Key result
Combined esmolol and nicardipine attenuates post-intubation blood pressure and heart rate spikes versus monotherapy.
Why the study?
Hypertensive patients experience significant blood pressure and heart rate increases after endotracheal intubation, and optimal pharmacologic strategies to blunt these responses are not well established.
Does a combination of low-dose esmolol and nicardipine prevent hypertension and tachycardia after tracheal intubation in hypertensive patients better than either drug alone?
RCT (n=45)
Randomly divided into three groups
No
Does a combination of low-dose esmolol and nicardipine prevent hypertension and tachycardia after tracheal intubation in hypertensive patients better than either drug alone?
Combining low doses of esmolol and nicardipine effectively blunts both the hypertensive and tachycardic reflex responses to endotracheal intubation in patients with underlying hypertension.
Low-dose esmolol-nicardipine combination may be preferred to blunt intubation responses in hypertensives; extends monotherapy evidence in RCT.
Background: This study was designed to determine the efficacy of a combined use of esmolol and nicardipine for blunting hypertension and tachycardia after tracheal intubation in hypertensive patients.Methods: Forty-five hypertensive patients were randomly divided into three group: group E (esmolol 0.5 mg/kg, n = 15), group N (nicardipine 30μg/kg, n = 15), group EN (esmolol 0.25 mg/kg, nicardipine 15μg/kg, n = 15).All patients received midazolam 0.5 mg/kg, and glycopyrrolate 0.2 mg IM for premedication.Fentanyl 1μg/kg was injected before induction of anesthesia, and then esmolol, nicardipine, or the mixed drugs were administrated as an IV bolus and immediately followed by the induction drugs: thiopental 5 mg/kg, and succinylcholine 1 mg/kg.Endotracheal intubation was performed 90 seconds after injection of the experimental drugs.Thereafter 50% Nitrous Oxide in oxygen and 2 vol % enflurane were inhaled.BP and HR were recorded at the resting state, before fentanyl injection (base {T0}), after injection test drug (T1), after induction (T2), immediately after intubation (T3), 2 min (T4), 3 min (T5), 4 min (T6), and 5 min (T7) after intubation.Results: There was a significant attenuation in SBP, MBP, DBP after tracheal intubation on the nicardipine & mixed groups compared to the esmolol group.HR was significantly lower in the esmolol and mixed groups than in the nicardipine group after tracheal intubation.Conclusions: Combined administration of esmolol (0.25 mg/kg) and nicardipine (15μg/kg) was effective in attenuating an increase of BP and HR during tracheal intubation in hypertensive patients.(Korean J Anesthesiol 2002; 43: 581∼587)
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Kim et al. (2002) conducted an RCT in Hypertension (requiring endotracheal intubation) (n=45). Esmolol and nicardipine combination vs. Esmolol 0.5 mg/kg alone or Nicardipine 30 μg/kg alone was evaluated on Changes in blood pressure (SBP, MBP, DBP) and heart rate after tracheal intubation (p=<0.05). Combined administration of esmolol (0.25 mg/kg) and nicardipine (15μg/kg) significantly attenuated the increase in blood pressure and heart rate during tracheal intubation compared to either drug alone.
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