title: Local airway anesthesia attenuates hemodynamic responses to intubation and extubation in hypertensive surgical patients.
abstract: BACKGROUND
  The aim of this study was to evaluate the effects of topical ropivacaine anesthesia on hemodynamic responses during intubation and extubation of hypertensive patients.
  
  
  METHODS
  One hundred fifty patients with hypertension ASA II-III were scheduled for noncardiac operations. Patients were divided into 3 groups: a control group receiving 5 ml saline, and 2 groups receiving topical anesthesia with 100 mg lidocaine or 37.5 mg ropivacaine. Hemodynamic responses, including blood pressure and heart rate (HR), were recorded at baseline (T0), before intubation (T1), during tracheal intubation (T2), 2 min after intubation (T3), upon eye opening on verbal commands (T4), during tracheal extubation (T5), and 2 min after extubation (T6). Patients were injected with urapidil 5 mg during intubation and extubation if their systolic blood pressure (SBP) was ≥160 mmHg or diastolic blood pressure (DBP) was ³90 mmHg, and esmolol 10 mg when HR was ≥90 bpm.
  
  
  RESULTS
  During extubation, the total dosages of urapidil and esmolol were significantly higher in the saline than in the lidocaine or ropivacaine groups, and were significantly lower in the ropivacaine than in the lidocaine group. At T2, SBP, SBP, MAP, and HR were lower in the lidocaine and ropivacaine groups than in the saline group, but the differences were not significant. From T4 to T6, SBP, DBP, MAP, and HR were significantly lower in the ropivacaine group than in the other 2 groups (P<0.05 each).
  
  
  CONCLUSIONS
  Topical lidocaine and ropivacaine anesthesia can effectively reduce hemodynamic responses during intubation, with ropivacaine better at inhibiting hemodynamic changes at emergence in hypertensive patients.
authors.affiliation: Department of Anesthesiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China (mainland).
authors.forename: You-Fan
authors.initials: YF
authors.lastname: Meng
authors.affiliation: Department of Anesthesiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China (mainland).
authors.forename: Guang-Xiao
authors.initials: GX
authors.lastname: Cui
authors.affiliation: Department of Anesthesiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China (mainland).
authors.forename: Wei
authors.initials: W
authors.lastname: Gao
authors.affiliation: Department of Anesthesiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China (mainland).
authors.forename: Zhi-Wen
authors.initials: ZW
authors.lastname: Li
mesh_terms: D060666:Airway Extubation; D000577:Amides / Q000008:administration & dosage / Q000494:pharmacology; D000772:Anesthesia, Local; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D062186:Arterial Pressure / Q000187:drug effects; D003710:Demography; D003971:Diastole / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology* / Q000601:surgery*; D007442:Intubation, Intratracheal; D008012:Lidocaine / Q000008:administration & dosage / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D011412:Propanolamines / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D000077212:Ropivacaine; D013599:Systole / Q000187:drug effects
chemical_list: D000577:Amides; D000959:Antihypertensive Agents; D010879:Piperazines; D011412:Propanolamines; D000077212:Ropivacaine; D008012:Lidocaine; C015568:urapidil; C036604:esmolol