Attenuation Of Hemodynamic Stress Response Research Articles

Comparison of Intravenous Tramadol vs Intravenous Morphine in Attenuation of Hemodynamic Stress response to Laryngoscopy and Endotracheal Intubation in Laparoscopic Cholecystectomy

Objective: To compare the efficacy of intravenous Tramadol and intravenous Morphine in attenuation of hemodynamic stress response to laryngoscopy and endotracheal intubation in laparoscopic cholecystectomy.
 Study Design: Quasi-experimental study
 Place and Duration: Department of Anesthesia, Combined Military Hospital, Mardan Pakistan, from Jun 2021 to Jun 2022.
 Methodology: A total of 136 patients were involved in the research. These patients were divided via a lottery method into two groups i.e., Group-T (Tramadol) and Group-M (Morphine) with 68 patients in each group. Patients aged 20-50 years planned for laparoscopic cholecystectomy with American Society of Anesthesiologists (ASA) Grade I or Grade II were included in the study.
 Results: Out of a total of 136 patients with equal distribution of 68(50%) patients in each group. Patients with ASA– I Grade from Group–T and Group-M were 52(76.5%) and 41(60.1%), respectively; however, ASA–II Grade patients were 16(23.5%) from Group–T and 27(39.7%) from Group–M. In this study, intravenous Tramadol was effective in 48(70.5%) out of 68 patients, while intravenous Morphine was effective in 60(88.24%) patients, with a p-value of 0.01.
 Conclusion: This study concluded that intravenous Morphine is more effective in attenuating hemodynamic stress response to laryngoscopy and endotracheal intubation in laparoscopic cholecystectomy than intravenous Tramadol.

EFFECT OF INTRAVENOUS LIGNOCAINE VERSUS INTRAVENOUS ESMOLOL IN ATTENUATION OF HEMODYNAMIC RESPONSES TO EXTUBATION IN ADULT PATIENTS: A COMPARATIVE STUDY

Background: The present study aims at comparing the efcacy of intravenous Esmolol to Intravenous Lignocaine in attenuation of hemodynamic stress response to endotracheal extubation in cases of elective surgery in adult patients. Methodology: 60 subjects were enrolled and by Simple Randomisation, patients were divided into two groups of 30 each, Group E and L Group E received iv. Esmolol 1.5mg/kg and Group L received iv. Lignocaine 1.5mg/kg. Hemodynamic responses were recorded. Results: The HR, SBP, DBP, MAP were signicantly reduced in Esmolol group than in Lignocaine group, p<0.05. Conclusion: This study concludes that Intrvenous esmolol 1.5mg/kg is more effective than Intrvenous Lignocaine 1.5mg/kg in blunting the hemodynamic stress response to extubation

Alleviating hemodynamic response to tracheal extubation: A comparative study between dexmedetomidine and lignocaine in surgical patients

Background: Tracheal extubation is a crucial step during general anesthesia involving the removal of artificial airway when the indication for its placement no longer exists. Airway and circulatory interferences could be due to diminished tolerance to the tracheal tube, catecholamine surge, surgical pain, and airway irritation on behalf of suctioning or change in posture of the tube. Complications are more common during extubation than that occurring during induction and intubation.Aim: The main aim of the study was to compare the effectiveness of a single dose of dexmedetomidine and lignocaine in alleviating hemodynamic and stress responses during extubation and recovery.Materials and Methodology: Sixty patients of the age group between 20 and 65 years belonging to ASA 1 and 2 undergoing elective surgical procedures with a minimum anticipated duration of 60 min requiring endotracheal intubation were included in the study. The patients were assigned randomly into two groups with 30 participants in each group and were called as Group D receiving dexmedetomidine 0.5 μg/kg and Group L receiving lignocaine 1.5 mg/kg.Observation and Results: Data were statistically analyzed with the SPSS version 20.0 software. Independent t-test analysis was used, and all the statistical test was examined with P ≤ 0.05 level of significance. Hemodynamic response was noted as more significant in Group D, whereas emergence and extubation time was noted sooner in Group L.Conclusion: We conclude that Dexmedetomidine 0.5 mcg/kg causes significant attenuation of hemodynamic stress response and deeper sedation when compared to lignocaine 1.5 mg/kg.

