A Study of the Efficacy of Cardiac Antidysrhythmic Drugs in Attenuating Haemodynamic Responses to Laryngoscopy and Endotracheal Intubation in the Black Population

Sanjeev Singh; Edwin Ferguson Laing; William Kwame Boakye Ansah Owiredu; Arti Singh; Anbarasu Annamalai

doi:doi:10.11648/j.ja.20130101.11

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A Study of the Efficacy of Cardiac Antidysrhythmic Drugs in Attenuating Haemodynamic Responses to Laryngoscopy and Endotracheal Intubation in the Black Population

Sanjeev Singh, Edwin Ferguson Laing, William Kwame Boakye Ansah Owiredu, Arti Singh, Anbarasu Annamalai

Published in Journal of Anesthesiology (Volume 1, Issue 1)

Received: 23 May 2013 Published: 30 June 2013

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Abstract

Background: Laryngeal, tracheal and bronchial receptors are stimulated by mechanical and chemical irritants during laryngoscopy and endotracheal intubation. That almost always triggers powerful cardiovascular responses. Various attempts have been made to attenuate these responses. The aim of this study was to compare the efficacy and safety of cardiac antidysrhythmic drugs lidocaine, diltiazem and esmolol in the attenuation of cardiovascular responses to endotracheal intubation in the Black normotensive population. Patients and Methods: A randomized controlled trial was conducted in 160 adult patients of ASA physical status I or II undergoing various elective surgeries. The patients were randomly divided into four groups of 40 patients in each group - C, L, D, and E. Group - “C” received no drug (control) as placebo, group -“L” received 1.5 mg kg-1 preservative free lidocaine, group -“D” received 0.2 mg kg-1 diltiazem, and group-“E” received 2mg kg-1 esmolol IV. Group “C”, “D” and “E”, “L” one and two minutes before intubation. Changes in heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were measured and then compared within and between groups. Rate pressure product (RPP) was calculated and evaluated as well. Patients were also observed for any complications. Result: There was a significant increase in SBP, DBP, HR, MAP and RPP from the base line in control group “C” at 1 minute with onward decreases at 3 and 5 minutes respectively after intubation. Percentage change in haemodynamic variables in groups C, L, D and E at 1 minute are as follows: SBP= 23.58%, 11.84%, 9.64% and 9.9%, DBP= 18.73%, 18.89%, 11.93% and 10.40%, HR= 30.45%, 26.00%, 7.01% and 1.50%; MAP= 20.80%, 15.89%, 10.90 and 10.20%; RPP= 61.44%, 40.86%, 17.26% and 11.68% respectively. Only patients receiving placebo had increased SBP, DBP, HR, MAP and RPP values after intubation compared with baseline values (p < 0.05). Conclusions: Given the difference in the pharmacological mechanisms of these drugs, the prophylactic therapy with 2mg kg-1 esmolol is significantly more effective and safe for attenuating haemodynamic changes to laryngoscopy and tracheal intubation, without producing increased risk of hypertension in the Black population.

Published in	Journal of Anesthesiology (Volume 1, Issue 1)
DOI	10.11648/j.ja.20130101.11
Page(s)	1-8
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2013. Published by Science Publishing Group

Keywords

Blood Pressure, Diltiazem, Esmolol, Heart Rate, Intubation, Laryngoscopy, Lidocaine, (Source: MeSH, NLM)

