不同剂量艾司洛尔复合异丙酚对气管插管时应激反应的影响

目的 了解艾司洛尔预防气管插管引起的血流动力学变化的合理用量。方法 30例病人随机分为3组。A组为对照组,B组为0．5mg.kg^-1艾司洛尔组,C组为1．0mg.kg^-1艾司洛尔组。静注异丙酚和维库溴铵诱导气管内插管。监测插管后1、3、5及10min收缩压（SP）、舒张压（DP）、心率（HR）;并抽取血标本用高压液相色谱仪测血浆中去甲肾上腺素（NE）、肾上腺素（E）和多巴胺（DA）浓度。结果 A组插管后1min时血压、心率显著升高（P＜0．01）或0．05）。B组插管后3、5及10min时血压、心率显著降低（P＜0．01或0．05）;3及5min时去甲肾上腺素与肾上腺素水平显著降低（P＜0．01或0．05）,与B组比较,插管后1和3min时肾上腺素水平显著降低（P＜0．01）。结论 1．0mg.kg^-1艾司洛尔复合异丙酚可缓解插管时的循环反应及儿茶酚胺反应。     

Combined use of esmolol and nicardipine to blunt the haemodynamic changes following laryngoscopy and tracheal intubation

We examined the effect of different combinations of esmolol and nicardipine upon the circulatory response to tracheal intubation. One hundred patients were randomly allocated into five groups of twenty to receive pretreatments of saline or different combinations of esmolol (0.5 or 1.0 mg x kg(-1)) and nicardipine (15 or 30 microg x kg(-1)). Significant tachycardia persisted over a 5-min period after intubation in all five groups compared with baseline levels (p < 0.05). Patients receiving esmolol 1.0 mg x kg(-1) and nicardipine 30 g x kg(-1) showed no significant change in systolic blood pressure after tracheal intubation compared with baseline and significant lower peak systolic blood pressure than those receiving saline (p = 0.023).     

The effect of propofol/remifentanil rapid-induction technique without muscle relaxants on intraocular pressure

Study ObjectiveTo evaluate the effect of propofol (two mg/kg)/remifentanil (4 μg/kg) on intraocular pressure (IOP) when used for rapid-sequence induction.DesignRandomized, double-blinded trial.SettingAmbulatory surgery center.Patients47 adult, ASA physical status I and II patients (ages 18-75 yrs), undergoing outpatient, elective, nonophthalmologic surgery.InterventionsAfter premedication with midazolam (two mg) and glycopyrrolate (0.2 mg), standard monitors and a bispectral index (BIS) monitor were applied. Patients underwent rapid-sequence induction with intravenous (IV) propofol two mg/kg and either remifentanil 4 μg/kg IV or succinylcholine 1.5 mg/kg IV. An experienced anesthesiologist, blinded to patient group assignment, performed intubation after 60 seconds.MeasurementsIOP, heart rate (HR), blood pressure, BIS scores, intubating conditions, and response to intubation (coughing or moving) were recorded at baseline, immediately after completion of induction, one minute after intubation, and three minutes after intubation. Time to return of spontaneous ventilation was also measured.Main ResultsRemifentanil produced a 39% decrease in IOP immediately after induction, which remained unchanged by laryngoscopy and intubation (P < 0.001). IOP remained below baseline even in patients who coughed or moved in response to intubation. Remifentanil caused a significant decrease in mean arterial pressure of 24% to 31% but no significant change in HR, and it blocked the hemodynamic response to laryngoscopy and intubation while providing intubating conditions comparable to those of succinylcholine.ConclusionsPropofol/remifentanil induction provides adequate intubating conditions, prevents an increase in IOP, and controls the hemodynamic stress response to laryngoscopy and intubation.     

