Korean J Anesthesiol.  1998 Dec;35(6):1061-1067. 10.4097/kjae.1998.35.6.1061.

Effects of both Clonidine Premedication and Esmolol Administration on the Hemodynamic Changes by Tracheal Intubation

• Lim JM
• Kim HK
• Chung CK

• KMID: 2237619
• DOI: http://doi.org/10.4097/kjae.1998.35.6.1061

Abstract

BACKGROUND: Tracheal intubation by direct laryngoscopy induces frequently transient hypertension, tachycardia and arrhythmia. The purpose of this study was to examine the effect of esmolol and clonidine in attenuating the changes of blood pressure and heart rate by tracheal intubation.
METHODS
Eighty patients were randomly divided into four groups: Group 1 (control , n=20), Group 2 (esmolol 0.5 mg/kg IV, n=20), Group 3 (clonidine 4 mcg/kg PO, n=20) and Group 4 (clonidine 4 mcg/kg PO and esmolol 0.5 mg/kg IV, n=20). The clonidine premedication were given orally with a sip of water 90 minutes before induction of anesthesia. Anesthesia was induced with thiopental 5 mg/kg, vecuronium 0.1 mg/kg, 50% nitrous oxide in oxygen and 2 vol % enflurane. After 5 minutes, tracheal intubation was performed. Patients in the group 2 and group 4 were given esmolol 0.5 mg/kg 90 seconds prior to tracheal intubation. Blood pressure and heart rate were measured at ward, preinduction, preintubation, immediately after intubation, 1, 3 and 5 minutes after intubation.
RESULTS
After tracheal intubation, the increase in systolic blood pressure was supressed significantly in the clonidine-treated patients (Group 3, Group 4) compared with control group (p<0.05). The attenuating effect on increase of mean arterial pressure(MAP) was sustained longer in group 4 than group 3. Heart rate increased after tracheal intubation in all groups, but were markedly increased in the control group (p<0.05). The differences of MAP which measured at preinduction and immediately postintubation were smaller in group 4 than control group (p<0.05). The differences of heart rate which measured at preinduction and immediately postintubation were smaller in group 4 than group 1 or group 3 (p<0.05).
CONCLUSIONS
Esmolol 0.5 mg/kg given as bolus, is effective for controlling the increase of heart rate but not in attenuating increase of blood pressure. Oral clonidine is effective for controlling the increase of blood pressure but not in attenuating increase of heart rate. Therefore esmolol combined with oral clonidine results in effective control of both heart rate and blood pressure.

Keyword

Intubation, tracheal, complications; Phamacology, clonidine, esmolol

MeSH Terms

Anesthesia
Arrhythmias, Cardiac
Blood Pressure
Clonidine*
Enflurane
Heart Rate
Hemodynamics*
Humans
Hypertension
Intubation*
Laryngoscopy
Nitrous Oxide
Oxygen
Premedication*
Tachycardia
Thiopental
Vecuronium Bromide
Water
Clonidine
Enflurane
Nitrous Oxide
Oxygen
Thiopental
Vecuronium Bromide
Water