Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942013000300001
Brazilian Journal of Anesthesiology
Scientific Article

Efeitos de esmolol, lidocaína e fentanil nos intervalos dispersão da onda P, QT, QTc e respostas hemodinâmicas à intubação endotraqueal durante indução com propofol: um estudo comparativo

Effects of esmolol, lidocaine and fentanyl on P wave dispersion, QT, QTc intervals and hemodynamic responses to endotracheal intubation during propofol induction: a comparative study

Volkan Hancı; ; Serhan Yurtlu; Turgut Karabağ; ; Dilek Okyay; Sedat Hakimoğ; lu; Gülay Kayhan; Çağ; atay Büyükuysal; Hilal Ayoğ; lu; Iş; ı; l Özkoçak Turan

http://dx.doi.org/10.1590/S0034-70942013000300001 Braz J Anesthesiol, vol.63, n3, p.235-244, 2013
PDF Português
PDF English
Downloads: 0
Views: 1203

Resumo

JUSTIFICATIVA E OBJETIVOS: Investigar o efeito de esmolol, lidocaína e fentanil na dispersão da onda P (DP), durações dos intervalos QT e QT corrigido (QTc) e as respostas hemodinâmicas à intubação endotraqueal durante a indução com propofol. MÉTODOS: Foram incluídos 80 pacientes adultos, estado físico ASA I ou II, idade entre 18 e 60 anos, neste estudo prospectivo, randômico e duplo-cego. Todos os pacientes foram submetidos a exame eletrocardiográfico (ECG) antes da indução da anestesia. Os pacientes foram randomicamente alocados em quatro grupos iguais. O grupo controle (Grupo C) recebeu 5 mL de solução salina; o grupo esmolol (Grupo E) recebeu 0,5 mg.kg-1 de esmolol; o grupo fentanil (Grupo F) recebeu 2 µg.kg-1 de fentanil e o grupo lidocaína (Grupo L) recebeu 1,5 mg.kg-1 de lidocaína antes da indução anestésica. A anestesia foi induzida com propofol. ECG foi feito em todos os pacientes durante o primeiro e o terceiro minutos de indução, 3 minutos após a administração de relaxante muscular e 5 e 10 minutos após intubação. A DP e intervalos QT foram medidos em todos os ECGs. Os intervalos QTc foram determinados com o uso da fórmula de Bazett. Frequência cardíaca (FC) e pressão arterial média (PAM) foram registradas antes e depois da indução anestésica, imediatamente após a intubação e em 1, 3, 5, 7 e 10 minutos após a intubação. RESULTADOS: Após a intubação, a FC aumentou significativamente nos Grupos C, L e F em comparação com o grupo controle. Porém, não houve diferença significativa nos valores da FC após a intubação entre os grupos E e controle. Nos Grupos C e L, a PAM aumentou significativamente após a intubação em comparação com o grupo controle. No entanto, nos Grupos L, F e E não houve diferença significativa entre os valores da PAM após a intubação em comparação com o grupo controle. A DP foi significativamente mais longa no Grupo C após a intubação em comparação com o grupo controle. Porém, nos grupos L, F e E não houve diferença significativa entre os valores de DP após a intubação em comparação com o grupo controle. A duração do intervalo QTc foi significativamente maior nos grupos C e L após a intubação em comparação com o grupo controle. Porém, não houve diferença significativa na duração do QTc nos grupos F e E após a intubação em comparação com o grupo controle. CONCLUSÃO: Concluímos que a administração de esmolol antes da intubação previne a taquicardia, o aumento da PAM e as durações da onda P e intervalo QTc causados pela laringoscopia e intubação traqueal.

Palavras-chave

ELETROCARDIOGRAFIA, INTUBAÇÃO TRAQUEAL, ANESTESIA, Antagonistas Adrenérgicos beta, ANESTÉSICOS, Local, lidocaína, HIPNOANALGÉSICOS, Fentanil, HIPNÓTICOS, Propofol

