Role of IV Nalbuphine in attenuation of haemodynamic response to laryngoscopy and endotracheal intubation (original) (raw)
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Low Dose Nalbuphine in Attenuation of Hemodynamic Responses to Laryngoscopy and Intubation – A Study
IOSR Journals , 2019
Various pharmacological interventions and methods have been tried to obtund the hemodynamic responses to laryngoscopy and intubation. A randomised, controlled, double blinded study was conducted in our centre on sixty adult patients scheduled for elective surgical procedures under general anaesthesia, randomised into two groups viz. Group A patients (100µg//kg nalbuphine intravenously) and Group B (150µg/kg nalbuphine intravenously), administered 5 minutes before induction. During laryngoscopy and endotracheal intubation, changes in the heart rate, systolic blood pressure, diastolic blood pressure and mean arterial blood pressure were recorded at baseline, after the study drug, at intubation, 1, 2, 3, 4, 5 and 10 minutes. An increase in the heart rate in group A from 89.10±3.58 to 98.46±2.96 beat per minute (10%), and in group B from 86.83± 2.83 beat per minute to 96.63±3.09 per minute (11%) was observed (p>0.05). A rise in systolic blood pressure during laryngoscopy and intubation compared to the baseline value i.e. 6% from baseline (p=0.01) was observed in both the groups. However, the mean arterial pressure (MAP) dropped from 95.55±2.43 to 87.60±2.46 mmHg (8%) in group A as compared to group B from 95.33±2.40 to 84.53±2.77mm Hg (11%) during intubation (p>0.05) but was significantly decreased when compared to the baseline in both the groups (p=0.02). It was concluded that nalbuphine in the two low doses effectively reduced tachycardia, hypertension associated with laryngoscopy and intubation. It also provided good intra operative haemodynamics and adequate post-operative analgesia.
Indian Journal of Clinical Anaesthesia
Laryngoscopy and intubation are noxious stimuli which result in marked sympathetic response. However, literature search did not reveal any study comparing nalbuphine and dexmedetomidine for attenuation of haemodynamic response to laryngoscopy and intubation. After Institutional Ethical Committee approval and written informed consent, 80 ASA I and II patients were randomised in two groups of 40 each. Group N received 0.2 mg/kg of nalbuphine; group D received 1 µg/kg dexmedetomidine over a period of 10 min. Anaesthesia was induced as per standard general anaesthesia practice. Haemodynamic parameters [Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), & Mean Arterial Pressure (MAP)] were recorded at baseline, 0, 1, 3, 5, 10, and 15 min following intubation. Patients were also observed for any side effects of the study drugs.There was a significant decrease (p<0.001) in mean HR in group D compared to group N, after administration of drug and 1 min after i...
Effect of nalbuphine and midazolam on haemodynamic response to intubation
Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2006
INTRODUCTION: Laryngoscopy and tracheal intubation produce stress response in the form of tachycardia, hypertens ion and increased levels of catecholamines.1,2, As the control of blood pressure and heart rate is of utmost importance to prevent the detrimental effects; there is a need for a safe and effective drug to attenuate the cardiovascular response to laryngoscopy and intubation. Nalbuphine and midazolam are inexpensive and most commonly used in our community as a premedicant. Our aim was to compare the effects of nalbuphine and midazolam on haemodymanic responses to endotracheal intubation to help the selection of a better drug in this respect. METHOD: After approval from the hospital committee a study was carried out on ninety adult male patients of ASA I or II status, undergoing general surgery under standard general anaesthesia. After informed consent, three groups of 30 patients each were made by random allocation. On arrival in the theatre, E.C.G monitor, pulse oximeter and Noninvasive blood pressure monitor were applied. After 3 minutes of preoxygenation, all groups were induced with thiopentone 4mg/kg and suxamathonium 1mg/kg. Group I was control in which 3ml of saline was given. Group II received nalbuphine 75ug/kg and Group III received midazolam 30ug/kg before the induction agents. Following intubation, anaesthesia was maintained with O2+N2O+halothane (0.8%). Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were recorded before induction, at laryngoscopy and intubation and after intubation every minute for three minutes. Concluding parameters were analysed statistically by ANOVA. p<0.05 was taken as significant. RESULTS: Demographic data showed similarity in age and weight between groups. Baseline values did not differ significantly between groups. A decrease in HR ,SBP, DBP, MAP was seen in Group II and III but the decrease was more pronounced in Group II.