Obtunding the sympathetic response to intubation. Experience at 2 minutes after administration of the test agent in patients with cerebral aneurysms.
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.
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
D000777:Anesthetics; D015760:Alfentanil; D008012:Lidocaine; D005283:Fentanyl