Abstract

BACKGROUND AND OBJECTIVES: In our study we aimed to investigate the effect of esmolol, lidocaine and fentanyl on P-wave dispersion (Pwd), QT and corrected QT (QTc) durations and hemodynamic responses to endotracheal intubation during propofol induction. METHODS: A total of eighty adult patients, American Society of Anesthesiologists (ASA) Physical Status I or II aged 18 to 60 years were included in this prospective, randomised, double-blind study. All patients had control electrocardiograms (ECGs) done before anesthesia induction. The patients were randomised into four equal groups. The control group (Group C) received saline 5 mL, the esmolol group (Group E) received esmolol 0.5 mg.kg-1, the fentanyl group (Group F) received fentanyl 2 µg.kg-1 and the lidocaine group (Group L) received lidocaine 1.5 mg.kg-1 before anesthesia induction. Anesthesia was induced with intravenous propofol. ECGs for all patients were performed during the 1st and 3rd minutes of induction, 3 minutes after administration of muscle relaxant, and at 5 minutes and 10 minutes after intubation. Pwd and QT intervals were measured on all ECGs. QTc intervals were determined using the Bazett formula. Heart rate (HR) and mean arterial pressure (MAP) were recorded before and after induction of anesthesia, immediately after intubation, and 1, 3, 5, 7 and 10 minutes after intubation. RESULTS: Compared with control, HR significantly increased in Group C, Group L and Group F after intubation. However, in Group E, there was no significant difference in HR values between control and after intubation. Compared with control, MAP significantly increased in Group C and Group L after the intubation. However, in Group E and Group F, there was no significant difference in MAP values between control and after the intubation. Compared with control, Pwd significantly increased in Group C after intubation. In Group L, Group F and Group E, there was no significant difference in Pwd values between control and after the intubation. Compared with control, QTc duration significantly increased in Group C and L after the intubation. In Group F and Group E, there was no significant difference in QTc durations between control and after the intubation. CONCLUSION: We concluded that administration of esmolol before intubation prevents tachycardia and an increase in MAP, Pwd and QTc duration caused by laryngoscopy and tracheal intubation.

Keywords

Electrocardiography, Intubation, Intratracheal, Anesthesia, Propanolamines, Lidocaine, Fentanyl, Propofol

Referências

Hanci V, Aydin M, Yurtlu BS. Anesthesia induction with sevoflurane and propofol: evaluation of P-wave dispersion, QT and corrected QT intervals. Kaohsiung J Med Sci. 2010;26:470-477.

Ugur B, Yüksel H, Odabasi AR, Ogurlu M, Onbasili A, Aydin ON. Effects of intravenous lidocaine on QTd and HRV changes due to tracheal intubation during sevoflurane induction. Int Heart J. 2006;47:597-606.

Owczuk R, Wujtewicz MA, Sawicka W. Effect of anaesthetic agents on p-wave dispersion on the electrocardiogram: comparison of propofol and desflurane. Clin Exp Pharmacol Physiol. 2008;35:1071-1076.

Chang DJ, Kweon TD, Nam SB. Effects of fentanyl pretreatment on the QTc interval during propofol induction. Anaesthesia. 2008;63:1056-1060.

Hancı V, Ayoğlu H, Yurtlu S. An evaluation of P wave dispersion, QT, QTc and QTc dispersion intervals on the electrocardiograms of malnourished adults. Anaesth Inten Care. 2010;38:122-127.

Hancı V, Gül S, Dogan SM. Evaluation of P wave and QTc dispersion in subarachnoid hemorrhage. Anaesth Inten Care. 2010;38:128-132.

Chandy J, Nakai T, Lee RJ. Increases in P wave dispersion predict postoperative atrial fibrillation after coronary artery bypass graft surgery. Anesth Analg. 2004;98:303-310.

Dagdelen S, Toraman F, Karabulut H. The value of P dispersion on predicting atrial fibrillation after coronary artery bypass surgery: effect of magnesium on P dispersion. Ann Noninvasive Electrocardiol. 2002;7:211-218.

Yazici M, Ozdemir K, Altunkeser BB. The effect of diabetes mellitus on the P-Wave dispersion. Circ J. 2007;71:880-883.

Stettler C, Bearth A, Allemann S. QTc interval and resting heart rate as long-term predictors of mortality in type 1 and type 2 diabetes mellitus: a 23-year follow-up. Diabetologia. 2007;50:186-194.

Cagirci G, Cay S, Karakurt O. P-Wave dispersion increases in prehypertension. Blood Press. 2009;18:51-54.

Dogru MT, Güneri M, Tireli E. QT interval and dispersion differences between normal and prehypertensive patients: effects of autonomic and left ventricular functional and structural changes. Anadolu Kardiyol Derg. 2009;9:15-22.

Kosar F, Aksoy Y, Ari F. P-wave duration and dispersion in obese subjects. Ann Noninvasive Electrocardiol. 2008;13:3-7.

