Document Detail

A comparative study of five different techniques to reduce left ventricular dysfunction during endotracheal intubation.
MedLine Citation:
PMID:  1785239     Owner:  NLM     Status:  MEDLINE    
Thirty-five non-selected, consenting patients were studied during induction of anesthesia before coronary artery bypass grafting. Anesthesia was induced with diazepam, thiopentone and fentanyl, followed by pancuronium. Before induction, 200 MBq Tc 99 m - HSA was given i.v. and ejection fraction (EF) of the left ventricle was measured with a collimated single-crystal probe. The patients were allocated to five groups (seven patients in each) treated with: Group A: nitroglycerin i.v. bolus 4 micrograms x kg-1 given 30-60 s before laryngoscopy; Group B: nitroglycerin i.v. in continuous infusion, 1 micrograms x kg-1 x min-1 started before induction; Group C: two-stage topical anesthesia of the vallecula region and larynx with lidocain; Group D: a combination of nitroglycerin and topical anesthesia (as in Group B and C); and Group E: propranolol i.v. 0.01 mg x kg-1 given 5 min before intubation. All groups reacted in the same way during induction of anesthesia up to the point of laryngoscopy. End-diastolic volume and systemic arterial pressure decreased while cardiac index remained unchanged and EF increased. During laryngoscopy and intubation, however, differences between the groups were evident. Nitroglycerin i.v. as a bolus effectively prevented a reduction in EF and an increase in left ventricular volume. In addition to these beneficial hemodynamic effects, there was a moderate increase in heart rate and a reduction of stroke index. Continuous infusion of nitroglycerin and propranolol i.v. had no effect, since EF fell and left ventricular volume increased. Patients receiving topical anesthesia demonstrated a blunted response to endotracheal intubation with a moderate decrease in EF and an unchanged (Group C) or slightly increased (Group D) left ventricular volume.
G Dahlgren; G Settergren; G Ohqvist; L A Brodin
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Acta anaesthesiologica Scandinavica     Volume:  35     ISSN:  0001-5172     ISO Abbreviation:  Acta Anaesthesiol Scand     Publication Date:  1991 Oct 
Date Detail:
Created Date:  1992-03-16     Completed Date:  1992-03-16     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370270     Medline TA:  Acta Anaesthesiol Scand     Country:  DENMARK    
Other Details:
Languages:  eng     Pagination:  609-15     Citation Subset:  IM    
Department of Cardiothoracic Anaesthetics, Karolinska Hospital, Stockholm, Sweden.
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MeSH Terms
Anesthesia, Local*
Cardiac Output, Low / drug therapy,  etiology*
Infusions, Intravenous
Injections, Intravenous
Intubation, Intratracheal / adverse effects*
Larynx / drug effects
Middle Aged
Nitroglycerin / administration & dosage,  therapeutic use*
Pharynx / drug effects
Trachea / drug effects
Ventricular Function, Left / physiology*
Reg. No./Substance:
137-58-6/Lidocaine; 525-66-6/Propranolol; 55-63-0/Nitroglycerin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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