尼卡地平、乌拉地尔和艾司洛尔对全麻诱导期间压力反射敏感性的影响

目的 观察尼卡地平、乌拉地尔和艾司洛尔对原发性高血压(EH)患者全麻诱导期间压力反射敏感性(BRS)的影响.方法 全身麻醉F行择期手术EH患者62例,随机分为四组,分别于诱导前2min静注尼卡地平0.5μg/kg(N组,15例)、乌拉地尔0.5 mg/kg(U组,16例)、艾司洛尔0.25 mg/kg(E组,16例)和牛理盐水(c组,15例).用相同药物进行全麻诱导.于诱导前、插管前即刻,以及插管后5、10、15、20、30 min不同时点静注硝普钠50～100μg.使SBP下降15～25mm Hg,记录SBP下降期间RR间期的变化,计算BRS.结果 N组、U组和C组插管前后各时间点BRS与基础值比较明显降低(P<0.05或P<0.01),N组中各时点BRS又明显低于C组(P<0.05),而E组明显高于C组(P<0.05).结论 伞麻诱导可降低EH患者的BRS;尼卡地平可使BRS进一步降低,乌拉地尔则无显著影响,而艾司洛尔则使伞麻诱导期的BRS升高.     

The effect of additional propofol on intubation conditions

Study ObjectiveTo evaluate whether an additional dose of propofol prior to intubation improves intubation conditions.DesignProspective, randomized, double-blinded clinical study.SettingOperating room in university hospital.Patients102 ASA physical status I and II patients undergoing elective surgery with general anesthesia.InterventionsPatients received different doses of propofol (Groups A and B, 1.5 mg/kg; Group C, 2 mg/kg) preceded by fentanyl (1.5 μg/kg). In Group B, additional propofol (0.5 mg/kg) was administered 45 seconds after rocuronium. Intubation was performed 90 seconds after administration of rocuronium 0.6 mg/kg. Intubation conditions and hemodynamic variables were compared among the three groups.Measurements and Main ResultsIntubation conditions were acceptable in 61.8% of Group A patients, 58.8% of Group C patients, and 91.1% of Group B patients (P = 0.005). Mean arterial pressure (MAP) three minutes after intubation was significantly lower in Group C (P = 0.006 vs. Groups A and B), while MAP did not differ between Group A and Group B.ConclusionsAdministration of an additional dose of propofol (0.5 mg/kg) prior to intubation may significantly improve intubation conditions without increasing the frequency of hypotension.     

艾司洛尔对老年患者非心脏手术围麻醉期应激反应的抑制作用

目的观察静脉持续输注艾司洛尔对老年患者非心脏手术围麻醉期应激反应的抑制作用。方法65岁以上择期全麻气管插管下行非心脏手术的患者40例，随机分为艾司洛尔组（n=20）与对照组（n=20）。艾司洛尔组麻醉前先静脉注射艾司洛尔0．25mg／kg，然后以20～50μg／（kg·min）的速度用输液泵持续输注，直到气管拔管后5min；对照组以生理盐水替代。记录入室、气管插管前、气管插管后即刻、切皮、手术结束、患者睁眼及拔管后即刻HR、MBP、RPP，以及入室、插管后即刻、切皮、手术结束及拔管后血糖、血香草扁桃酸（BVMA）及血皮质醇水平。结果与对照组比较，艾司洛尔组的HR、RPP在插管后即刻、患者睁眼以及气管拔管后即刻，MBP在气管插管后及睁眼时显著降低（P〈0．05），血糖值在手术结束及拔管后显著降低（P〈0．05或P〈0．01）。艾司洛尔组的芬太尼与异丙酚总量分别为（0．4±0．1）mg和（450．8±98．2）mg，显著少于对照组的（0．5±0．1）mg与（580．3±125．7）mg（P〈0．05）。结论艾司洛尔围麻醉期持续静脉输注可以很好地控制老年患者非心脏手术的应激反应，抑制围麻醉期患者血糖的升高，减少老年患者的麻醉药用量。     

RETRACTED ARTICLE: Effects of calcium channel blockers on circulatory response to tracheal intubation in hypertensive patients: nicardipine versus diltiazem

