Effects of calcium channel blockers on circulatory response to tracheal intubation in hypertensive patients: nicardipine versus diltiazem
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Nicardipine
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Mean arterial pressure
Summary 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 < 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.
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The efficacy of 2 or 3 mg/kg diazoxide given 2.5 min before laryngoscopy in attenuating the cardiovascular responses to laryngoscopy and intubation was studied in 30 patients undergoing elective surgery. Data were compared with those from 10 control patients receiving saline. Anaesthesia was induced using 5 mg/kg thiopentone given intravenously and tracheal intubation was facilitated with 0.2 mg/kg vecuronium bromide. Patients receiving saline showed a significant increase in mean arterial pressure and rate – pressure product associated with tracheal intubation. The increases following tracheal intubation were significantly reduced ( P <0.05) in diazoxide-treated patients compared with those in the control group, but there were no significant differences in heart rate following tracheal intubation among the three groups. Data suggest that diazoxide can be used as a supplement during induction of anaesthesia to attenuate the hypertensive response associated with laryngoscopy and tracheal intubation.
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Thiamylal
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Intranasal nitroglycerin (NTG) was first reported to successfully prevent an increase in arterial blood pressure following laryngoscopy and tracheal intubation by Hill et al. Various different effective dosages of NTG have been reported. Grover et al. indicated 0.75 mg of intranasal NTG to be the most suitable dose. However, no definite conclusion has yet been made. This study was designed to compare the efficacy of four different dosages of intranasal NTG (0.3, 0.5, 0.75, and 1.0 mg) in preventing pressor responses to laryngoscopy and tracheal intubation during the induction of general anesthesia.One hundred patients (ASA I or II) scheduled for elective surgery were included. These study subjects were divided into five groups and randomly assigned to four different dosages of intranasal NTG and a placebo. Each group consisted of 20 patients. The NTG solution was administered 1 min before the injection of thiopental. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP) and heart rate (HR) were recorded before the induction of anesthesia (T1), before laryngoscopy (T2), and at 0, 3, and 5 min after tracheal intubation (T3, T4, and T5 respectively).In patients who received a placebo (control group), there were significant increases in SAP, MAP, HR and rate-pressure-product (RPP) associated with tracheal intubation. Tachycardia was noted in all experimental groups. The increases in MAP associated with tracheal intubation were significantly less in patients who received NTG of 0.5 mg or more but not 0.3 mg. Although 0.5 mg of NTG did attenuate the increases in SAP after tracheal intubation, the increases in SAP of the other three experimental groups were no less than that of the control group. Rate-pressure-product (RPP) values of the experimental groups were noted to be equal to or higher than those of the control group during the period of study. Contrary to the results of the study conducted by Grover et al., 0.75 mg of NTG did not attenuate the pressor responses.Intranasal NTG does not attenuate the pressor responses to laryngoscopy and tracheal intubation.
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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.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.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.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.
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A randomized open study was carried out on 36, ASA I-II adult surgical patients to assess the effect of intravenous lidocaine and fentanyl on circulatory responses to laryngoscopy and intubation. The three treatment groups include: group L, intravenous lidocaine 1.5 mg.kg-1 2 minutes before laryngoscopy, group F, intravenous fentanyl 4 micrograms.kg-1, and group C, no treatment. Induction, preceded by preoxygenation was performed by intravenous vecuronium for precurarisation, followed by thiopental 4-5 micrograms.kg-1 and succinylcholine 1.5 mg.kg-1. Before induction of anesthesia, there were no significant differences among the three groups in mean arterial pressure (MAP), heart rate (HR) and rate pressure product (RPP). After laryngoscopy and intubation, the three hemodynamic variables increased significantly from control values in group L and group C. The maximum values attained after intubation did not differ significantly between the two groups for any of the variables. In group F, these hemodynamic variables showed no significant changes after laryngoscopy and intubation and were significantly less than those in group F and group C. Intubating conditions were better in the fentanyl group than in the lidocaine group.
