Which drug prevents tachycardia and hypertension associated with tracheal intubation: Lidocaine, fentanyl, or esmolol?

Eighty patients, ASA physical status II-IV, scheduled for noncardiac surgery, were randomly assigned in a double-blind, placebo-controlled manner to receive a preintubation dose of either placebo, 200 mg lidocaine, 200 μg fentanyl, or 150 mg esmolol. Induction of anesthesia was accomplished with 4-6 mg/kg thiopental IV followed immediately by the study drug; 1-1.5 mg/kg succinylcholine was given at minute 1. Laryngoscopy and intubation were performed at minute 2 with anesthesia thereafter maintained with 1 MAC (±10%) isoflurane in 60% nitrous oxide in oxygen at a 5 L/min flow for 10 min. Heart rate was recorded every 15 s and blood pressure every minute from induction until 10 min after intubation. Maximum percent increases in heart rate (mean ± SE) during and after intubation were similar in the placebo (44% ± 6%), lidocaine (51% ± 10%), and fentanyl (37% ± 5%) groups, but lower in the esmolol (18% ± 5%) group (P < 0.05). Maximum systolic blood pressure percent increases were lower in the lidocaine (20% ± 6%), fentanyl (12% ± 3%), and esmolol (19% ± 4%) groups than in the placebo (36% ± 5%) group (P < 0.05), but not different from each other (P > 0.05). Only esmolol provided consistent and reliable protection against increases in both heart rate and systolic blood pressure accompanying laryngoscopy and intubation.