We studied the circulatory responses to laryngoscopy and tracheal intubation in 37 hypertensive patients who received nicardipine 30 μg · kg^?1 iv (Group N, n = 12), diltiazem 0.3 mg · kg^?1 (Group D, n = 12) or saline placebo (Group C, n = 13) 60 sec before the initiation of laryngoscopy. Anaesthesia was induced with thiopentone 5 mg · kg^?1 iv, and succinylcholine 2 mg · kg^?1 iv was used to facilitate tracheal intubation after precurarization with vecuronium 0.02 mg · kg^?1 iv. In patients in Group C heart rate (HR) increased from 79 ± 14 (baseline) to 110 ± 12 (P < 0.05) associated with tracheal intubation; mean arterial pressure (MAP) increased from 116 ± 8 to 140 ± 77 (P < 0.05) and rate-pressure product (RPP) increased from 13385 ± 2393 to 21251 ± 3883 (P < 0.05). The changes from baseline values in HR and RPP after tracheal intubation in Group D were less than those in Groups C and N (P < 0.05). The increase in MAP following tracheal intubation in Groups N and D was lower than that in Group C (P < 0.05). We conclude that, compared with nicardipine, administration of diltiazem iv is associated with less circulatory response to tracheal intubation in hypertensive patients.     

The use of esmolol, nicardipine, or their combination to blunt hemodynamic changes after laryngoscopy and tracheal intubation

Laryngoscopy and tracheal intubation (LTI) often provoke an undesirable increase in blood pressure (BP) and/or heart rate (HR). We tested the premise that nicardipine (NIC) and esmolol (ESM) in combination (COMB) would oppose both. Adult surgical patients received pretreatment (randomized) with IV bolus NIC 30 microg/kg (n = 31), ESM 1.0 mg/kg (n = 34), or COMB (one-half dose each, n = 32). Peak BP and HR after LTI were compared with controls (CONT; n = 35) with no pretreatment. Anesthetic induction was standardized: IV thiopental (5-7 mg/kg), fentanyl (1-2 microg/kg), and succinylcholine (1.5 mg/kg). Systolic (S), diastolic (D), and mean (M) BP and HR awake before pretreatment (baseline) were similar in all test groups. No patient was treated for hypotension, bradycardia, or tachycardia after pretreatment or anesthetic induction. Peak HR after LTI was increased versus baseline in CONT and all test groups, but did not differ from CONT among the test groups. Peak SBP and DBP increased versus baseline in CONT, and with ESM and NIC, but not COMB. Peak SBP, DBP, and MBP were increased with ESM versus COMB, and peak DBP with ESM versus NIC. Compared with no pretreatment before the IV induction of general anesthesia, the peak increase in BP after LTI is best blunted by the combination of nicardipine and ESM, compared with either drug alone. No single drug or combination in the doses tested opposed increased HR. IMPLICATIONS: Compared with no pretreatment before the IV induction of general anesthesia, the peak increase in blood pressure after laryngoscopy and tracheal intubation is best blunted by the combination of nicardipine and esmolol, compared with either drug alone. No single drug or combination in the doses tested opposed increased heart rate.     

Comparação de esmolol em bolus e infusão contínua na resposta hemodinâmica à laringoscopia,intubação orotraqueal e esternotomia em cirurgia de revascularização coronária

Background and objective

The aim of this randomized, prospective and double blinded study is to investigate effects of different esmolol use on hemodynamic response of laryngoscopy, endotracheal intubation and sternotomy in coronary artery bypass graft surgery.

Methods

After approval of local ethics committee and patients’ written informed consent, 45 patients were randomized into three groups equally. In Infusion Group; from 10 min before intubation up to 5th minute after sternotomy, 0.5 mg/kg/min esmolol infusion, in Bolus Group; 2 min before intubation and sternotomy 1.5 mg/kg esmolol IV bolus and in Control Group; %0.9 NaCl was administered. All demographic parameters were recorded. Heart rate and blood pressure were recorded before infusion up to anesthesia induction in every minute, during endotracheal intubation, every minute for 10 minutes after endotracheal intubation and before, during and after sternotomy at first and fifth minutes.

Results

While area under curve (AUC) (SAP × time) was being found more in Group B and C than Group I, AUC (SAP × Tint and Tst) and AUC (SAP × T2) was found more in Group B and C than Group I (p < 0.05). Moreover AUC (HR × Tst) was found less in Group B than Group C but no significant difference was found between Group B and Group I.

