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

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.

scholarly journals Oral clonidine versus intravenous fentanyl in attenuation of hemodynamic responses to larngoscopy and endotracheal intubation: a comparative study

2019 ◽  
Vol 6 (3) ◽  
pp. 623
Author(s):  
Rukmini G. ◽  
Srinivas M. Reddy
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Endotracheal Intubation ◽  
Hemodynamic Responses ◽  
Cardiovascular Parameters ◽  
Oral Clonidine ◽  
Arterial Blood ◽  
Fentanyl Group

Background: During endotracheal intubation, it has been observed that there is evolvement of the responses of the circulatory in nature. These are difficult to control using the IV anesthetic drugs. Hence various agents are tried to overcome this drawback. Objective of research work was to study efficacy of oral clonidine on hemodynamic responses compared to IV fentanyl while patients undergo larngoscopy and endotracheal intubation.Methods: The patients were allocated into two groups of 30 each. i.e. 30 patients in clonidine group and 30 patients in fentanyl group. All the patients received were pre-medicated with glycoprrolate 0.2mg, ondansetron 4mg and tramadol 1mg/kg body weight. Cardiovascular parameters (heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure,) were recorded at the following intervals: pre-induction, after induction, at endotracheal intubation, one minute, three minutes and five minutes after intubation.Results: The heart rate was significantly more at various intervals in patients who belonged to fentanyl group and it was significantly lesser in clonidine group. The systolic blood pressure was significantly more at various intervals in patients who belonged to fentanyl group and it was significantly lesser in clonidine group. The diastolic blood pressure was significantly more at various intervals in patients who belonged to fentanyl group and it was significantly lesser in clonidine group. Similar was the case with mean arterial blood pressure.Conclusions: Clonidine has been found to be more effective than IV fentanyl in stabilizing the cardiovascular parameters. Not only that orally it is easier to administer and cost effective.

scholarly journals Comparison of Intravenous Lignocaine and Dexmedetomidine for Attenuation of Hemodynamic Stress Response to Laryngoscopy and Endotracheal Intubation

2021 ◽  
Vol 10 (16) ◽  
pp. 1123-1129
Author(s):  
Deepti N. Anandani ◽  
Manisha S. Kapdi ◽  
Ami D. Patel ◽  
Pratik Jain
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Stress Response ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Endotracheal Intubation ◽  
Normal Saline ◽  
Rate Pressure Product

BACKGROUND The purpose of the present study was to evaluate the efficacy of intravenous lignocaine 1.5 mg / kg & intravenous dexmedetomidine 1 mcg / kg for attenuating the haemodynamic response to laryngoscopy & endotracheal intubation in patients undergoing elective surgery under general anaesthesia. METHODS In this prospective randomised, comparative, clinical study, 60 patients were randomly divided into 2 groups, among them 30 patients were given infusion of 1.5 mg / kg IV lignocaine, diluted to 10 ml with normal saline, 3 minutes before intubation & 30 patients were given infusion of dexmedetomidine 1 mcg / kg diluted to 25 ml in normal saline over 10 minutes through infusion pump before induction. The heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, rate pressure product, oxygen saturation were measured at baseline, after study drug intubation at L + 1, L + 3, L + 5, L + 7 & L + 10 (L is onset of laryngoscopy). Statistical analysis was done by using descriptive & inferential statistics using chisquare test, Students paired & unpaired t test to find out the significance of the five variables namely mean heart rate (HR), mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP), mean arterial pressure (MAP) and mean rate pressure product (RPP). RESULTS Dexmedetomidine provided better blunting of stress response during laryngoscopy and intubation without causing clinically significant respiratory depression, bradycardia or hypotension. It is better in achieving a low RPP, which is a good predictor of myocardial oxygen consumption. Dexmedetomidine provides better cardio-protection in patients against pressure response than lignocaine. CONCLUSIONS In these 60 patients, dexmedetomidine (1 mcg / kg) was found to be superior to lignocaine (1.5 mg / kg) for attenuation of pressor response. KEY WORDS Laryngoscopy, Endotracheal Intubation, Dexmedetomidine, Lignocaine, Rate Pressure Product

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

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

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

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

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

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

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

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

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

scholarly journals COMPARISON BETWEEN HEMODYNAMIC CHANGES OF ATRACURIUM AND CISATRACURIUM IN PATIENTS UNDERGOING CABG SURGERY

2021 ◽  
Vol 70 (Suppl-4) ◽  
pp. S843-48
Author(s):  
Muhammad Ali ◽  
Syed Aqeel Hussain ◽  
Rashad Siddiqi ◽  
Fahad Ahmad Khan ◽  
Rehana Javaid ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiopulmonary Bypass ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Cardiac Patients ◽  
Care Hospital ◽  
Group A

