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Vazhakalayil STJ, Haroon S. Comparative Study Between Intravenous Clonidine and Preservative Free Intravenous Lignocaine in Attenuation of Pressor Response to Laryngoscopy and Endotracheal Intubation. J Pharmacol Pharmacother 2023. [DOI: 10.1177/0976500x221148539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Objectives To compare the attenuation of pressor responses by intravenous clonidine and preservative-free lignocaine to laryngoscopy and endotracheal intubation. Materials and Methods A randomized, prospective, comparative, double-blinded study was conducted in 80 adult patients who were randomized into two groups of 40 each, group clonidine (Group C) and group lignocaine (Group L). Group C patients were given 2 µg/kg clonidine in 20 ml of normal saline as a slow infusion over 10 min prior to intubation. Group L patients were given 1.5 mg/kg of preservative-free 2% lignocaine in 20 ml of normal saline as a single-dose infusion over 3 min prior to intubation. Baseline vital and hemodynamic parameters were monitored during the perioperative period at 1-, 5-, and 10-min post-intubation. Results The attenuation of heart rate (HR) after intubation was much better with clonidine than lignocaine as there is statistically significant difference in the mean HR between the two groups at 1, 5, and 10 min after intubation with the HR significantly lesser in the Group C than the Group L at all times after intubation. Both clonidine and lignocaine were effective in attenuating systolic blood pressure response after intubation, but clonidine was more effective than lignocaine as systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) in the Group C remained much lower than the Group L and the difference between the two groups was statistically significant at all times after intubation. Conclusion Premedicating with a single slow infusion of 2 µg/kg i.v. clonidine has been proven to be effective in maintaining perioperative hemodynamic stability at 1, 5, and 10 min post-intubation than lignocaine.
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Affiliation(s)
- Subha Teresa Jose Vazhakalayil
- Department of Anaesthesiology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune; Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
| | - Shahbaz Haroon
- Department of Anaesthesiology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune; Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
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Shionoya Y, Hirayama K, Saito K, Kawasaki E, Kantake Y, Okamoto H, Goi T, Sunada K, Nakamura K. Anesthetic Management of a Patient With Catecholaminergic Polymorphic Ventricular Tachycardia. Anesth Prog 2022; 69:24-29. [PMID: 35849806 DOI: 10.2344/anpr-68-04-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 09/23/2021] [Indexed: 11/11/2022] Open
Abstract
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare inherited arrhythmogenic disorder induced by adrenergic stress. Electrophysiologically, it is characterized by emotional stress- or exercise-induced bidirectional ventricular tachycardia that may result in cardiac arrest. Minimizing perioperative stress is critical as it can reduce fatal arrhythmias in patients with CPVT. Dexmedetomidine (DEX), a centrally acting sympatholytic anesthetic agent, was used in the successful intravenous (IV) moderate sedation of a 27-year-old female patient with CPVT, a history of cardiac events, and significant dental fear and anxiety scheduled to undergo mandibular left third molar extraction. Oral surgery was successfully performed under DEX-based IV sedation to reduce stress, and no arrhythmias were observed. IV sedation with DEX provided a sympatholytic effect with respiratory and cardiovascular stability in this patient with CPVT who underwent oral surgery.