Bezante GP, Scopinaro A, Papadia F. Biliopancreatic diversion reduces QT interval and dispersion in severely obese patients. Obesity. 2007;15:1448-54.

Hanci V, Yurtlu S, Aydin M. Preoperative abnormal P and QTc dispersion intervals in patients with metabolic syndrome. Anesth Analg. 2011;112:824-827.

Erdil F, Demirbilek S, Begec Z, Ozturk E, But A, Ozcan Ersoy M. The effect of esmolol on the QTc interval during induction of anaesthesia in patients with coronary artery disease. Anaesthesia. 2009;64:246-250.

Owczuk R, Wujtewicz MA, Sawicka W. The effect of intravenous lidocaine on QT changes during tracheal intubation. Anaesthesia. 2008;63:924-931.

Cafiero T, Di Minno RM, Di Iorio C. QT interval and QT dispersion during the induction of anesthesia and tracheal intubation: a comparison of remifentanil and fentanyl. Minerva Anestesiol. 2011;77:160-165.

Baral BK, Bhattarai BK, Rahman TR, Singh SN, Regmi R. Perioperative intravenous lidocaine infusion on postoperative pain relief in patients undergoing upper abdominal surgery. Nepal Med Coll J. 2010;12:215-220.

Inomata S, Maeda T, Shimizu T, Satsumae T, Tanaka M. Effects of fentanyl infusion on tracheal intubation and emergence agitation in preschool children anaesthetized with sevoflurane. Br J Anaesth. 2010;105:361-367.

Amr YM, Amin SM. Effects of preoperative oral beta blocker versus intraoperative nitroprusside or esmolol on quality of surgical field during tympanoplasty. J Clin Anesth. 2011;23:544-548.

Acampa M, Lazzerini PE, Guideri F. Homocysteine and P wave dispersion in patients with heart transplantation. Clin Transplant. 2011;25:119-125.

Derbyshire DR, Chmielewski A, Fell D, Vater M, Achola K, Smith G. Plasma catecholamine responses to tracheal intubation. Br J Anaesth. 1983;55:855-860.

Thomson IR. The hemodynamic response to intubation: a perspective. Can J Anaesth. 1989;36:367-369.

Kovac AL. Controlling the hemodynamic response to laryngoscopy and endotracheal intubation. J Clin Anesth. 1996;8:63-79.

Prys-roberts C, Greene LT, Meloche R. Studies of anaesthesia in relation to hypertansion II: haemodynamic consequences of induction and endotracheal intubation. Br J Anaesth. 1971;43:531-546.

Helfman MS, Gold IM, DeLisser AE. Which drug prevents tachycardia and hypertension associated with tracheal intubation: lidocaine, fentanyl or esmolol. Anesth Analg. 1991;72:482-486.

Guignard B, Menigaux C, Dupont X. The effect of remifentanil on the bispectral index change and hemodynamic responses after orotracheal ıntubation. Anesth Analg. 2000;90:161-167.

Van den Berg AA, Sava D, Honjol NM. Attenuation of hemodynamic responses to noxious stimuli in patients undergoing cataract surgery: A comparison of magnesium sulphate, esmolol, lidocaine, nitroglycerine and placebo given i.v. with induction of anaesthesia. Eur J Anaesthesiol. 1997;14:134-147.

Tan PH, Yang LC, Shih HC. Combined use of esmolol and nicardipine to blunt the hemodynamic changes following laryngoscopy and tracheal intubation. Anaesthesia. 2002;57:1195-212.

Muzzi DA, Susan B, Losasso . Labetalol and Esmolol in the control of hypertension after intracranial surgery. Anesth Analg. 1990;70:68-71.

Feng CK, Chan KH, Liu KN, Or CH, Lee TY. A comparison of lidocaine, fentanyl, and esmolol for attenuation of cardiovascular response to laryngoscopy and tracheal intubation. Acta Anaesthesiol Sin. 1996;34:61-67.

Ugur B, Ogurlu M, Gezer E, Nuri Aydin O, Gürsoy F. Effects of esmolol, lidocaine and fentanyl on haemodynamic responses to endotracheal intubation: a comparative study. Clin Drug Investig. 2007;27:269-277.

Owczuk R, Sawicka W, Wujtewicz MA, Kawecka A, Lasek J, Wujtewicz M. Influence of spinal anesthesia on corrected QT interval. Reg Anesth Pain Med. 2005;30:548-552.