Objective: To compare the hemodynamic effects of Atracurium versus Cisatracurium in Cardiac Patients Undergoing coronary artery bypass graft Surgery. Study Design: Randomized controlled trial. Place and Duration of Study: The study was conducted at Armed Forces Institute of Rawalpindi, a tertiary care hospital, after seeking hospital ethics committee permission, from Apr 2019 to Oct 2019. Methodology: A total of 200 consecutive patients were randomized into two equal groups, group-A and group-C (100 in each group). Group-A patients were induced with 0.5mg/kg of Atracurium, followed by infusion @ 10μg/kg/min whereas group C patients received Cisatracurium @ 0.2mg/kg at induction, followed by infusion @ 2μg/kg/min during the maintainence phase. Systolic blood pressure, diastolic blood pressure, Mean arterial pressure and heart rate were noted at different intervals of both groups. Decrease in systolic blood pressure of >20% from baseline or a value <90 mmHg was considered as hypotension. Results: The mean age of patients was 57.5 ± 6.75 years and 56.52 ± 4.46 years in group A and group C respectively. Systolic and diastolic blood pressure was better maintained with cisatracurium than atracurium. Also Mean arterial pressure remained more stable with cisatracurium (p<0.05), but after opening of sternum and before going on cardiopulmonary bypass, the difference was insignificant in both groups (p>0.05). Heart rate remained more steady with cisatracurium (p<0.05) but had insignificant difference before going on cardiopulmonary bypass (p>0.05). Conclusion: Cisatracurium found to be more suitable drug in maintaining the stable hemodynamics and preventing fluctuations in pressure in cardiac patients undergoing on-pump bypass surgery.

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

2018 ◽  
Vol 9 (2) ◽  
pp. 131-136 ◽  
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

To compare the haemodynamic stress response of direct laryngoscopy and oro-tracheal intubation using McCoy and Macintosh blade in general anaesthesia

2021 ◽  
Vol 12 (3) ◽  
pp. 28-32
Author(s):  
Arupratan Maiti ◽  
Sreya Moitro
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Stress Response ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Direct Laryngoscopy ◽  
Mean Blood Pressure ◽  
Macintosh Blade ◽  
Group 2 ◽  
Group 1

Background: Direct Laryngoscopy and intubation lead to extensive stress response and sympathetic stimulation in the body which can be critical for some patient subsets like cardiac ischemia, raised intracranial tension, cerebral aneurysm, open globe injury, glaucoma etc. Hence reduction of the intense stress response is of utmost importance for a stable and safe hemodynamics in those patients. Aims and Objectives: 1. To find out the hemodynamic stress response exerted by the Macintosh blade and McCoy blade. 2. To compare the hemodynamic stress responses between the two blades. Materials and Methods: In this study we had selected 60(male and female in equal number) ASA grade-1 and grade- 2 patients posted for elective general surgery. They were randomly divided into two groups - group 1(laryngoscopy done by McCoy blade)and group 2(laryngoscopy done by Macintosh blade). Systolic Blood Pressure, Diastolic Blood Pressure , Mean Blood Pressure and Heart Rate were recorded before and after anaesthesia induction, just after intubation and one, three and six minutes after orotracheal intubation. Results: The results were compared over time between the two groups. Mean values of Systolic Blood Pressure, Diastolic Blood Pressure, Mean Blood Pressure and heart rate were significantly higher in group 2 as compared to group 1(with p values as 0.009, 0.008, 00.004 and 0.000 respectively). Conclusion: Thus we conclude that the stress response was significantly higher when laryngoscopy was done with Macintosh blade as compared with McCoy blade. We would also like to stress that the art of laryngoscopy should just not be mastered but all anaesthesiologists should think of and practise techniques which would make laryngoscopy smooth and less stressful for our patients. Intubation with McCoy laryngoscope blade is one such technique.

Cardiovascular Responding during Anger and Fear Imagery

1982 ◽  
Vol 50 (1) ◽  
pp. 219-230 ◽  
Author(s):  
Richard J. Roberts ◽  
Theodore C. Weerts
Keyword(s):  
College Students ◽  
Blood Pressure ◽  
Heart Rate ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Scene Change ◽  
Emotional Responding ◽  
Analysis Of Change ◽  
Screening Interview

This study was designed to determine if visualization of anger- and fear-provoking scenes produced differential physiological patterns similar to those produced by in vivo manipulations. Normotensive college students were selected on the basis of their responses to newly developed Anger and Fear/Anxiety questionnaires and for their ability to construct arousing scenes during a screening interview. In a 2 × 2 design (intensity × emotion), four scenes (high and low anger, high and low fear) were constructed individually for each of 16 subjects to imagine. Diastolic blood pressure, systolic blood pressure, and heart rate were monitored during visualization of each scene. Change in diastolic blood pressure was significantly greater for high anger than for high fear as predicted. Analysis of change in heart rate and systolic blood pressure showed significant effects for intensity only. These results provide further support for the concept of physiological differentiation in human emotion and suggest the utility of imagery for systematic study of human emotional responding.

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