| The Effects of Verapamil , Labetalol , or Fentanyl on Hemodynamic Responses to Endotracheal Intubation. |
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Seong Su Kim, Jae Yang Kim, Jun Rae Lee, He Sun Song |
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Department of Anesthesiology, College of Medicine, Dental School, Chunbuk National University, Korea. |
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| Abstract |
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Induction of general anesthesia with direct laryngoscopy and tracheal intubation is a routine procedure. However, it is accompanied by varying degree of sympathetic stimulation as reflected by significant hypertension, tachycardia, and arrhythmia. These transient hemodynamic responses are undesirable, especially in patients with cardiovascular or intracranial diseases. Many approaches have been tried to attenuate these potentially adverse circulatory responses (topical or i.v. lidocaine, deep anesthesia with inhalation anesthetics, opioids, adrenergic blockers, calcium channel blockers, sedatives, etc), and several trials reduced the hemodynamic effects. This study was done to examine blunting effect of verapamil, labetalol, and fentanyl on the adverse hemodynamic changes following direct laryngoscopy and tracheal intubation. Eighty patients, ASA Physical Status I II, scheduled for elective surgery, were selected randomly.
These were divided into four groups. Group 1: Control (saline) (n = 20) Group 2: Verapamil 100 ug/kg (n = 20) Group 3: Labetalol 0.25 mg/kg (n = 20) Group 4: Fentanyl 3 ug/kg (n = 20) These were injected 3 minutes before induction with thiopental sodium (5mg/kg) and succinylcholine (1 mg/kg) i.v. in alI groups. Laryngoscopy and endotracheal intubation were performed 5 minutes after study drugs injection. After the completion of intubation, 50% nitrous oxide in oxygen and 1.5 Vol% halothane were inhaled. The blood pressure and heart rate were measured with automatic noninvasive blood pressure device and E.C.G monitoring every minutes for 10 minutes. The data were analyzed with Student's paired t-test within the groups and unpaired t-test between the groups. Results were considered statistically significant if p < 0.05. All study drugs, verapamil, labetalol, or fentanyl significantly blunted the increase in heart rate, arterial blood pressure, and rate pressure product caused by direct laryngoscopy and endotracheal intubation. There was no significant difference between verapamil and labetalol, but the blunting effects on hemodynamic changes were very significant in fentanyl group.
So, verapamil, labetalol, and fentanyl may offer on important role in patients in whom an inaease in blood pressure, heart rate, and/or rate pressure product should be avoided during the endotracheal intubation. |
| Key Words:
Verapamil; Labetalol; Fentanyl; Laryngoscopy; Tracheal intubation; Hemodynamic changes |
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