Conclusion

This study highlights that esmolol infusion is more effective than esmolol bolus administration on controlling systolic arterial pressure during endotracheal intubation and sternotomy in CABG surgery.     

艾司洛尔对患者麻醉诱导气管插管时脑电双频谱指数的影响

Objective To evaluate the effect of esmolol on bispectral index (BIS) in patients undergoing orotracheal intubation during induction of anesthesia and to investigate the mechanism of inhibiting the cardiovascular responses to tracheal intubation.Methode Forty patients in physical status of ASA Ⅰ or Ⅱ and aged 20-60 years were randomly divided into 2 groups ( n = 20 each): esmolol group (group E) and control group (group C). Anesthesia was induced with midazolam 0.1 mg/kg, fentanyl 5 μg/kg and vecuronium 0.1 mg/kg. In group E, esmolol 1 mg/kg was given intravenously before anesthesia induction and followed by an infusion of esmolol 250 μg· kg- 1·min-1, while a comparable volume of saline was given for group C. Mean arterial pressure (MAP), heart rate (HR) and BIS were recorded before esmolol administration, before induction of anesthesia, before orotracheal intubation, and at 1, 2 and 5 min after intubation, respectively.Results There were no significant differences in HR, MAP and BIS between the two groups before tracheal intubation. HR and MAP significantly increased after tracheal intubation in both groups, but BIS only in group C significantly increased after intubation.HR, MAP and BIS were significantly lower after intubation in group E than in group C ( P＜ 0.05).Conclusion Esmolol can decrease BIS during tracheal intubation and its antinociceptive property is related to the mechanism of inhibiting cardiovascular responses to tracheal intubation.     

Cardiovasular changes after placement of a classic endotracheal tube, double-lumen tube, and Laryngeal Mask Airway

Study ObjectiveTo compare hemodynamic responses, P wave dispersion (Pd), and QT dispersion (QTd) after placement of a classic endotracheal tube (ETT), double-lumen tube (DLT), or Laryngeal Mask Airway (LMA).DesignProspective study.SettingOutpatient surgery center.Patients75 adult, ASA physical status 1 and 2 patients undergoing cystoscopy and thoracoscopic surgery.InterventionsPatients were randomized to undergo placement of an ETT (Group T; n = 25), DLT (Group D; n = 25), or LMA (Group L; n = 25). Anesthesia was induced by etomidate 0.3 mg/kg and fentanyl 1.0 μg/kg, and maintained with nitrous oxide, oxygen, 2% to 3% sevoflurane, and rocuronium 0.5 mg/kg.MeasurementsMean arterial pressure (MAP) and heart rate (HR) were recorded immediately before intubation and after intubation at one, 3, 5, 10,15, 20, 25, and 30 minutes after intubation/airway insertion.ResultsQT dispersion after tube placement was significantly higher than before tube placement in Group D (P = 0.0001) and Group L (P = 0.03). Mean arterial pressure and HR in Group T were significantly higher than in Group L at the first minute after tube placement (P = 0.02). Heart rate and MAP at baseline were significantly higher than the other measurement times in Groups T and D (P < 0.01).ConclusionsThe LMA caused no change in Pd, HR, or MAP values during or after airway placement, but caused QTd after airway insertion. The ETT caused a sudden increase at the first minute after tube placement, without any Pd or QTd. In addition, DLT caused QTd without any serious change in hemodynamics.     

