BibTex RIS Cite

ENDOTRAKEAL ENTÜBASYON SIRASINDA OLUŞAN HEMODİNAMİK DEGİŞİKLİKLERE ESMOLOLÜN ETKİSİ

Year 2005, Volume: 6 Issue: 3, 23 - 28, 01.12.2005

Abstract

Amaç:Çalışmamızın amacı laringoskopi ve endotrakeal entübasyona yanıt olarak oluşan taşikardi vehipertansiyonu baskılamada, bir beta bloker olan esmolol'ün etkilerini araştırmaktır.Gereç ve yöntem:Çalışma prospektif, randomize, tek kör olarak düzenlendi,ASAI-II, 20-50 yaş arası 60 olgu 2gruba ayrılarak yapıldı. Grup Esmolol'e (Grup E) esmolol (Brevibloc®) 1.5 mg/kg, Grup Kontrol'e (Grup K) %5dekstroz 5 cc, laringoskopi ve entübasyondan 2 dakika önce İ.V bolus verildi. Preoperatif, indüksiyondan sonra,entübasyonun ardından ve 1., 3., 5., 7., 10. dakikalarda kalp atım hızı (KAH), ortalama arter basıncı (OAB) ve hızbasınç ürünü (RPP) değerleri kaydedildi.Bulgular:Grup K'da KAH bazal değeri ile karşılaştırıldığında; indüksiyondan sonra ,5., 7., 10. dk'da anlamlıdüşme, entübasyondan sonra ise anlamlı yükselme, Grup E'de ise; indüksiyondan sonra, 3., 5., 7., 10. dk'daanlamlı düşme saptandı (P<0.05). Grup K'da OAB bazal değeri ile karşılaştırıldığında; indüksiyondan sonra, 5.,7., 10. dk'da anlamlı düşme, entübasyondan sonra ve 1. dk'da anlamlı yükselme, Grup E'de indüksiyondan sonrave 3., 5., 7., 10. dk'da anlamlı düşme, entübasyondan sonra ise anlamlı yükselme saptandı (P<0.05). Grup K'daRPP bazal değeri ile karşılaştırıldığında; indüksiyondan sonra, 5., 7., 10. dk'da anlamlı düşme, entübasyondansonra ve 1. dakikada ise anlamlı yükselme, Grup E'de ise; indüksiyondan sonra ve 3., 5., 7., 10., dk'da anlamlıdüşme saptandı (P<0.05). Gruplar arasında Grup E'de indüksiyondan ve entübasyondan hemen sonra ve 1.dakikada KAH ve RPPbakımından anlamlı düşme gözlendi (P<0.05).Sonuç:Çalışmamızda esmololün bu dozda laringoskopi ve endotrakeal entübasyon sırasında oluşan taşikardi veRPP'yi baskılamada etkili, hipertansiyonu baskılamada yetersiz olduğunu gözlemledik

