scholarly journals Comparative study between sprayed and inhaled nebulized lidocaine for suppression of hemodynamic response to laryngoscopy and oral endotracheal intubation

2021 ◽  
Vol 23 (09) ◽  
pp. 772-787
Author(s):  
Ahmed Abdulmaged Ahmed ◽  
◽  
Dr. Hasan Sarhan Haider ◽  
Keyword(s):  
Heart Rate ◽  
Tracheal Intubation ◽  
General Anesthesia ◽  
Endotracheal Intubation ◽  
Outcome Measures ◽  
Cardiovascular Response ◽  
Hemodynamic Response ◽  
Secondary Outcome ◽  
Patient Acceptance ◽  
Significant Difference

Background: Direct laryngoscopic manipulation and endotracheal intubation are noxious stimuli capable of producing hemodynamic changes characterized by tachycardia, hypertension, and arrhythmias. Which are tolerated in normotensive healthy individuals but had greater impact in patients with cardiovascular and cerebrovascular diseases lead to increased morbidity and mortality. Aim of the study: To compare the efficacy of sprayed and inhaled nebulized lidocaine in suppressing the cardiovascular response to laryngoscopy and tracheal intubation in normotensive patients undergoing general anesthesia. Patient and method: 80 adult patients undergoing elective surgery under general anesthesia with endotracheal intubation were randomly allocated into two equal groups. Patients in nebulized lidocaine (NL) group received pre-induction nebulized (1ml of 10%) lidocaine, while those in sprayed lidocaine (SL) group received pre-induction sprayed (10 puffs of 10%) lidocaine. The general anesthesia technique was standardized for the two groups. The primary outcome measures were hemodynamic response at 1, 3, 6, 9, and 12 min after intubation. The secondary outcome measures were to note down any adverse effects associated with drugs. The statistical package used was SPSS version 25.Results: There was a statistically significant difference (P < 0.05) between nebulizes and sprayed lidocaine in heart rate, systolic, diastolic and mean arterial pressures at different time points after tracheal intubation with nebulized lidocaine being most effective and better toleration. Conclusion: The hemodynamic instability was lesser with nebulized lidocaine as compared to sprayed lidocaine. The effect was on heart rate and blood pressure. Use of nebulized lidocaine is simple, safe, effective and better patient acceptance.

scholarly journals “EFFECT ON HEMODYNAMIC RESPONSE TO LARYNGOSCOPY AND TRACHIAL INTUBATION AND THEIR ATTENUATION BY BOLUS ADMINISTRATION OF DEXMEDETOMIDINE”

2020 ◽  
pp. 34-36
Author(s):  
Rituraj Saini ◽  
Urmila Keshari
Keyword(s):  
Adverse Effects ◽  
Endotracheal Intubation ◽  
Outcome Measures ◽  
Hemodynamic Response ◽  
Secondary Outcome ◽  
Controlled Study ◽  
Bolus Administration ◽  
Double Blind ◽  
Significant Difference ◽  
Group D

Background and Aims- Laryngoscopic and endotracheal intubation are noxious stimuli causes tachycardia, arrhythmias and hypertension. The aim of this study was to compare dexmedetomidine with placebo to attenuate stress response during laryngoscopy and endotracheal intubation.Methods-It was a randomised, double-blind placebo-controlled study. After Institutional Ethical Committee clearance, 60 patients of ASA 1& 2 were enrolled and divided into 30 each. Group NS received normal saline and Group D received injection dexmedetomidine 1μg/kgas infusion over 10 min. The general anaesthesia technique was standardised for both groups. The primary outcome measures were haemodynamic response at 1, 2, 5 and 10 min after intubation. The secondary outcome measures were to note down any adverse effects associated with drugs. The statistical package used was SPSS version 15.Results- There was a statistically significant difference (P <0.05) between Group D and Group NS in heart rate, systolic, diastolic and mean arterial pressures after tracheal intubation with dexmedetomidine. Sedation scores were more with dexmedetomidine. None of the patients had any adverse effects. Conclusion-Dexmedetomidine 1 µg/kg as premedication can be used safely and effectively to attenuate hemodynamic response to laryngoscopy and endotracheal intubation.

