Attenuation Of Hemodynamic Response Research Articles

Comparison of two different doses of dexmedetomidine in attenuation of haemodynamic response during endotracheal extubation

The data in the published literature on the use of dexmedetomidine in various dosages during extubation from India is modest. We have compared the effectiveness of intravenous dexmedetomidine 0.5 µg/Kg body weight and 0.75 µg/Kg body weight during endotracheal extubation. Seventy-four patients aged more than 18 years posted for elective surgery under general anaesthesia were included in this randomised double- blind controlled study. Group D1 and Group D2 patients received 0.5 µg/Kg and 0.75 µg/Kg body weight intravenous dexmedetomidine respectively. The primary outcome measures were to compare haemodynamic parameters, whereas secondary outcome measures were to compare extubation quality, and post-extubation sedation. The mean heart rate at reversal, and after endotracheal extubation was considerably elevated in group D1 as compared to D2. The mean systolic blood pressure, diastolic blood pressure and mean arterial pressure after endotracheal extubation were considerably elevated in group D1 as compared to D2. The mean respiratory rate at reversal, and after endotracheal extubation were considerably elevated in Group D1 as compared to Group D2. The mean sedation score after endotracheal extubation was considerably elevated in Group D2 as compared to Group D1. The haemodynamic parameters were better in Group of patients who received intravenous dexmedetomidine 0.75 µg/Kg body weight as compared to Group of patients who received dexmedetomidine 0.50 µg/Kg during endotracheal extubation.

Efficacy of intravenous nitroglycerine in attenuation of hemodynamic response to tracheal extubation

Efficacy of intravenous nitroglycerine in attenuation of hemodynamic response to tracheal extubation

English

The above article has been withdrawn on authors’ request. Original CitationUnni S, Sebastian R, Joseph E, et al. Attenuation of haemodynamic response to placement of Mayfield skull pin head holder - comparison of dexmedetomidine versus propofol infusion - a randomized interventional trial done in a tertiary centre in central Kerala. J Evid Based Med Healthc 2021;8(29):2639-2643. DOI: 10.18410/jebmh/2021/486

Attenuation of Haemodynamic Response To Laryngoscopy And Intubation With Nitroglycerin

Background: Laryngoscopy and intubation are common procedures in anesthesia. Hemodynamic responses to mechanical stimulation of the laryngopharynx and tracheobronchial tree cause stimulation of sympathetic efferent fibres leading to an increased pressor response. We in the current study tried to evaluate the effect of nitroglycerine in the attenuation of hemodynamic responses due to laryngoscopy and intubation. Methods : Based on the inclusion and exclusion criteria n=80 cases were divided into two groups Group A (n=40) control group and group B (n=40) study group randomly by computergenerated number. A detailed history is taken and a complete physical examination is performed and the presence of any medical disorder and history of drug intake was ruled out. All patients were screened by radiological, biochemical, and histological investigations, in addition to routine pre-operative ECG.Pre-medication, induction agent and muscle relaxant to facilitate intubation was standardized for both groups. Results: The parameters recorded in the control group at one minute showed hemodynamic values were increased. The difference of SBP with the study group was 14.75 mm Hg, diastolic blood pressure by 5 mm Hg, mean blood pressure by 8.5 mm Hg, HR was 8 beats per minute al these values were pvalues <0.05 hence considered significant. At the end of three minutes, the comparison shows all the parameters SBP, DBP, MBP, HR, and RPP still increased significantly in the control group as compared to the test group. At the end of five minutes, all the parameters were found to still significantly higher in the control group (<0.05) as compared to the study group except for SBP change which was found not to be significant between both the groups. Conclusion: The study establishes the usefulness of intravenous Nitroglycerine to attenuate hemodynamic to laryngoscopy and tracheal intubation. The hemodynamic changes in the study group were well within the limits as compared to the control group. The study also shows that there were no incidences of adverse effects with nitroglycerine. Therefore, nitroglycerine must be considered for attenuation of hemodynamic responses to laryngoscopy in cases where it is indicated.