Comparison of the Efficacy of Intravenous Lignocaine and Intravenous Dexmedetomidine in Attenuation of Hemodynamic Stress Response to Laryngoscopy and Endotracheal Intubation

Objective: To study the effect of intravenous Lignocaine and Dexmedetomidine to attenuate cardiovascular stress reaction to laryngeal manipulation.
 Study Design: Quasi-experimental study.
 Place and Duration of Study: Department of Anesthesia, Combined Military Hospital, Peshawar Pakistan, from Oct 2019 to Apr 2020.
 Methodology: Patients were randomly divided into two Groups by lottery method. Seventy-three were in the intravenous Lignocaine-Group-(A), while 73 patients were in the intravenous Dexmedetomidine-Group-(B). Blood pressure, Pulse rate and ECG were documented at the start of general anaesthesia and after 1, 3 and 5 minutes of intubation. Efficacy was defined if systolic pressure and pulse remained within 20% of the patient's native findings between 1 and 5 minutes after endotracheal intubation.
 Results: A total of 146 patients were included in the stud. The mean baseline systolic BP of Group-A was 121.34±4.47mmHg and mean baseline diastolic BP was 80.31±3.57mmHg. While mean Baseline Systolic BP WAS 121.19±4.37mmHg in Group-B and mean baseline diastolic BP was 80.04±3.66mmHg. Efficacy was seen 74% patients of Group-A and 90.4% of Group-B (p=0.009).
 Conclusion: Dexmedetomidine 1 microgram/kg blunts the cardiovascular sympathetic reaction to laryngeal manipulation more pronounced than Lignocaine 1.5 milligram/kg without any harmful outcomes.

Comparative Study of Oral Clonidine, IV Fentanyl and IV Butorphanol in Attenuation of Hemodynamic Stress Response to Laryngoscopy and Endotracheal Intubation

Introduction: Laryngoscopy and endotracheal intubation is invariably associated with haemodynamic stress response which may have severe consequences in patients with comorbidities. Various drugs have been tried to attenuate this response. Ease of use, cost effectiveness and minimal side effects are some important considerations while choosing an agent. In this study we have compared the efficacy of oral clonidine with IV fentanyl and IV butorphanol in attenuating the stress response to laryngoscopy and intubation. Materials and Methods: This is a prospective, randomised, comparative study carried out on 75 patients aged 20–60 years, ASA I/II physical status, scheduled for elective surgery. These patients were randomly allocated into three groups- GROUP A received IV Fentanyl 2mcg/kg and GROUP B received IV Butorphanol 40 mcg/kg five mins prior to induction respectively. GROUP C received Oral Clonidine 4 mcg/kg 90 mins prior to induction. All thepatients were assessed for heart rate, systolic blood pressure and diastolic blood pressure before induction, during laryngoscopy, after intubation at 1 min, 2 min, 3 min and 5 minrespectively. Statistical analysis: The data was compared and analysed using Kruskal-Wallis test. Results: There was an increase in the hemodynamic parameters post laryngoscopy and intubation in all the groups.Astatistically significant difference in the mean heart rate, systolic blood pressure and diastolic blood pressure was observed; the increase being significantly lower and short-lived in the oral clonidine group compared to the other two groups. Although all the three drugs were effective in attenuating the pressor response, oral clonidine was moreeffective and consistent compared to IV fentanyl and IV butorphanol. Conclusion: Oral clonidine 4mcg/kg given 90 mins prior to induction is more effective than IV fentanyl and IV butorphanol in blunting the hemodynamic response to direct laryngoscopy and intubation without causing any significant side effects.

Intravenous use of Dexmedetomidine for Attenuation of Hemodynamic Stress Response to Laryngoscopy and Endotracheal Intubation in Contrast to Intravenous Lignocaine

In the very recent studies it has been reflected that direct laryngoscopic endotracheal tube intubation following induction of anaesthesia is invariably associated reflex sympathoadrenal discharge with changes in hemodynamic stress response.