瑞芬太尼复合艾司洛尔对全麻患者气管插管时心血管指标的影响

目的 评价瑞芬太尼复合艾司洛尔对全麻患者气管插管时心血管系统的影响.方法 选择择期上腹部手术患者60 例,ASAⅠ - Ⅱ级,随机分为3 组（n = 20）：瑞芬太尼2 μg/kg组（Ⅰ组）,芬太尼4 μg/kg ＋ 艾司洛尔1 mg/kg 组（Ⅱ组）和瑞芬太尼2 μg/kg ＋ 艾司洛尔1 mg/kg组（Ⅲ组）.分别注入上述药物、丙泊酚2 mg/kg 和阿曲库铵1.5 mg/kg 后行气管插管,机械通气.记录麻醉诱导前（T1）、麻醉诱导后1 min（T2）、气管插管后即刻（T3）、气管插管后1 min（T4）、3 min（T5）及10 min（T6）的HR、收缩压（SP）、舒张压（DP）,并于T1、T2、T4 时分别采集桡动脉血7 ml,测定血浆肾上腺素（Ad）和去甲肾上腺素（NA）的浓度.结果 与Ⅰ组比较,Ⅱ组和Ⅲ组HR、SP、DP 及血浆Ad 和NA 的浓度降低（P 〈 0.05）;与Ⅱ组比较,Ⅲ组HR、SP、DP 降低（P 〈 0.05）;与T1 比较,T2时3 组HR、SP、DP 及血浆Ad 和NA 的浓度降低（P 〈 0.05）;Ⅰ组T3 时HR、SP、DP 升高,Ⅱ组和Ⅲ组差异无统计学意义.结论 瑞芬太尼复合艾司洛尔可更好地预防全麻患者气管插管时的心血管副作用.     

Minimal effective dose of magnesium sulfate for attenuation of intubation response in hypertensive patients

Study ObjectiveTo study the minimal effective dose of magnesium sulfate to control blood pressure (BP) during intubation in hypertensive patients.DesignProspective, randomized, double-blind study.SettingOperating room of an academic medical center.Patients80 adult, ASA physical status 1 and 2, controlled hypertensive patients undergoing elective surgery under general anesthesia and requiring endotracheal intubation.InterventionsPatients were randomized to 4 groups. Patients in study groups received a magnesium sulfate infusion at a dose of 30 (Group I), 40 (Group II), or 50 mg/kg (Group III) before induction of anesthesia, while patients in control group (Group IV) received a 1.5 mg/kg lidocaine bolus 90 seconds before intubation. Anesthesia was induced and maintained with a propofol infusion. Laryngoscopy and intubation were performed 4 minutes after administration of vecuronium.MeasurementsHeart rate (HR) and BP were recorded before, during, and after endotracheal intubation for10 minutes. Measures to manage hemodynamic instability were recorded. Serum magnesium levels were also recorded.Main ResultsThe changes in HR were comparable among groups. Mean arterial pressure (MAP) was maintained within normal limits in Group I patients while Groups II and III patients showed a significant decrease in MAP (P = 0.01) compared with baseline. A total of 6 patients (30%) in Group II and 10 patients (50%) in Group III required interventions (P = 0.001). No patient in Group I and only one patient (5%) in Group IV required intervention.ConclusionsMagnesium 30 mg/kg is the optimum dose to control BP during intubation in hypertensive patients. A further increase in the dose of magnesium may cause significant hypotension.     

The effects of low-dose ephedrine on intubating conditions following low-dose priming with cisatracurium

Study ObjectiveTo determine whether low-dose ephedrine plus priming with low-dose cisatracurium improves intubating conditions.DesignProspective, randomized, double-blinded study.SettingOperating room.Patients124 ASA physical status I and II patients scheduled for elective surgery.InterventionsPatients were randomly assigned to 4 groups (n = 31): Group PE (priming + ephedrine), Group P (priming), Group E (ephedrine), and Group NPE (no priming, no ephedrine). All patients were induced with propofol two mg/kg and sulfentanil 0.15 μg/kg. In the priming groups, 0.005 mg/kg (10% ED₉₅) cisatracurium was given, followed three minutes later by 0.145 mg/kg of cisatracurium. In Groups E and NPE, a single dose of 0.15 mg/kg cisatracurium was given. Intravenous ephedrine 70 μg/kg was given in Groups PE and E. Tracheal intubation was attempted 60 seconds after the intubating dose of cisatracurium and was considered successful only if performed within 20 seconds.MeasurementsIntubating conditions were graded. Heart rate and non-invasive blood pressure, at one-minute intervals, were recorded during and 5 minutes after induction.Main ResultsThe tracheas of all patients in Group PE were successfully intubated within 20 seconds versus 74% in Group P, 77% in Group E, and 64% in Group NPE (P < 0.001 vs. Group PE). Intubating conditions were graded good to excellent in all PE patients, but in only 52% of Groups P and E, and 48% of NPE patients (P < 0.001). Hemodynamic variables were comparable among groups (P = ns).ConclusionsLow-dose ephedrine plus priming with low-dose cisatracurium before an intubating dose, significantly improved clinical intubating conditions at 60 seconds.     

