Effects of prostaglandin E1 on the cardiovascular response to tracheal intubation

Study Objective: To evaluate the efficacy of prostaglandin E, in attenuating the hypertensive response to laryngoscopy and intubation.

Design: Controlled, comparative, and randomized study.

Setting: Induction of anesthesia for elective surgery at a university hospital.

Patients: Thirty normotensive patients (ASA physical status I) undergoing elective surgery divided into three groups. Each group consisted of ten patients.

Interventions: Anesthesia was induced with thiopental sodium 5 mglkg intravenously, and tracheal intubation was facilitated with vecuronium 0.2 mglkg. Either 0.3 μglkg of prostaglandin E₁, 0.6 μg/kg of prostaglandin E₁, or saline (control) was injected 15 seconds before starting direct laryngoscopy (within 30 seconds), which was attempted 2 minutes after administration of thiopental sodium and vecuronium.

Measurements and Main Results: Patients receiving saline showed a significant increase in mean arterial pressure and rate-pressure product associated with tracheal intubation. These increases following tracheal intubation were significantly less in prostaglandin E₁-treated patients than in the control group (p < 0.05).

Conclusions: A single rapid intravenous administration of prostaglandin E₁ is a practical pharmacologic and safe method to attenuate the hypertensive response to tracheal intubation. The use of 0.6 μglkg of prostaglandin E₁ as a supplement during induction is recommended for reducing the pressor response to intubation on the basis of rate-pressure product and mean arterial pressure , following intubation as an index.