Abstract
The present study attenuation of cardiovascular responses to tracheal extubation: esmolol versus propofolwas a randomized study conducted to evaluate haemodynamic response to extubation with use of IV Propofol, IV Esmolol 2 minutes prior to extubation. After taking approval from institutional ethical committee and satisfying the inclusion and exclusion criteria; valid written informed consent was obtained from 60 adult patients were randomly allocated the two study groups. Patients were given following drugs two minutes prior to Extubation: Group E: patients received i.v. Esmolol 1.5 mg/kg and Group P patients received i.v. Propofol 0.5 mg/kg 2 minutes prior to extubation. Patients were given general anaesthesia as per protocol of our study. Haemodynamic parameters were monitored throughout the whole procedure, the study drug was given 2 minutes prior to Extubation. Heart rate ,Systolic blood pressure, Diastolic blood pressure, Mean arterial pressure, was monitored and recorded just before study drug administration (T)) {i.e. baseline in our study}, and before extubation (T-1), one (T-2), three (T-3), five (T-4) and ten (T-5) minutes after Extubation. On comparison of mean heart rate (HR) in both the study groups at different times of observation (T0-T5), when compared to the baseline; mean heart rate (HR) was observed to decline much more in group E than in group P. Systolic blood pressure, Diastolic blood pressure, Mean arterial pressure were comparable at baseline (T-0), declined up to 5minutes(T-4) and comparable after 10 minutes. At no point the mean SPO2 reduced below 98%. Propofol was observed to cause sedation in 8 patients and 2 patients in esmolol group experienced moderate cough at or after extubation. No major complication occurred in any patients included in our study. It was concluded that attenuation of haemodynamic response to extubation by injection esmolol was more effective than injection propofol. Even though less effective IV propofol too attenuated the hemodynamic resonse to extubation effectively.
Keywords: Esmlol, Propofol, Extubation, Hemodynamic resonse, Attenuation.
References
- Yörüko D, Göktug A, Alano Z, Tulunay M. Comparison of intravenous metoprolol, verapamil and diltiazem on the attenuation of haemodynamic changes associated with tracheal extubation. European journal of anaesthesiology. 1999 Jul 1; 16(07):462-7.
- Dyson A, Isaac PA, Pennant JH, Giesecke AH, Lipton JM. Esmolol attenuates cardiovascular responses to extubation. Anesthesia & Analgesia. 1990 Dec 1; 71(6):675-8.
- Bindu B, Pasupuleti S, Gowd UP, Gorre V, Murthy RR, Laxmi MB. A double blind, randomized, controlled trial to study the effect of dexmedetomidine on hemodynamic and recovery responses during tracheal extubation. Journal of Anaesthesiology, Clinical Pharmacology. 2013;29(2):162-167. doi:10.4103/0970-9185.111665.
- Conti J, Smith D. Haemodynamic responses to extubation after cardiac surgery with and without continued sedation. Br J Anaesth 1998;80:834-6
- Koga K, Asai T, Vaughan RS, Latto IP. Respiratory complications associated with tracheal extubation. Timing of tracheal extubation and use of the laryngeal mask during emergence from anaesthesia. Anaesthesia 1998;53:540-4.
- Westfall TC and Westfall PD. Adrenergic Agonist and Antagonist. Bruton LL, Chabner BA, Knollman BC. Twelfth: Goodman & Gilman's, The Pharmacological Basis of Therapeutics. McGraw Hill; 2011: 326
- Bharti N, Chari P, Kumar P. Effect of sevoflurane versus propofol-based anaesthesia on the haemodynamic response and recovery characteristics in patients undergoing micro laryngeal surgery. Saudi Journal of Anaesthesia. 2012; 6(4):380–84.
- Chabra B, Malhotra N, Bharadwaj M, Goel G. Haemodynamic response to extubation : attenuation with propofol, lignocaine and esmolol. J Anaesth Clin Pharmacol 2003; 19: 283-288.
- Wang YQ, Guo QL, Xie D. Effects of different doses of esmolol on cardiovascular responses to tracheal extubation. Hunan yi ke da xue xue bao= Hunan yike daxue xuebao= Bulletin of Hunan Medical University. 2003 Jun; 28(3):259-62.
- Jee D, Park SY. Lidocaine sprayed down the endotracheal tube attenuates the airway-circulatory reflexes by local anesthesia during emergence and extubation. Anesthesia & Analgesia. 2003 Jan 1; 96(1):293-7.
- Kasaba T, Takasaki M. Effects of landiolol on the cardiovascular response during tracheal extubation. Journal of anesthesia. 2008 Aug 1; 22(3):322-5.
- Turan G, Ozgultekin A, Turan C, Dincer E, Yuksel G. Advantageous effects of dexmedetomidine on haemodynamic and recovery responses during extubation for intracranial surgery. European journal of anaesthesiology. 2008 Oct 1; 25(10):816-20.
- Dyson A, Isaac PA, Pennant JH, Giesecke AH, Lipton JM. Esmolol attenuates cardiovascular responses to extubation. Anesthesia & Analgesia. 1990;71(6):675–678. [PubMed]
- O'Dwyer JP, Yorukoglu D, Harris MNE. The use of esmolol to attenuate the haemodynamic response when extubating patients following cardiac surgery- a double blind controlled study. Eur Heart J 1993; 14(5):701- 04
- Kovac AL, Masiongale A. Comparison of nicardipine versus esmolol in attenuating the hemodynamic responses to anesthesia emergence and extubation. J Cardiothorac Vasc Anesth. 2007;21:45–50. [PubMed]
- Kotambkar V, Katdare M. A Comparative study of effects of intravenous Nitroglycerine and intravenous Esmolol on hemodynamic response following tracheal extubation Indian Journal of Basic and Applied Medical Research; 2015:4, (3) 344-356.
- Muzzi DA, Black S, Losasso TJ, Cucchiara RF. Labetalol and esmolol in the control of hypertension after intracranial surgery. Anesth Analg 1990; 70(1):68-71
- Tendulkar MP , Ninave Prospective Comparision of Pressor and Airway Responses to IV Esmolol and IV Dexmedetomidine during Emergence from General Anaesthesia and Extubation. JKIMSU, 2017 (6)1:49-56.
- Hosseinzadeh H, Eidy M, Ghaffarlou M, Ghabili K, EJ Golzari S. Esmolol: A Unique Beta-Blocker in Maintaining Cardiovascular Stability Following Neurosurgical Procedures. Advanced Pharmaceutical Bulletin. 2012 ;2(2) :249-252.
- Shrestha S, Chand MB, Vaidya PR, Thapa P, Shrestha AB. Attenuation of Hemodynamic Response to Tracheal Extubation: Comparison of Esmolol and Lidocaine. PMJN; 2013,13(1) 26-30.
- Cheng Y-C, Li Y, Xu C-T, Xu L-X, Pan B-R. Effects of propofol versus urapidil on perioperative hemodynamics and intraocular pressure during anesthesia and extubation in ophthalmic patients. International Journal of Ophthalmology. 2011;4(2):170-174.
Corresponding Author
Dr G. Laxminarsaiah
Kakatiya Medical College, Warangal, Telangana State, India
Email: This email address is being protected from spambots. You need JavaScript enabled to view it., 9133647697