A comparative Study of Efficacy of Esmolol and Fentanyl For Blood Pressure and Heart Rate Attenuation During Laryngoscopy and Endotracheal Intubation

Background: Blood pressure and heart rate elevation during laryngoscopy and tracheal intubation maycause serious medical problems ex.: patients with cardiovascular disease as well as patients with increasedintracranial pressure. Aim of study: Comparism between Fentanyl and Esmolol in attenuating blood pressureand heart rate during laryngoscope and tracheal intubation. Patients and Method:60 adult patients of bothsex, ages between (20-33) , labeled as ASA I and ASA II will undergo elective surgery, divided into twogroups, each group contain 30 patients: Esmolol Group (E) takes 0.5 mg/kg esmolol IV. And Fentanyl Group(F) takes 1 mic/kg fentanyl IV.Blood pressure and heart rate was recorded before drugs administration asbaseline reading and another reading was taken after drug administration as well as after tracheal intubation.Result: blood pressure and heart rate readings of both groups, when compared to baseline reading showsthat Regarding heart rate, there are significance differences between the two groups, in that, esmololreduce heart rate in all stages when compared to fentanyl. Regarding systolic blood pressure, both drugsreduce systolic blood pressure and there are significances in all stages, favored esmolol except in T3 due torise in sbp when using fentanyl. Regarding diastolic blood pressure, both drugs also reduce diastolic bloodpressure but there are no significances in these reading except in T3 due to esmolol reduce dpb much morethan fentanyl does. Conclusions: esmolol in a dose of 0.5mg/kg is more effective than fentanyl in a dose of1mic/kg in attenuation of hemodynamic response after endotracheal intubation.

Lidocaine versus propofol administration on the attenuation of hemodynamic responses during extubation in the adult elective surgical patient: A prospective cohort

BackgroundTracheal extubation is the process of removing a tube from the trachea. It is associated with an increase in heart rate, blood pressure, intracranial pressure, intraocular pressure, coughing, bronchospasm, laryngospasm, and bleeding. Many techniques, as well as drugs, have been attempted for attenuation of the airway and cardiovascular responses. Propofol and lidocaine are widely available drugs in resource-limited settings even though their relative effectiveness for smooth extubation is not well established. ObjectivesTo assess the effectiveness of intravenous lidocaine and propofol on the attenuation of extubation-induced hemodynamic responses in the adult elective surgical patient from November 01, 2019, to February 30, 2020, at Asella teaching and referral hospital, Ethiopia. MethodsInstitutional-based prospective observational cohort study design was conducted on 72 ASA I patients who underwent elective surgery. The study participants were allocated into three groups equally based on anesthetists' extubation plan; Group P, 0.5 mg/kg propofol, group L, 1.5 mg/kg lidocaine administered 2 min before extubation and group C was a control group. Data were analyzed by SPSS version 20 after the normality of the data was checked by the Shapiro Wilk test. One-way ANOVA followed by a Tukey posthoc test has been employed to find the pair-wise significance and a p-value of <0.05 was considered as statistically significant. ResultsA demographic status and clinical characteristics of the patient were comparable between groups with p-values of >0.05. After extubation; heart rate, systolic, diastolic, and mean arterial blood pressure were decreased significantly in groups of propofol and lidocaine within 10 min. Propofol shows better results in maintaining stable systolic blood pressure up to 3 min, while heart rate, diastolic, and mean arterial pressure were maintained stable up to 5 min after extubation (p = 0.001). Conclusions0.5 mg/kg propofol or 1.5 mg/kg lidocaine might help to attenuate extubation induced hemodynamic responses.

