Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.01.014
Brazilian Journal of Anesthesiology
Original Investigation

Effects of lidocaine and esmolol on hemodynamic response to tracheal intubation: a randomized clinical trial

Efeitos de lidocaína e esmolol na resposta hemodinâmica à intubação traqueal: ensaio clínico randomizado

Fabrício Tavares Mendonça; Samuel Laurindo da Silva; Tiago Maurmann Nilton; Igor Reis Rodrigues Alves

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Abstract

Introduction and objectives: Although lidocaine is widely used to prevent cardiovascular changes resulting from laryngoscopy and orotracheal intubation, it is still unclear whether there are more efficacious drugs. This study aimed to compare the beta-blocker esmolol with lidocaine regarding the effects on hemodynamic response after orotracheal intubation.

Methods: The study has a prospective, randomized, double-blind, superiority design, and assessed 69 participants between 18 and 70 years of age, ASA I-II, scheduled for elective or emergency surgery under general anesthesia with orotracheal intubation. Participants were randomly allocated to receive 1.5 mg.kg-1 esmolol bolus followed by 0.1 mg.kg-1.min-1 esmolol infusion (n = 34) or 1.5 mg.kg-1 lidocaine bolus followed by 1.5 mg.kg-1.h-1 lidocaine infusion (n = 35). We recorded changes in heart rate, arterial blood pressure and incidence of adverse events.

Results: Post-intubation tachycardia episodes were significantly less frequent in the esmolol group (5.9% vs. 34.3%; Relative Risk (RR) 0.17; 95% Confidence Interval (95% CI) 0.04-0.71; Number Needed to Treat (NNT) 3.5; p = 0.015. After orotracheal intubation, mean heart rate was significantly lower in the esmolol group (74.5 vs. 84.5, p = 0.006). Similar results were observed in the subsequent 3 and 6 minutes (75.9 vs. 83.9, p = 0.023 and 74.6 vs. 83.0, p = 0.013, respectively).

Conclusion: Esmolol was a safe and more effective intervention to reduce incidence of tachycardia and control heart rate immediately after tracheal intubation when compared to lidocaine.

Keywords

Esmolol, Orotracheal intubation, Laryngoscopy, Lidocaine, Tachycardia

Resumo

Justificativa e objetivos: Apesar de a lidocaína ser amplamente empregada na prevenção de alterações cardiovasculares decorrentes da laringoscopia e intubação orotraqueal, ainda não está claro se outros medicamentos são mais eficazes. Este estudo objetivou comparar os efeitos do betabloqueador esmolol com aqueles da lidocaína na resposta hemodinâmica após intubação orotraqueal.

Métodos: Estudo prospectivo, randomizado, duplo-cego, de superioridade envolvendo 69 pacientes entre 18 e 70 anos, ASA I-II, escalados eletiva ou urgencialmente para a realização de cirurgias sob anestesia geral com programação de intubação orotraqueal. Os pacientes foram alocados aleatoriamente para receber esmolol 1,5 mg.kg-1 seguido de 0,1 mg.kg-1.min-1 (n= 34) ou lidocaína 1,5 mg.kg-1 seguido de 1,5 mg.kg-1.h-1 (n = 35). Variações de frequência cardíaca, pressão arterial e incidência de eventos adversos foram registrados.

Resultados: Os episódios de taquicardia após intubação foram significativamente menos frequentes no grupo esmolol (5,9% vs. 34,3%; risco relativo (RR) 0,17; intervalo de confiança de 95% (IC 95%) 0,04 a 0,71; número necessário para tratar (NNT) 3,5; p = 0,015). Após intubação orotraqueal, a média da frequência cardíaca foi significativamente menor no grupo do esmolol (74,5 vs. 84,5, p = 0,006). Resultados semelhantes foram observados nos 3 e 6 minutos subsequentes (75,9 vs. 83,9, p = 0,023 e 74,6 vs. 83,0, p = 0,013, respectivamente).

Conclusão: O esmolol demonstrou ser uma intervenção igualmente segura e mais eficaz na redução da incidência de taquicardia, no controle da frequência cardíaca imediatamente após a intubação comparado à lidocaína.

Palavras-chave

Esmolol, Intubação orotraqueal, Laringoscopia, Lidocaína, Taquicardia

References

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Submitted date:
08/27/2019

Accepted date:
01/25/2021

6154a235a95395537c5f4fa2 rba Articles

Braz J Anesthesiol

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