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Sympathoadrenal response to laryngoscopy and tracheal intubation manifests as transient, but distinct tachycardia and hypertension.The objective of this study is to compare the clinical effects of dexmedetomidine with esmolol and control in attenuating the presser response during laryngoscopy.A randomized, prospective, double-blind, controlled study.We studied consented, 90 adult, American Society of Anesthesiologists physical status I and II patients of either sex, scheduled for non-cardiac surgery requiring intubation. The patients were randomly divided into three groups (n = 30). Group C received placebo, Group E received 2.0 mg/kg of esmolol and Group D received 1.0 μg/kg of dexmedetomidine, intravenously over 10 min and 3 min before induction of general anesthesia. All patients were uniformly pre-medicated, induced and intubated using thiopentone and succinylcholine as per standard protocol. Heart rate (HR), systemic arterial pressures were recorded at baseline, after study drug infusion, after induction, immediately and 3, 5, 7, 10 min after intubation.Analysis of variance and t-test as appropriate.The mean arterial pressure was significantly increased in patients receiving placebo (P < 0.0001) and esmolol (P < 0.0001) after laryngoscopy and intubation compared with baseline value and Group D (P = 0.6294). The rise in HR (P = 0.08481) and rate pressure product (P = 0.0666) at the time of intubation were minimal and was statistically significant up to 15 min in Group D.Both the drugs attenuated the pressure response. Of the two drugs administered, dexmedetomidine 1.0 μg/kg provides a consistent, reliable and effective attenuation of pressure responses when compared to esmolol 2.0 mg/kg.
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Nicardipine
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Effect of Nicardipine on Haemodynamic and Bispectral Index Changes following Endotracheal Intubation
We investigated the effect of IV nicardipine on haemodynamic and bispectral index responses to the induction of general anaesthesia and intubation. Forty patients were randomly allocated to two groups of 20 to receive normal saline or nicardipine 15 μg/kg IV 30 s after induction. Ninety seconds later, tracheal intubation was performed. Systolic blood pressure, heart rate and bispectral index were measured at baseline, 1 min after induction, pre-intubation, and every minute until 5 min after endotracheal intubation. Rate–pressure product values were calculated. In the nicardipine group, systolic blood pressure decreased compared with the control group, and heart rate increased compared with the control group. Bispectral index and rate–pressure product showed no differences between the two groups. In conclusion, the administration of 15 μg/kg nicardipine IV does not affect anaesthetic depth in response to the induction of general anaesthesia and intubation.
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Objective: To observe the efficacy of Nicardipine and Diltiazem in attenuation the cardiovascular responses to laryngoscopy and tracheal intubation(LTI).Methods: 60 patients of ASA Ⅰ-Ⅱ were assigned to one of the following 3 groups at random,normal saline(group C),0.2 mg/kg Diltiazem(group D) or 15 μg/kg Nicardipine(group N).The medication for study was administered intravenously 2 minutes before the initiation of LTI.Blood pressure(BP),heart rate(HR),stroke volume index(SVI) and cardiac index(CI) were recorded at designed time points,before induction,immediate and after the bolus injection,immediate and 1,2,3 min after LTI.Rate-pressure product(RPP) were calculated.Results: After intubation,the peak MAP and HR values in group C increased by 21.7% and 31.1% over the baseline values(P0.01);changes of MAP and HR after tracheal intubation in group D were less than those in group C(P0.05);In group N,the increase in MAP provoked by LTI were less than group C and HR increased by 42.5% over the baseline;CI,SVI increased slightly after the bolus of Diltiazem and Nicardipine.Conclusion: Nicardipine is effective in attenuating pressure response to tracheal intubation but can not prevent tachycardia;Diltiazem produced greater attenuation on the circulatory responses to tracheal intubation.
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Bolus (digestion)
Mean arterial pressure
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