The use of esmolol, nicardipine, or their combination to blunt hemodynamic changes after laryngoscopy and tracheal intubation

John L. Atlee, M. Saeed Dhamee, Timothy L. Olund, Varghese George

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)280-285
Number of pages6
JournalAnesthesia and Analgesia
Volume90
Issue number2
StatePublished - Feb 14 2000
Externally publishedYes

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Nicardipine
Laryngoscopy
Intubation
Hemodynamics
Heart Rate
Blood Pressure
Drug Combinations
General Anesthesia
Anesthetics
Succinylcholine
Thiopental
Fentanyl
Bradycardia
esmolol
Tachycardia
Pharmaceutical Preparations
Hypotension

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

The use of esmolol, nicardipine, or their combination to blunt hemodynamic changes after laryngoscopy and tracheal intubation. / Atlee, John L.; Saeed Dhamee, M.; Olund, Timothy L.; George, Varghese.

In: Anesthesia and Analgesia, Vol. 90, No. 2, 14.02.2000, p. 280-285.

Research output: Contribution to journalArticle

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