Effect of pre-extubation low-dose fentanyl on attenuation of haemodynamic response and quality of extubation: A prospective randomised trial

BackgroundEmergence from anaesthesia, tracheal stimulation during extubation alters the hemodynamics, and coughing generates aerosol that needs to be avoided. AimThe study aimed to evaluate the effectiveness of low doses (0.5 μg/kg) of fentanyl at the end of the surgery in attenuating hemodynamic response and extubation quality. MethodsThis prospective, randomized, double-blind trial was conducted in a tertiary care center, with a total of 70 ASA PS I&II patients scheduled for elective laparoscopic cholecystectomy. Standard protocol followed for induction of the patients. At the end of the surgery, patients were randomly allocated to either Group-F and Group-C to receive intravenous fentanyl 0.5 μg/kg or an equal volume of normal saline respectively. Hemodynamic parameters before and after the drug, at awakening, while extubation (T0), one and minutes post-extubation (T1&T5 respectively) were measured. Airway reflex scores (ARS), extubation quality score (EQS), and Ramsay sedation scores (RSS) monitored during extubation. ResultsGroup-C patients had significantly higher mean arterial pressure at T1 (P = 0.021), higher incidence of agitation at T0(P = 0.002), T1(P = 0.002), and T5 (P = 0.009). Group-F patients had significantly better ARS at T0 and T1 (P < 0.001) and better EQS (P < 0.001). ConclusionLow-dose fentanyl at the time of extubation is an effective way to achieve smooth extubation, control unstable hemodynamics and agitation.

Comparative study of lignocaine nebulization with intravenous lignocaine for attenuation of hemodynamic response to laryngoscopy and endotracheal intubation

Comparative study of lignocaine nebulization with intravenous lignocaine for attenuation of hemodynamic response to laryngoscopy and endotracheal intubation

A Comparative Study of Dexmedetomidine and Clonidine for Attenuation of Hemodynamic Response during Laryngoscopy and Intubation

Background: The present study was conducted to compare dexmedetomidine and clonidine for attenuation of hemodynamic response during laryngoscopy and intubation. Subjects and Methods: Group I patients received 0.9% normal saline (placebo), group II patients received 0.5 µg/kg of dexmedetomidine and group III patients received 3 µg/kg of or clonidine. Each group had 15 patients. Results: The mean age in group I was 28.2 years, in group II was 32.1 years and in group III was 33.2 years, mean weight was 61.2 years, in group II was 60.4 years and in group III was 62.1 years, height was 156.2 cm, in group II was 157.1 cm and in group III was 152.8 cm. There were 8 males and 7 females in group I, 6 males and 9 females in group II and 7 males and 8 females in group III. The mean SBP (mm Hg) in group I was 121.4 and in group II was 122.6, and in group III was 127.4, DBP (mm Hg) was 76.2 in group I, 78.4 in group II and 78.2 in group III. MAP (mm Hg) was 86.7 in group I, 93.2 in group II and 92.5 in group III. HR (bpm) was 74.2 in group I, 78.4 in group II and 77.3 in group III. % oxygen saturation was 98.2in group I, 98.5 in group II and 97.9 in group III. The difference was non- significant (P&gt; 0.05). Conclusion: Authors found that both groups were equally effective in causing attenuation of hemodynamic response to endotracheal intubation.

