The efficacy of esmolol versus lidocaine to attenuate the hemodynamic response to intubation in isolated head trauma patients.
OBJECTIVE
To assess the effect of esmolol vs lidocaine to attenuate the detrimental rise in heart rate and blood pressure during intubation of patients with isolated head trauma.


METHODS
This was a prospective, double-blind, randomized study, performed at an urban, county teaching emergency department. Participants were 30 patients with isolated head trauma. Each underwent a standardized intubation protocol including esmolol or lidocaine, both at 2 mg/kg.


RESULTS
Esmolol was used in 16 patients and lidocaine in 14. Mechanisms of injury included 12 assaults, 6 motor vehicle collisions, 6 falls, 4 auto-vs-pedestrian crashes, and 2 bicycle incidents. Mean ethanol level was 0.116+/-0.133 SD (range 0-0.482). Mean Glasgow Coma Scale (GCS) score was 7.9+/-4.0 SD. Cranial computed tomography (CT) hemorrhagic findings included 9 subdural/epidural hematomas, 6 cortex hemorrhages, and 2 multi-hemorrhages. Eleven patients received surgical intervention: 9 patients received a craniotomy, and 2 a ventricular catheter. The 2-minute time interval around intubation was used to assess each drug's efficacy. The mean difference change between groups for heart rate was 4.0 beats/min (95% CI = -17.7 to 9.7 beats/min), for systolic blood pressure was 1.3 mm Hg (95% CI = -27.8 to 30.4 mm Hg), and for diastolic blood pressure was 2.6 mm Hg (95% CI = -27.1 to 21.9 mm Hg). The power of this study was 90% to detect a 20-beat/min difference in heart rate, a 35-mm Hg difference in systolic blood pressure, and a 20-mm Hg difference in diastolic blood pressure.


CONCLUSIONS
Esmolol and lidocaine have similar efficacies to attenuate moderate hemodynamic response to intubation of patients with isolated head trauma.
Levitt
M A
MA
Department of Emergency Medicine, Alameda County Medical Center, Highland Campus, Oakland, CA, USA. andrewl@hghed.com
Dresden
G M
GM
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000627:therapeutic use*; D006259:Craniocerebral Trauma / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D000431:Ethanol / Q000097:blood; D005260:Female; D015600:Glasgow Coma Scale; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007442:Intubation, Intratracheal; D008012:Lidocaine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011412:Propanolamines / Q000627:therapeutic use*
D000319:Adrenergic beta-Antagonists; D000779:Anesthetics, Local; D011412:Propanolamines; D000431:Ethanol; D008012:Lidocaine; C036604:esmolol