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Modification of the haemodynamic responses to induction of anaesthesia and tracheal intubation with alfentanil, esmolol and their combination

Abstract

The purpose of this double-blind randomized work was to study the effect of alfentanil and esmolol and their half-dose combination on the increases of heart rate and arterial pressure and on the prolongation of the QTc interval of the ECG occurring during anaesthetic induction. Sixty ASA class I– II patients with mean age ranging from 26 to 32 yr among the groups. Patients were allocated to one of four equal groups to receive saline, esmolol 2 mg · kg− 1, alfentanil 0.03 mg · kg− 1 and alfentanil 0.015 mg · kg− 1 + esmolol 1 mg · kg− 1. Anaesthesia was induced with thiopentone. Succinylcholine was used to facilitate tracheal intubation. Haemodynamic variables were measured non-invasively and the QTc interval with the aid of a microcomputer. Comparisons between the groups were performed using two-way analysis of variance with repeated measures. Both alfentanil and alfentanil-esmolol prevented the increase of heart rate and arterial pressure caused by intubation whereas esmolol prevented only the increase of the heart rate. None of the treatments prevented prolongation of the QTc interval after intubation and only alfentanil prevented that after succinylcholine. The present results suggest that in the prevention of the haemodynamic responses to tracheal intubation, the half-dose combination of alfentanil and esmolol is as effective as alfentanil and superior to esmolol. The combination is preferable to relatively large doses of either drug in circumstances where side effects, such as respiratory depression due to alfentanil or bradycardia due to both drugs should be minimized.

Résumé

Ce travail randomisé en double-aveugle avail pour but l’étude des effets de l’association de l’alfentanil avec l’esmolol à demidoses sur l’augmentation de la fréquence cardiaque et de la pression artérielle, et sur la prolongation de l’intervalle QTc de l’ECG pendant l’induction de l’anesthésie. Soixante patients ASA I et II dont la moyenne d’âge variait entre 25 et 32 ans ont fait partie de l’étude. Ces patients ont été répartis en quatre groupes pour recevoir respectivement: du soluté physiologique, de l’esmolol 2 mg · kg− 1, de l’alfentanil 0,03 mg · kg− 1, et de l’alfentanil 0,015 mg · kg− 1 + esmolol 1 mg · kg− 1. L’anesthésie a été induite au thiopentone. La succinylcholine a été utilisée pour l’intubation. Les paramètres hémodynamiques ont été enregistrés par voie non effractive et l’intervalle QTc grâce à un microordinateur. Les comparaisons ont été établies sur des mesures répétées par analyse de variance. L’alfentanil et l’alfentanil + esmolol ont empêché l’augmentation de la fréquence cardiaque et de la pression artérielle causée par l’intubation alors que l’esmolol n’a été efficace sur l’augmentation de la fréquence cardiaque. Aucun des traitements n’a été efficace pour la prévention de la prolongation de l’intervalle QTc après l’intubation et seul l’alfentanil l’a été après la succinylcholine. Ces résultats suggèrent que pour prévenir les effets hémodynamiques de l’intubation, une demidose d’esmolol avec alfentanil est aussi efficace que l’alfentanil et supérieure à l’esmolol. Cette association est préférable à des doses relativement plus fortes de chacune des drogues dans les circonstances au cours desquelles les effets secondaires comme la dépression respiratoire due à l’alfentanil ou la bradycardie due awe deux drogues doivent être réduites au minimum.

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Correspondence to R. Korpinen.

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Korpinen, R., Saarnivaara, L., Siren, K. et al. Modification of the haemodynamic responses to induction of anaesthesia and tracheal intubation with alfentanil, esmolol and their combination. Can J Anaesth 42, 298–304 (1995). https://doi.org/10.1007/BF03010706

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Key words

  • anaesthesia: induction
  • analgesics: alfentanil
  • intubation: complications
  • sympathetic nervous system: beta adrenergic antagonists, esmolol