English

BACKGROUND We wanted to evaluate the efficacy of IV nitroglycerine and IV dexmedetomidine in achieving and maintaining induced hypotension in patients undergoing FESS under general anaesthesia, compare haemodynamic response in terms of heart rate, blood pressure, mean arterial pressure, compare clarity of the surgical field, compare the effect on duration of surgery and study the intraoperative and postoperative complications, if any. METHODS This is a randomised control trial conducted from 01/01/2018 to 31/12/2018 among 50 patients, ASA 1 &amp; 2 undergoing FESS. They were randomly divided into 2 groups - group D (an infusion of dexmedetomidine was started with a loading dose of 1 μg / Kg over 10 min and thereafter was maintained between 0.5 - 1.0 μg / Kg / h) and group N (an infusion of nitroglycerine was started at the rate of 0.5 μg / Kg / min and was maintained between 0.5 - 2.0 μg / Kg / min). Haemodynamic data was recorded. Both the infusions were titrated to maintain a MAP between 65 and 75 mmHg. The visibility of the surgical site was checked by the surgeon at every 30 minutes using the Fromme and Boezaart scale. RESULTS Both groups consisted of 25 patients each and were demographically similar. In both groups heart rates remained within normal physiological limits, not requiring any pharmacological treatment. Both groups had comparable average MAP during surgery. The group D showed desirable attenuation of haemodynamic response at the time of intubation as well as at extubation. Both groups had comparable duration of surgery. Both the drugs were equally effective in creating clear surgical fields to the surgeons’ satisfaction. Dexmedetomidine provided better intraoperative analgesia and reduced requirement of incremental fentanyl as compared to nitroglycerine. Emergence time was significantly higher in dexmedetomidine group. CONCLUSIONS Both the groups provided comparable clarity of surgical field with comparable haemodynamic parameters during surgery. dexmedetomidine provided better haemodynamic stability and an additional benefit of reduced requirement of intraoperative supplemental analgesia. KEYWORDS Induced hypotension, FESS, Dexmedetomidine, Nitroglycerine

Attenuation of haemodynamic responses by dexmedetomidine during laryngoscopy and intubation: A double blinded randomized controlled study

Background: Laryngoscopy and tracheal intubation cause hemodynamic response which cause tachycardia, hypertension and increased myocardial oxygen demand which adversely affects the patient’s condition intraoperatively. Various drugs were investigated to attenuate the hemodynamic responses caused by laryngoscopy and intubation.A drug which can blunt both the heart rate response and blood pressure response of laryngoscopy and intubation, without having any adverse effects would be ideal.Dexmedetomidine, a relatively newer alpha agonist, has shown to attenuate haemodynamic response to direct laryngoscopy and endotracheal intubation without much side effects.The present study was undertaken to evaluate the effects of recently introduced alpha-2 agonist, dexmedetomidine as premedication in attenuating pressor response during Laryngoscopy and Endotracheal intubation. This was double blind, prospective, randomized controlled study. Material and Methods: Test group: Patients received Intravenous Dexmedetomidine 1μg per kg in 100ml normal saline infusion for 15minsControl group: Patients received 100ml normal saline infusion for 15mins.Results: Dexmedetomidine at a dose of 1 µg/kg body weight diluted in 100 ml of normal saline given intravenously before induction significantly attenuates the haemodynamic responses to laryngoscopy and tracheal intubation.Dexmedetomidine also decreases the requirement of induction dose of propofol. Dexmedetomidine also decreases the total dose of vecuronium bromide required for muscle relaxation. There were no significant adverse postoperative events associated with the use of preoperative dexmedetomidineConclusion: Dexmedetomidine at a dose of 1 µg/kg body weight diluted in 100 ml of normal saline given intravenously before induction significantly attenuates the haemodynamic responses to laryngoscopy and tracheal intubation.

THE COMPARISON OF ETOMIDATE AND PROPOFOL FOR ATTENUATION OF HAEMODYNAMIC RESPONSE TO INDUCTION AND ENDOTRACHEAL INTUBATION

Background: This study is designed to compare the degree of attenuation of hemodynamic response to induction, laryngoscopy and endotracheal intubation of etomidate with those of propofol in patients undergoing noncardiac surgical procedures.&#x0D; Methods: The present study conducted in Non Cardiac Surgeries in the Department of Anaesthesiology, Jhalawar Medical College &amp; Associated Hospitals, Jhalawar, Rajasthan.After institutional ethical committee’s approval and written informed consent from the patient’s attendant in the format as per proforma, the present study was conducted on 60 patients of ASA Grade I and II of either sex, aged 18 to 60 years, scheduled for a variety of non-cardiac surgical procedures requiring general anaesthesia.&#x0D; Results: The findings of the study suggest that use of etomidate as inducing agent provides more hemodynamic stability as compared to propofol and can be preffered in patients prone to hemodynamic instability, cardiovascular abnormalities, hypovolemia, prone to renal failure due to hypotension. Propofol may be preffered for induction where hypertension is contraindicated or hypotension is preffered and myoclonus is to be avoided.&#x0D; Conclusion: Etomidate provides a more stable hemodynamics during general anesthesia as compared to propofol.&#x0D; Keyword:- Etomidate, Propofol, Hemodynamic.

