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Pharmacological agents for preventing morbidity associated with the haemodynamic response to tracheal intubation

Creator:

Khan, F.A. and Ullah, H.

Subject Keywords: The primary objective of this review was to determine the effectiveness of pharmacological agents in preventing the morbidity and mortality resulting from the haemodynamic changes in response to laryngoscopy and tracheal intubation in adult patients aged 18 years and above who were undergoing elective surgery in the operating room setting
Type: Article
Region: International (other)
Description:

During general anaesthesia, a tube may be inserted into the trachea (windpipe) using an instrument called a laryngoscope in order to safely deliver oxygen and anaesthetic gases and to remove carbon dioxide. This procedure is known as laryngoscopy and tracheal intubation. It initiates a reflex response (the haemodynamic response to intubation) of an increase in blood pressure and heart rate. Several drugs in varied doses and by different routes have been used to blunt or prevent this response in order to prevent serious complications for the heart and the brain, which may even be fatal. This is because the increase in blood pressure and heart rate may put undue stress on the heart and the brain circulation. In some patients it may lead to abnormal heart rhythm (arrhythmias) and lack of oxygen to the heart muscle (myocardial ischaemia) resulting in changes in recorded electrical activity of the heart (shown on the electrocardiogram (ECG)), heart failure, or stroke. In spite of several studies on the use of drugs to suppress this response, it remains unclear what the best drugs to use are and in what dosages.

We included adult patients aged 18 years and above undergoing elective surgery in the operating room setting. We found that the effects of drugs on the stress response was the subject of 72 studies. The investigators used 32 drugs. Promising results were seen in the reduction of arrhythmias with intravenous injections of beta blockers (drugs that decrease the heart rate), narcotics (drug used to treat pain), local anaesthetics, and calcium channel blockers (drugs that block movement of calcium). Serious side effects were only reported with high doses of narcotics and an increase in airway pressure was seen in some patients with beta blockers. Only local anaesthetic drugs clearly reduced the risk of myocardial ischaemia but this evidence came from only one trial.

There was some difficulty in comparing and interpreting the results of these different trials. Patients at a high risk of complications were investigated in 17 trials. A reduction in arrhythmias with treatment was seen in this high risk group but the number of studies was too small to reach a conclusion. Doctors need to further research the effects of drugs used for blunting the haemodynamic response and their effect on outcomes in terms of morbidity, in a standardized manner.

Date:

03/07/2013

Rights: © The Cochrane Collaboration
Suggested citation:

Khan, F.A. and Ullah, H.. (2013) Pharmacological agents for preventing morbidity associated with the haemodynamic response to tracheal intubation [Online]. Available from: http://publichealthwell.ie/node/529402 [Accessed: 21st August 2019].

  

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