Does the choice of antihypertensive therapy influence haemodynamic responses to induction, laryngoscopy and intubation?

Br J Anaesth. 1994 Sep;73(3):303-8. doi: 10.1093/bja/73.3.303.

Abstract

We have measured haemodynamic responses to induction of anaesthesia, laryngoscopy and intubation in 103 mild-moderate hypertensive patients (83 patients (diastolic pressures < or = 110 mm Hg) currently receiving one of four monotherapies (ACE inhibitors, group A; beta adrenoceptor blocking drugs, group B; calcium channel antagonists, group C; diuretics, group D) and 24 were untreated hypertensive patients). Anaesthesia was induced with fentanyl 1.5-2.0 micrograms kg-1 and thiopentone 3-5 mg kg-1. Tracheal intubation was facilitated by vecuronium 0.1 mg kg-1 and anaesthesia maintained with enflurane and nitrous oxide in oxygen. Systolic and diastolic pressures (SAP, DAP) were measured at 1-min intervals by a non-invasive oscillometric method and cardiac output (CO) and stroke volume (SV) by thoracic bioimpedance. Induction of anaesthesia was associated with a decrease in SAP, DAP and CO in groups A-D (P < 0.05). Heart rate (HR) decreased in groups A and D (P < 0.01) and systemic vascular resistance (SVR) decreased in groups A and B (P < 0.05). SAP and HR increased in all groups after laryngoscopy and intubation (P < 0.01) as did SVR in groups A, B and D (P < 0.02). CO was unaltered. Similar changes occurred in the untreated hypertensive patients, although nine of 24 patients exhibited HR > or = 100 beat min-1 after laryngoscopy and intubation. Comparison of the changes in SAP, DAP, CO and SVR with time showed no differences in the five treatment groups; changes in HR were significantly less in group B compared with the other groups (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

MeSH terms

  • Adrenergic beta-Antagonists / pharmacology
  • Adult
  • Aged
  • Aged, 80 and over
  • Anesthesia, General*
  • Angiotensin-Converting Enzyme Inhibitors / pharmacology
  • Antihypertensive Agents / pharmacology*
  • Blood Pressure / drug effects
  • Calcium Channel Blockers / pharmacology
  • Cardiac Output / drug effects
  • Diuretics / pharmacology
  • Female
  • Heart Rate / drug effects
  • Hemodynamics / drug effects*
  • Humans
  • Intubation, Intratracheal*
  • Laryngoscopy
  • Male
  • Middle Aged
  • Vascular Resistance / drug effects

Substances

  • Adrenergic beta-Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Antihypertensive Agents
  • Calcium Channel Blockers
  • Diuretics