Abstract
Background and Aims: Laryngoscopy and tracheal intubation causes sympathoadrenal stimulation and cause transient rise in pulse rate and blood pressure. We evaluated the efficacy of Esmolol and Lignocaine in attenuating the pressor response during laryngoscopy and inutbation as compared to placebo.
Methods: 60 patients of ASA I & II between the age group of 20-60 were randomized to receive either Esmolol 1.5 mg/Kg, Lignocaine 1.5mg/Kg or 5ml normal saline just prior to induction of anaesthesia. Heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded before induction (baseline) and at regular intervals of 1, 3, 5, 7 and 10 minutes after induction. Statistical analysis was done using Student’s t test and chi-square test and p values obtained.
Results: There is an increase in HR, SBP and DBP in the control group which is maximum at 3 mins after induction (i.e. during laryngoscopy and tracheal intubation). Whereas in the study groups there was no significant variation in these parameters from baseline which is found to be more effective with Esmolol (p-value < 0.001) than Lignocaine.
Conclusion: Esmolol 1.5mg/Kg was found to be more effective in attenuating pressor response to laryngoscopy and intubation when compared to Lignocaine.
Keywords: Esmolol, lignocaine, attenuation of pressor response, laryngoscopy, tracheal intubation, pressor response, blood pressure, heart rate.
References
- Prys-Roberts, L. T. Greene, R. Meloche and P. Foex. Studies of Anaethesia in Relation to Hypertension II: Haemodynamic Consequences of Induction and Endo-tracheal intubation, Br J Anaesth. 1998; 80 : 106-122.
- Kovac A. L. Controlling the hemodynamic response to laryngoscopy and endotracheal intubation. J Clin Anesth., 1996; 8:63-79
- J Fox, G. S. Sklar, C. H. Hill, R. Villaneuva, B. D. King. Complications related to the pressor response to endotracheal intubation. Anesthesiology, 1977; 47:524-5
- Lev, P. Rosen. Prophylactic lidocaine use preintubation: A review. J Emerg Med., 1994; 12:499-506
- M. Hefman, M. I. Gold, E. A. DeLisser, C. A. Herrington. Which drug prevents tachycardia and hypertension associated with tracheal intubation: lidocaine, fentanyl or esmolol. Anesth. Analg., 1991; 72:482-6
- Bruder, D. Ortega, C. Granthil. Consequences and prevention methods of hemodynamic changes during laryngoscopy and intratracheal intubation. Ann. Fr. Anesth. Reanim., 1992; 11:57-71
- Stoelting R. K. Circulatory changes during direct laryngoscopy and tracheal intubation: influence of duration of laryngoscopy with or without prior lidocaine. Anesthesiology, 1977; 47:381-3
- Abou-Madi M, Keszler H, Yacoub J M. Cardiovascular reactions to laryngoscopy and tracheal intubation following small and large intravenous doses of lidocaine. Can. Anaesth. Soc. J., 1977; 24:12-19
- Singh H, Vichitvejpaisal P, Gaines G Y, White P F. Comparative effects of lidocaine, esmolol and nitroglycerine in modifying the hemodynamic response to laryngoscopy and intubation. J. Clin Anesth. 1995; 7(1):5-8.
- Sharma S, Mitra S, Grover VK, Kalra R. Esmolol blunts the hemodynamic responses to tracheal intubation in treated hypertensive patients. Can J Anaesth. 1996 Aug; 43(8):778-82.
- Sharma S, Ghani AA, Win N, Ahmad M. Comparison of two bolus doses of esmolol for attenuation of haemodynamic response to tracheal intubation. Med J Malaysia.1995 Dec; 50(4):372-6.
- Vucevic M, Purdy GM, Ellis FR. Esmolol hydrochloride for management of cardiovascular stress responses to laryngoscopy and tracheal intubation. Br J Anaesth.1992 May; 68(5):529-30.
- Kindler C H, Schumacher P G , Schneider M C, Urwyler A. Effects of intravenous lidocaine, and/or esmolol on haemodynamic responses to laryngoscopy and intubation: a double- blind, controlled clinical trial. J Clin 1996 Sep; 8(6):491-6.
- Miller D R, Martineau R J, Wynands J E, Hill J. .Bolus administration of esmolol for controlling the haemodynamic response to tracheal intubation: the Canadian Multicentre trial.Can J Anaesth. 1991 Oct; 38(7):849-58.
- Feng C K, Chan K H, Liu K N, Or C H, Lee T Y. A comparison of lidocaine, fentanyl and esmolol for attenuation of cardiovascular response to laryngoscopy and tracheal intubation. Acta Anaesthesiol Sin. 1996 Jun; 34(2):61-7.
Corresponding Author
Dr Ceena Panicker
Sandilands, Vidya Nagar 4, Pattathanam East, Kollam, Kerala, India, Pin 691021.
Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mobile no: +919447462064