Effects of intravenous lidocaine and/or esmolol on hemodynamic responses to laryngoscopy and intubation: A double-blind, controlled clinical trial

doi:10.1016/0952-8180(96)00109-2

Journal of Clinical Anesthesia

Volume 8, Issue 6, September 1996, Pages 491-496

https://doi.org/10.1016/0952-8180(96)00109-2 Get rights and content

Abstract

Study Objectives: To evaluate the efficacy of intravenous lidocaine and two doses of esmolol for attenuating the cardiovascular responses to laryngoscopy and intubation, and to assess whether a combination of both drugs is more effective than either drug alone.

Design: Randomized, prospective, double-blind, placebo-controlled study.

Setting: University hospital.

Patients: 90 ASA status I and II normotensive women scheduled for elective gynecologic procedures with general anesthesia.

Interventions: Induction of anesthesia was standardized for all patients. The first group received lidocaine 1.5 mg/kg (Group LID); the second and third groups received esmolol 1 mg/kg and 2 mg/kg, respectively (Groups E1 and E2, respectively); the fourth group received lidocaine 1.5 mg/kg and esmolol 1 mg/kg (Group LID-E1); the fifth group received lidocaine 1.5 mg/kg and esmolol 2 mg/kg (Group LID-E2); the sixth group received saline as a placebo (Group PLAC).

Measurements and Main Results: Systolic blood pressure and heart rate (HR) were recorded before induction, before injection of the first test drug, immediately before laryngoscopy, and 1, 2, and 5 minutes following intubation. Duration of laryngoscopy was recorded. Only patients receiving placebo had increased HR values after intubation compared with baseline values (p < 0.05). The proportion of patients with a maximum HR exceeding 90 beats/min was significantly higher in the placebo group (8 of 15 patients) than in both esmolol groups (E1 2 of 15; E2 2 of 15) (p < 0.05). Systolic blood pressure values after tracheal intubation did not differ among groups except for those receiving the combinations of lidocaine and esmolol, and they had significantly lower blood pressure (BP) values compared with placebo (p < 0.05).

Conclusions: Esmolol 1 to 2 mg/kg is reliably effective in attenuating HR response to tracheal intubation. Neither of the two doses of esmolol tested nor that of lidocaine affected the BP response. Only the combination of lidocaine and esmolol attenuated both HR and BP responses to tracheal intubation.

References (21)

AM Forbes et al.
Acute hypertension during intubation of anaesthesia and endotracheal intubation in normotensive man
Br J Anaesth
(1970)
D Pathak et al.
Effects of alfentanil and lidocaine on the hemodynamic responses to laryngoscopy and tracheal intubation
J Clin Anesth
(1990)
K Mikawa et al.
Effects of prostaglandin E₁ on the cardiovascular response to tracheal intubation
J Clin Anesth
(1990)
CD Miller et al.
IV lignocaine fails to attenuate the cardiovascular response to laryngoscopy and tracheal intubation
Br J Anaesth
(1990)
TJ Ebert et al.
Attenuation of hemodynamic responses to rapid sequence induction and intubation in healthy patients with a single bolus of esmolol
J Clin Anesth
(1990)
EJ Fox et al.
Complications related to the pressor response to endotracheal intubation
Anesthesiology
(1977)
JK Denlinger et al.
Effects of intratracheal lidocaine on circulatory responses to tracheal intubation
Anesthesiology
(1974)
MN Abou-Madi et al.
Cardiovascular reactions to laryngoscopy and tracheal intubation following small and large intravenous doses of lidocaine
Can Anaesth Soc J
(1977)
S Tam et al.
Intravenous lidocaine: optimal time of injection before tracheal intubation
Anesth Analg
(1987)
IG Wilson et al.
Intravenous lignocaine and sympathoadrenal responses to laryngoscopy and intubation. The effect of varying time of injection
Anaesthesia
(1991)

There are more references available in the full text version of this article.

