Attenuation of Haemodynamic Responses to Laryngoscopy and Intubation - A Comparative Study Between Iv Esmolol and Iv Dexmedetomidine

Abstract

BACKGROUNDLaryngoscopy and tracheal intubation in adults cause stress response manifested by a rise in heart rate and blood pressure. Intravenous Esmolol has been used to suppress this stress response. A highly selective α2 adrenoreceptor agonist, Dexmedetomidine is being increasingly used to attenuate this response. In this clinical comparative study, we compared these two drugs in attenuating the stress response to laryngoscopy and intubation. MATERIALS AND METHODS100 patients belonging to ASA1 and ASA2 posted for surgeries under general anaesthesia were randomly divided into 2 groups of 50 each. Both the groups were pre-medicated with Inj. Glycopyrrolate 0.005 mg/kg and Inj. Fentanyl 1.5 μg/kg was given. Group D received 0.5 μg/kg Dexmedetomidine IV in 100 mL 0.9% normal saline for 15 minutes prior to induction and Group E received 1 mg/kg bolus dose of Esmolol 90 seconds prior to intubation. Both groups were induced with 2.5% Thiopentone 5 mg/kg and Inj. Vecuronium 0.1 mg/kg. Laryngoscopy was done and intubation accomplished within 20 seconds. Heart rate, blood pressure, mean arterial pressure were recorded before induction (baseline) and at every minute for the first 5 minutes and at 10, 15, 30 and 45 mins. after intubation. Sedation scoring as per modified Ramsay sedation scale was noted after extubation in both the groups. Statistical analysis was done using Chi-square (χ2) test of significance and Student "t" test and P value obtained. RESULTSBoth groups showed attenuation of stress response. Esmolol and Dexmedetomidine affected heart rate to same extent upto 5 minutes (p > 0.05). Unlike Esmolol group, heart rate remained lower in Dexmedetomidine group even after 10 minutes. In Dexmedetomidine group there was increase in SBP, DBP and MBP upto 3 minutes, after that it was maintained below the baseline. In Esmolol group there was no rise in systolic and diastolic blood pressure, mean arterial blood pressure and rate pressure product compared to the baseline from the 1st minute of intubation which is statistically significant (p < 0.0001). Post extubation Dexmedetomidine group patients were more sedated than those in Esmolol group. CONCLUSIONBoth Esmolol and Dexmedetomidine attenuate the stress response to laryngoscopy and intubation. When both these drugs were compared, Esmolol attenuated the stress response to laryngoscopy and intubation better than Dexmedetomidine and afforded a good haemodynamic stability. Post extubation Dexmedetomidine group patients were more sedated than those in Esmolol group. KEYWORDSAnaesthesia, Haemodynamic, Esmolol, Dexmedetomidine, Laryngoscopy, Intubation. HOW TO CITE THIS ARTICLE:Reddy MM, Nagaraja AS. Attenuation of haemodynamic responses to laryngoscopy and intubationa comparative study between IV esmolol and IV dexmedetomidine. J. Evolution Med. Dent. Sci. 2016;5(85):6313-6317, DOI: 10.14260/jemds/2016/1426 BACKGROUND Laryngoscopy and endotracheal intubation are associated with physical trauma to the oral cavity and elicit physiological response in the form of sy...