CAN CALCIUM AND SODIUM CHANNEL BLOCKERS ATTENUATE HEMODYNAMIC RESPONSES TO ENDOTRACHEAL INTUBATION
2008
Aim: Direct laryngoscopy and endotracheal intubation following
induction of anesthesia almost always triggers powerful cardiovascular
responses. The purpose of this study was to investigate the efficacy of
diltiazem (calcium channel blocker), lidocaine (sodium channel blocker)
and a combination of these two drugs in the attenuation of circular
responses to endotracheal intubation in normotensive patients.
Methods: 120 Patients were randomly assigned to one of the following
four groups. Group I received a single 0.2 mg/kg IV bolus of diltiazem
1 minute prior to laryngoscopy and intubation (n=30), Group II received
a single 1.5 mg/kg IV bolus of lidocaine (n=30) 3 minutes prior and
Group III received combination of these two drugs 1 minute prior to
laryngoscopy and intubation (n=30). Group IV served as the control and
received a single 5 mL IV bolus of normal saline. 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. Results: Either diltiazem or lidocaine alone
blunts unwanted hemodynamic responses to intubation. However,
significantly less circulatory responses were experienced by patients
receiving both than those receiving either lidocaine or diltiazem
alone. Conclusion: Given the difference in the pharmacological
mechanisms of these two drugs, the prophylactic therapy with
combination of diltiazem+lidocaine is significantly more effective than
any one alone for attenuating hemodynamic changes to laryngoscopy and
tracheal intubation, without producing increased risk of hypertension.
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