References

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[2]	Gupta A, Wakhloo R, Gupta V, Mehta A, Kapoor BB. Comparison of Esmo-lol and Lignocaine for Atttenuation of Car-diovascular Stress response to Laryngosco-py and Endotracheal Intubation. JK Science 2009; 11: 78-81.
[3]	Pedersen T, Eliasen K, Henriksen E. A prospective study of risk factors and cardiopulmonary complications associated with anaesthesia and surgery:risk indicators of cardiopulmonary morbidity. Acta Anaesthesiol Scand 1990;34: 144-55.
[4]	Yuan L, Chia YY, Jan KT et al. The effect of single bolus dose of esmolol for controlling the tachycardia and hypertension during laryngoscopy and tracheal intubation. Acta Anaesthesiologica Sinica 1994;32:147-52.
[5]	Moon YE, Lee SH, Lee J. The optimal dose of esmolol and nicardipine for maintaining cardiovascular stability during rapid sequence induction. journal of Clinical Anaesthesia 2012; 24: 8-13.
[6]	Hall AP, Thompson JP, Leslie NAP, Fox AJ, Kumar N and Rowbotham DJ. Comparism of different doses of remifentanil on the cardiovascular response larngoscopy and tracheal intubation. Br J Anaesth 2000:84:100-2.
[7]	Rupakar VB, Raval B, Chadha I A. Attenuation of cardiovascular responses to laryngoscopy and endotracheal intubation with diltiazem-lignocaine combination. J Anaesth Clin Pharmacol 2009; 25:341-344.
[8]	Gibbs CR, Beevers DG, Lip GYH. The management of hypertensive disease in Black patients. QJM 1999;92:187-92.
[9]	Singh S, Laing EF, Owiredu WKBA, Singh A. Attenuation of Cardiovascular response by ß-blocker esmolol during laryngoscopy and intubation. Journal of Medical and Biomedical Sciences (UDS) 2012;4: 27-33.
[10]	Takita K, Morimoto Y, Kemmotsu O. Tracheal lidocaine attenuates the cardiovascular response to endotracheal intubation. Can J Anaesth 2001;48:732-6
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[12]	Splinter WM. Intravenous lidocaine does not attenuate the haemodynamic response of children to laryngoscopy and tracheal intubation. Can J Anaesth 1990;37:440-3
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[14]	Lev R, Rosen P. Prophylactic lidocaine use preintubation: a review. J Emerg Med 1994;12:499-506
[15]	Minogue SC, Ralph J, Lampa MJ. Laryngotracheal topicalization with lidocaine before intubation decreases the incidence of coughing on emergence from general anesthesia. Anesth Analg 2004;99:1253-7
[16]	Nishino T, Hiraga K, Sagimosi K. Effects of i.v. lignocaine on airway reflexes elicited by irritation of the tracheal mucosa in humans anaesthetized with cuflurane. Br J Anaesth 1990;64:682-7
[17]	Kato H, Takata Y. Differential effects of Ca antagonists on the noradrenaline release and contraction evoked by nerve stimulation in the presence of 4-aminopyridine. Br J Pharmacol 1987;90:191-201
[18]	Nathan N, Odin I. Induction of anaesthesia: a guide to drug choice. Drugs 2007;67:701-23
[19]	Fugit MD, Rubal BJ, Donovan DJ Effects of intracoronary nicardipine, diltiazem and verapamil on coronary blood flow. J Invasive Cardiol 2000;12:80-5
[20]	Lee KH, Jun ES, Chae YJ, Park GS, Choi JC, Lim HK. Effect of Diltiazem and Lidocaine on Cardiovascular Response to Tracheal Intubation. Korean J Anesthesiol 2002;43:710-5
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Sanjeev Singh, Edwin Ferguson Laing, William Kwame Boakye Ansah Owiredu, Arti Singh, Anbarasu Annamalai. (2013). A Study of the Efficacy of Cardiac Antidysrhythmic Drugs in Attenuating Haemodynamic Responses to Laryngoscopy and Endotracheal Intubation in the Black Population. International Journal of Anesthesia and Clinical Medicine, 1(1), 1-8. https://doi.org/10.11648/j.ja.20130101.11

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ACS Style

Sanjeev Singh; Edwin Ferguson Laing; William Kwame Boakye Ansah Owiredu; Arti Singh; Anbarasu Annamalai. A Study of the Efficacy of Cardiac Antidysrhythmic Drugs in Attenuating Haemodynamic Responses to Laryngoscopy and Endotracheal Intubation in the Black Population. Int. J. Anesth. Clin. Med. 2013, 1(1), 1-8. doi: 10.11648/j.ja.20130101.11

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AMA Style

Sanjeev Singh, Edwin Ferguson Laing, William Kwame Boakye Ansah Owiredu, Arti Singh, Anbarasu Annamalai. A Study of the Efficacy of Cardiac Antidysrhythmic Drugs in Attenuating Haemodynamic Responses to Laryngoscopy and Endotracheal Intubation in the Black Population. Int J Anesth Clin Med. 2013;1(1):1-8. doi: 10.11648/j.ja.20130101.11

