Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2015.08.004
Brazilian Journal of Anesthesiology
Scientific Article

Effects of lidocaine and magnesium sulfate in attenuating hemodynamic response to tracheal intubation: single-center, prospective, double-blind, randomized study

Os efeitos da lidocaína e do sulfato de magnésio na atenuação da resposta hemodinâmica à intubação orotraqueal: estudo unicêntrico, prospectivo, duplamente encoberto e aleatorizado

Fabricio Tavares Mendonça; Lucas Macedo da Graça Medeiros de Queiroz; Cristina Carvalho Rolim Guimarães; Alexandre Cordeiro Duarte Xavier

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Abstract

Abstract Background and objectives: Hemodynamic response to airway stimuli is a common phenomenon and its management is important to reduce the systemic repercussions. The objective of this study is to compare the efficacy of intravenous magnesium sulfate versus lidocaine on this reflex hemodynamics after laryngoscopy and tracheal intubation. Methods: This single-center, prospective, double-blind, randomized study evaluated 56 patients ASA 1 or 2, aged 18-65 years, scheduled for elective surgeries under general anesthesia with intubation. The patients were allocated into two groups: Group F received 30 mg·kg-1 of magnesium sulphate and Group L, 2 mg·kg-1 of lidocaine, continuous infusion, immediately before the anesthetic induction. Blood pressure (BP), heart rate (HR), and bispectral index (BIS) were measured in both groups at six different times related to administration of the study drugs. Results: In both groups there was an increase in HR and BP after laryngoscopy and intubation, compared to baseline. Group M showed statistically significant increase in the values of systolic and diastolic blood pressure after intubation, which was clinically unimportant. There was no difference in the BIS values between groups. Among patients receiving magnesium sulfate, three (12%) had high blood pressure versus only one among those receiving lidocaine (4%), with no statistical difference. Conclusion: Magnesium sulfate and lidocaine have good efficacy and safety for hemodynamic management in laryngoscopy and intubation.

Keywords

Laryngoscopy, Tracheal intubation, Lidocaine, Magnesium sulphate, Cardiovascular physiological phenomena

Resumo

Resumo Justificativa e objetivos: A resposta hemodinâmica aos estímulos das vias aéreas é um fenômeno comum e seu controle é importante para diminuir as repercussões sistêmicas. O objetivo deste trabalho é comparar os efeitos da administração endovenosa de sulfato de magnésio versus lidocaína na hemodinâmica desse reflexo após a laringoscopia e intubação orotraqueal. Métodos: Este estudo duplamente encoberto, aleatorizado, unicêntrico e prospectivo avaliou 56 pacientes, ASA 1 ou 2, entre 18 e 65 anos, escalados para cirurgias eletivas sob anestesia geral com intubação orotraqueal. Foram alocados em dois grupos, o M recebeu 30 mg·kg-1 de sulfato de magnésio e o L, 2 mg·kg-1 de lidocaína, em infusão contínua, imediatamente antes da indução anestésica. Os valores de pressão arterial (PA), frequência cardíaca (FC) e índice biespectral (BIS) foram aferidos nos dois grupos em seis momentos relacionados com a administração dos fármacos do estudo. Resultados: Em ambos os grupos houve aumento na FC e PA após a laringoscopia e intubação, em relação aos valores basais. No Grupo M observou-se elevação estatisticamente significativa, mas clinicamente pouco importante, nos valores das pressões arteriais sistólica e diastólica após a intubação. Não houve diferença nos valores de BIS entre os grupos. Dos pacientes que receberam o sulfato de magnésio, 3 (12%) apresentaram episódio de hipertensão, ao passo que apenas um dos que receberam lidocaína (4%) apresentou esse sinal, sem diferença estatística. Conclusão: Sulfato de magnésio e a lidocaína apresentam boa eficácia e segurança no controle hemodinâmico à laringoscopia e intubação.

Palavras-chave

Laringoscopia, Intubação intratraqueal, Lidocaína, Sulfato de magnésio, Fenômenos fisiológicos cardiovasculares

References

Puri GD, Marudhachalam KS, Chari P. The effect of magnesium sulphate on hemodynamics and its efficacy in attenuating the response to endotracheal intubation in patients with coronary artery disease. Anesth Analg. 1998;87:808-11.

