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
Abstract
Keywords
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.
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References
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Submitted date:
08/27/2019
Accepted date:
01/25/2021
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