Is there an ideal approach for rapid-sequence induction in hypertensive patients?
OBJECTIVE
To compare 4 different anesthesia induction protocols, in a simulated model of rapid-sequence induction, in controlled hypertensive patients.


METHODS
Prospective, randomized, double-blind, clinical investigation.


METHODS
Large metropolitan university hospital.


METHODS
120 ASA II-III adult hypertensive patients.


METHODS
Patients were allocated to 4 groups at random. After preoxygenation for 3 minutes, induction and tracheal intubation was performed in a 30 degrees head-up position. Thiopental (5-7 mg/kg) was the induction agent. Study groups were as follows: group LS (n = 30), lidocaine (1.5 mg/kg) and succinylcholine (1 mg/kg); group LR (n = 30), lidocaine (1.5 mg/kg) and rocuronium (1 mg/kg); group RS (n = 30), remifentanil (1 microg/kg) and succinylcholine (1 mg/kg); group RR (n = 30), remifentanil (1 microg/kg) and rocuronium (1 mg/kg). Patients were intubated 60 seconds after administration of muscle relaxant.


METHODS
Hemodynamic data were obtained before induction (baseline), after induction, at intubation, and at 1, 3, 5, and 10 minutes after intubation. More than 20% change in blood pressure and heart rate was considered significant.


RESULTS
Systolic and mean arterial blood pressures at intubation and 1 and 3 minutes after intubation were higher in group LS compared with groups RS and RR (P < 0.01). Mean arterial blood pressure decreased after induction in groups LS, LR, and RR, but increased at intubation and 1 minute after intubation in groups LS and LR (P < 0.01). Mean arterial blood pressure was similar at all measurement intervals in group RS. The median area under the systolic, mean, and diastolic blood pressure time curves was higher in groups LS and LR compared with groups RS and RR (P < 0.05 and P < 0.01).


CONCLUSIONS
Remifentanil is a better adjunct for attenuation of the response to laryngoscopy and intubation compared with lidocaine, whereas remifentanil-succinylcholine combination appears to be more beneficial in terms of hemodynamic stability in hypertensive patients.
Alanoğlu
Zekeriyya
Z
Ankara University Medical Faculty, Department of Anesthesiology and Reanimation, 06100 Ankara, Turkey. zekeriyya_69@yahoo.com
Ateş
Yeşim
Y
Yilmaz
Ali Abbas
AA
Tüzüner
Filiz
F
D000701:Analgesics, Opioid / Q000008:administration & dosage; D000732:Androstanols / Q000008:administration & dosage; D000758:Anesthesia; D000779:Anesthetics, Local / Q000008:administration & dosage; D001794:Blood Pressure / Q000187:drug effects; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007442:Intubation, Intratracheal; D007828:Laryngoscopy; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009467:Neuromuscular Depolarizing Agents / Q000008:administration & dosage; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D010880:Piperidines / Q000008:administration & dosage; D000077208:Remifentanil; D000077123:Rocuronium; D013390:Succinylcholine / Q000008:administration & dosage; D013874:Thiopental / Q000008:administration & dosage
D000701:Analgesics, Opioid; D000732:Androstanols; D000779:Anesthetics, Local; D006993:Hypnotics and Sedatives; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D010880:Piperidines; D008012:Lidocaine; D013390:Succinylcholine; D013874:Thiopental; D000077208:Remifentanil; D000077123:Rocuronium