(p<0.05) DISCUSSION: The haemodynamic observations were noteworthy in our study. Significant attenuation of cardiovascular response to laryngoscopy and tracheal intubation was seen with nalbuphine and midazolam as compared to the control group. Analysis of haemodynamic response showed better suppression with nalbuphine than midazolam. The results of our study were consistent with previous study showing reduction in heart rate and systolic arterial pressure with nalbuphine as compared to other drugs.4 CONCLUSION: Our study results suggest that nalbuphine when used as premedicant, in dose of 75ug/kg is more effective than midazolam in blunting the stress response to laryngoscopy and intubation. We recommend its use in our settings before induction of anaesthesia. REFERENCES:
Journal of Applied Pharmaceutical Research
The Department of Anaesthesia at SPMC Bikaner approved the trial and it was carried out during laparoscopic surgery OT with proper informed written permission. The study was a double-blind, randomised, prospective interventional trial. The study comprised 60 (ASA) Classes I and II patients between the ages of 18 and 60 who were scheduled for elective laparoscopic cholecystectomy. Using a computer-generated random number sequence, patients were divided into two groups of 30 each: Group A received 1.5 mg/kg of clonidine, whereas Group B received.2 mg/kg of nalbuphine in a 50 ml NS solution. Prior to administering the study drug, five minutes after premedication, hemodynamic parameters were recorded. Double-blind administration of the study medication occurred more than 10 minutes before anaesthesia onset. Hemodynamic parameters were recorded following the administration of the study medication, 1 and 5 minutes after intubation, prior to pneumoperitoneum, 5 minutes, 10 minutes, 20 minu...
Journal of Evolution of medical and Dental Sciences, 2015
BACKGROUND: Endotracheal intubation is a most noxious stimuli in anaesthesia in form of tachycardia and hypertension. Many drugs have been tried to attenuate these adverse hemodynamic responses, but no ideal drug has been discovered. We compare the effect of fentanyl and nalbuphine on modifying the hemodynamic response to laryngoscopy and tracheal intubation. METHODS: Two randomly assigned groups of 40 patient each, aged 20-60 years, were scheduled for elective surgery receive Group 1 inj. Fentanyl 2ug/kg or GROUP 2 inj. Nalbuphine 0.2mg/kg iv 5min before laryngoscopy and intubation. Haemodynamic parameters and post-operative complications were recorded. RESULTS: Immediately after drug administration, the heart rate (HR) in group I decreased from basal value of 85.55±10.85bpm to 83.75±14.11bpm, in group II increased from basal value of 89.83±1.48bpm to 95.33±16.99bpm (p<0.05). The decrease in mean SBP was in both the groups, but more in group II. Immediately after drug administra...
IP Innovative Publication Pvt. Ltd., 2018
Aims: Hemodynamic changes caused by laryngoscopy, endotrachial intubation and creation of pneumoperitonium in laparoscopic surgeries is deleterious to patients. This study was done to compare nalbuphine an agonist antagonist opioid with fentanyl, a gold standard opioid, when used in patients undergoing laparoscopic appendectomy under general anesthesia. Materials and Methods: This study included 60 ASA I patients who underwent elective appendectomy were randomised to receive either nalbuphine 0.1mg/kg or fentanyl 2µg/kg as analgesics 5 minutes prior to intubation. Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were recorded at baseline and at every 2 minutes post intubation till the end of surgery. The time of laparoscopic port insertion and creation of pneumoperitonium was noted. Independent student‘t’ test and chi square test was used to analyse continuous variables and categorical variables respectively. Results: The changes in heart rate were comparable between both groups at all time points of observation. Nalbuphine and fentanyl group showed an increase in heart rate of 3.81% and 6.03% respectively. Mean arterial pressure was comparable at all time points of observation except at the time of insertion of second port wherein fentanyl group showed 12.70% increase as compared to 4.54% fall from baseline in nalbuphine group. Side effects were comparable between both groups except sedation which was significantly more in nalbuphine group and pruritus more in fentanyl group. Conclusion: Nalbuphine due to its availability without license is an effective alternative to fentanyl in laparoscopic surgeries. Keywords: Nalbuphine, Fentanyl, Hemodynamic response, Laparoscopic surgery.