Esmolol for control of increases in heart rate and blood pressure during tracheal intubation after thiopentone and succinylcholine

Esmolol, an ultra-short-acting cardioselective beta-adrenergic blocker, was investigated in a double-blind prospective protocol for its ability to control haemodynamic responses associated with tracheal intubation after thiopentone and succinylcholine. Thirty ASA physical status I patients received a 12-minute infusion of esmolol (500 micrograms X kg-1 X min-1 for four minutes, then 300 micrograms X kg-1 X min-1 for 8 minutes) or saline. Five minutes after the start of the drug/placebo infusion, anaesthesia was induced with 4 mg X kg-1 thiopentone followed by succinylcholine for tracheal intubation. Prior to induction esmolol produced significant decreases in heart rate (HR) (9.3 +/- 1.8 per cent) and rate-pressure product (RPP) (13.1 +/- 1.8 per cent), systolic blood pressure (SAP) (4.3 +/- 1.5 per cent) and mean arterial blood pressure (MAP) (1.7 +/- 2.0 per cent). Increases in HR, SAP and RPP after intubation were approximately 50 per cent less in patients given esmolol compared to patients given placebo. There were highly significant differences in HR (p less than 0.0001), and RPP (p less than 0.0005) and significant differences in SAP (p less than 0.05) when the maximal esmolol post-intubation response was compared to the maximal placebo response. Infusion of esmolol in the dose utilized in this study significantly attenuated but did not completely eliminate cardiovascular responses to intubation.     

The effect of intraoperative use of esmolol and nicardipine on recovery after ambulatory surgery

There is controversy regarding the optimal technique for maintaining hemodynamic stability during anesthesia. We designed this prospective, randomized, double-blinded study to test the hypothesis that the technique used for maintaining hemodynamic stability during general anesthesia can influence recovery after ambulatory surgery. Forty-five healthy consenting women undergoing gynecologic laparoscopy procedures were randomly assigned to 1 of 3 treatment groups: Group 1 (control, n = 15) received normal saline 5 mL and 1 mL, followed by a saline infusion at a rate of 0.005 mL x kg(-1) x min(-1); Group 2 (n = 15) received esmolol 50 mg and saline 1 mL, followed by an esmolol infusion 5 microg x kg(-1) x min(-1); and Group 3 (n = 15) received esmolol 50 mg and nicardipine 1 mg, followed by an esmolol infusion 5 microg x kg(-1) x min(-1). The study drugs were administered after the induction of anesthesia with fentanyl 1.5 microg/kg, and propofol 2 mg/kg I.V. Tracheal intubation was facilitated with vecuronium 0.12 mg/kg I.V. Anesthesia was initially maintained with desflurane 2% end-tidal and N(2)O 67% in oxygen in all 3 groups. During surgery, the mean arterial blood pressure (MAP) was maintained within +/-15% of the baseline value by varying the study drug infusion rate and the inspired concentration of desflurane. In addition to MAP and heart rate values, electroencephalogram bispectral index values were recorded throughout the perioperative period. Recovery times and postoperative side effects were assessed. Compared with the control group, adjunctive use of esmolol and nicardipine attenuated the increase in heart rate (in Group 2) and MAP (in Group 3) after tracheal intubation. Furthermore, the use of an esmolol infusion as an adjunct to desflurane to control the acute autonomic responses during the maintenance period significantly decreased emergence times (4 +/- 2 versus 7 +/- 4 min), decreased the need for postoperative opioid analgesics (43% versus 80%), and reduced the time to discharge (209 +/- 89 versus 269 +/- 100 min). We conclude that the adjunctive use of esmolol alone or in combination with nicardipine during the induction of anesthesia reduced the hemodynamic response to tracheal intubation. Furthermore, use of an esmolol infusion as an adjuvant to desflurane-N(2)O anesthesia for controlling the acute hemodynamic responses during the maintenance period improved the recovery profile after outpatient laparoscopic surgery. IMPLICATIONS: The adjunctive use of the beta-adrenergic blocker esmolol to control the acute sympathetic responses during desflurane-based anesthesia provided a more rapid awakening from anesthesia, reduced the postoperative opioid analgesic requirement, and decreased the time to discharge home after ambulatory laparoscopic surgery.     

