Document Detail


A comparison of alfentanil, esmolol, lidocaine, and thiopental sodium on the hemodynamic response to insertion of headrest skull pins.
MedLine Citation:
PMID:  8695076     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY OBJECTIVES: To compare the effects of four techniques for preventing or blunting the hypertensive response to the insertion of Mayfield headrest skull pins: intravenous (IV) alfentanil (ALF), esmolol (ESM), thiopental sodium (TPL), and local anesthesia using plain lidocaine (Xylocaine; XYL). DESIGN: Randomized open study. PATIENTS: 40 adult patients undergoing intracranial or spinal surgery requiring the use of Mayfield headrest skull pins for head positioning and immobilization. INTERVENTIONS: 20 minutes after anesthetic induction, and 2 to 3 minutes prior to the insertion of headrest skull pins, one of three drugs was administered IV: ALF 10 mcg/kg, ESM 1 mg/kg, or TPL 1.5 mg/kg. The fourth drug, XYL, was administered by injection into the scalp. MEASUREMENTS AND MAIN RESULTS: Blood pressure and heart rate (HR) were recorded immediately prior to and after pin insertion with balanced general anesthesia, and at 30, 60, 120, and 180-second intervals after pin insertion. The measurements were compared with the immediate preinsertion values. In the ALF and XYL groups, there was no significant increase in mean arterial pressure (MAP) or HR for any of the measurement periods. MAP was elevated immediately on pin insertion and for up to 2 minutes in the TPL group, and for up to 3 minutes in the ESM group (p < 0.05). HR changes were seen in the TPL group for up to one minute (p < 0.05). Increases in systolic blood pressure were seen in the TPL and ESM groups for up to 3 minutes, and in diastolic blood pressure for up to 2 minutes (p < 0.05). No other significant changes were observed. CONCLUSIONS: IV ALF and local injection of XYL in the scalp prevent the hemodynamic response to the insertion of skull pins in anesthetized patients. Neither ESM nor TPL prevented the hypertensive response. Local anesthetic injection into the scalp requires coordination between the anesthesiologist and surgeon, it carries the risk of needle stick injury, and it must be repeated if the surgeon repositions the headrest. The rapid onset and short half-life of ALF, coupled with the absence of hemodynamic effects at the dose used, makes this drug an alternative to the use of XYL injection.
Authors:
D D Doblar; Y C Lim; N Baykan; L Frenette
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of clinical anesthesia     Volume:  8     ISSN:  0952-8180     ISO Abbreviation:  J Clin Anesth     Publication Date:  1996 Feb 
Date Detail:
Created Date:  1996-09-04     Completed Date:  1996-09-04     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8812166     Medline TA:  J Clin Anesth     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  31-5     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology, University of Alabama, Birmingham 35233, USA.
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists
Adult
Alfentanil
Anesthesia, Intravenous*
Anesthetics, Intravenous
Anesthetics, Local
Blood Pressure / drug effects
Heart Rate / drug effects
Hemodynamics / drug effects,  physiology*
Humans
Lidocaine
Middle Aged
Orthopedic Fixation Devices*
Propanolamines
Skull / surgery*
Spine / surgery
Thiopental
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Anesthetics, Intravenous; 0/Anesthetics, Local; 0/Propanolamines; 137-58-6/Lidocaine; 71195-58-9/Alfentanil; 76-75-5/Thiopental; 84057-94-3/esmolol

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


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