Key result
Both intravenous esmolol (1 mg/kg) and labetalol (0.4 mg/kg) significantly attenuated the haemodynamic reflex responses to laryngoscopy and intubation compared to placebo, with esmolol demonstrating a quicker response for blood pressure control.
Why the study?
Do intravenous esmolol or labetalol reduce hemodynamic stress responses during laryngoscopy and intubation in adult patients undergoing elective surgery?
RCT (n=75)
Double-blind
Randomized
No
Do intravenous esmolol or labetalol reduce hemodynamic stress responses during laryngoscopy and intubation in adult patients undergoing elective surgery?
p-value: p=<0.001
Both intravenous esmolol and labetalol effectively attenuate the hemodynamic stress response to laryngoscopy and intubation without side effects.
Esmolol or labetalol may blunt intubation stress response; leaves open comparative efficacy in randomized trials.
Background: Direct laryngoscopy and endotracheal intubation frequently induce cardiovascular stress response characterised by hypertension and tachycardia due to reflex sympathetic stimulation. Considering the clinical significance of these changes stress attenuation is needed to blunt these responses. β- blockers are used to reduce the unwanted hemodynamic responses. Esmolol is ultra-short acting cardio selective β blocker. Labetalol is useful in not only attenuating the response to laryngoscopy and intubation but also in preventing perioperative cardiovascular events. Present study compared the efficacy of esmolol and labetalol for attenuation of sympathomimetic response to laryngoscopy and intubation.Methods: It was a prospective, randomized, controlled study carried out in 75 adult patients with ASA 1 and ASA 2 posted for elective surgeries. Patients were allocated randomly into Group-1 (esmolol) and Group-2 (labetalol) and Group-3 (placebo) of 25 patients each. Inj. esmolol (1mg/kg) or Inj. labetalol (0.4 mg/kg) or placebo (0.9NS) dissolved up to 5 ml in distilled water was injected intravenously 5 minutes prior to intubation. All patients premeditated with Inj. glycopyrrolate (4µg/kg). Patient were then induced with Inj. propofol (2mg/kg), Inj. scoline (2mg/kg) given followed by laryngoscopy and intubation. Haemodynamic readings were noted at T0 (baseline before injecting the drug), T1 (1 minute after injecting the drug), T2 (after intubation), T3 (2 minutes after intubation), T4 (4 minutes after intubation), T5 (6 minutes after intubation), T6 (8 minutes after injection), T7 (10 minutes after injection).Results: Gr-1, Gr-2 and Gr-3, when compared with each other for systolic BP, diastolic BP, mean BP, and HR, showed a statistically significant difference at different intervals.Conclusions: Both the drugs are found to be effective in attenuation of hemodynamic reflex without any side effects. Further studies are recommended to substantiate the findings in present study.
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Kumar et al. (2017) conducted an RCT in Haemodynamic stress response during laryngoscopy and intubation (n=75). Esmolol and Labetalol vs. Placebo (0.9% normal saline) was evaluated on Haemodynamic changes (systolic BP, diastolic BP, mean arterial pressure, and heart rate) at various intervals up to 10 minutes post-intubation (p=<0.001). Both intravenous esmolol (1 mg/kg) and labetalol (0.4 mg/kg) significantly attenuated the haemodynamic reflex responses to laryngoscopy and intubation compared to placebo, with esmolol demonstrating a quicker response for blood pressure control.
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