The effect of combined ephedrine and lidocaine pretreatment on pain and hemodynamic changes due to propofol injection

ObjectivesInjection pain and hypotension are two main adverse effects of propofol that discourage uniform acceptation. The aim of this study was to compare the effect of ephedrine-lidocaine combination with lidocaine and ephedrine alone on injection pain and hemodynamic changes caused by propofol injection.MethodsOne hundred and sixty five patients were randomly allocated to five groups to receive either lidocaine 0.5 mg/kg (Group L) alone, ephedrine 30 μg/kg (Group E30) alone, ephedrine 70 μg/kg (Group E70) alone, lidocaine 0.5 mg/kg-ephedrine 30 μg/kg Group LE, or 2 mL saline (Group S). One minute after the respective study solution was given propofol 2 mg/kg was injected. Face pain scale and verbal rating scale were then evaluated. The mean arterial blood pressure (MAP) and heart rate (HR) were recorded before injection of the test solution, just before the intubation, and 1 minute after intubation.ResultsPatients in the Group L and Group LE showed significantly smaller pain scores compared with the saline group (Group S) [95% confidence interval (CI) 0.50–1.50; p = 0.003 and 95% CI 1.000–1.500; p = 0.004, respectively). The pain scores in Group E30 and Group E70 failed to show a significant difference with that of the Group S (p = 0.193 and p = 0.184, respectively). The changes of MAP before and after propofol injection between the Group L versus Group E30, Group E70, and Group LE were found to be significant (95% CI 5.27–14.49; p = 0.000), (95% CI 4.72–16.39; p = 0.001), and (95% CI 5.94–16.47; p = 0.001), respectively. The HR changes, before and after propofol injection, tended to be smaller in ephedrine groups than in Group L and Group S (p < 0.05).ConclusionPretreatment with combination of small-dose ephedrine and lidocaine could reduce the incidence and intensity of propofol-induced pain and also result in more stable hemodynamic profile, but however, the combination of two drugs failed to work better in further reduction of pain.     

Comparative effects of propofol, landiolol, and nicardipine on hemodynamic and bispectral index responses to endotracheal intubation: a prospective, randomized, double-blinded study

STUDY OBJECTIVES: To examine the comparative effects of propofol, landiolol, and nicardipine on hemodynamic responses and bispectral index (BIS) changes to endotracheal intubation. SETTING: Operating room of a university-affiliated general hospital. PATIENTS: 27 ASA physical status I and II patients who were scheduled to undergo elective general surgical, urological, or gynecological procedures with general anesthesia. STUDY DESIGN: Prospective, randomized, double-blinded study. INTERVENTIONS: Patients were divided into three groups as follows: Group 1 received propofol, 1 mg/kg; Group 2 received landiolol, 0.1 mg/kg; and Group 3 received nicardipine, 1 mg. After baseline measurements were recorded, anesthesia was induced with propofol, fentanyl, and vecuronium. Patients' lungs were ventilated with 100% oxygen for 120 seconds, at which time one of one of the study drugs was administered. Laryngoscopy and tracheal intubation were performed 4 minutes after anesthetic induction. MEASUREMENTS: Cardiac index (CI) and stroke volume index (SVI) were monitored continuously. Bispectral index was also monitored continuously from 5 minutes after tracheal intubation. MAIN RESULTS: Heart rate values in Group 3 increased 30 seconds after intubation; this increase lasted for 1 minute after intubation. Systolic blood pressure in all three groups decreased after induction of anesthesia and before tracheal intubation, and values returned closer to baseline values 30 seconds after intubation. In the propofol group, CI and SVI decreased after administration of additional propofol, lasting for 30 seconds after intubation. The BIS values rapidly decreased after induction of anesthesia, with no intergroup differences noted in BIS values (propofol group, 39+/-7; landiolol group, 44+/-14; nicardipine group, 41+/-9). However, BIS was significantly lower in the propofol group than in the other two groups from 30 seconds to 5 minutes after intubation. CONCLUSIONS: Landiolol, 0.1 mg/kg, before intubation provides effective hemodynamic stability in the postintubation period.     