scholarly journals Effect of remifentanil infusion on the hemodynamic response during induction of anesthesia in hypertensive and normotensive patients: a prospective observational study

2019 ◽  
Vol 47 (12) ◽  
pp. 6254-6267
Author(s):  
Soo Kyung Lee ◽  
Mi Ae Jeong ◽  
Jeong Min Sung ◽  
Hyo Jin Yeon ◽  
Ji Hee Chang ◽  
...  
Keyword(s):  
Heart Rate ◽  
General Anesthesia ◽  
Prospective Observational Study ◽  
Hemodynamic Response ◽  
Hemodynamic Instability ◽  
Remifentanil Infusion ◽  
Significant Difference ◽  
Blood Pressures ◽  
Post Intubation ◽  
Time Point

Background The induction of general anesthesia may cause hemodynamic instability. Remifentanil is often administered to suppress the hemodynamic response. We aimed to evaluate the effect of remifentanil infusion on the hemodynamic response to induction of anesthesia in hypertensive and normotensive patients. Methods Patients were divided into two groups: Group H (n = 102) were hypertensive patients and Group C (n = 107) were normotensive patients. During induction, all patients received 1 µg/kg of remifentanil as a loading dose over 2 minutes, followed by a continuous infusion at 0.05 µg/kg/minute. We analyzed the systolic, diastolic, and mean pressures and heart rate pre-induction, pre-intubation, immediately post-intubation, and at 2, 4, 6, 8, and 10 minutes after intubation. Results The systolic, diastolic, and mean pressures before induction were significantly higher in group H compared with group C, but there was no significant difference between the two groups immediately after intubation. Blood pressures immediately after intubation were similar to the pre-induction blood pressure. There was no significant difference in heart rate between the two groups at any time point. Conclusions Remifentanil infusion effectively attenuates the hemodynamic response to induction of general anesthesia in hypertensive and normotensive patients.

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 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 The Comparison of Hemodynamic Responses Following Laryngeal Mask Airway Insertion Versus Tracheal Intubation in Hypertensive Patients Scheduled for Elective Ophthalmic Surgery Under General Anesthesia

2019 ◽  
Author(s):  
Mehdi Sanatkar ◽  
Mehrdad Goudarzi ◽  
Alireza Ebrahim Soltani
Keyword(s):  
Heart Rate ◽  
Laryngeal Mask Airway ◽  
Tracheal Intubation ◽  
General Anesthesia ◽  
Endotracheal Intubation ◽  
Laryngeal Mask ◽  
Laryngeal Mask Airway Insertion ◽  
Ophthalmic Surgery ◽  
Hypertensive Patients ◽  
St Segment

 We compared hemodynamic responses following laryngeal mask airway insertion versus tracheal intubation in hypertensive patients who were scheduled for elective ophthalmic surgery under general anesthesia. We studied 48 controlled hypertensive patients that were randomly divided into two groups (n=24) for insertion of laryngeal mask airway (LMA) and endotracheal intubation (EI). The mean arterial blood pressure (MAP), heart rate, rate pressure product (RPP), and ST-segment changes were recorded preoperatively, immediately preintubation and 1, 3, and 5 minutes after LMA insertion or tracheal intubation in all patients and compared between two groups. There was a reduction in MAP after induction and immediately preintubation in all of patients of both groups (P<0.05). The MAP, heart rate and RPP increased immediately after both LMA insertion and tracheal intubation (P<0.05). The elevation of MAP and RPP were maintained for longer time in intubation group versus LMA group (P<0.05). There was no difference between the groups with respect to ST-segment variation. The incidence of airway injury was similar between two groups. The laryngeal mask airway insertion may be preferable to endotracheal intubation in hypertensive patients where attenuation of hemodynamic stress response is desired. © 2019 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2019;57(5):289-294.

