title: Which is responsible for the haemodynamic response due to laryngoscopy and endotracheal intubation? Catecholamines, vasopressin or angiotensin?
abstract: OBJECTIVE
  We have investigated the concentrations of epinephrine, norepinephrine, vasopressin and angiotensin converting enzyme activity to explore the role of these mediators in the neuroendocrine response to laryngoscopy and tracheal intubation.
  
  
  METHODS
  One hundred (50 male, 50 female) ASA I patients aged 20-50 yr (mean+/-SEM; 35.59+/-0.99) were included in the study. They were undergoing elective surgery under standard anaesthesia induction and maintenance using tracheal intubation. Plasma concentrations of epinephrine, norepinephrine and vasopressin as well as plasma angiotensin converting enzyme activity were determined at four time points, before (T1) and after (T2) induction, and 2 (T3) and 5 min (T4) after intubation. Blood pressure and heart rate were recorded at corresponding times to reveal if any correlation existed between haemodynamic parameters and neuroendocrine response.
  
  
  RESULTS
  Heart rate increased after induction and intubation (P<0.05) and decreased significantly at T4 (P<0.05). Systolic blood pressure decreased significantly (P<0.05) after induction and increased slightly after intubation decreasing to below baseline value (P<0.05) at T4. Diastolic blood pressure increased slightly after intubation and decreased significantly (P<0.05) at T4. Plasma epinephrine and norepinephrine concentrations decreased after induction and increased at T3 and T4 without reaching significance. Vasopressin concentrations increased slightly at T2 and T3 and decreased significantly at T4 (P<0.05). Angiotensin converting enzyme activity was unaffected when compared with baseline values.
  
  
  CONCLUSIONS
  Blood pressure, heart rate, plasma epinephrine, norepinephrine and vasopressin concentrations increased slightly in response to laryngoscopy and intubation, all returning to or below baseline 5 min later with no change in angiotensin converting enzyme activity in normotensive patients.
authors.affiliation: Baskent University, Faculty of Medicine, Department of Anaesthesiology, Ankara, Turkey. zeynepk@baskent-ank.edu.tr
authors.forename: Z
authors.initials: Z
authors.lastname: Kayhan
authors.forename: D
authors.initials: D
authors.lastname: Aldemir
authors.forename: H
authors.initials: H
authors.lastname: Mutlu
authors.forename: E
authors.initials: E
authors.lastname: Oğüş
mesh_terms: D000328:Adult; D000758:Anesthesia; D000809:Angiotensins / Q000097:blood / Q000502:physiology*; D002395:Catecholamines / Q000097:blood / Q000502:physiology*; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D007828:Laryngoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D007703:Peptidyl-Dipeptidase A / Q000097:blood; D014667:Vasopressins / Q000097:blood / Q000502:physiology*
chemical_list: D000809:Angiotensins; D002395:Catecholamines; D014667:Vasopressins; D007703:Peptidyl-Dipeptidase A; D009638:Norepinephrine