Haemodynamic responses to laryngoscopy and tracheal intubation in geriatric patients: effects of fentanyl, lidocaine and thiopentone

  • William M. Splinter
  • Frank Cervenko
Reports of Investigation

Abstract

The haemodynamic responses to laryngoscopy and intubation after induction of anaesthesia with thiopentone alone or in combination with 1.5 mg · kg−1 lidocaine and/or 1.5 or 3.0 μg · kg−1 fentanyl were measured in 150 patients over 64 years of age to determine whether lidocaine, fentanyl or both lidocaine and fentanyl attenuated the pressor response. Fentanyl reduced the rises in systolic, diastolic and mean arterial pressures, heart rate, and rate pressure product and lidocaine decreased the rises in arterial blood pressure and rate pressure product (P < 0.05). Fentanyl decreased the incidence of marked fluctuations in haemodynamic variables, often seen in geriatric patients (P < 0.05). The haemodynamic effects of lidocaine and fentanyl were independent of each other. Complications occurred in all groups. Lidocainetreated patients had fewer cardiac dysrhythmias (P < 0.05) and 34 per cent of them had tinnitus. Fentanyltreated patients had a higher incidence of hypotension (P < 0.05). Respiratory depression developed in only one per cent of the fentanyltreated patients. Both lidocaine and fentanyl are recommended adjuncts to induction of anaesthesia with thiopentone in geriatric patients.

Key words

anaesthesia: geriatric anaesthetics, intravenous: fentanyl, lidocaine intubation, tracheal: cardiovascular responses complications: hypertension, hypotension age factors 

Résumé

Nous avons mesuré les conséquences hémodynamiques de la laryngoscopie et de l’ intubation chez 150 patients de plus de 64 ans qui avaient eu une induction de leur anesthésie avec du thiopental seul ou en combinaison avec 1.5 mg · kg−1 de lidocaine etlou 1.5 ou 3.0 μg-kg−1 de fentanyl. Le fentanyl atténua l’augmentation des pressions artêrielles systolique, diastolique et moyenne, du pouls et du produit pouls-pression alors que la lidocaïne fït de même avec la pression artérielle et le produit pouls-pression (P < 0.05). En plus, les fluctuations himodynamiques fréquentes chez les patients agés, furent moins marquées avec le fentanyl (P < 0.05). Par ailleurs la lidocaine et le fentanyl agissaient indépendamment l’un de l’autre. Il y eu des complications dans tous les groupes: entre autres, 34 pour cent de tinnitus mais moins de dysrythmies pour la lidocaine (P < 0.05) et plus d’hypotension pour le fentanyl (P < 0.05) qui ne deprima la respiration que dans un seul cas. La lidocaïne et le fentanyl peuvent done être recommandés à titre de complément à l’induction de l’anesthésie au thiopental chez les patients agés.

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Copyright information

© Canadian Anesthesiologists 1989

Authors and Affiliations

  • William M. Splinter
    • 1
    • 2
    • 3
  • Frank Cervenko
    • 1
    • 2
    • 3
  1. 1.Department of AnaesthesiaQueen’s UniversityKingstonCanada
  2. 2.Department of PharmacologyQueen’s UniversityKingstonCanada
  3. 3.Department of ToxicologyQueen’s UniversityKingstonCanada

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