scholarly journals Comparative Study of Dexmedetomidine and Fentanyl to Obtund the Pressure Response to Laryngoscopy and Intubation

2019 ◽  
Vol 3 (3) ◽  
pp. 514-518
Author(s):  
Ajay Singh Thapa ◽  
Rajesh Kumar Yadav ◽  
Binita Dhakal
Keyword(s):  
Heart Rate ◽  
Tracheal Intubation ◽  
Comparative Study ◽  
Endotracheal Intubation ◽  
Cardiovascular Responses ◽  
Hemodynamic Response ◽  
Pressure Response ◽  
Baseline Heart Rate ◽  
Group A ◽  
Group B

Introduction: Airway manipulation during endotracheal intubation is associated with hemodynamic and cardiovascular responses. Different agents have been used to obtund the pressure response. Objectives: To evaluate the place of Dexmedetomidine for routine use during induction of anesthesia to blunt pressure response to laryngoscopy and intubation. Methodology: One hundred patients of ASA I and II were randomly divided into two groups. Group A received Midazolam (0.05 mg/kg) a n d Fentanyl (2 mcg/Kg) and group B received Dexmedetomidine (0.6 mcg/kg) 10 minutes before induction of anesthesia. Both groups were induced with Propofol (1.5 mg/Kg). In all patients after induction (loss of eye lashes reflex) tracheal intubation was facilitated using Rocuronium 1mg/kg. Baseline heart rate was noted and hemodynamic response to intubation was observed 3, 6 and 9 minutes after intubation. Results: In group A, time for loss of eyelashes reflex was 17.45±2.19 seconds and in group B it was 11.33±2.64 seconds. In group A, after intubation heart rate increased by 11.22±2.37, 5.71±1.68, 2.34±1.73 in3, 6 and 9 minutes respectively. In group A, after intubation MAP increased by 6.49±1.37, 3.30±1.15, and 1.24±1.50 from baseline in 3,6, and 9 minutes respectively. In group B after intubation heart rate increased by 2.49±0.89 from baseline at third minutes, however decreased by 2.85±1.58 and 4.73±1.86 at sixth and ninth minute respectively. In group B, MAP increased from baseline by 3.44±1.06 in third minute however decreased by 2.22±1.38 and 4.24±3.40 at sixth and ninth minutes respectively. Conclusion: Both the agents were observed to obtund pressure response to laryngoscopy and intubation however Dexmedetomidine proved to be better option compared to Fentanyl.

scholarly journals Donepezil for mild cognitive impairment in Parkinson’s disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kyoungwon Baik ◽  
Seon Myeong Kim ◽  
Jin Ho Jung ◽  
Yang Hyun Lee ◽  
Seok Jong Chung ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Treatment Group ◽  
Outcome Measures ◽  
Rating Scale ◽  
Secondary Outcome ◽  
Control Group ◽  
Significant Difference

AbstractWe investigated the efficacy of donepezil for mild cognitive impairment in Parkinson’s disease (PD-MCI). This was a prospective, non-randomized, open-label, two-arm study. Eighty PD-MCI patients were assigned to either a treatment or control group. The treatment group received donepezil for 48 weeks. The primary outcome measures were the Korean version of Mini-Mental State Exam and Montreal Cognitive Assessment scores. Secondary outcome measures were the Clinical Dementia Rating, Unified Parkinson’s Disease Rating Scale part III, Clinical Global Impression scores. Progression of dementia was assessed at 48-week. Comprehensive neuropsychological tests and electroencephalography (EEG) were performed at baseline and after 48 weeks. The spectral power ratio of the theta to beta2 band (TB2R) in the electroencephalogram was analyzed. There was no significant difference in the primary and secondary outcome measures between the two groups. However, the treatment group showed a significant decrease in TB2R at bilateral frontotemporoparietal channels compared to the control group. Although we could not demonstrate improvements in the cognitive functions, donepezil treatment had a modulatory effect on the EEG in PD-MCI patients. EEG might be a sensitive biomarker for detecting changes in PD-MCI after donepezil treatment.

