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Comparison of the hemodynamic response of dexmedetomidine versus additional intravenous lidocaine with propofol during tracheal intubation: a randomized controlled study

BACKGROUND: Laryngoscopy and tracheal intubation are strong stimuli that cause a reflex increase in blood pressure (BP), heart rate (HR), and serum catecholamine level. These can lead to myocardial infarction or cerebrovascular accidents. The purpose of this study is to compare the efficacy of dexme...

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Autores principales: Seangrung, Rattaphol, Pasutharnchat, Koravee, Injampa, Subundit, Kumdang, Sirima, Komonhirun, Rojnarin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8557037/
https://www.ncbi.nlm.nih.gov/pubmed/34717532
http://dx.doi.org/10.1186/s12871-021-01484-6
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author Seangrung, Rattaphol
Pasutharnchat, Koravee
Injampa, Subundit
Kumdang, Sirima
Komonhirun, Rojnarin
author_facet Seangrung, Rattaphol
Pasutharnchat, Koravee
Injampa, Subundit
Kumdang, Sirima
Komonhirun, Rojnarin
author_sort Seangrung, Rattaphol
collection PubMed
description BACKGROUND: Laryngoscopy and tracheal intubation are strong stimuli that cause a reflex increase in blood pressure (BP), heart rate (HR), and serum catecholamine level. These can lead to myocardial infarction or cerebrovascular accidents. The purpose of this study is to compare the efficacy of dexmedetomidine and lidocaine combined with propofol in attenuating the hemodynamic response following laryngoscopy and endotracheal intubation. METHODS: This study was a randomized controlled study and adhered to the CONSORT guidelines. One-hundred and six patients undergoing elective general anesthesia with endotracheal intubation were divided randomly into two groups. Group D received dexmedetomidine (1 μg kg(− 1)) before induction. Group LP received lidocaine (1.5 mg kg(− 1)) before induction with additional propofol (0.5 mg kg(− 1)) before laryngoscopy. The primary endpoint was hemodynamic including systolic (S) BP, diastolic (D) BP, mean arterial blood pressure (MAP) and HR measured before and after induction and ≤ 10 min after intubation. Secondary outcome was complications/adverse effects. RESULTS: After induction, the mean SBP, DBP, MAP and HR decreased significantly from baseline in both groups except for mean HR in group LP at 1 min. Differences in mean values of SBP, DBP, and MAP were significantly lower in group D after intubation at 4–10 min (P <  0.05). Group LP had a non-inferior effect in blunting BP at all time points except 1 and 2 min after induction, and 2 min after intubation. The mean difference in HR in group D was significantly lower than that in group LP at all time points (P <  0.001). Group D had significantly more episodes of bradycardia (18.87% vs. 0%, P = 0.001) and hypotension (52.83% vs. 15.09%, P < 0.001) than did group LP. CONCLUSION: Lidocaine (1.5 mg kg(− 1)) with additional propofol (0.5 mg kg(− 1)) had a non-inferior effect compared with dexmedetomidine (1 μg kg(− 1)) in attenuating the hemodynamic response following laryngoscopy and endotracheal intubation, and had fewer adverse effects. TRIAL REGISTRATION: Thai Clinical Trial Registry, (TRTC20190206002). Retrospectively registered 4 February 2019.
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spelling pubmed-85570372021-11-01 Comparison of the hemodynamic response of dexmedetomidine versus additional intravenous lidocaine with propofol during tracheal intubation: a randomized controlled study Seangrung, Rattaphol Pasutharnchat, Koravee Injampa, Subundit Kumdang, Sirima Komonhirun, Rojnarin BMC Anesthesiol Research BACKGROUND: Laryngoscopy and tracheal intubation are strong stimuli that cause a reflex increase in blood pressure (BP), heart rate (HR), and serum catecholamine level. These can lead to myocardial infarction or cerebrovascular accidents. The purpose of this study is to compare the efficacy of dexmedetomidine and lidocaine combined with propofol in attenuating the hemodynamic response following laryngoscopy and endotracheal intubation. METHODS: This study was a randomized controlled study and adhered to the CONSORT guidelines. One-hundred and six patients undergoing elective general anesthesia with endotracheal intubation were divided randomly into two groups. Group D received dexmedetomidine (1 μg kg(− 1)) before induction. Group LP received lidocaine (1.5 mg kg(− 1)) before induction with additional propofol (0.5 mg kg(− 1)) before laryngoscopy. The primary endpoint was hemodynamic including systolic (S) BP, diastolic (D) BP, mean arterial blood pressure (MAP) and HR measured before and after induction and ≤ 10 min after intubation. Secondary outcome was complications/adverse effects. RESULTS: After induction, the mean SBP, DBP, MAP and HR decreased significantly from baseline in both groups except for mean HR in group LP at 1 min. Differences in mean values of SBP, DBP, and MAP were significantly lower in group D after intubation at 4–10 min (P <  0.05). Group LP had a non-inferior effect in blunting BP at all time points except 1 and 2 min after induction, and 2 min after intubation. The mean difference in HR in group D was significantly lower than that in group LP at all time points (P <  0.001). Group D had significantly more episodes of bradycardia (18.87% vs. 0%, P = 0.001) and hypotension (52.83% vs. 15.09%, P < 0.001) than did group LP. CONCLUSION: Lidocaine (1.5 mg kg(− 1)) with additional propofol (0.5 mg kg(− 1)) had a non-inferior effect compared with dexmedetomidine (1 μg kg(− 1)) in attenuating the hemodynamic response following laryngoscopy and endotracheal intubation, and had fewer adverse effects. TRIAL REGISTRATION: Thai Clinical Trial Registry, (TRTC20190206002). Retrospectively registered 4 February 2019. BioMed Central 2021-10-30 /pmc/articles/PMC8557037/ /pubmed/34717532 http://dx.doi.org/10.1186/s12871-021-01484-6 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Seangrung, Rattaphol
Pasutharnchat, Koravee
Injampa, Subundit
Kumdang, Sirima
Komonhirun, Rojnarin
Comparison of the hemodynamic response of dexmedetomidine versus additional intravenous lidocaine with propofol during tracheal intubation: a randomized controlled study
title Comparison of the hemodynamic response of dexmedetomidine versus additional intravenous lidocaine with propofol during tracheal intubation: a randomized controlled study
title_full Comparison of the hemodynamic response of dexmedetomidine versus additional intravenous lidocaine with propofol during tracheal intubation: a randomized controlled study
title_fullStr Comparison of the hemodynamic response of dexmedetomidine versus additional intravenous lidocaine with propofol during tracheal intubation: a randomized controlled study
title_full_unstemmed Comparison of the hemodynamic response of dexmedetomidine versus additional intravenous lidocaine with propofol during tracheal intubation: a randomized controlled study
title_short Comparison of the hemodynamic response of dexmedetomidine versus additional intravenous lidocaine with propofol during tracheal intubation: a randomized controlled study
title_sort comparison of the hemodynamic response of dexmedetomidine versus additional intravenous lidocaine with propofol during tracheal intubation: a randomized controlled study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8557037/
https://www.ncbi.nlm.nih.gov/pubmed/34717532
http://dx.doi.org/10.1186/s12871-021-01484-6
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