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Which is responsible for the haemodynamic response due to laryngoscopy and endotracheal intubation? Catecholamines, vasopressin or angiotensin?

Published online by Cambridge University Press:  15 September 2005

Z. Kayhan ,
D. Aldemir ,
H. Mutlu  and
E. Öğüş
Z. Kayhan
Affiliation:
Başkent University, Faculty of Medicine, Department of Anaesthesiology, Ankara, Turkey
D. Aldemir
Affiliation:
Başkent University, Faculty of Medicine, Department of Biochemistry, Ankara, Turkey
H. Mutlu
Affiliation:
Başkent University, Faculty of Medicine, Department of Anaesthesiology, Ankara, Turkey
E. Öğüş
Affiliation:
Başkent University, Faculty of Medicine, Department of Biostatistics, Ankara, Turkey
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Extract

Summary

Background and objective: We have investigated the concentrations of epinephrine, norepinephrine, vasopressin and angiotensin converting enzyme activity to explore the role of these mediators in the neuroendocrine response to laryngoscopy and tracheal intubation. Methods: One hundred (50 male, 50 female) ASA I patients aged 20–50 yr (mean ± SEM; 35.59 ± 0.99) were included in the study. They were undergoing elective surgery under standard anaesthesia induction and maintenance using tracheal intubation. Plasma concentrations of epinephrine, norepinephrine and vasopressin as well as plasma angiotensin converting enzyme activity were determined at four time points, before (T1) and after (T2) induction, and 2 (T3) and 5 min (T4) after intubation. Blood pressure and heart rate were recorded at corresponding times to reveal if any correlation existed between haemodynamic parameters and neuroendocrine response. Results: Heart rate increased after induction and intubation (P < 0.05) and decreased significantly at T4 (P < 0.05). Systolic blood pressure decreased significantly (P < 0.05) after induction and increased slightly after intubation decreasing to below baseline value (P < 0.05) at T4. Diastolic blood pressure increased slightly after intubation and decreased significantly (P < 0.05) at T4. Plasma epinephrine and norepinephrine concentrations decreased after induction and increased at T3 and T4 without reaching significance. Vasopressin concentrations increased slightly at T2 and T3 and decreased significantly at T4 (P < 0.05). Angiotensin converting enzyme activity was unaffected when compared with baseline values. Conclusions: Blood pressure, heart rate, plasma epinephrine, norepinephrine and vasopressin concentrations increased slightly in response to laryngoscopy and intubation, all returning to or below baseline 5 min later with no change in angiotensin converting enzyme activity in normotensive patients.

Keywords

LARYNGOSCOPY, complicationsINTUBATION, INTRATRACHEALHAEMODYNAMIC PHENOMENA, blood pressureCATECHOLAMINES, epinephrine, norepinephrineVASOPRESSINSRENIN–ANGIOTENSIN SYSTEM
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 10 , October 2005 , pp. 780 - 785
Copyright
© 2005 European Society of Anaesthesiology

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References

Lasocki S, Iglarz M. Involvement of renin–angiotensin system in pressure–flow relationship. Anesthesiology 2002; 96: 261–263.Google Scholar
Colson P, Ryckwaert F, Coriat P. Renin–angiotensin system antagonists and anesthesia. Anesth Analg 1999; 89: 1143–1155.Google Scholar
McCarthy GJ, Hainsworth M, Lindsay K et al. Pressor responses to tracheal intubation after sublingual captopril. Anaesthesia 1990; 45: 243–245.Google Scholar
Matsukawa K, Ninomiya I, Nishiura N. Effects of anesthesia on cardiac and renal sympathetic nerve activities and plasma catecholamines. Am J Physiol 1993; 265: R793.Google Scholar
Mikawa K, Nishina K, Maekawa N, Obara H. Comparison of nicardipine, diltiazem and verapamil for controlling the cardiovascular responses to tracheal intubation. Br J Anaesth 1996; 76: 221–226.Google Scholar
Stoelting RK. Circulatory changes during direct laryngoscopy and tracheal intubation: influence of duration of laryngoscopy with or without prior lidocaine. Anesthesiology 1977; 47: 381–383.Google Scholar
Randell T. Hemodynamic responses to intubation: what more do we have to know? Acta Anaesthesiol Scand 2004; 48: 393–397.Google Scholar
Kautto U-M. Attenuation of the circulatory response to laryngoscopy and intubation by fentanyl. Acta Anaesthesiol Scand 1982; 26: 217–221.Google Scholar
Russel WJ, Morris RG, Frewin DB, Drew SE. Changes in plasma catecholamine concentration during endotracheal intubation. Br J Anaesth 1981; 53: 837–839.Google Scholar
Pernerstrorfer T, Krafft P, Fitzgerald RD et al. Stress response to tracheal intubation: direct laryngoscopy compared with blind oral intubation. Anaesthesia 1995; 50: 17–22.Google Scholar
Zalunardo MP, Zollinger A, Spahn DR et al. Effect of intravenous and oral clonidine on hemodynamic and plasma-catecholamine response dues to endotracheal intubation. J Clin Anesth 1997; 9: 143–147.Google Scholar
Colson P, Ryckwaert F, Coriat P. Renin angiotensin system antagonists and anesthesia. Anesth Analg 1999; 89: 1143–1155.Google Scholar
Barak M, Ziser A, Greenberg A, Lischinsky S, Rosenberg B. Hemodynamic and catecholamine response to tracheal intubation: direct laryngoscopy compared with fiberoptic intubation. J Clin Anaesth 2003; 15: 132–136.Google Scholar
McCoy EP, Mirakhur RK, McCloskey BV. A comparison of the stress response to laryngoscopy. The Macintosh versus the McCoy blade. Anaesthesia 1995; 50: 943–946.Google Scholar
Derbyshire DR, Chmielewski A, Fell D, Vater M, Acola KJ, Smith G. Plasma catecholamine responses to tracheal intubation. Br J Anaesth 1983; 55: 855–860.Google Scholar
Weatherill D, Spence AA. Anaesthesia and disorders of the adrenal cortex. Br J Anaesth 1984; 56: 741–749.Google Scholar
Zalunardo MP, Zollinger A, Spahn DR et al. Preoperative clonidine attenuates stress response during emergence from anesthesia. J Clin Anesth 2000; 12: 343–349.Google Scholar
Courneya CA, Korner PI. Neurohumoral mechanisms and the role of arterial baroreceptors in the reno-vascular response to hemorrhage in rabbits. J Physiol 1991; 437: 393–407.Google Scholar
Novak-Jankovic V, Paver-Eren V, Bovill JG, Ihan A, Osredkar J. Effect of epidural and intravenous clonidine on the neuroendocrine and immune stress response in patients undergoing lung surgery. Eur J Anaesthesiol 2000; 17: 50–56.Google Scholar
Boldt J, Papsdorf M, Uphus D, Müller M, Hempelmann G. Changes in regulators of the circulation in patients undergoing lung surgery. Br J Anaesth 1997; 79: 733–739.Google Scholar
Höhne C, Meier L, Boemke W, Kaczmarczyk G. ACE inhibition does not exaggerate the blood pressure decrease in the early phase of spinal anaesthesia. Acta Anaesthesiol Scand 2003; 47: 891–896.Google Scholar