ATTENUATION OF HAEMODYNAMIC RESPONSE TO LARYNGOSCOPY AND ORAL ENDOTRACHEAL INTUBATION IN CORONARY ARTERY BYPASS SURGERY PATIENTS: INTRAVENOUS MORPHINE AND LIDOCAINE VERSUS INTRAVENOUS MORPHINE AND LIDOCAINE SPRAY
AbstractBackground: Sympathetic response associated with laryngoscopy and endotracheal intubation is recognized as a potential cause for a number of complications especially in coronary bypass surgery patients. Various methods have been used to attenuate these hemodynamic responses, The aim of our study was to compare lidocaine spray in addition to intravenous morphine on attenuating the hemodynamic response to laryngoscopy and endotracheal intubation with intravenous lidocaine and morphine in coronary artery bypass surgery patients. Method: Sixty patients, scheduled for elective coronary bypass grafting surgery were included in this randomized controlled trial. The patients randomly divided in group-A (Intravenous Morphine 0.1mg/kg and Intravenous lidocaine 1.5 mg/kg) and group-B (Intravenous Morphine 0.1mg/kg and lidocaine spray 1.5 mg/kg). Results: Demographic data was comparable in both groups. There was no statistically significant difference between two groups in the duration of laryngoscopy and intubation. There was statistically insignificant attenuation in heart rate in both groups (p=0.134), the trends of attenuation of systolic blood pressure, diastolic blood pressure and mean arterial pressure in group-A compared to group-B (p=0.933), (p=0.768) and (p=0.136) respectively were statistically insignificant. Conclusions: Under the present study design, lidocaine spray in addition to intravenous morphine had no better effect on attenuating the hemodynamic response to laryngoscopy and endotracheal intubation as compared to intravenous lidocaine and morphine in coronary artery bypass surgery patients.Keywords: Lidocaine, Hemodynamic response, laryngoscopy, endotracheal intubation, coronary bypass grafting
Mikhail MS. Murray MJ. Larson CP, Jr. In: Morgan GE, Jr. Mikhail MS. Murray MJ, Editors. Clinical Anesthesiology. 4th ed. New York: McGraw Hill; 2006.p. 91–116.
Henderson J. Airway management in the adult. In: Miller RD, editor. Miller's Anaesthesia. 7th ed. Philadelphia: Churchill Livingstone; 2010.p. 1573–1610.
Helfman SM, Gold MI, DeLisser EA, Herrington CA. Which drug prevents tachycardia and hypertension associated with tracheal intubation: Lidocaine, fentanyl, or esmolol? Anesth Analg 1991;72:482–6.
Thompson JP, Hall AP, Russell J, Cagney B, Rowbotham DJ. Effect of remifentanil on the haemodynamic response to orotracheal intubation. Br J Anaesth 1998;80:467–9.
McCoy EP, Mirakhur RK, McCloskey BV. A comparison of the stress response to laryngoscopy: The Macintosh versus the McCoy blade. Anaesthesia 1995;50:943–6.
McDonald J, Lambert D. Opioid receptors. Continuing Education in Anaesthesia. Critical Care Pain 2005;5(1):22–5.
Kovac AL. Controlling the hemodynamic response to laryngoscopy and endotracheal intubation. J Clin Anesth 1996;8:63–79.
Shribman AJ, Smith G, Achola KJ. Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation. Br J Anaesth 1987;59:295–9.
Derbyshire DR, Chmielewski A, Fell D, Vater M, Achola K, Smith G. Plasma catecholamine responses to tracheal intubation. Br J Anaesth 1983;55:855–60.
Ebert TJ, Trotier TS, Arain SR, Uhrich TD, Barney JA. High concentrations of isoflurane do not block the sympathetic nervous system activation from desflurane. Can J Anaesth, 2001;48:133–8.
Morgan GE, Jr. Mikhail MS. Murray MJ. Anaesthesia for patients with cardiovascular disease. In: Morgan GE, Jr. Mikhail MS. Murray MJ, Editors. Clinical Anesthesiology. 4th ed. New York: McGraw Hill; 2006.p. 441–89.
Laurito CE, Baughman VL, Becker GL, Polek WV, Riegler FX, VadeBoncouer TR. Effects of aerosolized and/or intravenous lidocaine on hemodynamic responses to laryngoscopy and intubation. In outpatients Anesth Analg 1988;67:389–92.