References

  • 1. Kayhan Z. Endotrakeal entübasyon. Klinik Anestezi. İstanbul: Logos yayıncılık, 2004; 243.
  • 2. Barak M, Ziser A, Greenberg A, Lischinsky S, Rosenberg B. Hemodynamic and catecholamine response to tracheal intubation: direct laryngoscopy compared with fiberoptic intubation. J Clin Anesth 2003; 15:132-136.
  • 3. Kumar S, Mishra M.N, Mishra L.S, Batla S. Comparative study of the efficacy of i.v. esmolol, diltiazem and magnesium sulphate in attenuating haemodynamic response to laryngoscopy and tracheal intubation. Indian JAnaesthesia 2003; 47:41- 44.
  • 4. Tan PH, Yang LC, Shih HC, Lin CR, Lan KC, Chen CS. Combined use of esmolol and nicardipine to blunt the haemodynamic changes following laryngoscopy and tracheal intubation.Anaesthesia 2002; 57:1195-1212.
  • 5. Bedford RF, Marshall WK. Cardiovascular response to endotracheal intubation during four anesthetic techniques. Acta Anaesthesiol Scand 1984; 28:563- 566.
  • 6. Roy WL, Edelist G, Gilbert B. Myocardial ischemia during non-cardiac surgical procedures in patients with coronary-artery disease. Anesthesiology 1979; 51:393- 7.
  • 7. Kaplan JA. Hemodinamic monitoring. In: Kaplan JA (ed): Cardiac Anesthesia. Philadelphia: WB Saunders, 1987:179-225.
  • 8. Barash PG, Cullen BF, Stoelting RK. Opioidler, Klinik Anestezi El Kitabı. 3. baskı (Çeviren: Elar Z), İstanbul: Logos yayıncılık, 1999; 120.
  • 9. Messerli FH. Cardiovasscular drug therapy. In: Frishman WH, Murthy VS, Strom JA, Hershman D (eds), 2 ed. Philadelphia: WB Saunders , 1996; 507.
  • 10. www. Randomizer.org/form.htm.
  • 11. Korpinen R, Simola M, Saarnivaara L. Effect of esmolol on the hemodynamic and electrocardiographic changes during laryngomicroscopy under propofolalfentanil anesthesia. Acta Anaesthesiol Belg 1998; 49:123-32.
  • 12. Singh H, Vichitvejpaisal P, Gaines GY, White PF. Comparative effects of lidocaine, esmolol, and nitroglycerin in modifying the hemodynamic response to laryngoscopy and intubation. J Clin Anesth 1995; 7:5-8.
  • 13. Kindler CH, Schumacher PG, Schneider MC, Urwyler A. Effects of intravenous lidocaine and/or esmolol on hemodynamic responses to laryngoscopy and intubation: a double-blind, controlled clinical trial. J ClinAnesth 1996; 8:491-6.
  • 14. Samaha T, Ravussin P, Claquin C, Ecoffey C. Prevention of increase of blood pressure and intracranial pressure during endotracheal intubation in neurosurgery: esmolol versus lidocaine. Ann Fr Anesth Reanim 1996; 15:36-40.
  • 15. Figueredo E, Garcia-Fuentes EM. Assessment of the efficacy of esmolol on the haemodynamic changes induced by laryngoscopy and tracheal intubation: a meta-analysis. Acta Anaesthesiol Scand 2001; 45:1011-22.
  • 16. Rathore A, Gupta HK, Tanwar GL, Rehman H. Attenuation of the pressure response to laryngoscopy and endotracheal intubation with different doses of esmolol. Indian JAnaesthesia 2002; 46:449-452.
  • 17. Sharma S, Ghani AA, Win N, Ahmad M. Comparison of two bolus doses of esmolol for attenuation of haemodynamic response to tracheal intubation. Med J Malaysia 1995; 50:372-6.
  • 18. Ebert TJ, Bernstein JS, Stowe DF, Roerig D, Kampine JP. Attenuation of hemodynamic responses to rapid sequence induction and intubation in healthy patients with a single bolus of esmolol. J Clin Anesth 1990; 2:243-52.
  • 19. Parnass SM, Rothenberg DM, Kerchberger JP, Ivankovich AD. A single bolus dose of esmolol in the prevention of intubation-induced tachycardia and hypertension in an ambulatory surgery unit. J Clin Anesth 1990; 2:232-7.
  • 20. Oxorn D, Knox JW, Hill J. Bolus doses of esmolol for the prevention of perioperative hypertension and tachycardia. Can JAnaesth 1990; 37:206-9.
  • 21. Bensky KP, Donahue-Spencer L, Hertz GE, Anderson MT, James R. The dose-related effects of bolus esmolol on heart rate and blood pressure following laryngoscopy and intubation. AANA J 2000; 68: 437- 42.
  • 22. Sha fe r SL, Va rvel JR. Pha rmacokinetic s, pharmacodynamics, and rational opioid selection. Anesthesiology 1991;74:53-63.
  • 23. Dahlgren N, Messeter K. Treatment of stress response to laryngoscopy and intubation with fentanyl. Anaesthesia 1981; 36:1022-6.
  • 24. Kautto UM. Attenuation of the circulatory response to laryngoscopy and intubation by fentanyl. Acta Anaesthesiol Scand 1982; 26:217-21.
  • 25. Chung F, Evans D. Low-dose fentanyl: haemodynamic response during induction and intubation in geriatric patients. CanAnaesth Soc J 1985; 32:622-8.
  • 26. Martin DE, Rosenberg H, Aukburg SJ, Bartkowski RR, Edwards MW Jr, Greenhow DE, Klineberg PL. Lowdose fentanyl blunts circulatory responses to tracheal intubation.AnesthAnalg 1982; 61:680-4.
  • 27. Kitamura T, Yamada Y, Chinzei M, Du HL, Hanaoka K. Attenuation of haemodynamic responses to tracheal intubation by the styletscope. Br J Anaesth 2001; 86:275-7.
  • 28. Oczenski W, Krenn H, Dahaba AA, Binder M, ElSchahawi-Kienzl I, Jellinek H, Schwarz S, Fitzgerald RD. Hemodynamic and catecholamine stress responses to insertion of the Combitube, laryngeal mask airway or tracheal intubation.AnesthAnalg 1999; 88:1389-94.