The Professional Medical Journal, 2020
Laryngoscopy and tracheal intubation causes sympathetic over activity in the form of increased heart rate and blood pressure, which may lead to deleterious effects. Opioid drugs like fentanyl and nalbuphine are routinely used to attenuate this response during intubation. A few studies have claimed that acetaminophen is efficacious for this purpose too. Various studies have explored its role in blunting of pressor response but none have compared it with nalbuphine. We compared these drugs with the purpose, if both drugs are equally effective; acetaminophen would be a better alternative to nalbuphine without adverse effects of an opioid. Objectives: The objective of this study was to compare the efficacy of acetaminophen and nalbuphine in attenuating hemodynamic response during tracheal intubation. Study Design: Randomized, double-blind clinical trial. Setting: Main operation theatre complex of Fauji Foundation Hospital Rawalpindi. Period: From August to December 2018. Material & Meth...
2016
Background and aims: During general anaesthesia, maneuver of laryngoscopy and tracheal intubation is accompanied by varying degree of sympathetic stimulation. This may prove detrimental in patients with compromised cardiac and cerebrovascular reserve and hence many approaches have been tried to prevent the potentially adverse circulatory responses. In the present study, we compared dexmedetomidine with labetalol to assess and evaluate the haemodynamic responses to laryngoscopy and endotracheal intubation during induction of general anaesthesia and during extubation. Material and methods: This study was carried out in ninety patients who were posted for various surgeries requiring general anaesthesia with orotracheal intubation. They were allocated into three groups. Group D patients received 0.5mcg/kg dexmedetomidine, diluted to 5ml of 0.9% normal saline, group L received 0.25mg/kg labetalol diluted to 5 ml normal saline and group C received 5ml 0.9%normal saline. All study drugs were administered over 5 minutes followed by induction with IV Propofol 2mg/kg and suxamethonium 1.5 mg/kg. Maintenance of anaesthesia was done with 100% oxygen, sevoflurane and IV Atracurium. Haemodynamic monitoring of systolic and diastolic blood pressure, heart rate(HR), mean arterial pressure(MAP) were done. Calculation of rate pressure product(RPP) were done and all parameters were compared at intubation(I0), 1(I1), 3(I3), 5(I5), 10(I10) and 15(I15) minutes postintubation, intraoperatively and at extubation. Results: Group D and group L showed statistically significant fall in HR,SBP, DBP, MAP RPP at induction, at intubation(I0), I1, I3, I5, I10, I15 than group C(p<0.001). There were decrease in HR, SBP, RPP in group D than in group L (p<0.001), while at I10 and I15 fall in MAP was significant in group D(p<0.001). Group C showed incidence of tachycardia and hypertension to be 83% and 77% respectively. Group D showed bradycardia in three patients and hypotension in four out of thirty patients which were statistically insignificant when compared to group L.(p>0.05). Conclusion: The haemodynamic responses to laryngoscopy, endotracheal intubation and extubation are better controlled with dexmedetomidine than labetalol.
IP Innovative Publication Pvt. Ltd., 2018
Aims and Objectives: Propofol and etomidate are most frequently used intravenous induction agents, with very similar onset of action and duration of action, few advantages over each other and few unwanted effects. Recent studies and reintroduction of etomidate has paved way for its routine use in haemodynamically unstable patients. Materials and Methods: One hundred patients belonging to American Society of Anaesthesiologists (ASA) class I and II, aged between 18 to 60 years scheduled to undergo elective surgical procedure under general anaesthesia were selected. All the patients received tablet diazepam 0.2 mg/kg as premedication and fentanyl 2 mcg/kg body weight before induction. Patients were be randomly allocated to group P ((n = 50), who received propofol 2 mg/kg or group E (n = 50) who received, Etomidate 0.3 mg/kg as induction agent for general anaesthesia. Endotracheal intubation was facilitated by vecuronium 0.1mg/kg body weight. Heart rate (HR), Systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial blood pressure (MAP) were recorded at basal, after fentanyl, 1, 3, 5 and 10 min following induction. Results: There was no significant change in the heart rate at and after the induction, intubation in either group P or group E. There was significant decrease in SBP, DBP and MAP in group P following induction, whereas there was less decrease in Group E. There was increase in the SBP, DBP and MAP after intubation in both the groups, but in group P it did not increase above the basal and remained below the basal levels at 5 and 10 minutes following intubation. Conclusion: Etomidate provides stable haemodynamics at induction of general anaesthesia. But it does not attenuate the haemodynamic response to laryngoscopy and intubation. Propofol causes significant hypotension at induction and attenuates the pressor response to laryngoscopy and intubation. Keywords: Propofol, Etomidate, Haemodynamic, Laryngoscopy, Blood pressure.