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Affiliation(s)
- Yoshiki Shionoya
- Department of Dental Anesthesia, The Nippon Dental University Hospital, Tokyo, Japan
| | - Kaoru Hirayama
- Department of Dental Anesthesia, The Nippon Dental University Hospital, Tokyo, Japan
| | - Kaho Saito
- Department of Dental Anesthesia, The Nippon Dental University Hospital, Tokyo, Japan
| | - Eriko Kawasaki
- Department of Dental Anesthesia, The Nippon Dental University Hospital, Tokyo, Japan
| | - Yoko Kantake
- Department of Dental Anesthesia, The Nippon Dental University Hospital, Tokyo, Japan
| | - Hazuki Okamoto
- Department of Dental Anesthesiology, The Nippon Dental University School of Life Dentistry, Tokyo, Japan
| | - Takahiro Goi
- Department of Dental Anesthesia, The Nippon Dental University Hospital, Tokyo, Japan
| | - Katsuhisa Sunada
- Department of Dental Anesthesiology, The Nippon Dental University School of Life Dentistry, Tokyo, Japan
| | - Kiminari Nakamura
- Department of Dental Anesthesia, The Nippon Dental University Hospital, Tokyo, Japan
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Lv L, Yan L, Liu X, Chen M. Effectiveness of lidocaine/prilocaine cream on cardiovascular reactions from endotracheal intubation and cough events during recovery period of older patients under general anesthesia: prospective, randomized placebo-controlled study. BMC Geriatr 2020; 20:157. [PMID: 32366224 PMCID: PMC7197116 DOI: 10.1186/s12877-020-01567-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Endotracheal intubation is known to pose significant physiological, pharmacokinetic, and dynamic changes and postoperative respiratory complications in patients under general anesthesia. METHOD An RCT trial was organized by the Third Affiliated Hospital at Sun Yat-sen University, China. Patients were eligible for inclusion in the trial if they were over 60 years old and had upper-abdominal surgery during the induction of anesthesia and had enrolled in endotracheal intubations. The primary end point included cardiovascular reactions during the induction of anesthesia and endotracheal intubations and cough events during the recovery period. In the test group, 2 g of lidocaine/prilocaine cream (and in the control group, 2 g of Vaseline) were laid over the surface of the tracheal tube cuff. RESULTS The systolic blood pressure (F value = 62.271, p < 0.001), diastolic blood pressure (F value = 150.875, p < 0.001), and heart rate (F value = 75.627, p < 0.001) of the test group were significantly lower than the control group. Cough events during the recovery period in the test group were better (spontaneous cough, χ2 value = 10.591, p < 0.001; induced cough, χ2 value =10.806, p < 0.001). CONCLUSION In older patients, coughing and cardiovascular reactions under anesthesia and endotracheal intubations were reduced, as a result of using lidocaine/prilocaine cream on the surface of the tracheal tube cuff. TRIAL REGISTRATION International Clinical Trials Network NCT02017392, 2013-12-16.
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Affiliation(s)
- Linsheng Lv
- Operation Room, the third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, Guangdong, China
| | - Lei Yan
- Shanghai Shyndec Pharmaceutical Co., Ltd, Shanghai, 600420, China
| | - Xun Liu
- Division of Nephrology, the third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, Guangdong, China.
| | - Miaoxia Chen
- Nursing Department, the third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, Guangdong, China.
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Effects of stellate ganglion block on cardiovascular reaction and heart rate variability in elderly patients during anesthesia induction and endotracheal intubation. J Clin Anesth 2015; 27:140-5. [PMID: 25559299 DOI: 10.1016/j.jclinane.2014.06.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 05/19/2014] [Accepted: 06/09/2014] [Indexed: 12/25/2022]
Abstract
STUDY OBJECTIVE To investigate the effects of stellate ganglion block (SGB) on cardiovascular response and heart rate (HR) variability in elderly patients during anesthesia induction and endotracheal intubation. DESIGN A randomized, double-blinded, and placebo-controlled study. SETTING University-affiliated teaching hospital. PARTICIPANTS Eighty elderly patients (American Society of Anesthesiologists grades I and II) receiving elective surgery during general anesthesia. INTERVENTIONS Right stellate ganglion injection (SGB) was performed in all patients using 10 mL of 1% lidocaine or normal saline. MEASUREMENTS Systolic blood pressure (BP), diastolic BP, HR, and calculated rate pressure product. HR variability at the following time points: conscious status before induction (T0); immediately before intubation (T1); immediately after intubation (T2); and 1, 3, and 5 minutes postintubation (T3, T4, and T5). MAIN RESULTS No significant differences in BP and HR were observed between the 2 groups. Rate pressure product values significantly increased in the control group compared with baseline and SGB group values. Low-frequency power (LF) and LF/high-frequency power (HF) significantly increased, and HF and normalized units of HF significantly decreased in the control group compared with baseline values. LF, normalized units of LF, and LF/HF in the SGB group significantly decreased compared with those of the control group. CONCLUSION SGB protects the myocardium and effectively suppresses stress responses during anesthesia induction and tracheal intubation in elderly patients.
