Attenuation of hemodynamic responses to endotracheal extubation with different doses of diltiazem with lignocaine: A placebo-controlled study

Abstract

Introduction:Endotracheal extubation causes transient hemodynamic stimulation leading to increase in blood pressure and heart rate (HR) due to increase in sympathoadrenergic activity caused by epipharyngeal and laryngopharyngeal stimulation. Lignocaine, a sodium channel blocker, attenuates the hemodynamic response to tracheal extubation by inhibiting sodium channels in the neuronal cell membrane, decreasing the sensitivity of the heart muscles to electric impulses. Diltiazem, a calcium channel blocker, attenuates hemodynamic response by blocking voltage-sensitive L type channels and inhibiting calcium entry-mediated action potential in smooth and cardiac muscle.Aims and Objectives:The aims and objectives of this are to study and to compare the efficacy of combination of intravenous (i.v.) diltiazem 0.1 mg/kg and i.v. lidocaine 1.0 mg/kg, diltiazem 0.2 mg/kg and lidocaine 1.0 mg/kg, lignocaine 1.0 mg/kg with normal saline given to attenuate exaggerated hemodynamic extubation responses and airway reflexes during extubation.Materials and Methods:This study was undertaken with 105 patients belonging to the age group 20–65 years with physical status ASA Classes I and II of either sex. Group A received injection diltiazem 0.1 mg/kg and preservative-free lignocaine 1 mg/kg. Group B received injection diltiazem 0.2 mg/kg and lignocaine 1 mg/kg. Group C received injection lignocaine 1 mg/kg with normal saline. In this study group, the drug dosage was fixed based on the previous studies.Results:At postextubation, significant difference in HR, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) were observed from 1 to 10 min between three groups. The difference in HR, SBP, DBP, and MAP were statistically significant between Group C in comparison with Group A and Group B from 1 min postextubation to 10 min.Conclusion:Combined diltiazem and lidocaine are more effective prophylaxis than lidocaine alone for attenuating the cardiovascular responses to tracheal extubation.

Role of pre–extubation fentanyl in mastectomy: a randomized, controlled, double–blind study

“…Thus MAP and HR will be elevated during emergence and extubation and can trigger a hazardous increase in the myocardial oxygen demand in patients with coronary artery disease (CAD) and those with risk factors for CAD. 8 Many drugs are used to attenuate the extubation response e.g., short-acting opioids, esmolol, labetalol, lidocaine IV, and intratracheal instillation of local anesthetic solution. A dependable method for smooth and rapid extubation is still not fully evolved.…”

Comparative study of the effect of two different doses of intravenous labetalol on the cardiovascular response to endotracheal extubation

“…10 , 11 Careful monitoring and control of blood pressure at the end of surgery and during extubation is very important to prevent hypertension in the recovery room and postoperative bleeding. 12 …”

“…10,11 Careful monitoring and control of blood pressure at the end of surgery and during extubation is very important to prevent hypertension in the recovery room and postoperative bleeding. 12 A variety of techniques have been used to reduce cardiovascular responses and cough during extubation, including extubation under deep anesthesia and the use of drugs such as narcotics, dexmedetomidine, calcium channel blockers, and lidocaine. 13 Labetalol is an adrenergic antagonist antihypertensive agent that acts on selective 1α receptors and non-selective 1β and 2β receptors.…”