The cardiovascular changes during upper gastrointestinal endoscopy

Tracheal intubation under general anaesthesia causes a rise in heart rate and blood pressure. This can worsen myocardial ischaemia or precipitate infarction in patients with coronary artery disease. We monitored 50 sedated and non-sedated patients undergoing upper gastrointestinal endoscopy with continuous non-invasive blood pressure monitoring. We subsequently studied 15 patients undergoing endoscopy and oesophageal dilatation under general anaesthesia. We observed a signifkant (P < 0.01) rise in rate pressure product (RPP) occurring on oesophageal intubation in both sedated and non-sedated patients. There was no significant change in RPP on oesophageal intubation in patients under a general anaesthetic. The rise in RPP in response to tracheal intubation in those patients receiving a general anaesthetic was as great as the rise in RPP occurring in response to oesophageal intubation in the sedated and non-sedated patients. Oesophageal intubation in sedated and non-sedated patients produces a rise in RPP comparable to that associated with tracheal intubation in anaesthetised patients and may confer the same risk of worsening myocardial ischaemia in patients with coronary artery disease.