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CARDIOVASCULAR ANESTHESIA

The Use of Esmolol, Nicardipine, or Their Combination to Blunt Hemodynamic Changes After Laryngoscopy and Tracheal Intubation

John L. Atlee, MD^*, M. Saeed Dhamee, MD^*, Timothy L. Olund, MD, and Varghese George, PhD

Departments of *Anesthesiology and Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin

Address correspondence and reprint requests to John L. Atlee, MD, Department of Anesthesiology, Froedtert Hospital East, P.O. Box 26099, 9200 West Wisconsin Avenue, Milwaukee, WI 53226-3596. Address e-mail to jatlee{at}mcw.edu

Laryngoscopy and tracheal intubation (LTI) often provoke an undesirable increase in blood pressure (BP) and/or heart rate (HR). We tested the premise that nicardipine (NIC) and esmolol (ESM) in combination (COMB) would oppose both. Adult surgical patients received pretreatment (randomized) with IV bolus NIC 30 µg/kg (n = 31), ESM 1.0 mg/kg (n = 34), or COMB (one-half dose each, n = 32). Peak BP and HR after LTI were compared with controls (CONT; n = 35) with no pretreatment. Anesthetic induction was standardized: IV thiopental (5–7 mg/kg), fentanyl (1–2 µg/kg), and succinylcholine (1.5 mg/kg). Systolic (S), diastolic (D), and mean (M) BP and HR awake before pretreatment (baseline) were similar in all test groups. No patient was treated for hypotension, bradycardia, or tachycardia after pretreatment or anesthetic induction. Peak HR after LTI was increased versus baseline in CONT and all test groups, but did not differ from CONT among the test groups. Peak SBP and DBP increased versus baseline in CONT, and with ESM and NIC, but not COMB. Peak SBP, DBP, and MBP were increased with ESM versus COMB, and peak DBP with ESM versus NIC. Compared with no pretreatment before the IV induction of general anesthesia, the peak increase in BP after LTI is best blunted by the combination of nicardipine and ESM, compared with either drug alone. No single drug or combination in the doses tested opposed increased HR.

Implications: Compared with no pretreatment before the IV induction of general anesthesia, the peak increase in blood pressure after laryngoscopy and tracheal intubation is best blunted by the combination of nicardipine and esmolol, compared with either drug alone. No single drug or combination in the doses tested opposed increased heart rate.

This article has been cited by other articles:

				T. C. Mort Complications of Emergency Tracheal Intubation: Hemodynamic Alterations - Part I J Intensive Care Med, May 1, 2007; 22(3): 157 - 165. [Abstract] [PDF]

				F. R. Montes, J. C. Giraldo, L. A. Betancur, J. D. Rincon, I. E. Rincon, M. V. Vanegas, and H. Charris Endotracheal intubation with a lightwand or a laryngoscope results in similar hemodynamic variations in patients with coronary artery disease: [L'intubation endotracheale avec stylet lumineux ou laryngoscope produit des variations hemodynamiques comparables chez des malades atteints de cardiopathie ischemique] Can J Anesth, October 1, 2003; 50(8): 824 - 828. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999