The effect of diltiazem on the cardiovascular response to tracheal intubation

The efficacy of diltiazem in the attenuation of the cardiovascular response to laryngoscopy and tracheal intubation was studied in patients who received 0.2 or 0.3 mg/kg diltiazem 60 seconds before the start of laryngoscopy. These data were compared with a control group who received saline. Each group consisted of 10 patients who had elective surgery. Patients who received saline showed a significant increase in mean arterial pressure and rate pressure product associated with tracheal intubation. These increases after tracheal intubation were reduced in diltiazem-treated patients compared with those of the control group (p less than 0.05). The data suggest that a bolus injection of diltiazem is a simple, practical and effective method to attenuate the hypertensive response to laryngoscopy and tracheal intubation.     

Effects of combined intravenous nicardipine and diltiazem administration on the circulatory response to laryngoscopy and tracheal intubation

To evaluate the effect of combined intravenous administration of the calcium antagonists, nicardipine and diltiazem, on the circulatory responses to tracheal intubation, the mean arterial pressure (MAP) and rate pressure product (RPP) in response to laryngoscopy following tracheal intubation were compared in patients receiving saline placebo or nicardipine 10 μg·kg⁻¹ and diltiazem 0.1 mg·kg⁻¹ 60 s before the initiation of laryngoscopy. Each group was comprised of ten patients undergoing elective surgery. The patients receiving saline showed a significant increase in MAP and RPP associated with tracheal intubation. However, these increases were significantly attenuated (P<0.05) in the patients to whom nicardipine and diltiazem were administered concurrently.     

Gabapentin reduces cardiovascular responses to laryngoscopy and tracheal intubation

BACKGROUND AND OBJECTIVE: We have compared the effects of gabapentin on arterial pressure and heart rate at induction of anaesthesia and tracheal intubation in a randomized double-blind study. METHODS: Ninety normotensive patients (ASA I) undergoing elective surgery were divided into three groups of 30 patients each. Patients received oral placebo (Group I), 400 mg of gabapentin (Group II) or 800 mg of gabapentin (Group III) 1 h prior to surgery in the operating theatre. After induction of anaesthesia heart rate and mean arterial pressure were recorded at baseline 1, 3, 5, 10 and 15 min after intubation. RESULTS: Patients receiving placebo and 400 mg gabapentin showed a significant increase in blood pressure and heart rate associated with tracheal intubation compared to baseline levels and Group III. There was significant decrease in heart rate and arterial pressure in Group III after intubation 1, 3, 5 and 10 min (P < 0.001, P < 0.001, P < 0.05 and P < 0.05, respectively) compared to Groups I and II. CONCLUSION: Given 1 h before operation gabapentin 800 mg blunted the arterial pressure and heart rate increase in first 10 min due to endotracheal intubation. Oral administration of gabapentin 800 mg before induction of anaesthesia is a simple and practical method for attenuating pressor response to laryngoscopy and tracheal intubation after standard elective induction.     

