Revista Colombiana de Anestesiología Revista Colombiana de Anestesiología
Rev Colomb Anestesiol. 2010;38:457-69 - Vol. 38 Núm.4 DOI: 10.1016/S0120-3347(10)84004-3
INVESTIGACIÓN CIENTÍFICA Y TECNOLÓGICA
Attenuation of the Pressor Response to Laryngoscopy and Tracheal Intubation with Intravenous Diltiazem and Esmolol Intravenous in Controlled Hypertensive Surgical patients
Atenuación de la respuesta presora a la laringoscopia e intubación entre diltiazem y esmolol en pacientes hipertensos controlados
Gazi Parvez, Mohamad Ommid, Arun Kumar Gupta**, , Humariya Heena***, A.H. Hashia****
* MD Senior Resident, Dept. of Anaesthesiology and Critical Care. SKIMS, Soura, Jammu & Kashmir, India.
** MD Assistant Professor, Dept. of Anaesthesiology and Critical Care. Rural Medical College, Loni, Maharashtra, India.
*** Post Graduate, Dept. Of Community Medicine, SKIMS, Soura, J&K, India.
**** MD Professor and Head, Dept. of Anaesthesiology and Critical Care. Govt. Medical College, Srinagar, J&K, India.
Recibido 21 julio 2010, Aceptado 24 agosto 2010
SUMMARY
Introduction

Tachycardia and hypertension are well documented sequels of laryngoscopy and endotracheal intubation which is transient, highly variable and is generally well tolerated in healthy patients. In hypertensive patients, cardiovascular response to laryngoscopy and intubation is exaggerated. The aim of this study intended to find a better alternative by comparision amongst diltiazem and esmolol to attenuate the pressor response to laryngoscopy and intubation in Kasmiri Population.

Materials & Methods

Randomized placebo controlled double blind study. One hundred fifty hypertensive patients of both sexes (ASA II), controlled on antihypertensive drugs, between age range of 40-60 years scheduled for routine surgical procedures were divided into 3 groups Group A (10 ml of 5 % Dextrose), Group B (Diltiazem 0.2 mg/Kg) and Group C (Esmolol 1.5 mg/Kg). Baseline parameters, i.e. heart rate, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and rate pressure product were noted at baseline level, at 1 min., 3min. and 5min after tracheal intubation.

Results

Both Esmolol and Diltiazem showed statistically significant attenuation of rise in systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and rate pressure product when compared to control. However Diltiazem failed to attenuate rise in heart rate.

Conclusions

We conclude that Esmolol is a very effective agent in attenuating the pressor response to laryngoscopy and intubation in controlled hypertensive patients.

RESUMEN
Introducción

La taquicardia e hipertensión son efectos bien documentados de la laringoscopia e intubación orotraqueal que son transitorios, muy variables y generalmente bien toleradas en los pacientes sanos. Sin embargo, en los pacientes hipertensos, la respuesta cardíaca a la laringoscopia e intubación es exagerada. El objetivo de este estudio es encontrar la mejor alternativa entre diltiazem y esmolol para atenuar la respuesta presora a la laringoscopia e intubación en una población de Cachemira.

Materiales y métodos

Estudio aleatorizado controlado doble ciego. Ciento cincuenta pacientes hipertensos de ambos sexos (ASA II), controlados con drogas antihipertensivas con edades entre los 40 y 60 años programados para cirugías rutinarias fueron divididos en tres grupos, grupo A (10 ml de dextrosa al 5 %), grupo B (diltiazem 0,2 mg por kilo), y grupo C (esmolol 1,5 mg por kilo). Los parámetros de base como frecuencia cardíaca, presión arterial sistólica, presión arterial diastólica, presión arterial media y doble producto, fueron anotados al inicio al minuto 1 al minuto 3 y al minuto 5 después de la intubación traqueal.

Resultados

Tanto el esmolol como el diltiazem demostraron atenuación estadísticamente significativa de la presión arterial sistólica, diastólica y media, y del doble producto, cuando se compararon al control. Sin embargo el diltiazem no pudo evitar un aumento de la frecuencia cardíaca.

Conclusiones

Concluimos que el esmolol es un agente muy efectivo para atenuar la respuesta presora a la laringoscopia e intubación en pacientes hipertensos controlados.

Keywords
Esmolol, diltiazem, Laryngoscopy, Intubation, blood pressure (Source: MeSH, NLM)
Palabras clave
Propanolaminas, diltiazem, laringoscopia, intubación, presión sanguínea (Fuente: DeCS, BIREME)
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Copyright © 2010. Revista Colombiana de Anestesiología
Rev Colomb Anestesiol. 2010;38:457-69 - Vol. 38 Núm.4 DOI: 10.1016/S0120-3347(10)84004-3