Attenuation of hemodynamic responses to laryngoscopy and tracheal intubation during rapid sequence induction: remifentanil vs. lidocaine with esmolol.

AIM: This study was designed to compare the effectiveness of remifentanil vs. a lidocaine-esmolol combination in blunting the hemodynamic response to laryngoscopy and intubation during rapid sequence induction using thiopental and rocuronium in normotensive patients. METHODS: Sixty-six patients with American Society of Anesthesiologists (ASA) physical status class I who required tracheal intubation for elective surgery were randomly assigned to one of two groups. Group R received 0.9% saline 10 ml and remifentanil 1 microg/kg. Group LE received lidocaine 1.5 mg/kg and esmolol 1.0 mg/kg. Anesthesia was induced with thiopental sodium 5 mg/kg, followed by rocuronium 1.0 mg/kg. Mean arterial pressure and heart rate were recorded at baseline, after induction, immediately after intubation and every minute for five minutes after intubation. RESULTS: Changes in mean arterial pressure over time between the two groups were significantly different (P<0.0001). The maximum pressor response was observed immediately after intubation, at which time the mean arterial pressure change from baseline in group LE (29.7%) (95% confidence interval [CI]: 116.1, 121.9) was higher than that in group R (4.4%) (95% CI: 92.9, 98.5) (P<0.0001). Two patients in group R and 15 patients in group LE developed hypertension (odds ratio [OR]: 0.064) (P<0.001). Changes in heart rate over time between the two groups were not significantly different (P=0.465). CONCLUSION: The results of this study show that remifentanil 1 mg/kg is more effective than the combination of lidocaine 1.5 mg/kg and esmolol 1 mg/kg for attenuating the hemodynamic responses to rapid sequence intubation.