Attenuation of hypertensive response to tracheal intubation with nitroglycerin.
OBJECTIVE
To evaluate the efficacy and safety of intravenous (IV) nitroglycerin in attenuating the hypertensive response to laryngoscopy and intubation as a new application of the drug.


METHODS
Controlled, randomized, double-blind study.


METHODS
University hospital.


METHODS
Thirty normotensive patients (ASA physical status I) undergoing elective surgery were divided into three groups of ten patients each.


METHODS
Anesthesia was induced with thiopental sodium 5 mg/kg i.v., and tracheal intubation was facilitated with vecuronium 0.2 mg/kg i.v. During anesthesia, ventilation was assisted or controlled with 1% enflurane and 50% nitrous oxide in oxygen. Either 1.5 micrograms/kg of nitroglycerin, 2.5 micrograms/kg of nitroglycerin, or saline (control) was administered IV simultaneously with the start of laryngoscopy (lasting 30 seconds), which was attempted 2 minutes after administration of thiopental sodium and vecuronium.


RESULTS
Patients receiving saline showed a significant increase in mean arterial pressure and rate-pressure product associated with tracheal intubation. These increases following tracheal intubation were significantly reduced in nitroglycerin-treated patients compared with those in the control group (p < 0.05).


CONCLUSIONS
A single, rapid IV dose of nitroglycerin is a simple, practical, effective, and safe method to attenuate the hypertensive response to laryngoscopy and tracheal intubation.
Mikawa
K
K
Department of Anesthesiology, Kobe University School of Medicine, Japan.
Hasegawa
M
M
Suzuki
T
T
Maekawa
N
N
Kaetsu
H
H
Goto
R
R
Yaku
H
H
Obara
H
H
D000328:Adult; D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D001794:Blood Pressure / Q000187:drug effects; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000517:prevention & control*; D007275:Injections, Intravenous; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D007828:Laryngoscopy / Q000009:adverse effects*; D008297:Male; D005996:Nitroglycerin / Q000008:administration & dosage / Q000627:therapeutic use*; D013997:Time Factors
D005996:Nitroglycerin