Cardiovascular responses to larynogoscopy and endotracheal intubation with pancuronium during light general anesthesia

Intratracheal aerosolized etidocaine to attenuate cardiovascular and cough responses to laryngoscopy and intubation

Forty-five ASA I or II patients scheduled for elective surgery were randomized into one of three groups. Patients in Group 1 (n = 15) received no intratracheal aerosol at laryngoscopy. Patients in Group 2 (n = 15) and Group 3(n = 15) received 50 mg and 75 mg, respectively, of intratracheal aerosolized etidocaine at laryngoscopy. Cardiovascular and respiratory responses were observed at laryngoscopy and intubation and for the first ten minutes following laryngoscopy and intubation (with anesthesia provided by IV thiopental and nitrous oxide [70%] in oxygen). The magnitude and duration of blood pressure and heart rate increases caused by laryngoscopy and intubation were significantly less in the etidocaine-treated patients than in the controls (P less than .05). The incidence of coughing after intubation also was decreased significantly in the etidocaine-treated patients (P less than .05). Etidocaine did not, however, decrease the incidence of arrhythmias after intubation.

Modification of ketamine-induced intracranial hypertension in neurosurgical patients by pretreatment with midazolam

The effect on intracranial pressure (ICP) of ketamine as an anaesthetic induction agent following pretreatment with either midazolam (ten cases) or diazepam (five cases) was investigated in unpremedicated neurosurgical patients. In all patients in the midazolam group, ICP increased following ketamine while the cerebral perfusion pressure (CPP) fell in five cases. ICP rose further after intubation by a mean of 21 mmHg (2.8 kPa) with a further drop in CPP in two cases. The changes were usually terminated after pethidine was given but were allowed to continue for 10 min or more in two cases. There was little increase in ICP after the diazepam-ketamine combination, while the CPP fell in one case and increased markedly in two cases. The mean increase in ICP following intubation was 6 mmHg (0.8 kPa) above control values. All patients required assisted ventilation after either benzodiazepine-ketamine combination. It is concluded that midazolam much more effectively suppresses the cardiostimulatory action of ketamine than the increase in ICP and that neither a midazolam-ketamine nor a diazepam-ketamine combination should be considered safe for use in patients who may have reduced intracranial compliance.

Droperidol and endotracheal intubation. Attenuation of pressor response to laryngoscopy and intubation

The cardiovascular responses to anaesthesia, laryngoscopy and tracheal intubation were studied in 20 healthy adult patients. The mean arterial pressure increase following intubation was 1.60 mmHg (SEM +/- 3.52 mmHg) in patients to whom droperidol 150 microgram/kg was given intravenously before anaesthesia compared with a rise of 26.50 mmHg (SEM +/- 4.35 mmHg) in a control group of patients.