Abstract
Laryngoscopy and tracheal intubation are considered the most invasive stimuli in anesthesia. They provoked cardiovascular responses that include hypertension, tachycardia and dysrhythmias. Various pharmacological approaches have been used to blunt or attenuate such pressor responses. The present study was designed to evaluate the effect of medazolom, lignocaine and propranolol as a valuable adjuvant to fentanyl in attenuating hemodynamic responses to endotracheal intubation in normotensive patients. Thirty two patient with physical status I or II according to the score of American Society of Anesthesiologist (ASA), scheduled for elective surgery under standard general anesthesia, were randomly allocated into four groups (8 patients in each group), assigned as F, M, L and P groups. Each patient in the four groups received 1 µg/kg i.v fentanyl. Patients in groups M, L and P are treated with 0.2 mg/kg i.v medazolam, 1.5mg/kg i.v lignocaine and 0.01mg/kg i.v propranolol respectively. Induction of anesthesia was then accomplished with 2mg/kg thiopental sodium followed by1.5mg/kg succinylcholine. Tracheal intubation was performed 2 minutes after induction of anesthesia. Heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and rate pressure product were measured before induction, after induction and at 2, 4, 6 and 8 minutes after intubation. The results indicated no significant variation in the hemodynamic pressor response in all four groups with tracheal intubation. In conclusion, a minimum effective dose of i.v pre-medications (fentanyl, medazolom, lignocaine and propranolol) were found to be individually successful in attenuating and providing a reliable control of all hemodynamic response changes accompanied the process of laryngoscopy and intubation. Therefore, all are proved effective premedication and no one being superior.
 Key words: fentanyl, medazolom, lignocaine, propranolol, endotracheal intubation, hemodynamic response.
Highlights
Laryngoscopy and intubation are tolerated by healthy individuals, they mandatory for most patients undergoing may be deleterious in patients with surgery under general anesthesia, often hypertension, coronary artery diseases or accompanied by a hemodynamic pressor response [1,2,3]
Pre-operative use of minimum effective doses of pre-anesthetic medications (1μg/kg fentanyl, 0.2mg/kg medazolam, 1.5mg/kg lignocaine and 0.01mg/kg propranolol) in the present study was found to be effective in restricting the non-significant increase in systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) values during short period of time, each parameter start to decrease gradually until 8 minutes post- intubation; this means that all studied medications produce consistent and reliable protection against the abnormal increase in hemodynamic pressor response during laryngoscopy and intubation, similar to observations reported by other investigators [4,8,19,23]
In the present study, a non-significant increase in mean pulse rate and rate pressure product was reported in all groups of operated patients, starting from intubation and reach optimal values after 6-8 minutes post-intubation; this could be explained by the fact that surgical intervention usually starts after 6-8 minutes postintubation, which is by itself a stressful procedure, predominantly suppresses the pressor response more effectively than tachycardia as a response [24]
Summary
Laryngoscopy and intubation are tolerated by healthy individuals, they mandatory for most patients undergoing may be deleterious in patients with surgery under general anesthesia, often hypertension, coronary artery diseases or accompanied by a hemodynamic pressor response [1,2,3]. Various drugs including calcium channel blockers [5], vasodilators [6], β-adrenergic blockers [7,8], topical and intravenous lignocaine [9,10], opioids [11,12] and deep inhalational anesthesia [13,14] have been used in an attempt to attenuate or prevent pressor responses that accompanied endotracheal intubation, but non have been satisfactory. Recent studies suggested that propranolol and osmolol can provide consistent and reliable protection against the increase in both heart rate and systolic blood pressure that accompany intubation, and may reduce the risk of adverse cardiac events in patient undergoing major surgical operation [8,19]. The present study was designed to evaluate the effects of medazolam, lignocaine and propranolol, as adjuvants to fentanyl, on the hemodynamic pressor response during endotracheal intubation in normotensive patients
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