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

  • William M. Splinter
  • Frank Cervenko
Reports of Investigation


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 


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.


  1. 1.
    Fassoulaki A, Kaniaris P. Intranasal administration of nitroglycerine attenuates the pressor response to laryngoscopy and intubation of the trachea. Br J Anaesth 1983; 55: 49–52.PubMedCrossRefGoogle Scholar
  2. 2.
    Stoelting RK. Attenuation of blood pressure response to laryngoscopy and tracheal intubation with sodium nitroprusside. Anesth Analg 1979; 58: 116–9.PubMedGoogle Scholar
  3. 3.
    Kamra S, Wig J, Sapru RP. Topical nitroglycerin a safeguard against pressor responses to tracheal intubation. Anaesthesia 1986; 41: 1087–91.PubMedCrossRefGoogle Scholar
  4. 4.
    Bain JA.Spoerel WE. Prediction of arterial carbon dioxide tension during controlled ventilation with a modified Mapleson D system. Can Anaesth Soc J 1975; 22: 34–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Buffington CW. Hemodynamic determinants of ischemic myocardial dysfunction in the presence of coronary stenosis in dogs. Anesthesiology 1985; 63: 651–62.PubMedCrossRefGoogle Scholar
  6. 6.
    Chung F, Evans D. Low-dose fentanyl: haemodynamic response during induction and intubation in geriatric patients. Can Anaesth Soc J 1985; 32: 622–8.PubMedGoogle Scholar
  7. 7.
    Milocco I, Axsön-Lof B, William-Olsson G, Appelgren LK. Haemodynamic stability during anaesthesia induction and sternotomy in patients with ischaemic heart disease. A comparison of six anaesthetic techniques. Acta Anaesthesiol Scand 1985; 29: 465–73.PubMedGoogle Scholar
  8. 8.
    Magnusson J, Thulin T, Werner O, Jarhult J, Thomson D. Haemodynamic effects of pretreatment with metoprolol in hypertensive patients undergoing surgery. Br J Anaesth 1986; 58: 251–60PubMedCrossRefGoogle Scholar
  9. 9.
    Prys-Roberts C, Foex P, Biro GP, Roberts JG. Studies of anaesthesia in relation to hypertension. V: Adrenergic beta-receptor blockade. Br J Anaesth 1973; 45: 671–81.PubMedCrossRefGoogle Scholar
  10. 10.
    Cucchiara RF, Benefiel DJ, Matteo RS, DeWood M, Albin MS. Evaluation of esmolol in controlling increases in heart rate and blood pressure during endotracheal intubation in patients undergoing carotid endarterectomy. Anesthesiology 1986; 65: 528–31.PubMedCrossRefGoogle Scholar
  11. 11.
    Newsome LR, Roth JV, Hug CC Jr, Nagle D. Esmolol attenuates hemodynamic responses during fentanylpancuronium anesthesia for aortocoronary bypass surgery. Anesth Analg 1986; 65: 451–6.PubMedGoogle Scholar
  12. 12.
    Ghignone M, Quintin L, Duke PC, Kehler CH, Calvillo O. Effects of clonidine on narcotic requirements and hemodynamic responses during induction of fentanyl anaesthesia and endotracheal intubation. Anesthesiology 1986; 64: 36–42.PubMedCrossRefGoogle Scholar
  13. 13.
    Stoelting RK. Circulatory changes during direct laryngoscopy and tracheal intubation: influence of duration of laryngoscopy with or without prior lidocaine. Anesthesiology 1977; 47: 381–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Stoelting RK. Blood pressure and heart rate changes during short-duration laryngoscopy for tracheal intubation: influence of viscous or intravenous lidocaine. Anesth Analg 1978; 57: 197–9.PubMedGoogle Scholar
  15. 15.
    Abou-Madi MN, Keszler H, Yacoub JM. Cardiovascular reactions to laryngoscopy and tracheal intubation following small and large intravenous doses of lidocaine. Can Anaesth Soc J 1977; 24: 12–9.PubMedGoogle Scholar
  16. 16.
    Hamill JF, Bedford RF, Weaver DC, Colohan AR. Lidocaine before endotracheal intubation: intravenous or laryngotracheal? Anesthesiology 1981; 55: 578–81.PubMedCrossRefGoogle Scholar
  17. 17.