Zareba W, Moss AJ, le Cessie S. Dispersion of ventricular repolarization and arrhythmic cardiac death in coronary artery disease. Am J Cardiol. 1994;74:550-553.

Newman D. Overview of lidocaine. Cardiac Electrophysiology Review. 2000;4:248-250.

Khan IA, Gowda RM. Novel therapeutics for treatment of long-QT syndrome and torsade de pointes. Int J Cardiol. 2004;95:1-6.

Lin PL, Wang YP, Chou YM, Chan HL, Huang HH. Lack of intravenous lidocaine effects on HRV changes of tracheal intubation during induction of general anesthesia. Acta Anaesthesiologica Sinica. 2001;39:77-82.

Wilton NC, Hantler CB. Congenital long QT syndrome: changes in QT interval during anesthesia with thiopental, vecuronium, fentanyl, and isoflurane. Anesth Analgesia. 1987;66:357-360.

Lischke V, Wilke HJ, Probst S, Behne M, Kessler P. Prolongation of the QT-interval during induction of anesthesia in patients with coronary artery disease. Acta Anaesthesiol Scand. 1994;38:144-148.

Korpinen R, Simola M, Saanivaara L. Effect of esmolol on the hemodynamic and electrocardiographic changes during laryngomicroscopy under propofol-alfentanil anesthesia. Acta Anaesthesiol Belg. 1998;49:123-132.

Korpinen R, Saanivaara L, Siren K. QT interval of the ECG, heart rate and arterial pressure during anaesthetic induction: comparative effects of alfentanil and esmolol. Acta Anaesthesiol Scand. 1995;39:809-813.

Korpinen R, Saarnivaara L, Siren K, Sarna S. Modification of the haemodynamic responses to induction of anaesthesia and tracheal intubation with alfentanil, esmolol and their combination. Can J Anaesthesia. 1995;42:298-304.

Korpinen R, Simola M, Saarnivaara L. Effect of esmolol on the heart rate, arterial pressure and electrocardiographic changes during laryngomicroscopy. Acta Anaesthesiol Scand. 1997;41:371-375.

Korpinen R, Klemola UM, Simola M, Toivonen H. The electrocardiographic and hemodynamic effect of metohexital and propofol with and without esmolol. Acta Anaesthesiol Scand. 2006;50:188-192.

Alexander R, Binns J, Hetreed M. A controlled trial of the effects of esmolol on cardiac function. Br J Anaesthesia. 1994;72:594-595.

Sharma S, Mitra S, Grover VK, Kalra R. Esmolol blunts the haemodynamic responses to tracheal intubation in treated hypertensive patients. Can J Anaesthesia. 1996;43:778-782.

Kazanci D, Unver S, Karadeniz U. A comparison of the effects of desflurane, sevoflurane and propofol on QT, QTc, and P dispersion on ECG. Ann Card Anaesth. 2009;12:107-112.

Owczuk R, Wujtewicz MA, Sawicka W. Effect of anaesthetic agents on p-wave dispersion on the electrocardiogram: comparison of propofol and desflurane. Clin Exp Pharmacol Physiol. 2008;35:1071-1076.

Güneş Y, Tuncer M, Güntekin U, Ceylan Y. The effects of nebivolol on P wave duration and dispersion in patients with coronary slow flow. Anadolu Kardiyol Derg. 2009;9:290-295.

Tuncer M, Fettser DV, Gunes Y. Comparison of effects of nebivolol and atenolol on P-wave dispersion in patients with hypertension. Kardiologiia. 2008;48:42-45.

Tuncer M, Gunes Y, Guntekin U, Gumrukcuoglu HA, Eryonucu B. Short-term effects of cilazapril and atenolol on P-wave dispersion in patients with hypertension. Adv Ther. 2008;25:99-105.

Turgut O, Yilmaz MB, Yilmaz A, Yalta K, Kendirlioglu O, Tandogan I. Acute coronary syndrome: short-term effects of early intravenous metoprolol on maximum P wave duration and P wave dispersion. Adv Ther. 2007;24:14-22.

5dd421d70e8825ac07c63493 rba Articles
Links & Downloads
2352-2291 (Eletrônico) 0104-0014 (Impresso)
Braz J Anesthesiol ©2024 Todos os direitos reservados.

Braz J Anesthesiol

Share this page
Page Sections