Effects of Esmolol on Hemodynamic Responses to Endotracheal Intubation

Year 2005, Volume: 6 Issue: 3, 23 - 28, 01.12.2005

Abstract

Objective: To evaluate the efficacy of esmolol in modifying hemodynamic response to laryngoscopy and endotracheal intubation. Materials and methods: ASA I-II 60 subjects, aged between 20-50 years, were included in this prospective, randomized and single-blind study. Patients were divided into two groups. Group Esmolol(Group E) and Group Control (Group C) received IV bolus of esmolol 1.5 mg/kg and %5 dextrose 5 cc respectively, 2 minutes before laryngoscopy and intubation. We recorded heart rates (HR), mean arterial pressures (MAP), and rate pressure products (RPP) preoperatively, after induction and intubation and in 1st, 3rd, 5th, 7th, and 10th minutes after intubation. Results: In Group C, HR decreased after induction in 5th, 7th, and 10th minutes, whereas it increased after intubation. In Group E, HR decreased after induction, in 3rd, 5th, 7th, and 10th minutes (P<0.05). In Group C, MAP decreased after induction, in 5th, 7th, and 10th minutes, while it increased after intubation and in the first minute. In Group E, MAPdecreased after induction, in 3rd, 5th, 7th, and 10th minutes, but increased after intubation (P<0.05). In Group C, RPP decreased after induction, at 5th, 7th, and 10th minutes, however it increased in the first minute. In Group E, RPP decreased after induction, in 3rd, 5th, 7th, and 10th minutes (P<0.05). When we compared the two groups, HR and RPPdecreased in Group E immediately after induction and intubation and in the first minute. Conclusion: This dose of esmolol was effective in controlling the tachycardia and RPP, but it was ineffective in controlling the hypertensive response to laryngoscopy and endotracheal intubation.