Effect of Oligohydramnios on Fetal Heart Rate Patterns during Term Labor Induction

2018 ◽  
Vol 36 (07) ◽  
pp. 715-722
Author(s):  
Janine S. Rhoades ◽  
Molly J. Stout ◽  
George A. Macones ◽  
Alison G. Cahill
Keyword(s):  
Heart Rate ◽  
Fetal Heart Rate ◽  
Fetal Heart ◽  
Secondary Analysis ◽  
Neonatal Morbidity ◽  
Fetal Monitoring ◽  
Secondary Outcome ◽  
Significant Difference ◽  
Electronic Fetal Monitoring ◽  
Consecutive Term

Objective To estimate the effect of oligohydramnios on fetal heart rate (FHR) patterns in patients undergoing induction of labor (IOL) at term. Study Design Secondary analysis of a prospective cohort study of consecutive term, singleton deliveries from 2010 to 2015. We included all patients who underwent IOL. Our primary outcomes were electronic fetal monitoring (EFM) characteristics in the 2 hours preceding delivery. Outcomes were compared between those induced with oligohydramnios and those induced without a diagnosis of oligohydramnios. Our secondary outcome was composite neonatal morbidity. Logistic regression was used to control for confounders. Results Of 3,787 patients who underwent IOL, 147 had a diagnosis of oligohydramnios and 3,640 were included in the no oligohydramnios group. There was no significant difference in EFM characteristics between the two groups. There was no difference in composite neonatal morbidity. In patients with oligohydramnios, EFM patterns with baseline tachycardia for 30 minutes or greater were significantly associated with composite neonatal morbidity (31.3 vs. 5.3% adjusted odds ratio 8.63, 95% confidence interval 2.18, 34.1]). Conclusion Term patients undergoing IOL with oligohydramnios had EFM patterns that did not differ from their induced peers.

scholarly journals PREWARMING FOR PREVENTION OF PERIOPERATIVE HYPOTHERMIA IN PATIENTS WITH COMBINED EPIDURAL AND GENERAL ANESTHESIA: A RANDOMIZED CONTROLLED TRIAL

2021 ◽  
Author(s):  
Dang Tinh Pham ◽  
Thi Ngoc Le ◽  
Ton Ngoc Vu Phan ◽  
Parshal Bhandari ◽  
Sairah Zia ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
General Anesthesia ◽  
Outcome Measures ◽  
Medical Center ◽  
Controlled Trial ◽  
Secondary Outcome ◽  
Perioperative Hypothermia ◽  
Randomized Controlled ◽  
Physical Status Classification ◽  
American Society

OBJECTIVE The aim of this study was to access the influence of active warming after epidural anesthesia (EDA) and before general anesthesia in prevention of perioperative hypothermia. METHOD This randomized controlled trial was conducted in the department of anesthesiology in university medical center of Ho Chi Minh city, Vietnam from December 2019 until April 2020. This trial included 60 adult patients who were scheduled for major abdominal surgery with a duration of at least 120 minutes and under combined general anesthesia and EDA. Patients were excluded if age was below 18 years, American Society Anesthesiologists’ physical status classification of IV or higher, or refusal of EDA. Written informed consent was obtained for all patients. Patients were divided randomly into two groups. The first group received 10 minutes of active air-forced warming after EDA before the induction of general anesthesia. The second group was covered with a blanket 10 minutes after EDA and before general anesthesia. Core temperatures were recorded throughout the study. The primary outcome measures were the incidence of perioperative hypothermia and the degree of hypothermia. The secondary outcome measures were rate and time for body temperature to return to normal and incidence of postoperative body shivering. RESULTS Without active warming (n = 21), 70% of patients became hypothermic (<36°C) postoperatively. Active air-forced warming for 10 minutes after EDA and before induction of general anesthesia decreased the incidence of postoperative hypothermia to 26.7% (n = 8). CONCLUSION Active air-forced warming for 10 minutes after EDA and before induction of general anesthesia is efficient in reducing the incidence of perioperative hypothermia.