注药型气管导管表面麻醉抑制气管插管心血管反应临床研究

目的 观察"声门上下注药型气管导管"(专利号:ZL 200820111377.4)在全身麻醉气管插管后立刻注射表面麻醉药能否减轻气管插管的心血管反应.方法 择期骨科手术患者40例,ASA分级Ⅰ、Ⅱ级,年龄20~60岁,BMI 22~30 kg/m2,按随机数字表法分为试验组和对照组,每组20例.以咪达唑仑0.04 mg/kg、舒芬太尼0.2μg/kg、依托咪酯0.25 mg/kg和维库溴铵0.1 mg/kg麻醉诱导,手控呼吸3 min后30 s内完成经口插入声门上下注药型气管导管,试验组立即注射1%丁卡因1.5 ml(声门下即气管内1 ml,声门上即咽喉部0.5 ml)施表面麻醉,对照组不注射药.固定导管,接麻醉机通气.分别于入室安静时(基础值,T0)、插管前即刻(T1)、插管后即刻(T2)、插管后1 min(T3)、插管后3 min(T4)和插管后5 min(T5)记录BP、HR和抽取血液标本测定血浆肾上腺素(epinephrine,E)、去甲肾上腺素(noradrenaline,NE)、皮质醇(cortisol,Cor)水平.结果 试验组SBP仅在T2时较T0时显著升高17%(P<0.05),对照组SBP在T2、T3、T4时分别较T0时显著升高29%(P<0.01)、36%(P<0.01)、15%(P<0.05);在T2~T5时,试验组SBP比对照组明显降低(P<0.05).试验组HR插管后没有显著升高(P>0.05),而对照组HR在T2、T3时分别显著升高18%(P<0.01)和14%(P<0.05),组间比较差异有统计学意义(P<0.05).试验组血浆E水平在T3和T5时明显较对照组低(P<0.05),血浆NE水平在T3和T5时试验组明显较对照组低(P<0.05).试验组血浆Cor水平在T5时明显较对照组低(P<0.01).结论 使用注药型气管导管在插入时立即注射表面麻醉药实施气管内、咽喉表面麻醉,能明显降低气管插管引起的心血管反应.     

Effects of nicardipine on the circulatory responses to tracheal intubation in normotensive and hypertensive patients

This study was undertaken to examine the effects of nicardipine on circulatory responses to laryngoscopy and tracheal intubation in normotensive (n = 39) and hypertensive (n = 36) patients. Laryngoscopy and tracheal intubation were performed after induction of anaesthesia with thiamylal, followed by administration of intravenous saline or nicardipine 20 or 30 micrograms.kg-1 and suxamethonium. Blood pressure and heart rate were recorded, and rate-pressure product was calculated. Nicardipine 20 and 30 micrograms.kg-1 prevented the increase in mean arterial pressure after intubation in normotensive and hypertensive patients (p less than 0.01 compared with saline). The changes in heart rate after intubation were significantly greater in normotensive patients than in hypertensive patients when 20 or 30 micrograms.kg-1 of nicardipine was given (p less than 0.05 and p less than 0.01 respectively). Rate-pressure product increased significantly (p less than 0.01) after intubation in normotensive patients whether nicardipine was administered or not, but the increase was suppressed completely by nicardipine 20 or 30 micrograms.kg-1 in hypertensive patients. We conclude that nicardipine is effective in preventing the circulatory responses to laryngoscopy and tracheal intubation in hypertensive patients.     

Effects of nilvadipine on the cardiovascular responses to tracheal intubation.

STUDY OBJECTIVE: To evaluate the efficacy of nilvadipine given orally in attenuating the hypertensive response to laryngoscopy and intubation. DESIGN: Controlled, randomized, double-blind study. SETTING: Induction of anesthesia for elective surgery at a university hospital. PATIENTS: Thirty normotensive patients (ASA physical status I) undergoing elective surgery were divided into three groups of ten patients each. INTERVENTIONS: Either 2 mg of nilvadipine, 4 mg of nilvadipine, or a placebo (control) was administered orally 90 minutes before induction of anesthesia. Anesthesia was induced with thiopental sodium 5 mg/kg intravenously, and tracheal intubation was facilitated with vecuronium 0.2 mg/kg. During anesthesia, ventilation was assisted or controlled with 1% enflurane and 50% nitrous oxide (N2O) in oxygen. Laryngoscopy lasting 30 seconds was attempted 2 minutes after administration of thiopental sodium and vecuronium. MEASUREMENTS AND MAIN RESULTS: Patients receiving the placebo showed a significant increase in mean arterial pressure (MAP) and heart rate associated with tracheal intubation. The increase in MAP following tracheal intubation was significantly lower in nilvadipine-treated patients than in the control group (p less than 0.05). However, neither dose of nilvadipine attenuated the tachycardic response to intubation. CONCLUSIONS: Oral administration of nilvadipine before induction of anesthesia is a simple and practical method for attenuating pressor response to laryngoscopy and tracheal intubation after standard elective induction under additional 1% enflurane-N2O anesthesia.     

