Obtunding the sympathetic response to intubation. Experience at 2 minutes after administration of the test agent in patients with cerebral aneurysms
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The sympathetic response to laryngoscopy and intubation was studied in 39 patients who were to undergo surgical clipping of a cerebral aneurysm. Intravascular radial artery pressure and ECG monitoring for ST-segment changes or dysrhythmias were used. Ward blood pressures were controlled on bed rest and labetalol. Induction of anaesthesia was with pentothal 4 mg/kg and suxamethonium 1 mg/kg intravenously. This was followed by one of the following intravenous agents by random choice: alfentanil 30 μg/kg, fentanyl 5 μg/kg, lignocaine 2 mg/kg, and lignocaine 10% spray 2 mg/kg to the larynx. ECG changes at laryngoscopy and intubation were minimal. Intubation produced an immediate increase in blood pressure and pulse rate, maximal at 30-60 seconds, falling rapidly towards normal within 2-3 minutes. Alfentanil was very effective in obtunding this response with stable cardiovascular parameters; fentanyl produced a more variable response; and intravenous lignocaine was less satisfactory. Lignocaine spray was ineffective.
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