Hemodynamic changes during tracheal intubation using propofol and rocuronium after pre-treatment with ephedrine in adult patients -

Introduction: This was a prospective, randomized, placebo controlled, double blind study with the aim to determine if pre-treatment with ephedrine hydrochloride in adult patients during rapid tracheal intubation using propofol and rocuronium bromide improved intubating conditions without affecting hemodynamic parameters. Methods: One hundred adult patients, aged between 20 and 40 years, scheduled for various elective surgeries under general anesthesia were selected on the basis of a simple random sampling method. The study population was randomly divided using simple sealed envelope method into two groups, with 50 patients in each group: group EPR (ephedrine-propofol-rocuronium) and group SPR (saline-propofol-rocuronium). Patients in EPR group received ephedrine 70 µg/kg diluted to 5 ml with normal saline and the patients in SPR group received 5 ml of normal saline at the time of pre-oxygenation 3 min prior to laryngoscopy and intubation. Intubating conditions and hemodynamic parameters were assessed. Results: Pre-treatment with ephedrine hydrochloride prior to induction with propofol provided enhanced intubating conditions compared to propofol alone during rapid tracheal intubation 60 seconds after rocuronium bromide injection. However, it did not produce significant elevations of systolic and diastolic blood pressure as well as mean arterial pressure from the baseline. Pre-treatment in the EPR group resulted in an increase in the heart rate compared to the SPR group 1 min post intubation. Conclusion: The findings of the present study display that pre-treatment with ephedrine prior to propofol administration produces better intubating conditions compared to propofol alone during rapid tracheal intubation with rocuronium without significant hemodynamic changes. However, pre-treatment produced mild tachycardia, which was advantageous. It did not have any effect on the duration of laryngoscopy and the time taken for intubation.