Comparison of Intravenous Lignocaine and Dexmedetomidine for Attenuation of Hemodynamic Stress Response to Laryngoscopy and Endotracheal Intubation

Comparison of Intravenous Lignocaine and Dexmedetomidine for Attenuation of Hemodynamic Stress Response to Laryngoscopy and Endotracheal Intubation

Comparison of the efficacy of two doses of dexmedetomidine in attenuating the hemodynamic response to intubation in patients undergoing elective cardiac surgery: A randomized double-blinded study.

Background and Aims:Transient tachycardia and hypertension associated with laryngoscopy and intubation may be hazardous to patients presenting for cardiac surgery. The α 2 agonist dexmedetomidine may blunt this stress response, but the optimal dose which will accomplish this without causing hypotension and bradycardia is not well established. The primary objective of this study was to compare the efficacy of two doses of dexmedetomidine (0.5 and 1 μg/kg) as a 15 min infusion in attenuating the hemodynamic stress response to laryngoscopy and endotracheal intubation in elective cardiac surgery.Material and Methods:Seventy six patients scheduled for elective cardiac surgery received a single preoperative dose of dexmedetomidine of either 0.5 μg/kg (low dose) or 1 μg/kg (high dose) as a 15-min infusion prior to induction. The hemodynamic response to laryngoscopy and endotracheal intubation (heart rate, systolic blood pressure, mean arterial pressure, and diastolic blood pressure) were recorded at different times. Independent sample t-test, Chi-square test of association, and repeated measures analysis of variance were used to analyze the collected data.Results:The incidence of hypertension following intubation was significantly more in the low-dose group. Administration of 1 μg/kg dexmedetomidine was not accompanied by hypotension or bradycardia.Conclusion:Dexmedetomidine in a dose of 1 μg/kg is more effective than 0.5 μg/kg for attenuation of hemodynamic stress response to intubation in cardiac surgery. A more graded increase in the dose of dexmedetomidine may lead to an optimum dose in attenuating the hemodynamic response to intubation.

The Comparison of Hemodynamic Responses Following Laryngeal Mask Airway Insertion Versus Tracheal Intubation in Hypertensive Patients Scheduled for Elective Ophthalmic Surgery Under General Anesthesia

 We compared hemodynamic responses following laryngeal mask airway insertion versus tracheal intubation in hypertensive patients who were scheduled for elective ophthalmic surgery under general anesthesia. We studied 48 controlled hypertensive patients that were randomly divided into two groups (n=24) for insertion of laryngeal mask airway (LMA) and endotracheal intubation (EI). The mean arterial blood pressure (MAP), heart rate, rate pressure product (RPP), and ST-segment changes were recorded preoperatively, immediately preintubation and 1, 3, and 5 minutes after LMA insertion or tracheal intubation in all patients and compared between two groups. There was a reduction in MAP after induction and immediately preintubation in all of patients of both groups (P<0.05). The MAP, heart rate and RPP increased immediately after both LMA insertion and tracheal intubation (P<0.05). The elevation of MAP and RPP were maintained for longer time in intubation group versus LMA group (P<0.05). There was no difference between the groups with respect to ST-segment variation. The incidence of airway injury was similar between two groups. The laryngeal mask airway insertion may be preferable to endotracheal intubation in hypertensive patients where attenuation of hemodynamic stress response is desired.
 © 2019 Tehran University of Medical Sciences. All rights reserved.
 Acta Med Iran 2019;57(5):289-294.

Efficacy of intravenous dexmedetomidine for attenuation of hemodynamic stress response to laryngoscopy and intubation

Background: Hemodynamic variation during laryngoscopy and tracheal intubation with reflex increase in sympathetic and sympathoadrenal activity is always matter of major concern for anesthesiologist, which may result in catastrophic effect, such as tachycardia, hypertension, myocardial ischemia, cardiac arrhythmia or cerebrovascular accident. To attunate haemodynamic response various drug such as lignocaine, opioids, nitroprusside, nitroglycerine, verapamil, nifedipine, esmolol has been used. Αlpha-2 adrenergic agonist decrease sympathetic tone and obtunding hemodynamic response to noxious stimulation and prevent overall hemodynamic variability. Aims and objectives: To study the efficacy of iv dexmedetomidine for attenuating stress responses to laryngoscopy and intubation.Materials and Methods: Eighty patients, ASA grade I/II, undergoing routine general anesthesia were randomly premedicated by i.v. dexmedetomidine (1µg/kg in 50 cc NS) or saline via infusion pump over 10 min. Heart rate (HR), mean arterial pressure (MAP) were measured before, after the premedication, after propofol, after succinylcholine, at laryngoscopy, immediately after intubation and then 1 min, 3 min and 5 min after intubation. Results: The demographic data was comparable in both groups. After intubation the increase in heart rate was more in group C than group D (p