The effect of sufentanil on the cardiovascular responses to tracheal intubation

The effects of sufentanil 0.5 or 1 microgram/kg, given intravenously after induction of anaesthesia, on the cardiovascular responses to tracheal intubation were examined in a controlled, randomised, double-blind investigation. The control group of patients exhibited significant rises in arterial blood pressure and heart rate for 4 minutes after tracheal intubation. Heart rate exceeded 100 beats/minute and systolic pressure increased by over 20% in every patient. All patients moved or breathed within 10 minutes of the administration of suxamethonium. Sufentanil 0.5 microgram/kg prevented increases in the mean values of heart rate and arterial blood pressure, although increases were observed in five patients. Significant falls in the mean values of heart rate and arterial pressure occurred from 4 minutes after intubation until observations ended 15 minutes after induction of anaesthesia. Two patients moved or breathed during this time, although movement in response to nerve stimulation occurred in all patients 10 minutes after administration of suxamethonium. Sufentanil 1 microgram/kg was effective in suppressing a rise in heart rate or arterial pressure in every patient. Significant falls in these variables occurred from 2 minutes after tracheal intubation onwards. No patient moved or breathed for 15 minutes after induction of anaesthesia, although neuromuscular transmission was present 10 minutes after giving suxamethonium in each case.     

Effects of double administration of nicardipine of the cardiovascular response to tracheal intubation in hypertensive patients

The efficacy of intravenous nicardipine in attenuating the cardiovascular responses to laryngoscopy and tracheal intubation was studied in 20 hypertensive patients. Ten patients received intravenous 1 mg of nicardipine 1 min before induction (N1 group). The other ten received 1 mg of nicardipine 1 min before induction and an additional 1 mg just before laryngoscopy (N2 group). In the N1 group, arterial pressure and heart rate increased significantly after tracheal intubation. In the N2 group, arterial pressure did not increase but heart rate increased more than that in N1 group. There was no significant difference in rate pressure product between the two groups.     

Attenuation of cardiovascular response to laryngoscopy and tracheal intubation with bolus injection of diltiazem]

Effect of diltiazem on cardiovascular response to laryngoscopy and tracheal intubation was studied in 20 patients without hypertension and 10 patients with hypertension to be operated on under general anesthesia. The patients were divided into three groups: the first group without hypertension (group C, n = 10) received saline as control, the second group without hypertension (group N, n = 10) received bolus injection of diltiazem, and the third group with hypertension (group H, n = 10) received bolus injection of diltiazem. Diltiazem was administered 2 min before intubation at a dose of 0.2 mg.kg-1 as a bolus injection. Changes of mean blood pressure, rate pressure product, pressure rate quotient in group H and N decreased significantly compared with group C. Changes of heart rate were comparable among the three groups. Complications were not remarkable except one case in which systolic pressure decreased to 80 mmHg. The results suggest that bolus injection of diltiazem at a dose of 0.2 mg.kg-1 attenuates cardiovascular response to laryngoscopy and tracheal intubation without serious complications.     

Partial attenuation of the cardiovascular responses to tracheal intubation with oral manidipine

We conducted a placebo–controlled, randomized, and double–blinded study to evaluate the efficacy of manidipine given orally in attenuating the cardiovascular responses to laryngoscopy and tracheal intubation. Thirty normotensive patients (ASA physical status 1) undergoing elective surgery were allocated to one of three groups (n= 10 for each); placebo, 5 mg manidipine, and 10 mg manidipine groups. These tablets were orally administered 3 h before induction of anaesthesia. Anaesthesia was induced with thiopentone 5 mg kg^-1 iv , and tracheal intubation was facilitated with vecuronium 0.2 mg–kg^-1. Laryngoscopy lasting 30 sec was attempted 2 min after induction of anaesthesia. Patients receiving placebo showed a significant increase in systolic and diastolic blood pressure associated with tracheal intubation. These increases following tracheal intubation were significantly reduced in patients receiving manidipine 10 mg compared with patients receiving placebo or manidipine 5 mg ( P < 0.05). Oral administration of manidipine 10 mg before induction of anaesthesia is a simple and effective method for attenuating pressor response to laryngoscopy and tracheal intubation. We stressed that the potential beneficial effect of a reduced haemodynamic reaction to intubation might be obtained at the expense of hypotension later on.     

