Nicardipine Versus Lidocaine for Attenuating the Cardiovascular Response to Endotracheal Intubation

Purpose: The aim of this study was to compare the efficacy of nicardipine and lidocaine in attenuation of cardiovascular responses to endotracheal intubation.

Methods: In a randomized, double-blind, controlled trial, 60 unpremedicated (ASA I) patients undergoing elective surgery were given either 30 microg.kg(-1) nicardipine or 1.5 mg.kg(-1) lidocaine intravenously 2 min before intubation. Laryngoscopy and tracheal intubation were performed 1 min after induction of anesthesia with 5 mg.kg(-1) thiopentone, followed by administration of 1.5 mg.kg(-1) succinylcholine intravenously. Blood pressure and heart rate were monitored at baseline and every minute until 4 min after intubation. Repeated-measures ANOVA, Student's t test, the chi-square test, and 95% confidence intervals were used as appropriate. P < 0.05 was considered statistically significant.

Results: Baseline hemodynamic variables were not different between the groups. After administration of either agents, diastolic blood pressure and mean blood pressure were significantly lower in the nicardipine group. The heart rate in the nicardipine group was significantly higher. The mean between-group differences in diastolic blood pressure, mean blood pressure, heart rate, and rate-pressure product at baseline and 1 min after starting laryngoscopy were statistically significant.

Conclusion: Nicardipine can be used as an alternative to lidocaine in attenuation of cardiovascular response to tracheal intubation in patients without ischemic heart disease.