Dexmedetomidine versus Fentanyl in Attenuation of Haemodynamic Response during Laryngoscopy and IntubationA Randomised Controlled Trial

Dexmedetomidine versus Fentanyl in Attenuation of Haemodynamic Response during Laryngoscopy and IntubationA Randomised Controlled Trial

Comparative Study of Two Different Doses of Fentanyl Citrate 2 mcg/ kg and 4 mcg/kg in Attenuation of Hemodynamic Responses During Intubation

Comparative Study of Two Different Doses of Fentanyl Citrate 2 mcg/ kg and 4 mcg/kg in Attenuation of Hemodynamic Responses During Intubation

A Comparative Study of Attenuation of Hemodynamic Responses to Laryngoscopy and Intubation with and without Oral Clonidine

A Comparative Study of Attenuation of Hemodynamic Responses to Laryngoscopy and Intubation with and without Oral Clonidine

Evaluation of the efficacy of iv labetalol 0.25mg/kg in the attenuation of haemodynamic response to extubation

Evaluation of the efficacy of iv labetalol 0.25mg/kg in the attenuation of haemodynamic response to extubation

A randomized double blind comparative study of intravenous magnesium sulphate and intravenous lignocaine for attenuation of haemodynamic response to laryngoscopy and tracheal intubation

A randomized double blind comparative study of intravenous magnesium sulphate and intravenous lignocaine for attenuation of haemodynamic response to laryngoscopy and tracheal intubation

Attenuation of hemodynamic response to laryngoscopy and tracheal intubation in adult patients with a single intravenous bolus dose of dexmedetomidine - A prospective, randomized, double-blind, controlled clinical study

Background: Performing laryngoscopy and endotracheal intubation evokes a reflex circulatory response, which results in an increase in the blood pressure and heart rate (HR) and causes arrhythmia due to increased outflow from the sympatho-adrenal axis. Aim and Objective: The aim of this study was to evaluate the efficacy of a single bolus dose of 0.6 mg/kg body weight dexmedetomidine, a centrally acting α-2 agonist, through intravenous route, in attenuating the hemodynamic responses to laryngoscopy and endotracheal intubation. Materials and Methods: It was a randomized, prospective, two fold-blinded, and placebo-controlled clinical study. After obtaining Ethical Committee clearance, 100 adult patients in the age group of 18–50 years were enrolled. Blood pressure of the patients enrolled was within the normal range and they were posted for various elective surgeries. Categorization was performed with the American Society of Anaesthesiologists and Mallampatti as Class I and II Grade I and II, respectively. The patients were randomly distributed into two groups, Group A and Group B. Group A included 50 patients (n = 50) and was treated with 1 ml/kg of normal saline intravenously for about 10 min and 10 min before the induction. Group B included 50 patients (n = 50) and was treated with dexmedetomidine 1 ml/kg (0.6 μg/kg body weight), which was further diluted in 100 ml ordinary saline and given intravenously, for about 10 min and 10 min before the induction. After premedication, anesthesia was induced with injection thiopentone 5 mg/kg body weight and was given until the loss of eyelash reflex. Dose of thiopentone required was noted. It was followed by injection succinylcholine 1.5 mg/kg body weight. HR, systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were the various parameters for analysis and recorded at regular time intervals. Results: Initiation of laryngoscopy and intubation resulted in significant rise in the HR (36.14 bpm), SBP (29.22 mmHg), DBP (20.30 mmHg), and MAP (14.46 mmHg) in patients who were grouped under Group A. In Group B (dexmedetomidine), mean of HR, SBP, DBP, and MAP decreased by 2.86 bpm, 17.66 mmHg, 1.54 mmHg, and 4.98 mmHg, respectively, when compared to basal values which is statistically highly significant (P < 0.0001). Conclusion: Dexmedetomidine, at the dose of 0.6 μg/kg body weight when given intravenously 10 min before induction was noted to efficiently reduce the hemodynamic response to laryngoscopy and tracheal intubation.