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@article{10.11648/j.ja.20130101.11,
  author = {Sanjeev Singh and Edwin Ferguson Laing and William Kwame Boakye Ansah Owiredu and Arti Singh and Anbarasu Annamalai},
  title = {A Study of the Efficacy of Cardiac Antidysrhythmic Drugs in Attenuating Haemodynamic Responses to Laryngoscopy and Endotracheal Intubation in the Black Population},
  journal = {International Journal of Anesthesia and Clinical Medicine},
  volume = {1},
  number = {1},
  pages = {1-8},
  doi = {10.11648/j.ja.20130101.11},
  url = {https://doi.org/10.11648/j.ja.20130101.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ja.20130101.11},
  abstract = {Background: Laryngeal, tracheal and bronchial receptors are stimulated by mechanical and chemical irritants during laryngoscopy and endotracheal intubation. That almost always triggers powerful cardiovascular responses. Various attempts have been made to attenuate these responses. The aim of this study was to compare the efficacy and safety of cardiac antidysrhythmic drugs lidocaine, diltiazem and esmolol in the attenuation of cardiovascular responses to endotracheal intubation in the Black normotensive population. Patients and Methods: A randomized controlled trial was conducted in 160 adult patients of ASA physical status I or II undergoing various elective surgeries. The patients were randomly divided into four groups of 40 patients in each group - C, L, D, and E. Group - “C” received no drug (control) as placebo, group -“L” received 1.5 mg kg-1 preservative free lidocaine, group -“D” received 0.2 mg kg-1 diltiazem, and group-“E” received 2mg kg-1 esmolol IV. Group “C”, “D” and “E”, “L” one and two minutes before intubation. Changes in heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were measured and then compared within and between groups. Rate pressure product (RPP) was calculated and evaluated as well. Patients were also observed for any complications. Result: There was a significant increase in SBP, DBP, HR, MAP and RPP from the base line in control group “C” at 1 minute with onward decreases at 3 and 5 minutes respectively after intubation. Percentage change in haemodynamic variables in groups C, L, D and E at 1 minute are as follows: SBP= 23.58%, 11.84%, 9.64% and 9.9%, DBP= 18.73%, 18.89%, 11.93% and 10.40%, HR= 30.45%, 26.00%, 7.01% and 1.50%; MAP= 20.80%, 15.89%, 10.90 and 10.20%; RPP= 61.44%, 40.86%, 17.26% and 11.68% respectively. Only patients receiving placebo had increased SBP, DBP, HR, MAP and RPP values after intubation compared with baseline values (p < 0.05). Conclusions: Given the difference in the pharmacological mechanisms of these drugs, the prophylactic therapy with 2mg kg-1 esmolol is significantly more effective and safe for attenuating haemodynamic changes to laryngoscopy and tracheal intubation, without producing increased risk of hypertension in the Black population.},
 year = {2013}
}

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TY  - JOUR
T1  - A Study of the Efficacy of Cardiac Antidysrhythmic Drugs in Attenuating Haemodynamic Responses to Laryngoscopy and Endotracheal Intubation in the Black Population
AU  - Sanjeev Singh
AU  - Edwin Ferguson Laing
AU  - William Kwame Boakye Ansah Owiredu
AU  - Arti Singh
AU  - Anbarasu Annamalai
Y1  - 2013/06/30
PY  - 2013
N1  - https://doi.org/10.11648/j.ja.20130101.11
DO  - 10.11648/j.ja.20130101.11
T2  - International Journal of Anesthesia and Clinical Medicine
JF  - International Journal of Anesthesia and Clinical Medicine
JO  - International Journal of Anesthesia and Clinical Medicine
SP  - 1
EP  - 8
PB  - Science Publishing Group
SN  - 2997-2698
UR  - https://doi.org/10.11648/j.ja.20130101.11
AB  - Background: Laryngeal, tracheal and bronchial receptors are stimulated by mechanical and chemical irritants during laryngoscopy and endotracheal intubation. That almost always triggers powerful cardiovascular responses. Various attempts have been made to attenuate these responses. The aim of this study was to compare the efficacy and safety of cardiac antidysrhythmic drugs lidocaine, diltiazem and esmolol in the attenuation of cardiovascular responses to endotracheal intubation in the Black normotensive population. Patients and Methods: A randomized controlled trial was conducted in 160 adult patients of ASA physical status I or II undergoing various elective surgeries. The patients were randomly divided into four groups of 40 patients in each group - C, L, D, and E. Group - “C” received no drug (control) as placebo, group -“L” received 1.5 mg kg-1 preservative free lidocaine, group -“D” received 0.2 mg kg-1 diltiazem, and group-“E” received 2mg kg-1 esmolol IV. Group “C”, “D” and “E”, “L” one and two minutes before intubation. Changes in heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were measured and then compared within and between groups. Rate pressure product (RPP) was calculated and evaluated as well. Patients were also observed for any complications. Result: There was a significant increase in SBP, DBP, HR, MAP and RPP from the base line in control group “C” at 1 minute with onward decreases at 3 and 5 minutes respectively after intubation. Percentage change in haemodynamic variables in groups C, L, D and E at 1 minute are as follows: SBP= 23.58%, 11.84%, 9.64% and 9.9%, DBP= 18.73%, 18.89%, 11.93% and 10.40%, HR= 30.45%, 26.00%, 7.01% and 1.50%; MAP= 20.80%, 15.89%, 10.90 and 10.20%; RPP= 61.44%, 40.86%, 17.26% and 11.68% respectively. Only patients receiving placebo had increased SBP, DBP, HR, MAP and RPP values after intubation compared with baseline values (p < 0.05). Conclusions: Given the difference in the pharmacological mechanisms of these drugs, the prophylactic therapy with 2mg kg-1 esmolol is significantly more effective and safe for attenuating haemodynamic changes to laryngoscopy and tracheal intubation, without producing increased risk of hypertension in the Black population.
VL  - 1
IS  - 1
ER  -