References

  • 1. Kayhan Z. Endotrakeal entübasyon. Klinik Anestezi. İstanbul: Logos yayıncılık, 2004; 243.
  • 2. Barak M, Ziser A, Greenberg A, Lischinsky S, Rosenberg B. Hemodynamic and catecholamine response to tracheal intubation: direct laryngoscopy compared with fiberoptic intubation. J Clin Anesth 2003; 15:132-136.
  • 3. Kumar S, Mishra M.N, Mishra L.S, Batla S. Comparative study of the efficacy of i.v. esmolol, diltiazem and magnesium sulphate in attenuating haemodynamic response to laryngoscopy and tracheal intubation. Indian JAnaesthesia 2003; 47:41- 44.
  • 4. Tan PH, Yang LC, Shih HC, Lin CR, Lan KC, Chen CS. Combined use of esmolol and nicardipine to blunt the haemodynamic changes following laryngoscopy and tracheal intubation.Anaesthesia 2002; 57:1195-1212.
  • 5. Bedford RF, Marshall WK. Cardiovascular response to endotracheal intubation during four anesthetic techniques. Acta Anaesthesiol Scand 1984; 28:563- 566.
  • 6. Roy WL, Edelist G, Gilbert B. Myocardial ischemia during non-cardiac surgical procedures in patients with coronary-artery disease. Anesthesiology 1979; 51:393- 7.
  • 7. Kaplan JA. Hemodinamic monitoring. In: Kaplan JA (ed): Cardiac Anesthesia. Philadelphia: WB Saunders, 1987:179-225.
  • 8. Barash PG, Cullen BF, Stoelting RK. Opioidler, Klinik Anestezi El Kitabı. 3. baskı (Çeviren: Elar Z), İstanbul: Logos yayıncılık, 1999; 120.
  • 9. Messerli FH. Cardiovasscular drug therapy. In: Frishman WH, Murthy VS, Strom JA, Hershman D (eds), 2 ed. Philadelphia: WB Saunders , 1996; 507.
  • 10. www. Randomizer.org/form.htm.
  • 11. Korpinen R, Simola M, Saarnivaara L. Effect of esmolol on the hemodynamic and electrocardiographic changes during laryngomicroscopy under propofolalfentanil anesthesia. Acta Anaesthesiol Belg 1998; 49:123-32.
  • 12. Singh H, Vichitvejpaisal P, Gaines GY, White PF. Comparative effects of lidocaine, esmolol, and nitroglycerin in modifying the hemodynamic response to laryngoscopy and intubation. J Clin Anesth 1995; 7:5-8.
  • 13. Kindler CH, Schumacher PG, Schneider MC, Urwyler A. Effects of intravenous lidocaine and/or esmolol on hemodynamic responses to laryngoscopy and intubation: a double-blind, controlled clinical trial. J ClinAnesth 1996; 8:491-6.
  • 14. Samaha T, Ravussin P, Claquin C, Ecoffey C. Prevention of increase of blood pressure and intracranial pressure during endotracheal intubation in neurosurgery: esmolol versus lidocaine. Ann Fr Anesth Reanim 1996; 15:36-40.
  • 15. Figueredo E, Garcia-Fuentes EM. Assessment of the efficacy of esmolol on the haemodynamic changes induced by laryngoscopy and tracheal intubation: a meta-analysis. Acta Anaesthesiol Scand 2001; 45:1011-22.
  • 16. Rathore A, Gupta HK, Tanwar GL, Rehman H. Attenuation of the pressure response to laryngoscopy and endotracheal intubation with different doses of esmolol. Indian JAnaesthesia 2002; 46:449-452.
  • 17. Sharma S, Ghani AA, Win N, Ahmad M. Comparison of two bolus doses of esmolol for attenuation of haemodynamic response to tracheal intubation. Med J Malaysia 1995; 50:372-6.
  • 18. Ebert TJ, Bernstein JS, Stowe DF, Roerig D, Kampine JP. Attenuation of hemodynamic responses to rapid sequence induction and intubation in healthy patients with a single bolus of esmolol. J Clin Anesth 1990; 2:243-52.
  • 19. Parnass SM, Rothenberg DM, Kerchberger JP, Ivankovich AD. A single bolus dose of esmolol in the prevention of intubation-induced tachycardia and hypertension in an ambulatory surgery unit. J Clin Anesth 1990; 2:232-7.
  • 20. Oxorn D, Knox JW, Hill J. Bolus doses of esmolol for the prevention of perioperative hypertension and tachycardia. Can JAnaesth 1990; 37:206-9.
  • 21. Bensky KP, Donahue-Spencer L, Hertz GE, Anderson MT, James R. The dose-related effects of bolus esmolol on heart rate and blood pressure following laryngoscopy and intubation. AANA J 2000; 68: 437- 42.
  • 22. Sha fe r SL, Va rvel JR. Pha rmacokinetic s, pharmacodynamics, and rational opioid selection. Anesthesiology 1991;74:53-63.
  • 23. Dahlgren N, Messeter K. Treatment of stress response to laryngoscopy and intubation with fentanyl. Anaesthesia 1981; 36:1022-6.
  • 24. Kautto UM. Attenuation of the circulatory response to laryngoscopy and intubation by fentanyl. Acta Anaesthesiol Scand 1982; 26:217-21.
  • 25. Chung F, Evans D. Low-dose fentanyl: haemodynamic response during induction and intubation in geriatric patients. CanAnaesth Soc J 1985; 32:622-8.
  • 26. Martin DE, Rosenberg H, Aukburg SJ, Bartkowski RR, Edwards MW Jr, Greenhow DE, Klineberg PL. Lowdose fentanyl blunts circulatory responses to tracheal intubation.AnesthAnalg 1982; 61:680-4.
  • 27. Kitamura T, Yamada Y, Chinzei M, Du HL, Hanaoka K. Attenuation of haemodynamic responses to tracheal intubation by the styletscope. Br J Anaesth 2001; 86:275-7.
  • 28. Oczenski W, Krenn H, Dahaba AA, Binder M, ElSchahawi-Kienzl I, Jellinek H, Schwarz S, Fitzgerald RD. Hemodynamic and catecholamine stress responses to insertion of the Combitube, laryngeal mask airway or tracheal intubation.AnesthAnalg 1999; 88:1389-94.
There are 28 citations in total.

Details

Other ID JA79FZ96NG
Journal Section Research Article
Authors

Mustafa Oğurlu This is me

Bakiye Uğur This is me

Erdal Gezer This is me

Feray Gürsoy This is me

Publication Date December 1, 2005
Published in Issue Year 2005 Volume: 6 Issue: 3

Cite

EndNote Oğurlu M, Uğur B, Gezer E, Gürsoy F (December 1, 2005) Effects of Esmolol on Hemodynamic Responses to Endotracheal Intubation. Meandros Medical And Dental Journal 6 3 23–28.