A comparative study of efficacy of intravenous dexmedetomidine and intravenous esmolol for attenuation of stress response during laryngoscopy and endotracheal intubation

Abstract

INTRODUCTIONLaryngoscopy and tracheal intubation are noxious stimuli that evoke transient but marked sympathetic response manifesting as an increase in the heart rate, blood pressure, intraocular and intracranial pressure. These changes are seen maximum immediately after intubation and last for 5 to 10 minutes.1 Topical or intravenous (I.V.) lidocaine, opioids, inhaled anesthetics, vasodilators, calcium channel blockers or adrenergic blockers have been used successfully for decreasing the hemodynamic response to laryngoscopy. [2][3][4][5][6][7] Esmolol is a water soluble, rapid onset, ultra-short-acting, selective β adrenergic receptor antagonist with proven efficacy to provide hemodynamic stability during laryngoscopy and tracheal intubation.2 It has a half-life of nine minutes.Dexmedetomidine is an imidazole derivative and selective alpha α2 adrenergic receptor agonist. 8 α2-agonists produce hyperpolarization of noradrenergic neurons and suppression of neuronal firing in the locus ceruleus which leads to decreased systemic noradrenaline release resulting in attenuation of sympathoadrenal responses and hemodynamic stability during laryngoscopy and tracheal intubation. We conducted this study to compare the efficacy of esmolol and dexmedetomidine for attenuation of the ABSTRACT Background: The present study compares the effects of I.V. dexmedetomidine and I.V. esmolol on hemodynamic response occurring due to laryngoscopy and endotracheal intubation in elective general surgery. Methods: A total of 60 patients aged 18-60 years, American Society of Anesthesiologists physical status I or II, either sex, scheduled for elective surgical procedures were included in this study. Patients were randomly allocated by chit method into two equal groups of 30 each, comprising of group dexmedetomidine (group D) 1 μg/kg diluted with 0.9% saline to 10 ml I.V. over 10min and group esmolol (group E) 1 mg/kg diluted with 0.9% saline to 10 ml I.V. given just before induction. Heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure were recorded at baseline, after 5 min of infusion, after induction and at 1, 3, 5 and 10 min after endotracheal intubation. Results: In group D, there was no statistically significant increase in HR and blood pressure after intubation at any time intervals, where as in group E, there was a statistically significant increase in blood pressure and heart rate after intubation at 1, 3, 5 and 10 min. Conclusions: Dexmedetomidine 1 μg/kg is more effective than esmolol for attenuating the hemodynamic response to laryngoscopy and intubation in elective surgical patients.

Comparison of esmolol and dexmedetomidine for suppression of hemodynamic response to laryngoscopy and endotracheal intubation in adult patients undergoing elective general surgery: A prospective, randomized controlled double-blinded study

“…conducted a similar study in neurosurgical patients and found dexmedetomidine better. [ 21 ] Gupta and Vyas[ 22 ] and Selvaraj and Manoharan[ 23 ] also observed similar results.…”

Effects of Intubation on heart rate: Xylocard and Esmolol

“…The presser response due to CO2 retention is delayed and less abrupt. [7] A significant rise in heart rate was observed during laryngoscopy, which was similar to the finding of stilting R.K. (1976 and 1977) and Den linger (1974). The heart rate increase was similar in all the groups A,B and C. it increase by an average of 4 beats/minute following induction.…”