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

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

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; Laryngoscopy; Lidocaine; Orotracheal intubation; Tachycardia.

Copyright © 2021 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

Figures

Figure 1
Figure 1
Times and moments of participant assessments. T1: Admission to operating room; T2: 2 minutes after IV administration of midazolam; T3: 3 minutes after induction of anesthesia; T4: 1 minute after Orotracheal Intubation (OTI); T5: 3 minutes after OTI; T6: 6 minutes after OTI.
Figure 2
Figure 2
Randomization flowchart.
Figure 3
Figure 3
Effects of intravenous administration of esmolol and lidocaine on heart rate. (A) Variation of heart rate over time. Both the (B) Area Under the Curve (AUC,) and the (C) positive incremental Area Under the Curve (piAUC) were calculated by trapezoidal integration of heart rate measurements over time.
Figure 4
Figure 4
Effects of intravenous administration of esmolol and lidocaine on mean arterial pressure. (A) Variation of mean arterial pressure over time. Both the (B) Area Under the Curve (AUC), and the (C) positive incremental Area Under Curve (piAUC) were calculated by trapezoidal integration of mean arterial pressure measurements over time.

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