Review Article
Year: 2020 | Month: July | Volume: 7 | Issue: 7 | Pages: 360-363
A Review of Various Methods for Prevention of Pressor Response to Intubation
Neha Bhardwaj1, Abhishake Thakur2, Abhishek Sharma3
1Medical Officer (Anesthesia), Health & Family Welfare Department, Himachal Pradesh.
2Senior Resident, Department of Anesthesia, PGIMER, Chandigarh.
3DM Resident, Department of Cardiac Anesthesia, UN Mehta Institute of Cardiology and Research Centre, Asarwa, Ahmedabad, Gujarat.
Corresponding Author: Abhishake Thakur
ABSTRACT
Endotracheal intubation has become an integral component of airway management. Intubation is associated with sympathetic surge leading to tachycardia and hypertension. Although these sympathetic responses following intubation are brief, they still carry grave consequences for high risk patients and may cause arrhythmias, myocardial infarction, cardiac failure, intracerebral hemorrhage and raised intracranial pressure (ICP). Since multiple drugs and techniques have been used to prevent the intubation response, the purpose of this review was to study the various drugs available in literature and their success in combating intubation response. The methods used can either (a) block the afferent pathway- superior laryngeal nerve block via topical application or infiltration of local anesthetic; (b) block the central mechanism of integration and sensory input via opioids etc; or (c) block the efferent pathway and effector sites- beta blockers (BB), calcium channel blockers (CCB), lignocaine. Among the various drugs available, dexmedetomidine appears to have better attenuation of intubation response followed by beta blockers and calcium channel blockers. Lignocaine appears to be least effective in prevention of pressor response to intubation and laryngoscopy.
Keywords: pressor response, intubation response, sympathetic surge, esmolol, dexmedetomidine, ligocain, calcium channel blocker, fentanyl.
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