    Himes RS, Difazio CA, Burney RG. Effect of lidocaine on the anesthetic requirements for nitrous oxide and halothane. Anesthesiology 1977; 47: 437–40.PubMedCrossRefGoogle Scholar
  18. 18.
    Kasten GW, Owens E. Evaluation of lidocaine as an adjunct to fentanyl anaesthesia for coronary artery bypass graft surgery. Anesth Analg 1986; 65: 511–5.PubMedGoogle Scholar
  19. 19.
    Chraemmer-Jørgensen B, Høilund-Carlsen PF, Marving J, Christensen V. Lack of effect of intravenous lidocaine on hemodynamic responses to rapid sequence induction of general anesthesia. A double-blind controlled clinical trial. Anesth Analg 1986; 65: 1037–41.PubMedGoogle Scholar
  20. 20.
    Derbyshire DR, Smith G, Achola KJ. Effect of topical lignocaine on the sympathoadrenal responses to tracheal intubation. Br I Anaesth 1987; 59: 300–4.CrossRefGoogle Scholar
  21. 21.
    Badrinaih SK, Vazeery A, McCarthy RJ, Ivankovich A. The effect of different methods of inducing anesthesia on intraocular pressure. Anesthesiology 1986; 65: 431–5.CrossRefGoogle Scholar
  22. 22.
    Tarn S, Chung F, Campbell M. Intravenous lidocaine: optimal time of injection before tracheal intubation. Anesth Analg 1987; 66: 1036–8.CrossRefGoogle Scholar
  23. 23.
    Haasio J, Hekali R, Rosenberg PH. Influence of premedication on lignocaine-induced acute toxicity and plasma concentrations of lignocaine. Br J Anaesth 1988; 61: 131–4.PubMedCrossRefGoogle Scholar
  24. 24.
    Dahlgren N, Messeter K. Treatment of stress response to laryngoscopy and intubation with fentanyl. Anaesthesia 1981; 36: 1022–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Martin DE, Rosenburg H, Aukbury SJ et al. Low-dose fentanyl blunts circulatory responses to tracheal intubation. Anesth Analg 1982; 61: 680–4.PubMedGoogle Scholar
  26. 26.
    Black TE, Kay B, Healy TEJ. Reducing the haemodynamic responses to laryngoscopy and intubation. A comparison of alfentanil with fentanyl. Anaesthesia 1982; 39: 883–7.Google Scholar
  27. 27.
    Hynynen M, Korttilea K, Wirtavuori K, Lehtinen A-M. Comparison of alfentanil and fentanyl as supplements to induction of anaesthesia with thiopentone. Acta Anaesthesiol Scand 1985; 29: 168–74.PubMedCrossRefGoogle Scholar
  28. 28.
    Kay B, Healy TEJ, Bolder PM. Blocking the circulatory responses to tracheal intubation. A comparison of fentanyl and nalbuphine. Anaesthesia 1985; 40: 960–3.PubMedCrossRefGoogle Scholar
  29. 29.
    Kay B, Nolan D, Mayall R, Healy TEJ. The effect of sufentanil on the cardiovascular responses to tracheal intubation. Anaesthesia 1987; 42: 382–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Morton NS, Hamilton WF. Alfentanil in an anaesthetic technique for penetrating eye injuries. Anaesthesia 1986; 41: 1148–51.PubMedCrossRefGoogle Scholar
  31. 31.
    Montejo LS, Coriat P, Godet G, Baron JF, Viars P. Hemodynamic predictors of myocardial ischemia in patients undergoing aortic vascular surgery: at last we can measure them! Anesthesiology 1988; 69: A279.CrossRefGoogle Scholar
  32. 32.
    Goehner P, Hollenberg M, Leung J et al. Hemodynamic control suppresses myocardial ischemia during isoflurane or sufentanil anesthesia for CABG. Anesthesiology 1988; 69: A32.CrossRefGoogle Scholar
  33. 33.
    Robinson BF. Relation of heart rate and systolic blood pressure to the onset of pain in angina pectoris. Circulation 1967; 35: 1073–83.PubMedGoogle Scholar
  34. 34.
    Hoffman JI. Transmural myocardial perfusion. Prog Cardiovasc Dis 1987; 29: 429–64.PubMedCrossRefGoogle Scholar
  35. 35.
    Rooke GA, Feigel EO. Work as a correlate of canine left ventricular oxygen consumption, and the problem of catecholamine oxygen wasting. Circ Res 1982; 50: 273–86.PubMedGoogle Scholar

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

Personalised recommendations