Comparative effects of lidocaine, esmolol, and nitroglycerin in modifying the hemodynamic response to laryngoscopy and intubation.
OBJECTIVE
To compare the safety and efficacy of lidocaine, esmolol, and nitroglycerin in modifying the hemodynamic response to laryngoscopy and intubation.


METHODS
Randomized, placebo-controlled, double-blind study.


METHODS
University-affiliated VA medical center.


METHODS
40 ASA physical status I and II patients undergoing electric surgery with general endotracheal anesthesia.


METHODS
Anesthesia was induced with thiopental sodium 5 mg/kg, and intubation was facilitated with vecuronium 0.15 mg/kg. Isoflurane (0.5% to 1%) and 50% nitrous oxide in oxygen were used for maintenance of anesthesia. In addition, patients received one of the following four study drugs intravenously (i.v.) prior to laryngoscopy: Group 1 (control) = saline 5 ml; Group 2 = lidocaine 1.5 mg/kg; Group 3 = esmolol 1.4 mg/kg; Group 4 = nitroglycerin 2 micrograms/kg.


RESULTS
Mean arterial pressure (MAP) and heart rate (HR) were recorded every minute for 20 minutes following induction of anesthesia. Following laryngoscopy and intubation, MAP increased significantly in all four treatment groups (control 49% +/- 19%, lidocaine 55% +/- 26%, esmolol 25% +/- 11%, nitroglycerin 45% +/- 21%) compared with preinduction baseline values. In the esmolol-pretreated patients, the increase in HR was significantly lower (20% +/- 3%) compared with the nitroglycerin (37% +/- 8%), lidocaine (52% +/- 8%), and control (29% +/- 4%) groups.


CONCLUSIONS
Lidocaine 1.5 mg/kg i.v. and nitroglycerin 2 micrograms/kg i.v. were ineffective in controlling the acute hemodynamic response following laryngoscopy and intubation. Esmolol 1.4 mg/kg i.v. was significantly more effective than either lidocaine or nitroglycerin in controlling the HR response to laryngoscopy and intubation (p < 0.05). Esmolol also was significantly more effective than lidocaine in minimizing the increase in MAP (25% vs. 55%).
Singh
H
H
Department of Anesthesiology and Pain Management, University of Texas, Southwestern Medical Center at Dallas 75235-9068, USA.
Vichitvejpaisal
P
P
Gaines
G Y
GY
White
P F
PF
D000319:Adrenergic beta-Antagonists / Q000494:pharmacology*; D000771:Anesthesia, Intravenous; D001794:Blood Pressure / Q000187:drug effects*; D004311:Double-Blind Method; D017558:Elective Surgical Procedures; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D007442:Intubation, Intratracheal; D007828:Laryngoscopy; D008012:Lidocaine / Q000494:pharmacology*; D008875:Middle Aged; D005996:Nitroglycerin / Q000494:pharmacology*; D010919:Placebos; D011412:Propanolamines / Q000494:pharmacology*; D013874:Thiopental; D014673:Vecuronium Bromide
D000319:Adrenergic beta-Antagonists; D010919:Placebos; D011412:Propanolamines; D014673:Vecuronium Bromide; D008012:Lidocaine; D005996:Nitroglycerin; D013874:Thiopental; C036604:esmolol