Comparison of Lignocaine and Esmolol in Attenuating Cardiovascular Response to Laryngoscopy and Endotracheal Intubation: A Randomized Study of 70 Cases

Background: Laryngoscopy and endotracheal intubation trigger sympathetic stimulation leading to tachycardia and hypertension. Pharmacologic blunting with intravenous lignocaine or esmolol is common, but comparative effectiveness is context- dependent. Aim: To compare the efficacy and safety of lignocaine vs esmolol in attenuating hemodynamic responses to direct laryngoscopy and endotracheal intubation in adult surgical patients. Design: Prospective, randomized, double‑blind, parallel‑group trial. Methods: Seventy ASA I–II adults (18–60 years) scheduled for elective surgery under general anesthesia were randomized (1:1) to receive (A) Lignocaine 1.5 mg·kg⁻¹ IV or (B) Esmolol 1.5 mg·kg⁻¹ IV. Study drug was administered over 30–60 s, 3 minutes before laryngoscopy. Standardized induction used fentanyl, propofol, and a non‑depolarizing neuromuscular blocker. Hemodynamics (HR, SBP, DBP, MAP) were recorded at baseline, post‑induction (pre‑laryngoscopy), at intubation (time 0), and 1-, 3-, and 5-minutes post‑intubation. Primary outcome: peak rate‑pressure product (RPP) within 5 min after intubation. Secondary outcomes: absolute/percent changes in HR and MAP; arrhythmias; adverse events (hypotension, bradycardia). Results: Both groups were comparable in demographic characteristics and baseline hemodynamics. At intubation, there was a significant rise in HR and MAP in the lignocaine group compared to the esmolol group (p < 0.01). The peak RPP was significantly lower in the esmolol group (11,250 ± 1,200) than the lignocaine group (13,400 ± 1,350). Esmolol effectively blunted tachycardia with mean HR at 1 min post‑intubation of 86 ± 10 bpm versus 102 ± 12 bpm in the lignocaine group (p < 0.001). MAP increase was attenuated in both groups, though the difference favored esmolol (p = 0.04). Adverse events were infrequent: transient hypotension occurred in 2 patients in the esmolol group and 1 in the lignocaine group, all responsive to fluids/vasopressor. No episodes of severe bradycardia or arrhythmia were observed. Conclusion: Both lignocaine and esmolol attenuate the hemodynamic response to laryngoscopy and intubation, but esmolol is more effective in controlling tachycardia and reducing myocardial oxygen demand. Esmolol should be considered the preferred agentwhen precise control of heart rate is desired, particularly in patients at risk of ischemia.