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The Efficacy of Esmolol versus Lidocaine to Attenuate the Hemodynamic Response to Intubation in Isolated Head Trauma Patients
Author(s) -
Levitt M. Andrew,
Dresden Graham M.
Publication year - 2001
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.2001.tb00541.x
Subject(s) - medicine , esmolol , anesthesia , blood pressure , heart rate , intubation , lidocaine , glasgow coma scale , trauma center , mean arterial pressure , surgery , retrospective cohort study
.Objective: To assess the effect of esmolol vs lidocaine to attenuate the detrimental rise in heart rate and blood pressure during intubation of patients with isolated head trauma. Methods: This was a prospective, double‐blind, randomized study, performed at an urban, county teaching emergency department. Participants were 30 patients with isolated head trauma. Each underwent a standardized intubation protocol including esmolol or lidocaine, both at 2 mg/kg. Results: Esmolol was used in 16 patients and lidocaine in 14. Mechanisms of injury included 12 assaults, 6 motor vehicle collisions, 6 falls, 4 auto‐vs‐pedestrian crashes, and 2 bicycle incidents. Mean ethanol level was 0.116 ± 0.133 SD (range 0‐0.482). Mean Glasgow Coma Scale (GCS) score was 7.9 ± 4.0 SD. Cranial computed tomography (CT) hemorrhagic findings included 9 subdural/epidural hematomas, 6 cortex hemorrhages, and 2 multi‐hemorrhages. Eleven patients received surgical intervention: 9 patients received a craniotomy, and 2 a ventricular catheter. The 2‐minute time interval around intubation was used to assess each drug's efficacy. The mean difference change between groups for heart rate was 4.0 beats/min (95% CI = ‐17.7 to 9.7 beats/min), for systolic blood pressure was 1.3 mm Hg (95% CI = ‐27.8 to 30.4 mm Hg), and for diastolic blood pressure was 2.6 mm Hg (95% CI = ‐27.1 to 21.9 mm Hg). The power of this study was 90% to detect a 20‐beat/min difference in heart rate, a 35‐mm Hg difference in systolic blood pressure, and a 20‐mm Hg difference in diastolic blood pressure. Conclusions: Esmolol and lidocaine have similar efficacies to attenuate moderate hemodynamic response to intubation of patients with isolated head trauma.