Effects of beta-adrenoceptor antagonism on the cardiovascular and catecholamine responses to tracheal intubation

The catecholamine and cardiovascular responses to laryngoscopy and tracheal intubation were studied in 20 patients who underwent elective gynaecological surgery and who were allocated randomly to receive either practolol 10 mg or saline intravenously prior to induction of anaesthesia. Anaesthesia was induced with fentanyl and thiopentone; atracurium was administered and the lungs were ventilated artificially with 67% nitrous oxide in oxygen. Tracheal intubation was performed when muscle relaxation was adequate. Arterial pressure, heart rate, plasma noradrenaline and adrenaline concentrations were measured before and after tracheal intubation. A significant increase in catecholamine concentrations occurred in both groups in response to tracheal intubation but the magnitude of the increase in adrenaline was greater in the practolol group. There were no significant differences in arterial pressure or heart rate changes between the groups. We conclude that pretreatment with practolol is of no value in the attenuation of the hypertensive response to direct laryngoscopy and tracheal intubation in previously normotensive patients.     

Comparison of effects of remifentanil, alfentanil and fentanyl on cardiovascular responses to tracheal intubation in morbidly obese patients

BACKGROUND AND OBJECTIVE: The effects of remifentanil, alfentanil and fentanyl were compared on cardiovascular responses to laryngoscopy and endotracheal intubation in morbidly obese patients. METHODS: Eighty morbidly obese ASA I-II patients were included in the study. Patients were randomly divided into four groups to receive either 1 microgkg(-1) fentanyl (Group F), 10 microgkg(-1) alfentanil (A), 1 microgkg(-1) followed by an infusion of 0.5 pg kg min(-1) remifentanil (R) or saline (P). The patients corrected weight was used to calculate the drug doses. Body mass indices (range) were: 54.3 +/- 7.37 (49-78.4), 55.67 +/- 7.44 (48.5-78.4), 53.17 +/- 5.36 (48.1-63.2), and 56.3 +/- 6.09 (46.6-67.7) kg m(-2), in Groups F, R, A and P respectively. Systolic, diastolic and mean arterial pressures and heart rate were measured non-invasively at three time points, which were 2 min before induction, 2 min after induction and 2 min after endotracheal intubation. RESULTS: After induction of anaesthesia, arterial pressures decreased significantly in all groups, but the decrease was more pronounced in Groups A and R. After induction, heart rate decreased significantly in all groups except in Group P. After intubation, haemodynamic responses were similar in the remifentanil, fentanyl and alfentanil groups and were within normal limits. In Group P, arterial pressures and heart rates were significantly higher. CONCLUSIONS: Alfentanil, fentanyl and remifentanil in the doses described had similar effects in controlling the haemodynamic response to tracheal intubation in ASA I-II morbidly obese patients.     

Effect of continuous infusion of diltiazem on cardiovascular responses to laryngoscopy and intubation]

We studied the cardiovascular responses to laryngoscopy and intubation in 30 patients who received continuous infusion of either diltiazem 10 micrograms.kg-1.min-1, 40 micrograms.kg-1.min-1 or saline as control group during 20 min before induction. Heart rate, arterial pressure, rate pressure product (RPP), pressure rate quotient (PRQ) were measured starting 20 min before induction to 3 min after tracheal intubation. The increases in arterial pressure and RPP following tracheal intubation were reduced significantly in patients receiving diltiazem 40 micrograms.kg-1.min-1, but they were not reduced in patients receiving diltiazem 10 micrograms.kg-1.min-1 compared with control. We conclude that continuous infusion of diltiazem during 20 min before induction is effective for preventing the increases in arterial pressure and RPP following tracheal intubation, and the optimal infusion rate is from 10 to 40 micrograms.kg-1.min-1.     

