Anesthesiology and Pain Medicine

Published by: Kowsar

Attenuation of the Pressor Response to Tracheal Intubation in Severe Preeclampsia: Relative Efficacies of Nitroglycerine Infusion, Sublingual Nifedipine, and Intravenous Hydralazine

Mohammadreza Safavi 1 , Azim Honarmand 1 , * and Neda Azari 1
Authors Information
1 Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Article information
  • Anesthesiology and Pain Medicine: September 23, 2011, 1 (2); 81-89
  • Published Online: September 26, 2011
  • Article Type: Research Article
  • Received: June 28, 2011
  • Revised: August 22, 2011
  • Accepted: August 27, 2011
  • DOI: 10.5812/kowsar.22287523.1782

To Cite: Safavi M, Honarmand A, Azari N. Attenuation of the Pressor Response to Tracheal Intubation in Severe Preeclampsia: Relative Efficacies of Nitroglycerine Infusion, Sublingual Nifedipine, and Intravenous Hydralazine, Anesth Pain Med. 2011 ; 1(2):81-89. doi: 10.5812/kowsar.22287523.1782.

Copyright © 2011, Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Background
2. Objectives
3. Patients and Methods
4. Results
5. Discussion
  • 1. Hodgkinson R, Husain FJ, Hayashi RH. Systemic and pulmonary blood pressure during caesarean section in parturients with gestational hypertension. Can Anaesth Soc J. 1980; 27(4): 389-94[PubMed]
  • 2. Connell H, Dalgleish JG, Downing JW. General anaesthesia in mothers with severe pre-eclampsia/eclampsia. Br J Anaesth. 1987; 59(11): 1375-80[PubMed]
  • 3. Evans CS, Gooch L, Flotta D, Lykins D, Powers RW, Landsittel D, et al. Cardiovascular system during the postpartum state in women with a history of preeclampsia. Hypertension. 2011; 58(1): 57-62[DOI][PubMed]
  • 4. Kronborg CS, Gjedsted J, Vittinghus E, Hansen TK, Allen J, Knudsen UB. Longitudinal measurement of cytokines in pre-eclamptic and normotensive pregnancies. Acta Obstet Gynecol Scand. 2011; 90(7): 791-6[DOI][PubMed]
  • 5. Lawes EG, Downing JW, Duncan PW, Bland B, Lavies N, Gane GA. Fentanyl-droperidol supplementation of rapid sequence induction in the presence of severe pregnancy-induced and pregnancy-aggravated hypertension. Br J Anaesth. 1987; 59(11): 1381-91[PubMed]
  • 6. Magee LA, Abalos E, von Dadelszen P, Sibai B, Easterling T, Walkinshaw S. How to manage hypertension in pregnancy effectively. Br J Clin Pharmacol. 2011; 72(3): 394-401[DOI][PubMed]
  • 7. Ashton WB, James MF, Janicki P, Uys PC. Attenuation of the pressor response to tracheal intubation by magnesium sulphate with and without alfentanil in hypertensive proteinuric patients undergoing caesarean section. Br J Anaesth. 1991; 67(6): 741-7[PubMed]
  • 8. Ramanathan J, Sibai BM, Mabie WC, Chauhan D, Ruiz AG. The use of labetalol for attenuation of the hypertensive response to endotracheal intubation in preeclampsia. Am J Obstet Gynecol. 1988; 159(3): 650-4[PubMed]
  • 9. Strauss RG, Keefer JR, Burke T, Civetta JM. Hemodynamic monitoring of cardiogenic pulmonary edema complicating toxemia of pregnancy. Obstet Gynecol. 1980; 55(2): 170-4[PubMed]
  • 10. Shinider SM, Levinson G. Anesthesia for obstetrics. Anesthesiology. 1987; 67(4): 615
  • 11. Longmire S, Leduc L, Jones MM, Hawkins JL, Joyce TH, 3rd, Cotton DB. The hemodynamic effects of intubation during nitroglycerin infusion in severe preeclampsia. Am J Obstet Gynecol. 1991; 164(2): 551-6[PubMed]
  • 12. Trapani A, Jr, Goncalves LF, Pires MM. Transdermal Nitroglycerin In Patients With Severe Preeclampsia With Placental Insufficiency: Effect On Doppler Velocimetry Of The Uterine, Umbilical And Middle Cerebral Arteries. Ultrasound Obstet Gynecol. 2011; 38(4): 389-94[DOI][PubMed]
  • 13. Kumar N, Batra YK, Bala I, Gopalan S. Nifedipine attenuates the hypertensive response to tracheal intubation in pregnancy-induced hypertension. Can J Anaesth. 1993; 40(4): 329-33[DOI][PubMed]
  • 14. Lenfant C. Working group report on high blood pressure in pregnancy. J Clin Hypertens (Greenwich, Conn). 2001; 3(2): 75[PubMed]
  • 15. Rey E, LeLorier J, Burgess E, Lange IR, Leduc L. Report of the Canadian Hypertension Society Consensus Conference: 3. Pharmacologic treatment of hypertensive disorders in pregnancy. CMAJ. 1997; 157(9): 1245-54[PubMed]
  • 16. Cutler JA. Calcium-channel blockers for hypertension--uncertainty continues. N Engl J Med. 1998; 338(10): 679-81[DOI][PubMed]
  • 17. Grossman E, Messerli FH, Grodzicki T, Kowey P. Should a moratorium be placed on sublingual nifedipine capsules given for hypertensive emergencies and pseudoemergencies? JAMA. 1996; 276(16): 1328-31[PubMed]
  • 18. Cunningham FG, Williams JW, Leveno KJ, Bloom S, Hauth JC, Rouse DJ. Williams obstetrics. 1997;
