im
Keyword(s):  
Blood Pressure ◽  
Spinal Cord ◽  
Heart Rate ◽  
Tracheal Intubation ◽  
Endotracheal Intubation ◽  
Spinal Cord Injuries ◽  
Plasma Concentrations ◽  
Cardiovascular Responses ◽  
Plasma Catecholamine ◽  
Cord Injury

Background Endotracheal intubation in patients undergoing general anesthesia often causes hypertension and tachycardia, which may be altered when the efferent sympathetic fiber to the cardiovascular system is interrupted. The aim of the current study was to investigate the effects of different levels of spinal cord injury on the cardiovascular responses to intubation. Methods Fifty-four patients with traumatic complete cord injuries requiring tracheal intubation were grouped into quadriplegics (above C7; n = 22), high paraplegics (T1-T4, n = 8), and low paraplegics (below T5, n = 24) according to the level of injury. Twenty patients without spinal injury served as controls. Arterial pressure, heart rate, and rhythm were recorded at intervals for up to 5 min after intubation. Plasma concentrations of catecholamines were also measured. Results The intubation increased the systolic blood pressure similarly in control, high-paraplegic, and low-paraplegic groups (P &lt; 0.05), whereas it did not alter the blood pressure in the quadriplegic group. Heart rate was significantly increased in all groups; however, the magnitude was more pronounced in the high-paraplegic group (67%) than in the control (38%) and quadriplegic (33%) groups. Plasma concentrations of norepinephrine were significantly increased after intubation in all groups; however, values were lower in the quadriplegic group and higher in the low-paraplegic group compared with those in the control group. Incidence of arrhythmias did not differ among groups. Conclusions The cardiovascular and plasma catecholamine changes associated with endotracheal intubation may differ according to the affected level in patients with complete spinal cord injuries.

scholarly journals Comparison of hemodynamic responses along with perfusion index to tracheal intubation with Macintosh and McCoy laryngoscopes

2018 ◽  
Vol 6 (5) ◽  
pp. 1673 ◽  
Author(s):  
Vineet K. Choudhary ◽  
Bhawana Rastogi ◽  
V. P. Singh ◽  
Savita Ghalot ◽  
Vijay Dabass ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Tracheal Intubation ◽  
Arterial Pressure ◽  
Macintosh Laryngoscope ◽  
Hemodynamic Response ◽  
Perfusion Index ◽  
Additional Parameter ◽  
Significant Difference

Background: The McCoy Laryngoscope in comparison to macintosh laryngoscope requires less force for performing laryngoscopy and as a result may alter the associated hemodynamic response. Perfusion index (PI) is a noninvasive numerical value of peripheral perfusion obtained from a pulse oximeter.Methods: A randomized prospective single blind comparative clinical study was conducted on 80 patients of ASA physical status I-II aged between 18 years to 58 years of either sex with body mass index (B.M.I) between 20 and 25 undergoing elective surgeries under general anesthesia. 80 patients were divided into 2 groups: Group A (n=40)- Tracheal Intubation with Macintosh Laryngoscope, Group B (n=40)-Tracheal Intubation with McCoy Laryngoscope. Blood Pressure (systolic blood pressure, diastolic blood pressure, and mean arterial pressure) and heart rate (HR), oxygen saturation (SpO2) via pulse oximeter were monitored.Results: The demographic profile showed no significant difference between the groups. Heart rate, systolic, diastolic and mean arterial pressure had highly significant difference in both groups. Perfusion index was statistically significant immediately post laryngoscopy and intubation till 4 mins. Immediately after laryngoscopy and intubation, the correlation between PI and MAP was statistically significant and it was a negative average to good correlation.Conclusions: The McCoy laryngoscope elicits lesser haemodynamic response to laryngoscopy and tracheal intubation as compared to Macintosh laryngoscope in normotensive patients. Perfusion index can also serve as an additional parameter to assess hemodynamic response since it has good negative correlation with the mean arterial pressure.

scholarly journals The Effects of Suxamethonium and D-Tubocurarine on the Pressor and Plasma Catecholamine Responses to Tracheal Intubation

1983 ◽  
Vol 11 (2) ◽  
pp. 103-106 ◽  
Author(s):  
M. F. Cummings ◽  
W. J. Russell ◽  
D. B. Frewin ◽  
J. R. Jonsson
Keyword(s):  
Mean Arterial Pressure ◽  
Tracheal Intubation ◽  
Arterial Pressure ◽  
Endotracheal Intubation ◽  
Pressor Response ◽  
Significant Rise ◽  
Plasma Noradrenaline ◽  
Plasma Catecholamine ◽  
Plasma Catecholamine Concentrations ◽  
Induction Of Anaesthesia

Changes in mean arterial pressure (MAP) and plasma catecholamine concentrations in response to endotracheal intubation were examined in 8 patients who had received d-tubocurarine and 10 who had received suxamethonium. MAP fell after induction of anaesthesia and administration of the relaxant by a mean of 11 mmHg in those who had received suxamethonium and 19 mmHg in those who had received d-tubocurarine (p <0.05 for each). MAP rose sharply when the trachea was intubated, by a mean of 29 mmHg for the suxamethonium group, and 35 mmHg for the curare group (p <0.001 for each). A significant rise in plasma noradrenaline was also noted after intubation in each group, 51% (p <0.01) for the suxamethonium group and 28% (p <0.05) for the d-tubocurarine. The results suggest that the fall in MAP after administration of d-tubocurarine does not attenuate the pressor response associated with intubation.

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