Comparison of Nalbuphine and Midazolam on the cardiovascular response to Laryngoscopy and intubation (original) (raw)
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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:
Innovative Publication, 2016
Background: Laryngoscopy and endotracheal intubation evoke a haemodynamic response leading to increased heart rate and blood pressure. Purpose of present study was to evaluate the efficacy of Nalbuphine for attenuation of haemodynamic response to laryngoscopy and intubation. Methods: 120 patients belonging to ASA Grade I and II, posted for elective laparoscopic surgery under general anaesthesia were included in this double blind prospective randomised study. Patients were randomly allocated in two groups to receive either injection Nalbuphine IV 0.2mg/kg diluted to 5 ml with normal saline (Group N) or 5 ml normal saline (Group C), five minutes before induction. Monitoring of heart rate, systolic blood pressure, diastolic blood pressure and mean arterial blood pressure was done at laryngoscopy and endotracheal intubation and 1, 3, 5, 7 and 10 minutes after laryngoscopy and endotracheal intubation. Results: Increase in heart rate, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure in Group N was lower than in Group C. Conclusion: Intravenous Nalbuphine in the dose of 0.2 mg/kg appears to be a promising drug which can be used to attenuate the haemodynamic response to laryngoscopy and intubation.
GLOBAL JOURNAL FOR RESEARCH ANALYSIS
BACKGROUND AND AIM: Laryngoscopy & intubation are associated with tachycardia & hypertension. These hemodynamic changes are temporary & do not cause any complication in healthy person. But these changes can be detrimental to the patient with history of coronary artery disease and can facilitate and accelerate the development of myocardial ischemia, arrhythmias, infraction and also heart failure. The present study was designed to evaluate and study the efciency of intravenous midazolam, esmolol and their combination in the attenuation of cardiovascular response to laryngoscopy and intubation in normotensive individuals. METHOD: This randomized prospective double-blind study was performed on 90 patients of ASA physical status I and II undergoing various elective abdominal surgeries under general anaesthesia with endotracheal intubation. Patients were randomized in three groups, Group M (midazolam) 0.05mg/kg I.V, Group E (esmolol) 2mg/kg I.V and Group M/E (midazolam 0.05mg/kg + Esmolo...
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...
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.