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Abstract
The hemodynamic response to the stress of laryngoscopy and endotracheal intubation
does not present a problem for most patients. However, patients with cardiovascular
or cerebral disease may be at increased risk of morbidity and mortality from the tachycardia
and hypertension resulting from this stress. These hemodynamic effects gained notice
after the introduction and use of muscle relaxants, such as curare and succinylcholine,
for endotracheal intubation at the time of anesthesia induction. A variety of anesthetic
techniques and drugs are available to control the hemodynamic response to laryngoscopy
and intubation. The method or drug of choice depends on many factors, including the
urgency and length of surgery, choice of anesthetic technique, route of administration,
medical condition of the patient, and individual preference. The possible solutions
number as many as the medications and techniques available and depend on the individual
patient and anesthesia care provider. This paper reviews these medications and techniques
to guide the clinician in choosing the best methods.