Key result
Intravenous esmolol 1.5 mg/kg significantly attenuated the rise in heart rate and blood pressure following laryngoscopy and intubation compared to intravenous lignocaine 1.5 mg/kg.
Why the study?
Direct laryngoscopy and endotracheal intubation cause hypertension and tachycardia that can be detrimental in systemic disease, creating a need to evaluate cost-effective drugs like esmolol and lignocaine to attenuate these responses.
Does intravenous esmolol reduce the cardiovascular stress response to laryngoscopy and intubation compared to intravenous lignocaine in patients undergoing elective surgery?
Observational (n=140)
No
Does intravenous esmolol reduce the cardiovascular stress response to laryngoscopy and intubation compared to intravenous lignocaine in patients undergoing elective surgery?
Absolute Event Rate: 84.8% vs 91.3%
p-value: p=0.0001
Intravenous esmolol (1.5 mg/kg) is more effective than lignocaine (1.5 mg/kg) in attenuating the transient cardiovascular stress response, including tachycardia and hypertension, associated with laryngoscopy and intubation.
BACKGROUND Direct laryngoscopy and endotracheal intubation frequently induce a cardiovascular stress response characterized by hypertension and tachycardia due to reflex sympathetic discharge due to laryngotracheal stimulation which leads to increased plasma nor epinephrine concentration. The response is transient occurring 30 seconds after intubation and lasting for less than 10 minutes. Laryngoscopy and endotracheal intubation are associated with undesirable haemodynamic response which is of little significance in healthy patients but may be detrimental in patients with systemic diseases like hypertension, ischemic heart disease, stroke, perforated eye injury, increased intracranial tension etc. There is a need to attenuate these haemodynamic changes to decrease the mortality and morbidity. This study is designed to evaluate the attenuation of the haemodynamic response to laryngoscopy and endotracheal intubation with available cost effective drugs (esmolol and lignocaine) which are routinely used. METHODS This was an observational study conducted in the department of anaesthesiology, Travancore Medical College, Kollam among 140 patients in the age group 18 to 65 years posted for elective surgery from October 2017 to September 2018. Patients who received lignocaine or esmolol as intravenous agent prior to the induction of anaesthesia were recommended to group ‘L’ and ‘E’ respectively. Blood pressure and heart rate was recorded prior to laryngoscopy as well as 1 minute, 3minutes, 5 minutes and 10 minutes after laryngoscopy and intubation. Collected data was tabulated and analyzed using appropriate statistical software (SPSS20). RESULTS The rise in heart rate, systolic BP, diastolic BP, and mean arterial pressure were better controlled by esmolol than lignocaine. CONCLUSIONS Intravenous esmolol 1.5mg/kg is found to be more effective in the attenuation of hemodynamic responses to laryngoscopy and endotracheal intubation than intravenous lignocaine 1.5mg/kg.
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Sreesabari et al. (2022) conducted an observational in Elective non-cardiac surgery requiring general anesthesia and intubation (n=140). Esmolol vs. Lignocaine 1.5 mg/kg IV was evaluated on Mean heart rate at 1 minute after intubation (beats per minute) (p=0.0001). Intravenous esmolol 1.5 mg/kg significantly attenuated the rise in heart rate and blood pressure following laryngoscopy and intubation compared to intravenous lignocaine 1.5 mg/kg.
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