Cardiovascular effects of esmolol, lidocaine and fentanyl on endotracheal intubation in hypertensive patient

Lee, Sang Gon; Yeo, Sang Im; Min, Byung Woo; Park, Dae Pal

Abstract

This study is designed to compare the effectiveness of single-bolus lidocaine, fentanyl and esmolol at the time of postintubation to blunt the hemodynamic intubation response in hypertensive patients. Sixty mildly hypertensive patients, scheduled for elective surgery, were randomly assigned in a double blind to receive a preintubation dose : in the firat group(Group A),20 patients received 1.5mg/kg lidocaine ; in the second group(Group B), another 20 patients received 3 ug/kg fentanyl; and in the third group(Group C), another 20 patients received 100mg esmolol. Within the above mentioned framework, this study obtained the following results : Systolic arterial pressure (SAP), heart rste (HR) and rate-pressure product (RPP) all significantly increased 1 minute after intubation. Fentanyl was more effective in protecting sgainst increase in SAP than lidocaine, which proves to be significant as shown in P<0.05. The statistical result, however, did not show the effectiveness of fentanyl signifieantly differed from that of esmolol in this respect. Esmolol preloading was significantly more effective in blunting hesrt rate than any other drugs. On the other hand, preloading of esmolol or fentanyl was significantly more effective in blunting rate-pressure product thsn lidocaine,which turned out to be P <0.05. Given these results, the present study concludes that esmolol preloading provides a reliable protection against increases in both heart rate and systolic srterial pressure accompanying laryngoscopy and intubation in hypertensive patients.