Comparative evaluation of dexmedetomidine and labetalol for attenuating hemodynamic stress responses during laparoscopic cholecystectomy in borderline hypertensive patients

Abstract Objective Various pharmacological agents have been tried to attenuate the pressor response in laparoscopic cholecystectomy patients. We have compared single pre-induction intravenous injection of dexmedetomidine with labetalol for attenuation of hemodynamic stress response. Methods A total of 160 patients were considered for this prospective, randomised, double blind clinical study done in a single tertiary care institution. Patients were either included in group D, to receive 1.0 μg kg−1 i.v. dexmedetomidine or group L, to receive 0.3 mg kg−1 i.v. labetalol in 100 ml of normal saline before induction of anaesthesia. Patient's hemodynamic parameters were noted pre-operatively before starting infusion and at fixed intervals afterwards till extrubation. Results After intubation, mean systolic blood pressure (SBP) was higher in patients of group L (128.0 ± 13.866) as compared to group D (123.2 ± 10.672). Afterwards the SBP was comparable until extrubation. Similarly, after intubation patients in group D tended to have lower diastolic pressure (73.1 ± 9.683 vs. 79.2 ± 14.153, p value 0.0017) compared to patients in group L. Also, the relative incidence of bradycardia and hypotension was higher in patients who had received inj. labetalol. Conclusion In patients predisposed to significant fluctuations in blood pressure or heart rate dexmedetomidine may be more suitable than labetalol due to better preservation of normal hemodynamics especially during periods of stress showing a relatively lower incidence of side effects.

A Prospective, Randomized, Single-Blind, Comparative Study of Dexmedetomidine and Propofol Infusion for Intraoperative Hemodynamics and Recovery Characteristics in Laparoscopic Surgeries.

Background:Creation of pneumoperitoneum in laparoscopic surgeries with carbondioxide to intra-abdominal pressures higher than 10 mmHg induces significant alterations of hemodynamics. To counteract, propofol or dexmedetomidine was compared and postoperative recovery assessed.Aims:The aim of this study was to compare the efficacy of standard dose of propofol versus low-dose dexmedetomidine as infusions to limit hemodynamic instability with pneumoperitoneum and facilitate recovery.Settings and Design:This was a prospective, randomized, single-blind, comparative study.Materials and Methods:Seventy patients between 18 and 60 years belonging to the American Society of Anesthesiologists Physical Status Class 1 and 2 scheduled for laparoscopic surgeries were randomly divided – Group D: To receive dexmedetomidine 1 μg/kg over 10 min before and 0.2 μg/kg/h infusion after intubation till the end of pneumoperitoneum and Group P: To receive propofol 100 μg/kg/min after intubation till the end of pneumoperitoneum. Variables such as heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded at baseline, preinduction, after loading dose of dexmedetomidine, postinduction, postintubation, at pneumoperitoneum, every 15 min till the end of surgery, at extubation, and postoperatively for 2 h monitored with Ramsay Sedation Scale and modified Aldrete's score.Results:Hemodynamic stability was better maintained in Group D than Group P with significant attenuation of hemodynamic stress response to pneumoperitoneum in terms of HR (3% decrease vs. 18% increase), SBP (5% decrease vs. 12% increase), DBP (2%increase vs. 16% increase), and MAP (4% decrease vs. 7% increase). Postoperatively, significant sedation was noted till 90 min in Group D and recovery was better in Group P.Conclusion:With doses of test drug infusion used, there is better attenuation of hemodynamic stress response to pneumoperitoneum with dexmedetomidine and faster recovery with propofol.