Partial attenuation of the cardiovascular responses to tracheal intubation with oral nisoldipine.

STUDY OBJECTIVE: To evaluate the efficacy and safety of nisoldipine given orally in attenuating the cardiovascular responses to laryngoscopy and tracheal intubation. DESIGN: Randomized, double-blind, placebo-controlled study. SETTING: Induction of anesthesia for elective surgery at a university hospital. PATIENTS: Thirty normotensive patients (ASA physical status I) undergoing elective surgery were assigned to one of three groups; placebo, nisoldipine 5 mg, or nisoldipine 10 mg. Each group consisted of ten patients. INTERVENTIONS: Either 5 mg of nisoldipine, 10 mg of nisoldipine, or a placebo was administered orally 2 hours before induction of anesthesia. Anesthesia was induced with thiopental sodium 5 mg/kg intravenously, and tracheal intubation was facilitated with vecuronium 0.2 mg/kg. During anesthesia, ventilation was assisted or controlled with 1% enflurane and 50% nitrous oxide in oxygen. Laryngoscopy lasting 30 seconds was attempted 2 minutes after administration of thiopental sodium and vecuronium. MEASUREMENTS AND MAIN RESULTS: Patients receiving the placebo showed a significant increase in mean arterial pressure associated with tracheal intubation. These increases following tracheal intubation were significantly reduced in patients receiving nisoldipine 10 mg compared with patients receiving the placebo (p less than 0.05). CONCLUSIONS: Oral administration of nisoldipine before induction of anesthesia is a simple, practical, and safe method for attenuating pressor response to laryngoscopy and tracheal intubation.     

曲吗多静脉诱导时对心血管反应的影响

采用经食管无创伤超声血流测定仪监测４５例择期手术病例，随机分三组：巨组，安定０．４ｍｇ／ｋｇ； Ⅱ组，咪唑安定０．３ｍｍ／ｋｍ；Ⅲ组，依托咪酯０． ３ｍｍ／ｋｍ。三组病例均静注曲吗多４ｍｇ／ｋｇ、阿曲可林０．５ｍｇ／ ｋｇ，观察插管前、插管时、插管后心排血量（ＣＯ）、心脏指数（ＣＩ）、周围血管阻力（ＳＶＲ）、平均动脉压（ＭＡＰ）、心率（ＨＲ）的变化。结果表明用曲吗多后 ＨＲ减慢， Ⅰ、Ⅱ组 ＣＯ、ＣＩ、ＭＡＰ下降，Ⅲ组 ＭＡＰ、ＣＯ、ＣＩ、无明显变化，插管时，插管后ＣＯ、ＣＩ、ＭＡＰ、ＨＲ无显著变化（Ｐ＞０．０５）。提示曲吗多有预防插管时的心血管副反应作用。     

Landiolol attenuates the cardiovascular response to tracheal intubation

Purpose The objective of this prospective study was to compare the cardiovascular responses with or without landiolol to the induction of general anesthesia and tracheal intubation. Methods Twenty-two patients were randomly allocated to receive a loading dose of landiolol 125 μg kg⁻¹ min⁻¹ for 1 min followed by an infusion at 40 μg kg⁻¹ min⁻¹ for 4 min, or placebo. Four minutes after landiolol or placebo was started, propofol and succinylcholine were administered. Laryngoscopy and tracheal intubation were performed 1 min after the administration of succinylcholine. Heart rate and blood pressure were measured noninvasively every minute. Results A significant attenuation of the heart rate and blood pressure response were seen in the landiolol group for 3 min after intubation. Heart rate and systolic blood pressure in the landiolol group were decreased for 2 min before intubation and just before intubation compared with baseline, srespectively. Conclusion Continuous administration of landiolol before tracheal intubation results in the attenuation of cardiovascular response for tracheal intubation.