The effect of ephedrine on intubating conditions and haemodynamics during rapid tracheal intubation using propofol and rocuronium

Background: We compared the effect of pre-treatment with ephedrine 75, 100, 150 μg kg^-1 and saline on intubating conditions and haemodynamics during rapid tracheal intubation using propofol and rocuronium. Methods: One hundred adult patients randomized into one of the four groups - PE 75, PE 100, PE 150, and saline (control) groups - were pre-treated with i.v. ephedrine 75, 100, 150 μg kg^-1 or saline, respectively, 1 min before rapid tracheal intubation using propofol 2.5 mg kg^-1 and rocuronium 0.6 mg kg^-1. A blinded anaesthesiologist assessed the intubating conditions. Heart rate and mean arterial pressure were recorded before anaesthesia induction (baseline), post-induction, and every minute after intubation for 5 min. A 20% change in haemodynamic variables from baseline was regarded as clinically significant. Data were analysed using anova test with post hoc Tukey's test and x² or Fisher's exact test. P<0.05 was regarded as significant. Results: Patient characteristics, baseline heart rate, and mean arterial pressure were comparable between the groups. Intubating conditions were significantly better in the PE 75 (P = 0.003) and PE 100 (P = 0.001) groups. A significant increase in heart rate was observed in the PE 75 and PE 150 groups when compared with the saline group. A statistically significant difference in mean arterial pressure was noted between PE 75 and PE 150 groups and between PE 150 and saline groups at most of the time intervals. However, when considering the clinical significance of these, all groups were comparable (P>0.05). Conclusions: Ephedrine either 75 or 100 μg kg^-1 given before rapid tracheal intubation using propofol and rocuronium bromide improves the intubation conditions. It is not effective in preventing the hypotension which follows ensuing induction of anaesthesia.