Comparison of esmolol and labetalol, in low doses, for attenuation of sympathomimetic response to laryngoscopy and intubation

Abstract

Objective:The present study compared the efficacy of esmolol and labetalol, in low doses, for attenuation of sympathomimetic response to laryngoscopy and intubation.Design:Prospective, randomized, placebo controlled, double-blinded study.Setting:Operation room.Patients and Methods:75 ASA physical status I and II adult patients, aged 18-45 years undergoing elective surgical procedures, requiring general anesthesia and orotracheal intubation.Interventions:Patients were allocated to any of the three groups (25 each)-Group C (control)10 ml 0.9% saline i.v. Group E (esmolol) 0.5 mg/kg diluted with 0.9% saline to 10 ml i.v. Group L (labetalol) 0.25 mg/kg diluted with 0.9% saline to 10 ml i.v. In the control group 10 ml of 0.9% saline was given both at 2 and 5 min prior to intubation. In the esmolol group 0.5 mg/kg of esmolol (diluted with 0.9% saline to 10 ml) was given 2 min prior and 10 ml of 0.9% saline 5 min prior to intubation. In the labetalol group 10 ml of 0.9% saline was administered 2 min prior and 0.25 mg/kg of labetalol (diluted with 0.9% saline to 10 ml) 5 min prior to intubation. All the patients were subjected to the same standard anesthetic technique.Measurements:Heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded prior to induction, at time of intubation and 1, 3, 5, and 10 min after intubation. Mean arterial pressure (MAP) and rate pressure product (RPP) were calculated. Abnormal ECG changes were also recorded.Results:Compared to placebo and esmolol (0.5 mg/kg), labetalol (0.25 mg/kg) significantly attenuated the rise in heart rate, systolic blood pressure, and RPP during laryngoscopy and intubation. However, the difference was not statistically significant among the values for DBP and MAP.Conclusion:In lower doses, labetalol (0.25 mg/kg) is a better agent than esmolol (0.5 mg/kg) in attenuating the sympathomimetic response to laryngoscopy and intubation.

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

“…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.…”

“…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.…”

A comparative randomized study to evaluate the effect of gabapentin alone and in combination with labetalol in attenuating the pressor response to direct laryngoscopy and intubation

“…Montazeri et al [25] observed similar results with 800 mg gabapentin, especially on systolic, diastolic, and MAPs. Singh et al [18] found labetalol 0.25 mg/ kg more effective than esmolol 0.5 mg/kg for the attenuation of pressor response when given to patient 1 h before intubation. Chung et al [16] demonstrated that intermediate dose of labetalol blunts HR response to laryngoscopy and intubation in healthy patients but has minimal effect on BP, and in our study, the combination of labetalol and gabapentin blunted HR response better than gabapentin alone.…”

“…Roelofse et al [17] found labetalol 1 mg/kg more effective when compared with acebutolol 0.25 mg/kg and lidocaine 2 mg/kg for attenuation of pressor response. Singh et al [18] found labetalol 0.25 mg/kg more effective than esmolol 0.5 mg/kg for attenuation of pressor response when given to patient 1 h before intubation. Gabapentin is a relatively new drug, which was introduced as antiepileptic but proved to be effective in controlling neuropathic pain.…”

Effect of Labetalol and Esmolol on Onset of Action of Rocuronium: A Prospective Double-Blinded Randomized Controlled Trial

“…Labetalol due to its peripheral vasodilation property does not affect the cardiac output [8]. Labetalol has been shown to have an effect on blunting the hemodynamic response to tracheal intubation [9][10][11]. Thus, we hypothesized that labetalol while blunting the hemodynamic response to tracheal intubation will not lengthen the time to onset of action of rocuronium.…”