Effect of Magnesium Sulphate and Dexmedetomidine for Attenuation of hemodynamic stress Response to Intubation

Effect of Magnesium Sulphate and Dexmedetomidine for Attenuation of hemodynamic stress Response to Intubation

Evaluation and Comparison of Intravenous Magnesium sulphate and Intravenous Dexmedetomidine for Attenuation of hemodynamic stress Response to Laryngoscopy and Intubation:A Randomized Controlled Study

Evaluation and Comparison of Intravenous Magnesium sulphate and Intravenous Dexmedetomidine for Attenuation of hemodynamic stress Response to Laryngoscopy and Intubation:A Randomized Controlled Study

Comparison of two doses of intravenous Dexmedetomidine 0.6mcg/kg and 1mcg/kg given prior to induction in attenuation of hemodynamic stress response of laryngoscopy and endotracheal intubation

Comparison of two doses of intravenous Dexmedetomidine 0.6mcg/kg and 1mcg/kg given prior to induction in attenuation of hemodynamic stress response of laryngoscopy and endotracheal intubation

Comparison of two doses of intravenous Dexmedetomidine 0.6mcg/kg and 1mcg/kg given prior to induction in attenuation of hemodynamic stress response of laryngoscopy and endotracheal intubation

Comparison of two doses of intravenous Dexmedetomidine 0.6mcg/kg and 1mcg/kg given prior to induction in attenuation of hemodynamic stress response of laryngoscopy and endotracheal intubation

Comparison of Esmolol and Magnesium Sulphate for Attenuation of Hemodynamic Stress Response to Laryngoscopy and Intubation in Elective ENT Surgeries

SUMMARY: This randomized prospective single blinded study was designed to evaluate efficacy of Esmolol and Magnesium sulphate in attenuating hemodynamic stress response to laryngoscopy and intubation .Ninety patients of ASA PS I and II were randomly allocated into three groups of thirty each. P---received normal saline, E—Esmolol 1.5mg/kg, M—Magnesium Sulphate 50mg/kg, The following observations were made: 1. Group E showed maximum attenuation of heart rate and blood pressure. 2. Group M also showed significant attenuation of blood pressure response but produced tachycardia on infusion of the drug. Heart rate response was not statistically significant compared to group E. 3. All patients recovered well. 4. Incidence of side effects was not significant between the groups. CONCLUSION: From this study, it is concluded that hemodynamic changes to laryngoscopy and intubation can be attenuated by giving intravenous Esmolol 1.5mg/kg. Esmolol is effective in blunting the response followed by Magnesium Sulphate which blunts the hypertensive response but produces tachycardia during infusion of the drug. Placebo was ineffective in blunting hemodynamic stress response to laryngoscopy and intubation.

Effect of Oral Clonidine Premedication on Propofol Consumption for Patient Undergoing Laparoscopic Cholecystectomy

Background: Various goals of premedication includes anxiolysis, sedation, amnesia, analgesia, attenuation of autonomic reflexes, and reduction of anaesthetic dose requirement. Preanaesthetic oral clonidine has been shown to produce anxiolysis, sedation and attenuation of hemodynamic stress response to tracheal intubation.Objective: To investigate the clinical efficacy of oral clonidine on propofol consumption in patients undergoing laparoscopic cholecystectomy.Methods: This was a prospective, randomized, double-blind placebo controlled study conducted in ninety consecutive patients randomly divided into three equal groups (placebo, tab. clonidine 150 mcg and tab. clonidine 300 mcg) meeting inclusion and exclusion criteria who underwent laparoscopic cholecystectomy. Study drug was given 60 minutes before induction of anaesthesia. Anaesthesia was induced with intravenous pethidine 1mg/kg followed by propofol . The dose of propofol for loss of verbal command was recorded. Anaesthesia was maintained with propofol at the rate of 10 mg/kg/h for 10 minutes then to 8 mg/kg/h for 10 minutes and ultimately decreased to 6 mg/kg/h after tracheal intubation. The rate of propofol infusion was adjusted by 2mg/kg/h to obtain adequate depth of anaesthesia (maintaining hemodynamic parameters within 20% of baseline).Results: The propofol induction dose was less in clonidine 150 mcg (1.2±0.2 mg/kg) and clonidine 300 mcg (1.08±0.24 mg/ kg) groups as compared to placebo group ( 1.4±0.3 mg/kg) (p=˂0.001). The rate of propofol infusion in mg/kg/h and in mcg/kg/h was lower in clonidine 150 mcg (6.7±1.6 and 121.3±11.37) and clonidine 300 mcg (7±1.4 and 120.0±9.8) groups as compared to placebo (10±3.2 and 148.0±32.53) group (p =˂ 0.001).Conclusion: oral clonidine premedication reduces propofol requirement for induction and maintenance of anaesthesiain patients undergoing laparoscopic cholecystectomy.Health Renaissance 2014;12(3): 204-208