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Author Information

Sanjeev Singh

Department of Anaesthesia and Intensive Care
Edwin Ferguson Laing

Molecular Medicine, School of Medical Sciences, College of Health Sciences
William Kwame Boakye Ansah Owiredu

Molecular Medicine, School of Medical Sciences, College of Health Sciences
Arti Singh

University Health Services, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, West Africa
Anbarasu Annamalai

Department of Cardiac Anaesthesia, NHIMS, Bangalore, Karnataka, India

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APA Style

Sanjeev Singh, Edwin Ferguson Laing, William Kwame Boakye Ansah Owiredu, Arti Singh, Anbarasu Annamalai. (2013). A Study of the Efficacy of Cardiac Antidysrhythmic Drugs in Attenuating Haemodynamic Responses to Laryngoscopy and Endotracheal Intubation in the Black Population. International Journal of Anesthesia and Clinical Medicine, 1(1), 1-8. https://doi.org/10.11648/j.ja.20130101.11

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ACS Style

Sanjeev Singh; Edwin Ferguson Laing; William Kwame Boakye Ansah Owiredu; Arti Singh; Anbarasu Annamalai. A Study of the Efficacy of Cardiac Antidysrhythmic Drugs in Attenuating Haemodynamic Responses to Laryngoscopy and Endotracheal Intubation in the Black Population. Int. J. Anesth. Clin. Med. 2013, 1(1), 1-8. doi: 10.11648/j.ja.20130101.11

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AMA Style

Sanjeev Singh, Edwin Ferguson Laing, William Kwame Boakye Ansah Owiredu, Arti Singh, Anbarasu Annamalai. A Study of the Efficacy of Cardiac Antidysrhythmic Drugs in Attenuating Haemodynamic Responses to Laryngoscopy and Endotracheal Intubation in the Black Population. Int J Anesth Clin Med. 2013;1(1):1-8. doi: 10.11648/j.ja.20130101.11

Copy | Download

@article{10.11648/j.ja.20130101.11,
  author = {Sanjeev Singh and Edwin Ferguson Laing and William Kwame Boakye Ansah Owiredu and Arti Singh and Anbarasu Annamalai},
  title = {A Study of the Efficacy of Cardiac Antidysrhythmic Drugs in Attenuating Haemodynamic Responses to Laryngoscopy and Endotracheal Intubation in the Black Population},
  journal = {International Journal of Anesthesia and Clinical Medicine},
  volume = {1},
  number = {1},
  pages = {1-8},
  doi = {10.11648/j.ja.20130101.11},
  url = {https://doi.org/10.11648/j.ja.20130101.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ja.20130101.11},
  abstract = {Background: Laryngeal, tracheal and bronchial receptors are stimulated by mechanical and chemical irritants during laryngoscopy and endotracheal intubation. That almost always triggers powerful cardiovascular responses. Various attempts have been made to attenuate these responses. The aim of this study was to compare the efficacy and safety of cardiac antidysrhythmic drugs lidocaine, diltiazem and esmolol in the attenuation of cardiovascular responses to endotracheal intubation in the Black normotensive population. Patients and Methods: A randomized controlled trial was conducted in 160 adult patients of ASA physical status I or II undergoing various elective surgeries. The patients were randomly divided into four groups of 40 patients in each group - C, L, D, and E. Group - “C” received no drug (control) as placebo, group -“L” received 1.5 mg kg-1 preservative free lidocaine, group -“D” received 0.2 mg kg-1 diltiazem, and group-“E” received 2mg kg-1 esmolol IV. Group “C”, “D” and “E”, “L” one and two minutes before intubation. Changes in heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were measured and then compared within and between groups. Rate pressure product (RPP) was calculated and evaluated as well. Patients were also observed for any complications. Result: There was a significant increase in SBP, DBP, HR, MAP and RPP from the base line in control group “C” at 1 minute with onward decreases at 3 and 5 minutes respectively after intubation. Percentage change in haemodynamic variables in groups C, L, D and E at 1 minute are as follows: SBP= 23.58%, 11.84%, 9.64% and 9.9%, DBP= 18.73%, 18.89%, 11.93% and 10.40%, HR= 30.45%, 26.00%, 7.01% and 1.50%; MAP= 20.80%, 15.89%, 10.90 and 10.20%; RPP= 61.44%, 40.86%, 17.26% and 11.68% respectively. Only patients receiving placebo had increased SBP, DBP, HR, MAP and RPP values after intubation compared with baseline values (p < 0.05). Conclusions: Given the difference in the pharmacological mechanisms of these drugs, the prophylactic therapy with 2mg kg-1 esmolol is significantly more effective and safe for attenuating haemodynamic changes to laryngoscopy and tracheal intubation, without producing increased risk of hypertension in the Black population.},
 year = {2013}
}

