British Journal of Anaesthesia, Vol 76, Issue 2 221-226, Copyright © 1996 by The Board of Management and Trustees of the British Journal of Anaesthesia
K. Mikawa, K. Nishina, N. Maekawa and H. Obara
We have compared the efficacy of three calcium channel blockers,
nicardipine, diltiazem and verapamil, in attenuating the cardiovascular
responses to laryngoscopy and intubation in 60 normotensive patients (ASA
I) undergoing rapid sequence induction of anaesthesia with thiopentone and
fentanyl. We also examined whether or not these blockers inhibited
catecholamine release induced by intubation. The patients were allocated to
one of four groups (n = 15 for each): saline (control), nicardipine 30
micrograms kg-1, diltiazem 0.2 mg kg-1 or verapamil 0.1 mg kg-1. Verapamil
and the three other drugs were administered 45 s and 60 s before the start
of direct laryngoscopy, respectively, in a double-dummy design. Anaesthesia
was induced with thiopentone 4 mg kg-1 i.v. and fentanyl 2 micrograms kg-1
i.v. Tracheal intubation was facilitated with vecuronium 0.2 mg kg-1.
During anaesthesia, ventilation was assisted or controlled with 1%
isoflurane and 50% nitrous oxide in oxygen. Laryngoscopy lasting 30 s was
attempted 2 min after administration of thiopentone and vecuronium.
Patients receiving saline exhibited significant increases in systolic and
diastolic arterial pressures (AP), heart rate (HR) and plasma
concentrations of catecholamines associated with tracheal intubation. The
increase in AP was attenuated in patients treated with any calcium channel
blocker. The greatest effect was elicited by verapamil, which attenuated
the increase in HR, although nicardipine seemed to enhance tachycardia. All
three drugs failed to suppress the increase in plasma catecholamine
concentrations in response to tracheal intubation. These findings suggest
that bolus injection of verapamil 0.1 mg kg-1 was a more effective method
of controlling hypertension and tachycardia associated with intubation than
diltiazem 0.2 mg kg-1 or nicardipine 30 micrograms kg-1, and that these
prophylactic effects were not caused by inhibition of the catecholamine
response.
CLINICAL INVESTIGATIONS
Comparison of nicardipine, diltiazem and verapamil for controlling the cardiovascular responses to tracheal intubation
Department of Anaesthesiology, Kobe University School of Medicine, Kusunoki-cho 7, Chuo-ku, Kobe, 650, Japan
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