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Comparação de esmolol em bolus e infusão contínua na resposta hemodinâmica à laringoscopia, intubação orotraqueal e esternotomia em cirurgia de revascularização coronária. Braz J Anesthesiol 2014; 64:247-52. [DOI: 10.1016/j.bjan.2013.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 07/15/2013] [Indexed: 11/21/2022] Open
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Efe EM, Bilgin BA, Alanoglu Z, Akbaba M, Denker C. Comparison of bolus and continuous infusion of esmolol on hemodynamic response to laryngoscopy, endotracheal intubation and sternotomy in coronary artery bypass graft. Braz J Anesthesiol 2013; 64:247-52. [PMID: 24998108 DOI: 10.1016/j.bjane.2013.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 07/15/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The aim of this randomized, prospective and double blinded study is to investigate effects of different esmolol use on hemodynamic response of laryngoscopy, endotracheal intubation and sternotomy in coronary artery bypass graft surgery. METHODS After approval of local ethics committee and patients' written informed consent, 45 patients were randomized into three groups equally. In Infusion Group; from 10 min before intubation up to 5th minute after sternotomy, 0.5mg/kg/min esmolol infusion, in Bolus Group; 2 min before intubation and sternotomy 1.5mg/kg esmolol IV bolus and in Control Group; %0.9 NaCl was administered. All demographic parameters were recorded. Heart rate and blood pressure were recorded before infusion up to anesthesia induction in every minute, during endotracheal intubation, every minute for 10 minutes after endotracheal intubation and before, during and after sternotomy at first and fifth minutes. RESULTS While area under curve (AUC) (SAP×time) was being found more in Group B and C than Group I, AUC (SAP×Tint and Tst) and AUC (SAP×T2) was found more in Group B and C than Group I (p<0.05). Moreover AUC (HR×Tst) was found less in Group B than Group C but no significant difference was found between Group B and Group I. CONCLUSION This study highlights that esmolol infusion is more effective than esmolol bolus administration on controlling systolic arterial pressure during endotracheal intubation and sternotomy in CABG surgery.
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Affiliation(s)
- Esra Mercanooglu Efe
- Department of Anesthesiology and Reanimation, Ankara University Medical Faculty, Ankara, Turkey.
| | - Basak Atabey Bilgin
- Department of Anesthesiology and Reanimation, Ankara University Medical Faculty, Ankara, Turkey
| | - Zekeriyya Alanoglu
- Department of Anesthesiology and Reanimation, Ankara University Medical Faculty, Ankara, Turkey
| | - Murat Akbaba
- Department of Anesthesiology and Reanimation, Ankara University Medical Faculty, Ankara, Turkey
| | - Cigdem Denker
- Department of Anesthesiology and Reanimation, Ankara University Medical Faculty, Ankara, Turkey
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Zalunardo MP, Ivleva-Sauerborn A, Seifert B, Spahn DR. [Quality of premedication and patient satisfaction after premedication with midazolam, clonidine or placebo : Randomized double-blind study with age-adjusted dosage]. Anaesthesist 2010; 59:410-8. [PMID: 20224951 DOI: 10.1007/s00101-010-1695-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Premedication aims at alleviating preoperative anxiety and nervousness and also at minimizing adverse effects. To our knowledge there is no study comparing efficacy and patient satisfaction of different premedications in age-adjusted dosage. METHODS In 139 patients anxiety, sedation and adverse effects were measured at 6 consecutive perioperative time points after administration of midazolam, clonidine or a placebo. RESULTS Midazolam showed the strongest sedative and anxiolytic effects, clonidine less and placebo none. Clonidine and midazolam reduced the risk of postoperative nausea and vomiting (PONV). Midazolam showed minimal adverse effects and the best patient satisfaction. CONCLUSION Midazolam was the most anxiolytic, sedative and favored premedication with the least adverse effects. Most patients would choose midazolam next time.
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Affiliation(s)
- M P Zalunardo
- Institut für Anästhesiologie, Universitätsspital Zürich, Rämistr. 100, 8091 Zürich, Schweiz.