Efficacy of injection clonidine in attenuation of haemodynamic response to laryngoscopy and orotracheal intubation

Efficacy of injection clonidine in attenuation of haemodynamic response to laryngoscopy and orotracheal intubation

Effects of nitroglycerine spray and lignocaine spray on the hemodynamic responses to laryngoscopy and endotracheal intubation: A comparative study

BACKGROUND: Laryngoscopy and tracheal intubation cause hypertension and tachycardia in anesthetized patients, which is undesirable, especially in patients with cardiovascular or neurosurgical diseases undergoing anesthesia. Various drug regimens and techniques have been used from time to time for attenuating the pressor response to laryngoscopy and tracheal intubation. The aim is to study, evaluate, and compare the efficacy of nitroglycerine (NTG) spray and 10% lignocaine spray in the attenuation of hemodynamic responses to laryngoscopy and endotracheal intubation and to observe and evaluate any side effects if any associated with the use of these drugs and their management. MATERIALS AND METHODS: This study was conducted on ninety patients under the American Society of Anesthesiologists (ASA) I and ASA II scheduled for elective surgeries. The patients were divided randomly into equal groups of 30 patients and received the following drugs before induction of general anesthesia: Group N-30 patients will be given NTG sublingual spray (2 puffs) 800 mcg 60s before laryngoscopy and group L-30 patients will be given lignocaine spray (2 puffs) 20 mg 60s before laryngoscopy. Hemodynamic variables were continuously recorded from baseline until 15 min after intubation and statistically analyzed. RESULTS: The demographic profile was comparable. The heart rate (HR) increased in both groups, although the increase in HR in the lignocaine group is higher than the increase in HR in NTG group. There was a significant difference in HR values immediately after intubation, 1, 3 min, and 5 min after intubation when the values were lower in group N, and the difference was statistically significant (P 0.05). There was a significant difference in systolic blood pressure (SBP) values immediately after intubation, 1, 3, and 5 min after intubation when the values were lower in group N and the difference was statistically significant (P 0.05). At 1, 3, and 5 min after intubation, the SBP values were significantly higher than baseline in the lignocaine group. However, there was a downward trend in SBP observed in the NTG group until 5 min after intubation, and it was statistically significant. There was a significant difference in diastolic blood pressure (DBP) values immediately after intubation, 1, 3 and 5 min after intubation when the values were lower in group N and the difference was statistically significant (P 0.05). The increase in mean DBP observed in the lignocaine spray group was statistically highly significant when compared to the increase in mean DBP in the NTG spray group. There was a significant difference in mean arterial pressure (MAP) values immediately after intubation, 1, 3 and 5 min after intubation when the values were lower in group N and the difference was statistically significant (P 0.05). NTG spray decreases the MAP more effectively as compared to lignocaine following laryngoscopy and endotracheal intubation. CONCLUSION: Based on our study, we conclude that: In lignocaine spray group patients who received a dose of 20 mg (2 puffs), there was a significant rise in HR, SBP, DBP, mean arterial blood pressure. In the NTG spray group patients who received a dose of 800 mcg (2 puffs), there is effective attenuation of the pressor response to laryngoscopy and intubation in normotensive ASA I–II patients. However, NTG is not able to attenuate the rise in HR due to reflex tachycardia due to vasodilation. Thus, it can be a better alternative in attenuating the hemodynamic responses to laryngoscopy and intubation.