Control of haemodynamic response to tracheal intubation in cigarette smokers compared with non-smokers

Some authors have demonstrated that a bolus dose of 1 microg/kg followed by an infusion rate of 0.5 microg/kg/min is adequate to attenuate the haemodynamic response to laringoscopy and tracheal intubation. In this study we have evaluated the efficacy of Remifentanil in controlling haemodynamic and some neuroendocrine responses to tracheal intubation in smokers compared with non-smokers. We studied 126 patients, ASA I-II, aged 20-49 yr, submitted laparoscopic cholecystectomy (66 male, 60 female); sixty-three patients were non-smokers and 63 patients smoked 10 or more cigarettes per day. Anaesthesia was induced with thiopental 3-5 mg/kg and remifentanil 1 microg/kg. Vecuronium 0.1 mg/kg was administrated to facilitate tracheal intubation. Immediately after intubation heart rate of smokers (mean 101.2 +/- 17 beat/min) was significantly higher (p < 0.001) than non-smokers (mean 90.2 +/- 14 beat/min) and also the neuroendocrine responses of smokers (epinephrine value 155 +/- 173 pcg/ml; norepinephrine value 276 +/- 164 pcg/ml) was significantly higher (p < 0.01) than non-smokers (epinephrine 95 +/- 75, norepinephrine 154 +/- 76). These findings may be clinically important to evaluate the risk of ischaemic heart diseases.