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Landoni G, Turi S, Biondi-Zoccai G, Bignami E, Testa V, Belloni I, Cornero G, Zangrillo A. Esmolol Reduces Perioperative Ischemia in Noncardiac Surgery: A Meta-analysis of Randomized Controlled Studies. J Cardiothorac Vasc Anesth 2010; 24:219-29. [PMID: 19800816 DOI: 10.1053/j.jvca.2009.07.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2009] [Indexed: 02/08/2023]
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Ugur B, Ogurlu M, Gezer E, Nuri Aydin O, Gürsoy F. Effects of esmolol, lidocaine and fentanyl on haemodynamic responses to endotracheal intubation: a comparative study. Clin Drug Investig 2007; 27:269-77. [PMID: 17358099 DOI: 10.2165/00044011-200727040-00006] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND AND OBJECTIVE Predicting the haemodynamic changes that may result in myocardial ischaemia for patients undergoing laryngoscopy and tracheal intubation will help to avoid events that trigger ischaemia and allow immediate treatment. The objective of this study was to compare the effects of esmolol with those of lidocaine (lignocaine) and fentanyl on prevention of tachycardia and hypertension caused by endotracheal intubation. METHODS This was a prospective, randomised, double-blind study. The study was conducted at the Adnan Menderes University Hospital in Aydin, Turkey and involved 120 patients of American Society of Anesthesiologists physical status I or II aged 20-50 years. The patients were randomised into four equal groups. The control group (group C) received dextrose 5% 5 mL, the esmolol group (group E) received esmolol 1.5 mg/kg, the fentanyl group (group F) received fentanyl 1 microg/kg and the lidocaine group (group L) received lidocaine 1.5 mg/kg 2 minutes before endotracheal intubation. Heart rate (HR), mean arterial pressure (MAP) and rate-pressure product (RPP) were recorded before and after induction of anaesthesia, immediately after intubation, and 1, 3, 5, 7 and 10 minutes after intubation. RESULTS Compared with control, HR decreased significantly in group E after induction, immediately after intubation and 1 minute after intubation (p < 0.0083). In group F there was an increase in MAP immediately after intubation, but the increase was less than in other groups. Compared with control, RPP decreased significantly in groups E and F after induction, immediately after intubation and 1 minute after intubation (p < 0.0083). RPP was significantly lower in group E than in controls and group L 3 minutes after intubation (p < 0.0083), and it was significantly lower in group F than in controls 10 minutes after intubation (p < 0.0083). CONCLUSION It can be concluded that administration of esmolol 1.5 mg/kg 2 minutes before intubation prevents tachycardia and an increase in RPP caused by laryngoscopy and tracheal intubation, and can be beneficial when administered before laryngoscopy and tracheal intubation in patients with tachycardia.
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Affiliation(s)
- Bakiye Ugur
- Department of Anaesthesiology and Reanimation, Adnan Menderes University Faculty of Medicine, Aydin, Turkey
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Willigers HM, Prinzen FW, Roekaerts PMHJ. The Effects of Esmolol and Dexmedetomidine on Myocardial Oxygen Consumption During Sympathetic Stimulation in Dogs. J Cardiothorac Vasc Anesth 2006; 20:364-70. [PMID: 16750737 DOI: 10.1053/j.jvca.2006.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2005] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the potential of the beta(1)-adrenergic receptor blocker esmolol and the alpha(2)-adrenergic receptor agonist dexmedetomidine to suppress the cardiovascular and neuroendocrine response to a sympathetic stimulus. DESIGN Experimental study. SETTING Laboratory of university. PARTICIPANTS Eleven anesthetized dogs. INTERVENTIONS Catheters for arterial and coronary venous blood sampling and calculation of myocardial oxygen consumption were inserted. Pressure sensors were placed in the aorta, left ventricle, and a carotid artery. Flow probes were placed around the aortic root and around the left anterior descending coronary artery. Esmolol was infused (loading dose of 1 mg/kg, infusion of 0.3 mg/kg/h), and the adequacy of beta-blockade was checked. Thirty minutes after stopping esmolol, dexmedetomidine infusion was started (loading dose of 1 microg/kg, infusion of 1.5 microg/kg/min). Occlusion of both carotid arteries was used as a sympathetic stimulus before and during infusion of esmolol and before and during infusion of dexmedetomidine. MEASUREMENTS AND MAIN RESULTS The variables were measured just before and during sympathetic stimulation, and changes were calculated. Both drugs suppressed the increase in dPdT(max). Dexmedetomidine suppressed the increase in plasma norepinephrine and the increase in systemic vascular resistance (dexmedetomidine 4% +/- 4% and esmolol 25% +/- 19% increase, p = 0.02). Esmolol attenuated the heart rate response (esmolol 2% +/- 2% and dexmedetomidine 20% +/- 18% increase, p = 0.02). However, dexmedetomidine decreased baseline heart rate more than esmolol; therefore, the absolute maximal heart rate during sympathetic stimulation was lower in the presence of dexmedetomidine (dexmedetomidine 119 +/- 14 and esmolol 141 +/- 15 beats/min, p = 0.01). Neither drug suppressed the increase in myocardial oxygen consumption. CONCLUSIONS Both esmolol and dexmedetomidine have the potential to suppress some of the cardiovascular and neuroendocrine changes to a sympathetic stimulus but neither drug abolished the increase in myocardial oxygen consumption.
