Key result
Adding esmolol to alfentanil yields an absolute ~30% reduction in post-intubation hypertension in hypertensive patients.
Why the study?
The efficacy and clinical usefulness of alfentanil alone versus combined alfentanil and esmolol for blunting hemodynamic responses after tracheal intubation in hypertensive patients requiring rapid sequence induction needed to be determined.
Does a combination of alfentanil and esmolol improve hemodynamic stability compared to alfentanil alone during endotracheal intubation in hypertensive patients?
RCT (n=40)
Randomized
No
Does a combination of alfentanil and esmolol improve hemodynamic stability compared to alfentanil alone during endotracheal intubation in hypertensive patients?
The combination of alfentanil and esmolol effectively blunts hemodynamic responses, particularly tachycardia and hypertension, during rapid sequence endotracheal intubation in hypertensive patients.
Supports alfentanil-esmolol combination to blunt intubation hemodynamics in hypertensives; confirms additive effect in this RCT.
BACKGROUND This study was desined to determine the efficacy and clincial usefulness of alfentanil and a combined use of alfentanil and esmolol for blunting hemodynamic responses after tracheal intubation in hypertensive patients who needed a rapid sequence induction. METHODS Group 1 received alfentanil 15microgram/kg and group 2 received alfentanil 15microgram/kg and esmolol 1 mg/kg intravenously. Thiopental sodium 5 mg/kg and succinylcholine 1 mg/kg were used for the induction of anesthesia. Changes in blood pressure and herat rate were measured during intubation and induction of anesthesia with enflurane-N2O-O2 and vecuronium. Rate pressure products (RPP) was calculated and the frequencies of hypertension, hypotension, tachycardia, bradycardia were measured. RESULTS In group 1, systolic blood pressure increased significantly at 1, 2 minute and decreased significantly at 4, 5, 10, 15 minute compared to base, and diastolic blood pressure increased significantly at 1 minute and decreased significantly at 4, 5, 10 minute. Heart rate increased significantly at 1, 2 minute. In group 2, systolic blood pressure decrease significantly at 3, 4, 5 minute after tracheal intubation compared to base, and diastolic blood pressure increased at 1 minute and decreased at 4, 5, 10, 15 minute. HR did not change significantly (P < 0.05). CONCLUSION In treated hypertensive patients, the use of a combination of alfentanil 15/kg and esmolol 1 mg/kg is a useful method to attenuate hemodynamic responses after endotracheal intubation and especially for rapid sequence induction.
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Kang et al. (2005) conducted an RCT in Hypertension undergoing endotracheal intubation during rapid sequence induction (n=40). Alfentanil plus esmolol vs. Alfentanil 15 μg/kg IV alone was evaluated on Post-intubation hypertension (systolic blood pressure ≥ 170 mmHg) at 1 minute after endotracheal intubation (p=<0.05). Combining alfentanil (15 μg/kg) and esmolol (1 mg/kg) significantly attenuated post-intubation blood pressure and heart rate increases compared to alfentanil alone in hypertensive patients (P<0.05).
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