  • 19. Mabie WC, Gonzalez AR, Sibai BM, Amon E. A comparative trial of labetalol and hydralazine in the acute management of severe hypertension complicating pregnancy. Obstet Gynecol. 1987; 70(3 Pt 1): 328-33[PubMed]
  • 20. Stoelting RK. Circulatory changes during direct laryngoscopy and tracheal intubation: influence of duration of laryngoscopy with or without prior lidocaine. Anesthesiology. 1977; 47(4): 381-4[PubMed]
  • 21. Bruder N, Ortega D, Granthil C. [Consequences and prevention methods of hemodynamic changes during laryngoscopy and intratracheal intubation]. Ann Fr Anesth Reanim. 1992; 11(1): 57-71[PubMed]
  • 22. Russell WJ, Morris RG, Frewin DB, Drew SE. Changes in plasma catecholamine concentrations during endotracheal intubation. Br J Anaesth. 1981; 53(8): 837-9[PubMed]
  • 23. Shribman AJ, Smith G, Achola KJ. Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation. Br J Anaesth. 1987; 59(3): 295-9[PubMed]
  • 24. Park BY, Jeong CW, Jang EA, Kim SJ, Jeong ST, Shin MH, et al. Dose-related attenuation of cardiovascular responses to tracheal intubation by intravenous remifentanil bolus in severe pre-eclamptic patients undergoing Caesarean delivery. Br J Anaesth. 2011; 106(1): 82-7[DOI][PubMed]
  • 25. Miyake W, Oda Y, Ikeda Y, Tanaka K, Hagihira S, Iwaki H, et al. Effect of remifentanil on cardiovascular and bispectral index responses following the induction of anesthesia with midazolam and subsequent tracheal intubation. J Anesth. 2010; 24(2): 161-7[DOI][PubMed]
  • 26. Morison DH. Anaesthesia and pre-eclampsia. Can J Anaesth. 1987; 34(4): 415-22[DOI][PubMed]
  • 27. Talebi H, Nourozi A, Fateh S, Mohammadzadeh A, Eghtesadi-Araghi P, Jabbari S, et al. Effects of oral clonidine premedication on haemodynamic response to laryngoscopy and tracheal intubation: a clinical trial. Pak J Biol Sci. 2010; 13(23): 1146-50[PubMed]
  • 28. Rout CC, Rocke DA. Effects of alfentanil and fentanyl on induction of anaesthesia in patients with severe pregnancy-induced hypertension. Br J Anaesth. 1990; 65(4): 468-74[PubMed]
  • 29. Ramanathan J. Pathophysiology and anesthetic implications in preeclampsia. Clin Obstet Gynecol. 1992; 35(2): 414-25[PubMed]
  • 30. Ring G, Krames E, Shnider SM, Wallis KL, Levinson G. Comparison of nitroprusside and hydralazine in hypertensive pregnant ewes. Obstet Gynecol. 1977; 50(5): 598-602[PubMed]
  • 31. Hill AB, Bowley CJ, Nahrwold ML, Knight PR, Kirsh MM, Denlinger JK. Intranasal administration of nitroglycerin. Anesthesiology. 1981; 54(4): 346-8[PubMed]
  • 32. van den Berg AA, Savva D, Honjol NM. Attenuation of the haemodynamic responses to noxious stimuli in patients undergoing cataract surgery. A comparison of magnesium sulphate, esmolol, lignocaine, nitroglycerine and placebo given i. v. with induction of anaesthesia. Eur J Anaesthesiol. 1997; 14(2): 134-47[PubMed]
  • 33. Mikawa K, Hasegawa M, Suzuki T, Maekawa N, Kaetsu H, Goto R, et al. Attenuation of hypertensive response to tracheal intubation with nitroglycerin. J Clin Anesth. 1992; 4(5): 367-71[PubMed]
  • 34. Fassoulaki A, Kaniaris P. Intranasal administration of nitroglycerine attenuates the pressor response to laryngoscopy and intubation of the trachea. Br J Anaesth. 1983; 55(1): 49-52[PubMed]
  • 35. Mahajan RP, Ramachandran R, Saxena N. Topical nitroglycerin prevents the pressor response to tracheal intubation and sternotomy in patients undergoing coronary artery bypass graft surgery. Anaesthesia. 1993; 48(4): 297-300[PubMed]
  • 36. Ferlinz J. Drugs Five Years Later Nifedipine in Myocardial Ischemia, Systemic Hypertension, and Other Cardiovascular Disorders. Ann Intern Med. 1986; 105(5): 714-29[DOI]
  • 37. Jegasothy R, Paranthaman S. Sublingual nifedipine compared with intravenous hydrallazine in the acute treatment of severe hypertension in pregnancy: potential for use in rural practice. J Obstet Gynaecol Res. 1996; 22(1): 21-4[PubMed]
  • 38. Kubota R, Komiyama T, Shimada H. Evaluation of the method for nifedipine administration for a rapid onset of clinical effect: a clinical study in normal volunteers. Yakugaku Zasshi. 2001; 121(5): 355-64[PubMed]
  • 39. Fenakel K, Fenakel G, Appelman Z, Lurie S, Katz Z, Shoham Z. Nifedipine in the treatment of severe preeclampsia. Obstet Gynecol. 1991; 77(3): 331-7[PubMed]
  • 40. Kwawukume EY, Ghosh TS. Oral nifedipine therapy in the management of severe preeclampsia. Int J Gynaecol Obstet. 1995; 49(3): 265-9[PubMed]
Creative Commons License Except where otherwise noted, this work is licensed under Creative Commons Attribution Non Commercial 4.0 International License .

Search Relations:



Create Citiation Alert
via Google Reader

Readers' Comments