<p class="abstract"><strong>Background:</strong> Laryngoscopy and tracheal Intubation are invariably associated with certain stress responses due to the sympatho-adrenal stimulation. These cardiovascular and neurohumoral alterations may directly affect the physiology and increase the risk. So far, various drugs have been tried but none has been considered ideal for blunting this presser response. We therefore, planned this comparative study to evaluate and compare the efficacy of intravenous magnesium sulphate (30 mg/kg) versus sublingual nitroglycerine spray (0.4 mg/spray) in attenuating the presser response to Laryngoscopy and Tracheal Intubation.</p><p class="abstract"><strong>Methods:</strong> Fifty patients, aged 15–50 years, scheduled for elective surgery under general anaesthesia, were randomly assigned to one of the two groups of 25 each, Group A (magnesium group) and Group B<strong> </strong>(nitroglycerine group). Study drug was given 90-120 seconds before tracheal intubation. Heart rate, Systolic blood pressure and Rate pressure product were recorded at different intervals after administering the study drug till 3 minutes after intubation.</p><p class="abstract"><strong>Results:</strong> Mean heart rate was significantly higher from the baseline at all times after administering the study drug in both the groups. Increase in systolic blood pressure as a presser response was limited to 7.25% in Group A and 5.83% in Group B from the baseline after tracheal intubation. There was relative hypotension after administration of the study drug in both the groups.</p><p class="abstract"><strong>Conclusions: </strong>Intravenous magnesium or sublingual nitroglycerine pre-treatment is found to be effective in attenuating the presser response to laryngoscopy and intubation. These drugs may lead to rise in HR but it is transient and dose dependent. However, both the drugs can significantly control the hypertensive response after laryngoscopy and intubation.</p><p class="abstract"> </p>
Background: Pneumoperitoneum created during laparoscopy results in patho-physiologic changes, especially in the cardiovascular system. Clonidine diminishes stress response by reducing circulating catecholamines and hence increases perioperative circulatory stability in patients undergoing laparoscopic surgeries. This comparative clinical study was planned compare with controls the effects of oral clonidine premedication (150 micrograms) on the intraoperative haemodynamics during laparoscopic cholecystectomy.Methods: Sixty adult patients between 15-50 years, scheduled for laparoscopic cholecystectomy under general anaesthesia were enrolled in the study. The patients were randomly assigned to two study groups of 30 patients each, Group CL: received oral clonidine (150 microgram) 90 minutes before induction of anaesthesia and Group C: received placebo. Anaesthetic technique was same for both the study groups. Hemodynamic variables (Heart rate, systolic (SBP), diastolic (DBP), mean arterial pressure (MAP), and EtCO2 were recorded at specific times - baseline; 90 minutes following study drug administration; induction of anaesthesia; 5 and 10 minutes following intubation; At skin incision; after creation of CO2 pneumoperitoneum and every 15 minutes thereafter till end of surgery; after desufflation; 5 minutes following extubation.Results: Patients in clonidine group had lower HR, SBP and DBP values as compared to control group at all points of time after giving the study drug (P <0.05). Percent change from baseline in HR and Blood pressure at different points of time was significantly high in control group than in clonidine group.Conclusions: Oral clonidine premedication (150 micrograms) is safe and provides perioperative hemodynamic stability in ASA I and II patients undergoing laparoscopic cholecystectomy, and hence can be recommended as a routine premedication for laparoscopic procedures.
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