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British Journal of Anaesthesia, 1994, Vol. 73, No. 3 303-308
© 1994 The Board of Management and Trustees of the British Journal of Anaesthesia

research-article

Does the choice of antihypertensive therapy influence haemodynamic responses to induction, laryngoscopy and intubation ?{dagger}

J. W. SEAR, MA, BSC, PHD, FRCA, C. JEWKES, MB, BS, FRCA, J.-C. TELLEZ, MD and P. FOËX, MD, DPHIL, FRCA

Nuffield Department of Anaesthetics, University of Oxford, John Radcliffe Hospital Headington, Oxford OX3 9DU

Correspondence to J. W. S.

We have measured haemodynamic responses to induction of anaesthesia, laryngoscopy and intubation in 103 mild-moderate hypertensive patients (83 patients (diastolic pressures ≤ 110 mm Hg) currently receiving one of four monotherapies (ACE inhibitors, group A; ß adrenoceptor blocking drugs, group B; calcium channel antagonists, group C; diuretics, group D) and 24 were untreated hypertensive patients). Anaesthesia was induced with fentanyl 1.5–2.0 µg kg–1 and thiopentone 3–5 mg kg–1. Tracheal intubation was facilitated by vecuronium 0.1 mg kg–1 and anaesthesia maintained with enflurane and nitrous oxide in oxygen. Systolic and diastolic pressures (SAP, DAP) were measured at 1-min intervals by a noninvasive oscillometric method and cardiac output (CO) and stroke volume (SV) by thoracic bioimpedance. Induction of anaesthesia was associated with a decrease in SAP, DAP and CO in groups A-D (P < 0.05). Heart rate (HR) decreased in groups A and D (P < 0.01) and systemic vascular resistance (SVR) decreased in groups A and B (P < 0.05). SAP and HR increased in all groups after laryngoscopy and intubation (P < 0.01) as did SVR in groups A, B and D (P < 0.02). CO was unaltered. Similar changes occurred in the untreated hypertensive patients, although nine of 24 patients exhibited HR i 100 beat mm–1 after laryngoscopy and intubation. Comparison of the changes in SAP, DAP, CO and SVR with time showed no differences in the five treatment groups; changes in HR were significantly less in group B compared with the other groups (P < 0.01). We conclude that the pressor responses to laryngoscopy and intubation are unaffected by concurrent medication in mild-moderate hypertensive patients and changes of a similar magnitude are observed also in untreated hypertensive patients.

{dagger} Presented in part at the 12th Meeting of the European Academy of Anaesthesiology, Cardiff, September 1990 and published in abstract form (Sear JW, Jewkes C, Sanders DJ, Foëx P. Does the choice of antihypertensive therapy matter? European Journal of Anaesthesiology 1991; 8: 414–415).


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