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.

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 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 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 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

2019 ◽  
Vol 19 (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.

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 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 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 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.

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.

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