Attenuation of hemodynamic responses to rapid sequence induction and intubation in healthy patients with a single bolus of esmolol

The effectiveness of a single preinduction intravenous (IV) bolus of esmolol in blunting hemodynamic responses to rapid sequence induction and tracheal intubation was evaluated. In a randomized double-blind study, 32 ASA I and II healthy patients scheduled for surgery were monitored with electrocardiography (EKG) lead V5, arterial cannulation, and impedance cardiography. After preoxygenation and a priming dose of vecuronium (0.01 mg/kg), patients received either saline (n = 12), esmolol 100 mg (n = 10), or esmolol 200 mg (n = 10) as an IV bolus (20 ml volume). This procedure was immediately followed by a 5 ml IV saline flush, cricoid pressure, thiopental sodium 5 mg/kg, and succinylcholine 1.5 mg/kg. Patients receiving 200 mg of esmolol had a 50% reduction in the usual tachycardia associated with induction and a greater decline in systolic blood pressure (SP) (by 50%) prior to intubation as compared with the placebo group (p less than 0.05). The increase in diastolic blood pressure (DP) and the reduction in stroke volume (SV) produced by induction and intubation were similar in all the groups. Plasma norepinephrine levels at 1.5 minutes after intubation increased in the esmolol groups about 130% above that measured in the placebo group. This finding was associated with a more gradual return of peripheral resistance to baseline following tracheal intubation. However, both doses of esmolol effectively attenuated heart rate (HR), SP, and rate pressure product (RPP) increases (p less than 0.05 vs placebo) produced by laryngoscopy and tracheal intubation.     

Comparison of nicardipine versus esmolol in attenuating the hemodynamic responses to anesthesia emergence and extubation

OBJECTIVE: The purpose of this study was to compare the effectiveness of intravenous (IV) nicardipine versus esmolol in controlling heart rate (HR) and blood pressure (BP) responses to emergence and extubation. DESIGN: Prospective, randomized, double blind. SETTING: University hospital, single institution. PARTICIPANTS: Twenty-two American Society of Anesthesiologists physical class 1 to 3 adult inpatients scheduled for general anesthesia. INTERVENTIONS: General endotracheal anesthesia with oxygen/isoflurane and muscle relaxation. At end of surgery, with at least 2 twitches by nerve stimulator and end-tidal isoflurane <0.4%, muscle relaxant reversal was accomplished with neostigmine and glycopyrrolate. Two minutes postreversal, the IV study drug nicardipine, 0.03 mg/kg, or esmolol, 1.5 mg/kg, was administered. HR and BP were measured every minute up to 10 minutes and at minute 15 postreversal. MEASUREMENTS AND MAIN RESULTS: There were no significant differences between groups in age, weight, gender, American Society of Anesthesiologists physical class or preoperative hemodynamics (HR, BP, mean arterial pressure [MAP]). Compared with nicardipine, 0.03 mg/kg IV, esmolol, 1.5 mg/kg IV, significantly (p < 0.05) attenuated HR more than nicardipine for the 15-minute time period poststudy drug. Compared with esmolol, nicardipine was significantly (p < 0.05) more effective in controlling MAP and systolic BP for the 1- to 3-minute and diastolic BP for the 1- to 2-minute time periods poststudy drug. There were no episodes of hypotension or adverse events. CONCLUSIONS: Although esmolol, 1.5 mg/kg, IV was more effective than nicardipine, 0.03 mg/kg, IV for attenuating the HR response to extubation, nicardipine was more effective in controlling the BP response.