[The effect of different doses of esmolol on hemodynamic, bispectral index and movement response during orotracheal intubation: prospective, randomized, double-blind study]

Dosing study of esmolol for reducing hemodynamic changes during lightwand intubation

Background

Lightwand is a convenient tool that can be used instead of a laryngoscope for intubation. Tracheal intubation causes direct stimulation of the larynx, drastically increasing hemodynamic values including blood pressure and heart rate. This study aims to identify the effect of different doses of esmolol on hemodynamic changes during lightwand intubation.

Methods

The study subjects included 140 patients who underwent general anesthesia for elective surgery. The patients were randomly divided into four groups (35 patients in each group). The ‘C’ group only received 20 ml of normal saline, while the ‘E0.5’, ‘E1’, and ‘E2’ groups received 20 ml of normal saline containing esmolol—0.5 mg/kg, 1 mg/kg, and 2 mg/kg, respectively, injected 2 min prior to intubation. The patients’ blood pressure, heart rate, and rate-pressure product were measured six times, before and after the intubation.

Results

The degree of heart rate elevation was suppressed in the E1 and E2 groups compared to the C group, and RPP after intubation significantly decreased in the E2 group compared to the C group.

Conclusions

Esmolol injection, 1-2 mg/kg, prior to lightwand intubation effectively blunts heart rate elevation, and 2 mg/kg of esmolol injection blunts rate-pressure product elevation.

Dexmedetomidine in the Management of Awake Fiberoptic Intubation

Awake Fibreoptic Intubation (AFOI) is, nowadays, the gold standard in predicted difficult airway management. Numerous practice guidelines have been developed to assist clinicians facing with a difficult airway. If conducted without sedation, it is common that this procedure may lead to high patient discomfort and severe hemodynamic responses. Sedation is frequently used to make the process more tolerable to patients even if it is not always easy to strike a balance between patient comfort, safety, co-operation, and good intubating conditions. In the last years, many drugs and drug combinations have been described. This minireview aims to discuss the evidence supporting the use of Dexmedetomidine (DEX) in the AFOI management.

Efficacy of dexmedetomidine versus remifentanil to blunt the hemodynamic response to laryngoscopy and orotracheal intubation: a randomized clinical trial

The study aims to compare the efficacy of dexmedetomidine (DEX) vs. remifentanil (REM) to blunt the hemodynamic response to laryngoscopy and orotracheal intubation. Enrolled in a double-blind clinical trial, 124 patients undergoing elective surgery under general anesthesia at Amirkabir Hospital (Arak, Iran), were assigned into four groups equally (31 patients in each group), DEX, REM, DEX-REM, and normal saline (NS), who received intravenous DEX (1 µg/kg), REM (1 µg/kg), their equal mixture (each 0.5 µg/kg, 1 minute before tracheal intubation), and NS, respectively. Then, blood pressure (BP), heart rate (HR), and arterial oxygen saturation (SaO₂) were measured on arrival to the operating room, 1 minute before laryngoscopy and tracheal intubation, immediately after intubation, and afterwards every 5 to 15 minutes, and finally the data were analyzed using SPSS 18.0. The groups were same regarding to age, sex and baseline hemodynamic variables including mean of BP (P = 0.157), HR (P = 0.105) and SaO₂ (P = 0.366). Tukey post-hoc test showed that there DEX, REM, and a DEX + REM groups was same regarding to MBP and HR, but these hemodynamic responses were higher in NS group than other groups at all time after laryngoscopy and intubation (P < 0.05). Moreover, repeated measure test showed a decreasing trend in MBP and HR in three intervention groups at all time after intubation (P > 0.05). A DEX/REM mixture had the lowest BP and three intervention groups had lower HR than the NS group. A mixture of the drugs used seems to lead to not only a prevented increase in HR and BP during laryngoscopy but also a decreased BP and HR. This study was registered in Iranian Registry Clinical Center with the registration No. IRCT2016092722254N1.

Effects of different dosages of oxycodone and fentanyl on the hemodynamic changes during intubation

Objectives:

To investigate the effectiveness of oxycodone compared with fentanyl for attenuating the hemodynamic response during endotracheal intubation.

Methods:

This study was conducted from June 2014 to February 2015 on healthy adults undergoing general anesthesia at the Yeungnam University Hospital, Daegu, Republic of Korea. Ninety-five patients were randomly assigned to one of 3 groups to receive the following drugs; Group F: fentanyl 2 µg/kg; Group O/70: oxycodone 140 µg/kg; Group O/100: oxycodone 200 µg/kg. Five minutes after injection of the study drug, general anesthesia was induced with propofol 1.5 mg/kg and rocuronium 0.8 mg/kg. The mean blood pressure (MBP), heart rate (HR), peripheral oxygen saturation (SpO₂), and bispectral index (BIS) were compared before administration of the study drug (T1), just before endotracheal intubation (T2), one minute after endotracheal intubation (T3), and 7.5 minutes after endotracheal intubation (T4). Complications were assessed.

Results:

The 2 oxycodone groups showed no significant differences in MBP, HR, SpO₂, and BIS compared to Group F at the time points assessed. The incidence of complications was comparable among the groups.

Conclusions:

Oxycodone could successfully be used to attenuate the sympathetic response during anesthetic induction. The hemodynamic profiles and incidence of complications were clinically similar among the groups, but Group O/70 tended to show a lower rate of complications of apnea.