The use of esmolol, nicardipine, or their combination to blunt hemodynamicchanges after laryngoscopy and tracheal intubation

Laryngoscopy and tracheal intubation (LTI) often provoke an undesirable inc rease in blood pressure (BP) and/or heart rate (HR). We tested the premise that nicardipine (NSC) and esmolol (ESM) in combination (COMB) would oppose both. Adult surgical patients received pretreatment (randomized) with IV b olus NIC 30 mu g/kg (n = 31), ESM 1.0 mg/kg (n = 34), or COMB (one-half dos e each, n = 32). Peak BP and HR after LTI were compared with controls (CONT ; n = 35) with no pretreatment. Anesthetic induction was standardized: IV t hiopental (5-7 mg/kg), fentanyl (1-2 mu g/kg), and succinylcholine (1.5 mg/ kg). Systolic (S), diastolic (D), and mean (M) BP and HR awake before pretr eatment (baseline) were similar in all test groups. No patient was treated for hypotension, bradycardia, or tachycardia after pretreatment or anesthet ic induction. Peak HR after LTI was increased versus baseline in CONT and a ll test groups, but did not differ from CONT among the test groups. Peak SE P and DBP increased versus baseline in CONT, and with ESM and NIC, but not COMB. Peak SEP, DBP, and MBP were increased with ESM versus COMB, and peak DBP with ESM versus NIC. Compared with no pretreatment before the IV induct ion of general anesthesia, the peak increase in BP after LTI is best blunte d by the combination of nicardipine and ESM, compared with either drug alon e. No single drug or combination in the doses tested opposed increased HR. Implications: Compared with no pretreatment before the IV induction of gene ral anesthesia, the peak increase in blood pressure after laryngoscopy and tracheal intubation is best blunted by the combination of nicardipine and e smolol, compared with either drug alone. No single drug or combination in t he doses tested opposed increased heart rate.