Nebulized bupivacaine attenuates the heart rate response following tracheal intubation.
OBJECTIVE
To determine whether nebulized bupivacaine attenuates the acute hemodynamic response to laryngoscopy and intubation.


METHODS
Prospective, randomized, placebo-controlled study.


METHODS
Operating room at a university medical center.


METHODS
40 health ASA physical status I and II patients scheduled for minor surgical procedures.


METHODS
Patients were randomized to receive 4 ml of a nebulized solution of either saline (n = 20) or 0.75% bupivacaine (n = 20) 15 minutes before induction of anesthesia. On completion of the aerosol treatment, fentanyl 1.5 micrograms/kg was given intravenously (i.v.), and 3 minutes later anesthesia was induced with thiopental sodium 5 mg/kg i.v. and succinylcholine 1.5 mg/kg i.v.. Laryngoscopy was begun 60 seconds after induction, and the trachea was intubated at 90 seconds. Anesthesia was maintained with 50% nitrous oxide in oxygen following intubation, and 1% isoflurane was administered at 180 seconds.


RESULTS
Heart rate (HR) and blood pressure were recorded automatically every 30 seconds for 5 minutes. Bupivacaine significantly attenuated HR (p < 0.05) but not the hypertensive response to laryngoscopy and intubation.


CONCLUSIONS
Nebulized 0.75% bupivacaine was only partially effective in blunting the hemodynamic response to tracheal intubation.
Victory
R A
RA
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas 75235-9068, USA.
Gajraj
N M
NM
Pace
N A
NA
Ostman
L P
LP
White
P F
PF
D000328:Adult; D000336:Aerosols; D000771:Anesthesia, Intravenous; D001794:Blood Pressure / Q000187:drug effects; D002045:Bupivacaine / Q000008:administration & dosage / Q000494:pharmacology*; D005260:Female; D005283:Fentanyl; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D007442:Intubation, Intratracheal; D007828:Laryngoscopy; D008297:Male; D013511:Minor Surgical Procedures; D009330:Nebulizers and Vaporizers; D010919:Placebos; D011446:Prospective Studies; D013390:Succinylcholine; D013874:Thiopental
D000336:Aerosols; D010919:Placebos; D013390:Succinylcholine; D013874:Thiopental; D005283:Fentanyl; D002045:Bupivacaine