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TY  - JOUR
T1  - A Study of the Efficacy of Cardiac Antidysrhythmic Drugs in Attenuating Haemodynamic Responses to Laryngoscopy and Endotracheal Intubation in the Black Population
AU  - Sanjeev Singh
AU  - Edwin Ferguson Laing
AU  - William Kwame Boakye Ansah Owiredu
AU  - Arti Singh
AU  - Anbarasu Annamalai
Y1  - 2013/06/30
PY  - 2013
N1  - https://doi.org/10.11648/j.ja.20130101.11
DO  - 10.11648/j.ja.20130101.11
T2  - International Journal of Anesthesia and Clinical Medicine
JF  - International Journal of Anesthesia and Clinical Medicine
JO  - International Journal of Anesthesia and Clinical Medicine
SP  - 1
EP  - 8
PB  - Science Publishing Group
SN  - 2997-2698
UR  - https://doi.org/10.11648/j.ja.20130101.11
AB  - Background: Laryngeal, tracheal and bronchial receptors are stimulated by mechanical and chemical irritants during laryngoscopy and endotracheal intubation. That almost always triggers powerful cardiovascular responses. Various attempts have been made to attenuate these responses. The aim of this study was to compare the efficacy and safety of cardiac antidysrhythmic drugs lidocaine, diltiazem and esmolol in the attenuation of cardiovascular responses to endotracheal intubation in the Black normotensive population. Patients and Methods: A randomized controlled trial was conducted in 160 adult patients of ASA physical status I or II undergoing various elective surgeries. The patients were randomly divided into four groups of 40 patients in each group - C, L, D, and E. Group - “C” received no drug (control) as placebo, group -“L” received 1.5 mg kg-1 preservative free lidocaine, group -“D” received 0.2 mg kg-1 diltiazem, and group-“E” received 2mg kg-1 esmolol IV. Group “C”, “D” and “E”, “L” one and two minutes before intubation. Changes in heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were measured and then compared within and between groups. Rate pressure product (RPP) was calculated and evaluated as well. Patients were also observed for any complications. Result: There was a significant increase in SBP, DBP, HR, MAP and RPP from the base line in control group “C” at 1 minute with onward decreases at 3 and 5 minutes respectively after intubation. Percentage change in haemodynamic variables in groups C, L, D and E at 1 minute are as follows: SBP= 23.58%, 11.84%, 9.64% and 9.9%, DBP= 18.73%, 18.89%, 11.93% and 10.40%, HR= 30.45%, 26.00%, 7.01% and 1.50%; MAP= 20.80%, 15.89%, 10.90 and 10.20%; RPP= 61.44%, 40.86%, 17.26% and 11.68% respectively. Only patients receiving placebo had increased SBP, DBP, HR, MAP and RPP values after intubation compared with baseline values (p < 0.05). Conclusions: Given the difference in the pharmacological mechanisms of these drugs, the prophylactic therapy with 2mg kg-1 esmolol is significantly more effective and safe for attenuating haemodynamic changes to laryngoscopy and tracheal intubation, without producing increased risk of hypertension in the Black population.
VL  - 1
IS  - 1
ER  -

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