scholarly journals Perbedaan Respon Hemodinamik dengan Penambahan Blok Scalp Levobupivakain pada Operasi Kraniotomi

2020 ◽  
Vol 9 (1) ◽  
pp. 8-15
Author(s):  
Arya Justisia Sani ◽  
Ardhana Tri Arianto ◽  
Muhammad Husni Thamrin
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Hemodynamic Response ◽  
Anesthesia Induction ◽  
Group I ◽  
Significant Difference ◽  
Scalp Block ◽  
One Way Anova

Latar Belakang dan Tujuan: Peningkatan respon hemodinamik yang disebabkan oleh nyeri dapat menyebabkan peningkatan aliran darah otak dan tekanan intrakranial. Blok scalp pada kraniotomi menumpulkan respon hemodinamik karena rangsangan nyeri serta mengurangi penambahan analgesi lain. Penelitian ini bertujuan untuk mengetahui efektifitas blok scalp sebagai analgetik pada kraniotomi.Subjek dan Metode: Penelitian ini menggunakan uji klinik acak tersamar ganda pada 36 pasien dengan status fisik ASA 1–3 dilakukan operasi kraniotomi eksisi dan memenuhi kriteria inklusi. Sampel dibagi menjadi kelompok I (dengan blok scalp) dan kelompok II (tanpa blok scalp). Blok dilakukan sesaat setelah induksi anestesi. Digunakan levobupivakain 0,375% sebanyak 3 ml tiap insersi, pada masing-masing saraf. Tekanan darah, tekanan arteri rata-rata, detak jantung sebelum intubasi dan setelah intubasi, pemasangan pin, insisi kulit dan insisi duramater serta total kebutuhan fentanyl tambahan dicatat. Data yang diperoleh dianalisis dengan program komputer SPSS versi 17 lalu diuji menggunakan uji Kruskal-Wallis atau One-way ANOVA. Batas kemaknaan yang diambil adalah p < 0,05.Hasil: Selama kraniotomi, detak jantung, tekanan darah, tekanan arteri rata-rata secara signifikan lebih tinggi pada pasien tanpa blok scalp terutama pada saat pemasangan pin. Hasil uji statistik menunjukkan perbedaan signifikan, penambahan fentanyl pada pasien dengan blok scalp lebih sedikit dibandingkan tanpa blok scalp, p=0,000 (p<0,05).Simpulan: Blok scalp levobupivakain efektif dalam menurunkan respon hemodinamik terutama pada saat pemasangan pin. Pasien kraniotomi dengan blok scalp membutuhkan penambahan fentanyl lebih sedikit. Differences on Hemodynamic Response with Levobupivacaine Scalp Block in Craniotomy SurgeryAbstractBackground and Objective: Increased hemodynamic response caused by pain can lead to increased cerebral blood flow and intracranial pressure. Scalp block in craniotomy blunts hemodynamic response due to pain and reduce other analgesics addition. This study aims to determine effectiveness of scalp blocks as analgesic in craniotomy.Subject and Method: This study used a double-blind randomized clinical trial in 36 patients with physical status ASA 1-3 who underwent craniotomy and met inclusion criteria. Samples were divided into group I (with scalp block) and group II (without scalp block). Scalp Block was performed right after anesthesia induction. Using levobupivacaine 0.375% 3 ml for each insertion. Blood pressure, mean arterial pressure, heart rate before and after intubation, during pin placement, skin incision and duramater incision and total need for additional fentanyl were recorded. SPSS version 17 was used and data were analysed using Kruskal-Wallis or One-way ANOVA. Statistical significance was accepted at p < 0.05.Result: During craniotomy, heart rate, blood pressure, mean arterial pressure were significantly higher in patients without scalp block especially during pin placement. Statistical test showed significant difference, additional fentanyl in patients with scalp blocks was lesser, p = 0.000 (p <0.05). Conclusion: Levobupivacaine scalp block was effective to blunt hemodynamic response especially during pin placement. Scalp block also decreased additional fentanyl in craniotomy.

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