Abstract
The circulatory response to a 30-second laryngoscopy followed by orotracheal intubation was recorded in 60 patients of ASA physical status III or TV undergoing a variety of non-cardiac surgical procedures. Patients were randomly allocated to either the placebo, esmolol (500μg·kg−1·min− 1 × 6 minutes, followed by 300 μg· kg− 1· min− 1 × 9 minutes), or fentanyl (0.8μg·kg− 1.min− 1 × 10 minutes) group, and the observer was blinded to the infusion administered. Esmolol blunted the heart rate (HR) response, while fentanyl decreased it below the baseline and maintained it there, in spite of laryngoscopy. Similarly, fentanyl decreased the systolic (SBP), mean (MBP) and diaslolic blood pressures (DBP) significantly below the baseline, while these pressures were either retained at or elevated slightly above control in the esmolol group. In these doses, the HR response to laryngoscopy was more effectively blocked by fentanyl, while esmolol better retained perfusion pressure. There were no complications or ischaemic electrocardiographic changes in any patient.
Résumé
Nous avons mesuré la riponse hemodynamique à une laryngoscopie de 30 secondes suivie d’ une intubation orotrachéale chez 60 patients de classe ASA III ou IV devant subir diverses interventions chirurgicales autres que cardiaques. Le hasard determinant si la manoeuvre allait être précédée d’ un placebo, desmolol (500μg·kg− 1·min− 1 × 6 minutes, puis 300 μg·kg− 1· min− 1 × 9 minutes), ou de fentanyl (0.8 μg·kg− 1·min− 1× 10 minutes) et ce, à l’insu d’un observateur neutre. L’esmolol limitait l’accélération dupouls tandis que le fentanyl ralentissait le coeur avant, pendant et apris la laryngoscopie. Avec le fentanyl, on a vu s’abaisser significativement les pressions artérielles systoliques, moyennes et diastoliques alors qu’elles se maintenaient ou s’élevaient légèrement avec l’esmolol. Ainsi, aux doses employées, le fentanyl prévient mieux la réponse chronotrope à la laryngoscopie alors que l’esmolol maintient la pression de perfusion. Nous n’avons noté aucune complication ni aucun signe électrocardiographique d’ischémie pendant cette etude.
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References
Kaplan JA, King SB. The precordial electrocardiographic lead (V5) in patients who have coronary artery disease. Anesthesiology 1976; 45: 570–4.
Shapiro HM, Wyte SR, Harris AB, Galindo A. Acute intraoperative intracranial hypertension in neurosurgical patients: mechanical and pharmacologic factors. Anesthesiology 1972; 37: 399–405.
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.
Prys-Roberts C, Greene LT, Meloche R, Foëx P. Studies of anaesthesia in relation to hypertension. II: Haemo-dynamic consequences of induction and endotracheal intubation. Br J Anaesth 1971; 43: 531–46.
Sorenson MB, Jacobsen E. Pulmonary hemodynamics during induction of anesthesia. Anesthesiology 1977; 46:246–51.
Roy WL, Edelist G, Gilbert B. Myocardial ischemia during non-cardiac surgical procedures in patients with coronary artery disease. Anesthesiology 1979; 51: 393–7.
Fox EJ, Sklar GS, Hill CH, Villanueva R, King BD. Complications related to the pressor response to endotracheal intubation. Anesthesiology 1977; 47: 524–5.
Tomori Z, Widdicombe JG. Muscular, bronchomotor and cardiovascular reflexes elicited by mechanical stimulation of the respiratory tract. J Physiol 1969; 200: 25–49.
Shepard LC, Gelman S, Reves JG, Oparil S. Humoral response of hypertensive patients to laryngoscopy. Anesth Analg 1981; 60: 276–7.
Menkhaus PG, Reves JG, Kissin I et al. Cardiovascular effects of esmolol in anesthetized humans. Anesth Analg 1985; 64: 327–34.
Denlinger JK, Ellison N, Ominsky AJ. Effects of intratracheal lidocaine on circulatory responses to tracheal intubation. Anesthesiology 1974; 41: 409–12.
Stoelting RK. Attenuation of blood pressure response to laryngoscopy and tracheal intubation with sodium nitroprusside. Anesth Analg 1979; 58: 116–9.
Safwat AM, Reitan JA, Misle GR, Hurley EJ. Use of propranolol to control rate-pressure product during cardiac anesthesia. Anesth Analg 1981; 60: 732–5.
Martin DE, Rosenberg H, Aukburg SJ et al. Low-dose fentanyl blunts circulatory responses to tracheal intubation. Anesth Analg 1982; 61: 680–4.
Bedford RF, Marshall WK. Hemodynamic response to endotracheal intubation: four anesthetics. Anesthesiology 1981; 55: A270.
Gorczynski RJ, Shaffer JE, Lee RJ. Pharmacology of ASL-8052, a novel β-adrenergic receptor antagonist with an ultrashort duration of action. J Cardiovasc Pharmacol 1983; 5: 668–77.
Barreto RS. Effect of intravenously administered succinylcholine upon cardiac rate and rhythm. Anesthesiology 1960; 21: 401–4.
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.
Dagnino J, Prys Roberts C. Assessment of β- adrenoceptor blockade during anesthesia in humans: use of isoproterenol dose-response curves. Anesth Analg 1985; 64:305–1.
Becker LD, Paulson BD, Miller RD, Severinghaus JW, Eger EL. Biphasic respiratory depression after fentanyl-droperidol or fentanyl alone used to supplement nitrous oxide anesthesia. Anesthesiology 1976; 44: 291–6.
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Ebert, J.P., Pearson, J.D., Gelman, S. et al. Circulatory responses to laryngoscopy: the comparative effects of placebo, fentanyl and esmolol. Can J Anaesth 36, 301–306 (1989). https://doi.org/10.1007/BF03010769
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DOI: https://doi.org/10.1007/BF03010769