A Study of the Efficacy of Cardiac Antidysrhythmic Drugs in Attenuating Haemodynamic Responses to Laryngoscopy and Endotracheal Intubation in the Black Population
International Journal of Anesthesia and Clinical Medicine
Volume 1, Issue 1, July 2013, Pages: 1-8
Received: May 23, 2013;
Published: Jun. 30, 2013
Views 3486 Downloads 89
Sanjeev Singh, Department of Anaesthesia and Intensive Care;Department of Cardiac Anaesthesia, NHIMS, Bangalore, Karnataka, India
Edwin Ferguson Laing, Molecular Medicine, School of Medical Sciences, College of Health Sciences
William Kwame Boakye Ansah Owiredu, Molecular Medicine, School of Medical Sciences, College of Health Sciences
Arti Singh, University Health Services, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, West Africa
Anbarasu Annamalai, Department of Cardiac Anaesthesia, NHIMS, Bangalore, Karnataka, India
Follow on us
Background: Laryngeal, tracheal and bronchial receptors are stimulated by mechanical and chemical irritants during laryngoscopy and endotracheal intubation. That almost always triggers powerful cardiovascular responses. Various attempts have been made to attenuate these responses. The aim of this study was to compare the efficacy and safety of cardiac antidysrhythmic drugs lidocaine, diltiazem and esmolol in the attenuation of cardiovascular responses to endotracheal intubation in the Black normotensive population. Patients and Methods: A randomized controlled trial was conducted in 160 adult patients of ASA physical status I or II undergoing various elective surgeries. The patients were randomly divided into four groups of 40 patients in each group - C, L, D, and E. Group - “C” received no drug (control) as placebo, group -“L” received 1.5 mg kg-1 preservative free lidocaine, group -“D” received 0.2 mg kg-1 diltiazem, and group-“E” received 2mg kg-1 esmolol IV. Group “C”, “D” and “E”, “L” one and two minutes before intubation. Changes in heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were measured and then compared within and between groups. Rate pressure product (RPP) was calculated and evaluated as well. Patients were also observed for any complications. Result: There was a significant increase in SBP, DBP, HR, MAP and RPP from the base line in control group “C” at 1 minute with onward decreases at 3 and 5 minutes respectively after intubation. Percentage change in haemodynamic variables in groups C, L, D and E at 1 minute are as follows: SBP= 23.58%, 11.84%, 9.64% and 9.9%, DBP= 18.73%, 18.89%, 11.93% and 10.40%, HR= 30.45%, 26.00%, 7.01% and 1.50%; MAP= 20.80%, 15.89%, 10.90 and 10.20%; RPP= 61.44%, 40.86%, 17.26% and 11.68% respectively. Only patients receiving placebo had increased SBP, DBP, HR, MAP and RPP values after intubation compared with baseline values (p < 0.05). Conclusions: Given the difference in the pharmacological mechanisms of these drugs, the prophylactic therapy with 2mg kg-1 esmolol is significantly more effective and safe for attenuating haemodynamic changes to laryngoscopy and tracheal intubation, without producing increased risk of hypertension in the Black population.
Blood Pressure, Diltiazem, Esmolol, Heart Rate, Intubation, Laryngoscopy, Lidocaine, (Source: MeSH, NLM)
To cite this article
Edwin Ferguson Laing,
William Kwame Boakye Ansah Owiredu,
A Study of the Efficacy of Cardiac Antidysrhythmic Drugs in Attenuating Haemodynamic Responses to Laryngoscopy and Endotracheal Intubation in the Black Population, International Journal of Anesthesia and Clinical Medicine.
Vol. 1, No. 1,
2013, pp. 1-8.
Manjunath HG, Venkatesh GS, Prima V, Jennifer LV, Sathees BCC. Can calcium and sodium channel blockers attenuate hemodynamic responses to endotracheal intubation? Eur J Gen Med 2008;5:198-207.
Gupta A, Wakhloo R, Gupta V, Mehta A, Kapoor BB. Comparison of Esmo-lol and Lignocaine for Atttenuation of Car-diovascular Stress response to Laryngosco-py and Endotracheal Intubation. JK Science 2009; 11: 78-81.
Pedersen T, Eliasen K, Henriksen E. A prospective study of risk factors and cardiopulmonary complications associated with anaesthesia and surgery:risk indicators of cardiopulmonary morbidity. Acta Anaesthesiol Scand 1990;34: 144-55.