The efficacy of labetalol vs dexmedetomidine for attenuation of hemodynamic stress response to laryngoscopy and endotracheal intubation

ObjectiveTo assess the effectiveness of labetalol vs dexmedetomidine for attenuation of hemodynamic stress response to laryngoscopy and endotracheal intubation. DesignProspective, randomized, controlled, observer-blinded study. SettingThis study was carried out in Tanta University Hospital. PatientsNinety patients of both sexes; American Society of Anesthesiologists physical status I and II; age range from 20 to 60 years; scheduled for elective surgery under general anesthesia. InterventionsPatients were divided into 3 groups (30 each). Group A received 1 μg/kg of dexmedetomidine as intravenous (IV) infusion, group B received labetalol 0.25mg/kg IV, and group C received 10mL saline IV. MeasurementsThe groups were compared for heart rate (HR), mean arterial pressure (MAP), and rate pressure product (RPP). Hemodynamic parameters were recorded during the preinduction; after induction; at intubation; and at 1, 3, 5, 10, and 15minutes. The primary outcomes were hemodynamic changes (HR, MBP, and RPP), and the secondary outcome was propofol dose requirement for induction of general anaesthesia. ResultsSignificant decrease (P < .05) in HR, MBP, and RPP in groups A and B in comparison with group C and in group A in comparison with group B. Just before intubation, there was a significant decrease (P < .05) in HR, MBP, and RPP in groups A and B in comparison with group C. In group C, there was a significant increase in HR, MBP, and RPP at all points when compared with the baseline. In group A, the mean propofol induction dose (mg) was statistically significantly low as compared with that in groups B and C. ConclusionDexmedetomidine attenuates the hemodynamic stress response to laryngoscopy and intubation more effectively compared with labetalol without any deleterious effects. Furthermore, dexmedetomidine decreases dose of propofol for induction of anesthesia as guided by bispectral index.

Comparison of intravenous lignocaine and intravenous dexmedetomidine for attenuation of hemodynamic stress response to laryngoscopy and endotracheal intubation

Context: Direct laryngoscopy and endotracheal intubation following induction of anesthesia is almost always associated with hemodynamic stress response due to reflex sympathoadrenal discharge. Aim: Aim of our study was to compare the efficacy of lignocaine and dexmedetomidine in attenuating the hemodynamic response to laryngoscopy and intubation. Settings and Design: The present prospective randomized study was carried out in a tertiary care teaching hospital. A total of 100 American Society of Anesthesiologist physical status I and II patients posted for elective surgery under general anesthesia were enrolled in the study. Patients were randomly divided into two groups, group L (lignocaine group) and group D (dexmedetomidine group) with 50 patients in each group. Materials and Methods: Group L received 1.5 mg/kg of lignocaine intravenous (IV) and group D received 1 mcg/kg of dexmedetomidine as IV infusion. Thiopentone was given until eyelash reflex disappeared, and intubation was facilitated with succinylcholine. Anesthesia was maintained with 33:66 oxygen: Nitrous oxide, isoflurane, and vecuronium. Hemodynamic parameters were recorded during the basal period, preinduction, after induction, during intubation, 1 min, 3 min, 5 min, and 10 min after intubation. Statistical Analysis Used: Data were analyzed using Graphpad Prism Software version 6.03 (Graphpad Software Inc., USA). P Results: Maximum increase in heart rate was around 38% in group L and 10% in group D (P = 0.000). Maximum increase in mean arterial pressure was 22% in group L and 6% in group D (P = 0.000). Thiopentone dose requirement was 19% less in group D compared to group L (P Conclusion: Dexmedetomidine attenuates the hemodynamic stress response to laryngoscopy and intubation more effectively compared with lignocaine without any deleterious effects. Furthermore, dexmedetomidine decreases dose of thiopentone for induction of anesthesia.