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Which is responsible for the haemodynamic response due to laryngoscopy and endotracheal intubation? Catecholamines, vasopressin or angiotensin?

Published online by Cambridge University Press:  15 September 2005

Z. Kayhan ,
D. Aldemir ,
H. Mutlu  and
E. Öğüş
Z. Kayhan
Affiliation:
Başkent University, Faculty of Medicine, Department of Anaesthesiology, Ankara, Turkey
D. Aldemir
Affiliation:
Başkent University, Faculty of Medicine, Department of Biochemistry, Ankara, Turkey
H. Mutlu
Affiliation:
Başkent University, Faculty of Medicine, Department of Anaesthesiology, Ankara, Turkey
E. Öğüş
Affiliation:
Başkent University, Faculty of Medicine, Department of Biostatistics, Ankara, Turkey
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Summary

Background and objective: We have investigated the concentrations of epinephrine, norepinephrine, vasopressin and angiotensin converting enzyme activity to explore the role of these mediators in the neuroendocrine response to laryngoscopy and tracheal intubation. Methods: One hundred (50 male, 50 female) ASA I patients aged 20–50 yr (mean ± SEM; 35.59 ± 0.99) were included in the study. They were undergoing elective surgery under standard anaesthesia induction and maintenance using tracheal intubation. Plasma concentrations of epinephrine, norepinephrine and vasopressin as well as plasma angiotensin converting enzyme activity were determined at four time points, before (T1) and after (T2) induction, and 2 (T3) and 5 min (T4) after intubation. Blood pressure and heart rate were recorded at corresponding times to reveal if any correlation existed between haemodynamic parameters and neuroendocrine response. Results: Heart rate increased after induction and intubation (P < 0.05) and decreased significantly at T4 (P < 0.05). Systolic blood pressure decreased significantly (P < 0.05) after induction and increased slightly after intubation decreasing to below baseline value (P < 0.05) at T4. Diastolic blood pressure increased slightly after intubation and decreased significantly (P < 0.05) at T4. Plasma epinephrine and norepinephrine concentrations decreased after induction and increased at T3 and T4 without reaching significance. Vasopressin concentrations increased slightly at T2 and T3 and decreased significantly at T4 (P < 0.05). Angiotensin converting enzyme activity was unaffected when compared with baseline values. Conclusions: Blood pressure, heart rate, plasma epinephrine, norepinephrine and vasopressin concentrations increased slightly in response to laryngoscopy and intubation, all returning to or below baseline 5 min later with no change in angiotensin converting enzyme activity in normotensive patients.

Keywords

LARYNGOSCOPY, complicationsINTUBATION, INTRATRACHEALHAEMODYNAMIC PHENOMENA, blood pressureCATECHOLAMINES, epinephrine, norepinephrineVASOPRESSINSRENIN–ANGIOTENSIN SYSTEM
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 10 , October 2005 , pp. 780 - 785
Copyright
© 2005 European Society of Anaesthesiology

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