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Affiliation(s)
- Henriëtte M Willigers
- Department of Anesthesiology, University Hospital, Maastricht, Maastricht, the Netherlands
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Pandharipande P, Ely E, Maze M. Dexmedetomidine for sedation and perioperative management of critically ill patients. ACTA ACUST UNITED AC 2006. [DOI: 10.1053/j.sane.2006.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Morin AM, Geldner G, Schwarz U, Kahl M, Adams HA, Wulf H, Eberhart LHJ. Factors influencing preoperative stress response in coronary artery bypass graft patients. BMC Anesthesiol 2004; 4:7. [PMID: 15387891 PMCID: PMC521687 DOI: 10.1186/1471-2253-4-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2004] [Accepted: 09/23/2004] [Indexed: 11/23/2022] Open
Abstract
Background In many studies investigating measures to attenuate the hemodynamic and humoral stress response during induction of anaesthesia, primary attention was paid to the period of endotracheal intubation since it has been shown that even short-lasting sympathetic cardiovascular stimulation may have detrimental effects on patients with coronary artery disease. The aim of this analysis was, however, to identify the influencing factors on high catecholamine levels before induction of anaesthesia. Methods Various potential risk factors that could impact the humoral stress response before induction of anaesthesia were recorded in 84 males undergoing coronary aortic bypass surgery, and were entered into a stepwise linear regression analysis. The plasma level of norepinephrine measured immediately after radial artery canulation was chosen as a surrogate marker for the humoral stress response, and it was used as the dependent variable in the regression model. Accordingly, the mean arterial blood pressure, heart rate and the calculated pressure-rate product were taken as parameters of the hemodynamic situation. Results Stepwise regression analysis revealed that the oral administration of low-dose clonidine (mean dose 1.75 μg·kg-1) on the morning of surgery was the only significant predictor (p = 0.004) of the high variation in preoperative norepinephrine plasma levels. This intervention decreased norepinephrine levels by more than 40% compared to no clonidine administration, from 1.26 to 0.75 nmol·l-1. There was no evidence for dose-responsiveness of clonidine. All other potential predictors were removed from the model as insignificant (p > 0.05). The use of beta-blocker, ace-inhibitors, ejection fraction, and body mass index were significant determinants for the hemodynamic situation (heart rate, mean arterial pressure, pressure rate product) of the patient during the pre-induction period. Conclusion The oral administration of clonidine is the only significant predictor for the observed variation of norepinephrine levels during the preoperative period. Lack of significant dose responsiveness suggests that even a low dose of the drug can attenuate the preoperative stress response and thus is recommended in cardiovascular high risk patients.
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Affiliation(s)
- Astrid M Morin
- Department of Anaesthesiology and Critical Care Medicine (Professor and Chairman: Hinnerk Wulf) Philipps-University Marburg Baldingerstrasse 35043 Marburg Germany
| | - Götz Geldner
- Department of Anaesthesiology and Critical Care Medicine (Professor and Chairman: Hinnerk Wulf) Philipps-University Marburg Baldingerstrasse 35043 Marburg Germany
| | - Udo Schwarz
- Department of Anaesthesiology and Critical Care Medicine (Professor and Chairman: Hinnerk Wulf) Philipps-University Marburg Baldingerstrasse 35043 Marburg Germany
| | - Martin Kahl
- Department of Anaesthesiology and Critical Care Medicine (Professor and Chairman: Hinnerk Wulf) Philipps-University Marburg Baldingerstrasse 35043 Marburg Germany
| | - Hans A Adams
- Department of Anaesthesiology and Critical Care Medicine (Professor and Chairman: Hinnerk Wulf) Philipps-University Marburg Baldingerstrasse 35043 Marburg Germany
| | - Hinnerk Wulf
- Department of Anaesthesiology and Critical Care Medicine (Professor and Chairman: Hinnerk Wulf) Philipps-University Marburg Baldingerstrasse 35043 Marburg Germany
| | - Leopold HJ Eberhart
- Department of Anaesthesiology and Critical Care Medicine (Professor and Chairman: Hinnerk Wulf) Philipps-University Marburg Baldingerstrasse 35043 Marburg Germany
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Fernandez-Galinski S, Bermejo S, Mansilla R, Pol O, Puig MM. Comparative assessment of the effects of alfentanil, esmolol or clonidine when used as adjuvants during induction of general anaesthesia. Eur J Anaesthesiol 2004. [DOI: 10.1097/00003643-200406000-00010] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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