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Korean J Anesthesiol > Volume 14(4); 1981 > Article
Korean Journal of Anesthesiology 1981;14(4):383-395.
DOI: https://doi.org/10.4097/kjae.1981.14.4.383   
The Effect of Endotracheal Intabation and Extubation on the Blood Pressure and Heart Rate .
Sun Hee Kim, Young Joo Kim, Jong Rae Kim, Kwang Won Park
Department of Anesthesiology, Yonsei University School of Medicine, Seoul, Korea.
Abstract
Transient increases in blood pressure and heart rate following laryngoscopy, endotracheal intubation and extubation are common(King et al, 1951; Takeahima et al, 1964; Forbes and Dally, 1970; Edde, 1979; Paik et al, 1980). Tomori and Widdicombe(1969) found these responses are associated with an increased impulse traffic in the cervical sympathetic efferent nerve fibers. These nervous activities were especially increased by mechanical stimulation of the epi. and alryngopharyngeal regions(Forbes and Dally, 1970). Also various arrhythmias were elicited by vagal stimulation during endotracheal in tubation (Buratein et al, 1950 : King et al, 1951; Lander and Moyer, 1965; Forbes and Dally 1970). and it has been known that cardiac arrest could occur in some cases(Dwyer, 1953; Raffan, 1954). Increased blood pressure and heart rate can produce cerebral hemorrhage, left ventricular failure and life threatening cardiac arrhythima. So pharmacologic attempts to lessen these blood pressure and heart rate elevation and appearances of arrhythmias have been tried but these approaches have been only partially successful. The present study was undertaken to observe the effects of intubation and extubation on the cardiovascular system. Adult patients who had received elective surgery under general anesthesia with endotracheal intubation were randomly selected at Severance Hospital. Eighty five patients in one group and sixty in the other were selected for the responses following intubation and extubation respectively, and these were divided into 3 groups each: Group l served as a control group for intubation(n=25) and extubation(n=20). Group ll served as a intravenous lidocaine injected group for intubation(n=30) and extubation(n=20). Group lll served as a lidocaine sprayed group for intubation(n=30) and extubation(n=20). The changes of arterial blood pressure and pulse rate and the appearance of arrhythmias following intubation and extubation were analysed and data were compared among the groups. The results were as follows: 1) In the lidocaine intravenously injected or sprayed group, the systolic blood pressure elevation following intubation was of less magnitude than in the control group (statistically significant) and rapidly returned to the pre-induction level. 2) In the lidocaine sprayed group, the magnitude of diastolic blood pressure elevation following intubation was ess than in the control and intravenous lidocaine injected groups (statistically significant). 3) In the lidocaine intravenously injected or sprayed groups, the magnitude of the heart rate elevation following intubation was less than in the control group (statistically significant). In the lidocatine sprayed group, systolic blood pressure elevation following extubation was prevented (statistically significant). 4) In the lidocaine intravenously injected group, the magnitude of systolic blood pressure elevation following extubation was less than in the control group (statistically significant). In the lidocaine sprayed group, systolic blood pressure elevation following extubation was prevented (statistically significant). 5) The diastolic blood pressure elevation following extubation was prevented in the lidocaine intravenously injected group (statistically significant) and more rapidly returned to pre-extubation levels in the lidocaine sprayed group than in the control group. 6) The elevation of the heart rate following extubation was prolonged in the lidocaine intravenously injected group and more rapidly returned to pre-extubation levels in the lidocaine sprayed group than in the control group. 7) The effects of lidocaine on the prevention of EKG abnormalities following intubation and extubation were not significant. It is suggested from the above results that the lidocaine intravenous injection and spray of the laryngopharyngeal region decreases the magnitude of blood pressure elevation following intubation and extubation under general anesthesia and is effective for rapid return to the awake level.
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