Fawcett WJ, Haxby EJ, Male EA. Magnesium: physiology and pharmacology. Br J Anaesth. 1999;83:302-20.

Panda NB, Bharti N, Prasad S. Minimal effective dose of magnesium sulfate for attenuation of intubation response in hypertensive patients. J Clin Anesth. 2013;25:92-7.

Vivancos GG, Klamt JG, Garcia LV. Efeito da utilização de 2 mg·kg-1 de lidocaína endovenosa na latência de duas doses diferentes de rocurônio e na resposta hemodinâmica à intubação traqueal. Rev Bras Anestesiol. 2011;61:1-12.

Kindler CH, Schumacher PG, Schneider MC. Effects of intravenous lidocaine and/or esmolol on hemodynamic responses to laryngoscopy and intubation: a double-blind, controlled clinical trial. J Clin Anesth. 1996;8:491-6.

Souza ACD, Alvarez MAP, Menezes MS. Bloqueio das alterações cardiocirculatórias provocadas pela laringoscopia e intubação traqueal: estudo comparativo entre fentanil e lidocaína venosa. Rev Bras Anestesiol. 1991;41:381-5.

Nooraei N, Dehkordi ME, Radpay B. Effects of intravenous magnesium sulfate and lidocaine on hemodynamic variables followingdirectlaryngoscopy and intubation in elective surgery patients. Tanaffos. 2013;12:57-63.

Oliveira CMB, Issy AM, Sakata RK. Lidocaína por via venosa intraoperatória. Rev Bras Anestesiol. 2010;60:325-33.

Finnerup NB, Biering-Sorensen F, Johannesen IL. Intravenous lidocaine relieves spinal cord injury pain: a randomized controlled trial. Anesthesiology. 2005;102:1023-30.

Paesano CR, González OM, Rodríguez B. Laringoscopia e intubación traqueal: uso de sulfato de magnesio para atenuar la respuesta cardiovascular refleja. Rev Ven Anestesiol. 1998;3:66-71.

Turlapaty PDMV, Carrier O. Influence of magnesium on calcium induced responses of atrial and vascular muscle. J Pharmacol Exp Ther. 1973;187:86-98.

Caro D. Pretreatment agents for rapid sequence intubation in adults. UpToDate. .

Choyce A, Avidan MS, Harvey A. The cardiovascular response to insertion of the intubating laryngeal mask airway. Anaesthesia. 2002;57:330-3.

Kihara S, Brimacombe J, Yaguchi Y. Hemodynamic responses among three tracheal intubation devices in normotensive and hypertensive patients. Anesth Analg. 2003;96:890-5.

Tong JL, Ashworth DR, Smith JE. Cardiovascular responses following laryngoscope assisted, fibreopticorotracheal intubation. Anaesthesia. 2005;60:754-8.

Xue FS, Liao X, Liu KP. The circulatory responses to tracheal intubation in children: a comparison of the oral and nasal routes. Anaesthesia. 2007;62:220-6.

Xue FS, Zhang GH, Sun HY. Blood pressure and heart rate changes during intubation: a comparison of direct laryngoscopy and a fibreoptic method. Anaesthesia. 2006;61:444-8.

Kerr ME, Rudy EB, Weber BB. Effect of short-duration hyperventilation during endotracheal suctioning on intracranial pressure in severe head-injured adults. Nurs Res. 1997;46:195-201.

Rudy EB, Turner BS, Baun M. Endotracheal suctioning in adults with head injury. Heart Lung. 1991;20:667-74.

Ramirez PC, Rodríguez B, Lengua M. Magnesio y Anesthesia. Rev Ven Anestesiol. 1996;1:32-40.

Figueredo E, Garcia-Fuentes EM. Assessment of the efficacy of esmolol on the haemodynamic changes induced by laryngoscopy and tracheal intubation: a meta-analysis. Acta Anaesthesiol Scand. 2001;45:1011-22.

Park SJ, Cho YJ, Oh JH. Pretreatment of magnesium sulphate improves intubating conditions of rapid sequence tracheal intubation using alfentanil, propofol, and rocuronium - a randomized trial. Korean J Anesthesiol. 2013;65:221-7.

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