Comparative effects of lidocaine and esmolol in attenuating the hemodynamic response to laryngoscopy and intubation.
Abstract
Introduction: Transient hemodynamic instability is an inevitable outcome of laryngoscopy and intubation which can have serious effects in patients with COPD, heart disease and hypertension. Hemodynamic stability is one of the main goals of the anesthesiologist. This study was performed to compare the safety and effectiveness of lidocaine and esmolol in comparison to placebo-control group, in modifying the hemodynamic response to laryngoscopy and intubation.Methods: After approval of the study protocol by the institutional review board (IRB), written informed consent was obtained from each patient. It was a randomized placebo-controlled, double-blinded study. 75 patients of American Society of Anesthesiologists physical status I and II, scheduled for general surgery under GA, aged between 20-60 years were randomly allocated into three groups: placebo control group (n=25), lidocaine group (n=25) and esmolol group (n=25). Placebo group received 12 ml normal saline, lidocaine group received 1.5mg/kg lidocaine (total volume 12 ml) and esmolol group received 1.4mg/kg esmolol (total volume 12ml).Results: Following laryngoscopy and intubation, the increase in systolic blood pressure, diastolic blood pressure and heart rate were significantly lower (p < 0.05) in esmolol group compared to the lidocaine and placebo group but there was no statistical significance (p > 0.05) between control and lidocaine group.Conclusion: Esmolol 1.4 mg/kg IV was significantly more effective in controlling the hemodynamic response following laryngoscopy and intubation in comparison to lidocaine 1.5 mg/kg.References
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14. Feng CK, Chan KH, Liu KN, Or CH, Lee TY. A comparison of lidocaine, fentanyl, and esmolol for attenuation of cardiovascular response to laryngoscopy and tracheal intubation. Acta Anaesthesiol Sin. 1996;34(2):61-7.
15. Helfman SM, Gold MI, DeLisser EA, Herrington CA. Which drug prevents tachycardia and hypertension associated with tracheal intubation: lidocaine, fentanyl, or esmolol? Anesth Analg. 1991;72(4):482-6.
16. Liu J, Latson TW, Wu G, White PF. Effects of IV and/or aerosolized lidocaine on the hemodynamic and EEG responses to laryngoscopy and tracheal intubation. Anesthesiology. 1993;79: A157.
17. Miller CD, Warren SJ. IV lignocaine fails to attenuate the cardiovascular response to laryngoscopy and tracheal intubation. Br J Anaesth. 1990;65(2):216-9.
18. Wang YQ, Guo QL, Xie D. Effect of different doses of esmolol on cardiovascular responses to tracheal extubation. Hunan Yi Ke Da Xue Xue Bao. 2003;28(3):259-62.
19. Parnass SM, Rothenberg DM, Kerchberger JP, Ivankovich AD. A single bolus dose of esmolol in the prevention of intubation–induced tachycardia and hypertension in an ambulatory surgery unit. J Clin Anesth. 1990;2(4):232-7.
20. Fox EJ, Sklar GS, Hill CH, Villanueva R, King BD. Complications related to the pressor response to endotracheal intubation. Anesthesiology. 1977;47(6):524-5.
21. Wilson IG, Meiklejohn BH, Smith G. Intravenous lignocaine and sympathoadrenal responses to laryngoscopy and intubation. The effect of varying time of injection. Anaesthesia. 199;46(3):177-80.
22. Khan N, Aslam M, Naz N, Khan MR. Comparative effects of lidocaine and esmolol in modifying the hemodynamic response to laryngoscopy and intubation. Pak J Med Health Sci. 2013;7(2):301-6.
23. Miller DR, Martineau RJ, Wynands JE, Hill J. Bolus administration of esmolol for controlling the haemodynamic response to tracheal intubation: the Canadian Multicentre Trial. Can J Anaesth. 199`;38(7):849-58.
24. Tam S, Chung F, Campbell M. Intravenous lidocaine: optimal time of injection before tracheal intubation. Anesth Analg. 1987;66(10):1036-8.
2. Begum M, Akter P, Hossain MM, Alim SMA, Khatun UHS, Islam SMK, et al. A comparative study between efficacy of esmolol and lignocaine for attenuating haemodynamics response due to laryngoscopy and endotracheal intubation. Faridpur Med Coll J. 2010;5(1):25-28.
3. Shepard LC, Gelman S, Reeves JG. Humoral response of hypertensive patients to laryngoscopy. Anesth Analg. 1981;60(4):276-7.
4. Reid LC, Brace DE. Irritation of the respiratory tract and its reflex effect upon heart. Surg Gynecol Obstet. 1940;70:157-62.
5. ColemanAJ, Jordan C. Cardiovascular response to anesthesia. Influence of beta-adrenoceptor blockade with metoprolol. Anaesthesia. 1980;35(10):972-8.
