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

S. M. Helfman, M. I. Gold, E. A. DeLisser, C. A. Herrington

Research output: Contribution to journalArticle

120 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)482-486
Number of pages5
JournalAnesthesia and Analgesia
Volume72
Issue number4
StatePublished - Jan 1 1991
Externally publishedYes

Fingerprint

Fentanyl
Lidocaine
Intubation
Tachycardia
Hypertension
Laryngoscopy
Heart Rate
Placebos
Blood Pressure
Pharmaceutical Preparations
Anesthesia
Succinylcholine
Thiopental
Isoflurane
Nitrous Oxide
Oxygen
esmolol

Keywords

  • analgesics, fentanyl
  • anesthetics, local - lidocaine
  • intubation, tracheal - prevention of vascular responses
  • sympathetic nervous system, pharmacology - esmolol

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Which drug prevents tachycardia and hypertension associated with tracheal intubation : Lidocaine, fentanyl, or esmolol? / Helfman, S. M.; Gold, M. I.; DeLisser, E. A.; Herrington, C. A.

In: Anesthesia and Analgesia, Vol. 72, No. 4, 01.01.1991, p. 482-486.

Research output: Contribution to journalArticle

Helfman, S. M. ; Gold, M. I. ; DeLisser, E. A. ; Herrington, C. A. / Which drug prevents tachycardia and hypertension associated with tracheal intubation : Lidocaine, fentanyl, or esmolol?. In: Anesthesia and Analgesia. 1991 ; Vol. 72, No. 4. pp. 482-486.
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