Cited by (76)

Effects of lidocaine and magnesium sulfate in attenuating hemodynamic response to tracheal intubation: single‐center, prospective, double‐blind, randomized study
2017, Brazilian Journal of Anesthesiology
A resposta hemodinâmica aos estímulos das vias aéreas é um fenômeno comum e seu controle é importante para diminuir as repercussões sistêmicas. O objetivo deste trabalho é comparar os efeitos da administração endovenosa de sulfato de magnésio versus lidocaína na hemodinâmica desse reflexo após a laringoscopia e intubação orotraqueal.
Este estudo duplamente encoberto, aleatorizado, unicêntrico e prospectivo avaliou 56 pacientes, ASA 1 ou 2, entre 18 e 65 anos, escalados para cirurgias eletivas sob anestesia geral com intubação orotraqueal. Foram alocados em dois grupos, o M recebeu 30 mg·kg⁻¹ de sulfato de magnésio e o L, 2 mg·kg⁻¹ de lidocaína, em infusão contínua, imediatamente antes da indução anestésica. Os valores de pressão arterial (PA), frequência cardíaca (FC) e índice biespectral (BIS) foram aferidos nos dois grupos em seis momentos relacionados com a administração dos fármacos do estudo.
Em ambos os grupos houve aumento na FC e PA após a laringoscopia e intubação, em relação aos valores basais. No Grupo M observou‐se elevação estatisticamente significativa, mas clinicamente pouco importante, nos valores das pressões arteriais sistólica e diastólica após a intubação. Não houve diferença nos valores de BIS entre os grupos. Dos pacientes que receberam o sulfato de magnésio, 3 (12%) apresentaram episódio de hipertensão, ao passo que apenas um dos que receberam lidocaína (4%) apresentou esse sinal, sem diferença estatística.
Sulfato de magnésio e a lidocaína apresentam boa eficácia e segurança no controle hemodinâmico à laringoscopia e intubação.
Hemodynamic response to airway stimuli is a common phenomenon and its management is important to reduce the systemic repercussions. The objective of this study is to compare the efficacy of intravenous magnesium sulfate versus lidocaine on this reflex hemodynamics after laryngoscopy and tracheal intubation.
This single‐center, prospective, double‐blind, randomized study evaluated 56 patients ASA 1 or 2, aged 18 to 65 years, scheduled for elective surgeries under general anesthesia with intubation. The patients were allocated into two groups: Group F received 30 mg·kg⁻¹ of magnesium sulphate and Group L, 2 mg·kg⁻¹ of lidocaine, continuous infusion, immediately before the anesthetic induction. Blood pressure (BP), heart rate (HR), and bispectral index (BIS) were measured in both groups at six different times related to administration of the study drugs.
In both groups there was an increase in HR and BP after laryngoscopy and intubation, compared to baseline. Group M showed statistically significant increase in the values of systolic and diastolic blood pressure after intubation, which was clinically unimportant. There was no difference in the BIS values between groups. Among patients receiving magnesium sulfate, three (12%) had high blood pressure versus only one among those receiving lidocaine (4%), with no statistical difference.
Magnesium sulfate and lidocaine have good efficacy and safety for hemodynamic management in laryngoscopy and intubation.
Attenuation of hemodynamic response to laryngoscopy and endotracheal intubation with two different doses of labetalol in hypertensive patients
2016, Egyptian Journal of Anaesthesia
Citation Excerpt :
However, these changes can facilitate and accelerate the development of myocardial ischemia, arrhythmia, infarction and cerebral hemorrhage in patients with coronary artery disease, hypertension or cerebrovascular disease [3,4]. Different pharmacologic agents such as lidocaine, vasodilator agents inhibiting sympatho-adrenal response, α- and ß-adrenergic blockers, opioids and calcium channel blockers can be administered prior to tracheal intubation in order to prevent hemodynamic responses [5–10]. Labetalol is an unique oral and parenteral antihypertensive drug that is α1- and nonselective β1- and β2-adrenergic antagonist.
The present study compared the efficacy of two different doses of labetalol, for attenuation of hemodynamic response to laryngoscopy and intubation in hypertensive patients.
75 hypertensive patients, aged 18–60 years undergoing elective surgical procedures, require general anesthesia and orotracheal intubation. Patients were allocated to any of the three groups (25 each), Group C (control) 5 ml 0.9% saline. Group L1 (labetalol) 0.15 mg/kg diluted with 0.9% saline to 5 ml. Group L2 (labetalol) 0.3 mg/kg diluted with 0.9% saline to 5 ml. In the control group 5 ml of 0.9% saline was given i.v. 5 min prior to intubation. In the L1 group 0.15 mg/kg of labetalol was given i.v. 5 min prior to intubation. In the L2 group 0.3 mg/kg of labetalol was given i.v. 5 min prior to intubation. All the patients were subjected to the same standard anesthetic technique. Heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded prior to induction, at time of intubation and 1, 3, 5, and 10 min after intubation. Mean arterial pressure (MAP) and rate pressure product (RPP) were calculated.
