Key result
Diltiazem blunts intubation-induced mean arterial pressure surges, while adding lidocaine provides no added benefit.
Why the study?
Transient cardiovascular responses to direct laryngoscopy and tracheal intubation can cause hypertension and tachycardia, posing risks especially in patients with cardiac or cerebrovascular disease. The study aimed to investigate the hemodynamic effects of diltiazem and lidocaine on these responses.
Does intravenous diltiazem, alone or in combination with lidocaine, attenuate the hypertensive response to tracheal intubation in healthy adults?
Does intravenous diltiazem, alone or in combination with lidocaine, attenuate the hypertensive response to tracheal intubation in healthy adults?
Intravenous diltiazem 0.3 mg/kg safely attenuates the hypertensive response to laryngoscopy and tracheal intubation without needing adjunctive low-dose lidocaine.
Diltiazem 0.3 mg/kg monotherapy attenuates intubation hypertension; confirms no additive benefit from lidocaine in this RCT.
Background: Transient cardiovascular responses are frequently associated with direct laryngoscopy and tracheal intubation.The aim of this study was to investigate the change of hemodynamic response in laryngoscopy and intubation after injection of diltiazem and lidocaine.Methods: We studied eighty adult patients (ASA 1-3).After intravenous injection of thiopental sodium, each patient received saline (Control), 1 mg/kg lidocaine (Group L), 0.3 mg/kg diltiazem (Group D), or 0.3 mg/kg diltiazem + 1 mg/kg lidocaine (Group DL) 90 seconds before a laryngoscopy.Heart rate and arterial blood pressure were obtained at baseline, just before the laryngoscopy, immediately after intubation, 1, 2, 3 and 4 minutes after intubation.Results: There were no significant differences in the changes of heart rate among all groups.Patients who received saline and lidocaine showed a significant increase in mean arterial pressure associated with tracheal intubation, and these responses were attenuated in diltiazem and diltiazem + lidocaine treated patients.However, there was no significant difference between the diltiazem group and diltiazem + lidocaine group.Conclusions: This data suggests that 0.3 mg/kg diltiazem or 0.3 mg/kg diltiazem + 1 mg/kg lidocaine treatment are effective methods to attenuate the hypertensive response to laryngoscopy and tracheal intubation.However, injection of diltiazem + a low dose of lidocaine was not more effective than the diltiazem alone group.(Korean J Anesthesiol 2002; 43: 710∼715) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ
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Lee et al. (2002) studied Adults undergoing surgery under general anesthesia requiring endotracheal intubation (n=80). Diltiazem vs. Saline or 1 mg/kg Lidocaine IV alone was evaluated on Mean arterial pressure and rate pressure product following tracheal intubation (p=<0.05). Diltiazem 0.3 mg/kg significantly attenuated the increase in mean arterial pressure associated with tracheal intubation, whereas the addition of 1 mg/kg lidocaine provided no further benefit.
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