6. Ebert TJ, Bernstein JS, Stowe DF, Roerig D, Kampine JP. Attenuation of hemodynamic responses to rapid sequence induction and intubation in healthy patients with a single bolus of esmolol. J Clin Anesth. 1990;2(4):243-52.
7. Rathore A, Gupta HK, Tanwar GL. Attenuation of the pressure response to laryngoscopy and endotracheal intubation with different doses of esmolol. Indian J Anaesth. 2002;46(6)449-52.
8. Stoelting RK. Attenuation of blood pressure response to laryngoscopy and tracheal intubation with sodium nitroprusside. Anesth Analg. 1979:58(2):116-9.
9. Mikawa K, Nishina K, Maekawa M, Obara H. Comparision of nicardipine, diltiazem and verapamil for controlling the cardiovascular responses to tracheal intubation. Br J Anaesth. 1996;76(2):221-6.
10. Nishikawa T, Namiki A. Attenuation of the pressor response to laryngoscopy and tracheal intubation with intravenous verapamil. Acta Anaesthesiol Scand. 1989;33(3):232-5.
11. Ghignone M, Calvillo O, Quintin L. Anesthesia and hypertension: the effect of clonidine on perioperative hemodynamics and isoflurane requirements. Anesthesiology. 1987;67(1):3-10.
12. Marino PL. The ICU Book. 3rd ed. Lippincott Williams & Wilkins; 2007.
13. Singh H, Vichitvejpaisal P, Gaines GY, White PF. Comparative effects of lidocaine, esmolol, and nitroglycerin in modifying the hemodynamic response to laryngoscopy and intubation. J Clin Anesth. 1995;7(1):5-8.
14. Feng CK, Chan KH, Liu KN, Or CH, Lee TY. A comparison of lidocaine, fentanyl, and esmolol for attenuation of cardiovascular response to laryngoscopy and tracheal intubation. Acta Anaesthesiol Sin. 1996;34(2):61-7.
15. Helfman SM, Gold MI, DeLisser EA, Herrington CA. Which drug prevents tachycardia and hypertension associated with tracheal intubation: lidocaine, fentanyl, or esmolol? Anesth Analg. 1991;72(4):482-6.
16. Liu J, Latson TW, Wu G, White PF. Effects of IV and/or aerosolized lidocaine on the hemodynamic and EEG responses to laryngoscopy and tracheal intubation. Anesthesiology. 1993;79: A157.
17. Miller CD, Warren SJ. IV lignocaine fails to attenuate the cardiovascular response to laryngoscopy and tracheal intubation. Br J Anaesth. 1990;65(2):216-9.
18. Wang YQ, Guo QL, Xie D. Effect of different doses of esmolol on cardiovascular responses to tracheal extubation. Hunan Yi Ke Da Xue Xue Bao. 2003;28(3):259-62.
19. Parnass SM, Rothenberg DM, Kerchberger JP, Ivankovich AD. A single bolus dose of esmolol in the prevention of intubation–induced tachycardia and hypertension in an ambulatory surgery unit. J Clin Anesth. 1990;2(4):232-7.
20. Fox EJ, Sklar GS, Hill CH, Villanueva R, King BD. Complications related to the pressor response to endotracheal intubation. Anesthesiology. 1977;47(6):524-5.
21. Wilson IG, Meiklejohn BH, Smith G. Intravenous lignocaine and sympathoadrenal responses to laryngoscopy and intubation. The effect of varying time of injection. Anaesthesia. 199;46(3):177-80.
22. Khan N, Aslam M, Naz N, Khan MR. Comparative effects of lidocaine and esmolol in modifying the hemodynamic response to laryngoscopy and intubation. Pak J Med Health Sci. 2013;7(2):301-6.
23. Miller DR, Martineau RJ, Wynands JE, Hill J. Bolus administration of esmolol for controlling the haemodynamic response to tracheal intubation: the Canadian Multicentre Trial. Can J Anaesth. 199`;38(7):849-58.
24. Tam S, Chung F, Campbell M. Intravenous lidocaine: optimal time of injection before tracheal intubation. Anesth Analg. 1987;66(10):1036-8.
Published
2016-08-03
How to Cite
KOJU, Ram Bhakta.
Comparative effects of lidocaine and esmolol in attenuating the hemodynamic response to laryngoscopy and intubation..
J Soc Surg Nep, [S.l.], v. 17, n. 2, p. 23-30, aug. 2016.
ISSN 2392-4772.
Available at: <https://jssn.org.np/index.php?journal=jssn&page=article&op=view&path%5B%5D=167>. Date accessed: 23 oct. 2024.
Issue
Section
Original Article
Keywords
Cardiovascular response; Esmolol; Hemodynamics; Intubation; Laryngoscopy; Lidocaine.
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