Compared to placebo both the doses of labetalol (0.15 mg/kg) and (0.3 mg/kg) significantly attenuated the rise in heart rate, systolic blood pressure, and RPP during laryngoscopy and intubation. However, the difference was not statistically significant between both doses of labetalol at intubation, 1 min, 3 min and 10 min post-intubation.
Both doses of labetalol (0.15 mg/kg and 0.3 mg/kg) attenuate hemodynamic response to laryngoscopy and intubation in dose dependent manner.
Evaluation of the association between postintubation hypotension and lidocaine administered as a premedication for rapid sequence intubation: Acomparison between traditional regression methods and propensity score matching-based method
2013, Journal of Acute Medicine
Citation Excerpt :
Lidocaine is a prerequisite premedication agent during RSI for attenuating airway reaction and resistance,12,13 reducing cough reflex and preventing increase in intracranial pressure (ICP) in the case of head injury.14,15 Although some studies have reported16 that lidocaine reduced secondary brain injury by decreasing cerebral flow, cerebral vascular resistance, and cerebral metabolism, and by stabilizing neuronal membranes by acting as a sodium channel blocker, other studies indicate17,18 that lidocaine increases heart rate and blood pressure, decreases the mean arterial pressure, and decreases perfusion pressure leading to poor neurological outcome in cases of acute stroke. The advantages and disadvantages of lidocaine are still controversial.19
Lidocaine is commonly used for rapid sequence intubation (RSI) in emergency departments. Its benefits remain controversial. Traditional regression methods are commonly used to draw causal inferences. Propensity score matching based method, could be the solution for studies with limited sample size.
To re-examine the association between postintubation hypotension (PIH) and lidocaine injection using different analysis methods.
Secondary analysis was conducted of a retrospective cohort study with patients in emergency departments undergoing RSI. Clinical information was recorded. PIH was defined as postintubation systolic blood pressure of <90 mmHg. Based on the propensity score of having lidocaine injection generated by several variables, matching methods were applied and a comparable control group generated. Outcome models based on logistic regression were compared using the original and matched datasets.
Among 149 patients who received RSI agents, 28 developed PIH. Among 120 who received lidocaine injection, 27 developed PIH, as did one the 29 patients who did not receive lidocaine. Lidocaine was not significantly associated with PIH in the traditional regression model adjusting preintubation systolic blood pressure ≤ 140 mmHg, underlying history of chronic obstructive pulmonary disease, ongoing septic status, and body weight. After 1:5 nearest matching with replacement based on the propensity score, most measurable potential confounders were comparable in lidocaine-treated and control groups, except ongoing heart disease (e.g., atrial fibrillation and coronary artery disease). In the subsequent logistic regression model adjusted for ongoing heart disease in the matched dataset, lidocaine was significantly associated with PIH.
Lidocaine injection could be associated with PIH; however, further investigation is needed. Alternative statistical methods should be considered when making a causal inference.
A Comparative Study of the Effect of Labetalol and Remifentanil on Pain Control after Bariatric Surgery
2023, Anesthesiology and Pain Medicine
Emergent Airway Management: an Update
2023, Journal of Internal Medicine of Taiwan
Intravenous lidocaine for attenuation of pressor response after endotracheal intubation. A randomized, double-blinded dose-finding study
2023, Egyptian Journal of Anaesthesia

View all citing articles on Scopus

^∗: Staff Anesthesiologist.

View full text

Original contributionEffects of intravenous lidocaine and/or esmolol on hemodynamic responses to laryngoscopy and intubation: A double-blind, controlled clinical trial

Abstract

Br J Anaesth

J Clin Anesth

J Clin Anesth

Br J Anaesth

J Clin Anesth

Complications related to the pressor response to endotracheal intubation

Anesthesiology

Effects of intratracheal lidocaine on circulatory responses to tracheal intubation

Anesthesiology

Cardiovascular reactions to laryngoscopy and tracheal intubation following small and large intravenous doses of lidocaine

Can Anaesth Soc J

Intravenous lidocaine: optimal time of injection before tracheal intubation

Anesth Analg

Intravenous lignocaine and sympathoadrenal responses to laryngoscopy and intubation. The effect of varying time of injection

Anaesthesia

Original contribution
Effects of intravenous lidocaine and/or esmolol on hemodynamic responses to laryngoscopy and intubation: A double-blind, controlled clinical trial