title: Obtunding the sympathetic response to intubation. Experience at 2 minutes after administration of the test agent in patients with cerebral aneurysms.
abstract: The sympathetic response to laryngoscopy and intubation was studied in 39 patients who were to undergo surgical clipping of a cerebral aneurysm. Intravascular radial artery pressure and ECG monitoring for ST-segment changes or dysrhythmias were used. Ward blood pressures were controlled on bed rest and labetalol. Induction of anaesthesia was with pentothal 4 mg/kg and suxamethonium 1 mg/kg intravenously. This was followed by one of the following intravenous agents by random choice: alfentanil 30 micrograms/kg, fentanyl 5 micrograms/kg, lignocaine 2 mg/kg, and lignocaine 10% spray 2 mg/kg to the larynx. ECG changes at laryngoscopy and intubation were minimal. Intubation produced an immediate increase in blood pressure and pulse rate, maximal at 30-60 seconds, falling rapidly towards normal within 2-3 minutes. Alfentanil was very effective in obtunding this response with stable cardiovascular parameters; fentanyl produced a more variable response; and intravenous lignocaine was less satisfactory. Lignocaine spray was ineffective.
mesh_terms: D000328:Adult; D015760:Alfentanil; D000770:Anesthesia, Endotracheal; D000777:Anesthetics / Q000494:pharmacology*; D001794:Blood Pressure / Q000187:drug effects; D005283:Fentanyl / Q000031:analogs & derivatives / Q000494:pharmacology; D006801:Humans; D002532:Intracranial Aneurysm / Q000503:physiopathology* / Q000601:surgery; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008012:Lidocaine / Q000494:pharmacology; D008875:Middle Aged; D011674:Pulse / Q000187:drug effects; D013997:Time Factors
chemical_list: D000777:Anesthetics; D015760:Alfentanil; D008012:Lidocaine; D005283:Fentanyl