Yuan L, Chia YY, Jan KT et al. The effect of single bolus dose of esmolol for controlling the tachycardia and hypertension during laryngoscopy and tracheal intubation. Acta Anaesthesiologica Sinica 1994;32:147-52.
Moon YE, Lee SH, Lee J. The optimal dose of esmolol and nicardipine for maintaining cardiovascular stability during rapid sequence induction. journal of Clinical Anaesthesia 2012; 24: 8-13.
Hall AP, Thompson JP, Leslie NAP, Fox AJ, Kumar N and Rowbotham DJ. Comparism of different doses of remifentanil on the cardiovascular response larngoscopy and tracheal intubation. Br J Anaesth 2000:84:100-2.
Rupakar VB, Raval B, Chadha I A. Attenuation of cardiovascular responses to laryngoscopy and endotracheal intubation with diltiazem-lignocaine combination. J Anaesth Clin Pharmacol 2009; 25:341-344.
Gibbs CR, Beevers DG, Lip GYH. The management of hypertensive disease in Black patients. QJM 1999;92:187-92.
Singh S, Laing EF, Owiredu WKBA, Singh A. Attenuation of Cardiovascular response by ß-blocker esmolol during laryngoscopy and intubation. Journal of Medical and Biomedical Sciences (UDS) 2012;4: 27-33.
Takita K, Morimoto Y, Kemmotsu O. Tracheal lidocaine attenuates the cardiovascular response to endotracheal intubation. Can J Anaesth 2001;48:732-6
Jolliffe CT, Leece EA, Adams V, Marlin DJ. Effect of intravenous lidocaine on heart rate, systolic arterial blood pressure and cough responses to endotracheal intubation in propofol-anaesthetized dogs. Vet Anaesth Analg 2007;34:322-30
Splinter WM. Intravenous lidocaine does not attenuate the haemodynamic response of children to laryngoscopy and tracheal intubation. Can J Anaesth 1990;37:440-3
Miller CD, Warren SJ. Intravenous lignocaine fails to attenuate the cardiovascular response to laryngoscopy and tracheal intubation. Br J Anaesth. 1990 ;65:216–19.
Lev R, Rosen P. Prophylactic lidocaine use preintubation: a review. J Emerg Med 1994;12:499-506
Minogue SC, Ralph J, Lampa MJ. Laryngotracheal topicalization with lidocaine before intubation decreases the incidence of coughing on emergence from general anesthesia. Anesth Analg 2004;99:1253-7
Nishino T, Hiraga K, Sagimosi K. Effects of i.v. lignocaine on airway reflexes elicited by irritation of the tracheal mucosa in humans anaesthetized with cuflurane. Br J Anaesth 1990;64:682-7
Kato H, Takata Y. Differential effects of Ca antagonists on the noradrenaline release and contraction evoked by nerve stimulation in the presence of 4-aminopyridine. Br J Pharmacol 1987;90:191-201
Nathan N, Odin I. Induction of anaesthesia: a guide to drug choice. Drugs 2007;67:701-23
Fugit MD, Rubal BJ, Donovan DJ Effects of intracoronary nicardipine, diltiazem and verapamil on coronary blood flow. J Invasive Cardiol 2000;12:80-5
Lee KH, Jun ES, Chae YJ, Park GS, Choi JC, Lim HK. Effect of Diltiazem and Lidocaine on Cardiovascular Response to Tracheal Intubation. Korean J Anesthesiol 2002;43:710-5
Savio KH, Tait G, Karkouti K, Wijeysundera D, McCluskey S, Beattie WS. The Safety of Perioperative Esmolol: A System-atic Review and Meta-Analysis of Randomized Controlled Trials. Anesthesia & Analgesia;2011: 112, 267-81.
Bostana H, Eroglu A. Comparison of the Clinical Efficacies of Fentanyl, Esmolol and Lidocaine in Preventing the Hemody-namic Responses to Endotracheal Intuba-tion and Extubation. Journal of Current Surgery 2012; 2: 24-28.
Kumar S, Mishra MN, Mishra LS, Bathla S. Comparative study of the efficacy of i.v. esmolol, diltiazem and magnesium sulphate in attenuating haemodynamic response to laryngoscopy and tracheal intuba-tion. Indian J. Anaesth;2003: 47, 41-44.