Role of Intravenous Midazolam, Esmolol and Their Combination in Attenuation of Cardiovascular Stress Response To Laryngoscopy and Intubation - A Comparative Clinical Study

Abstract

BACKGROUND AND AIM: Laryngoscopy & intubation are associated with tachycardia & hypertension. These hemodynamic changes are temporary & do not cause any complication in healthy person. But these changes can be detrimental to the patient with history of coronary artery disease and can facilitate and accelerate the development of myocardial ischemia, arrhythmias, infraction and also heart failure. The present study was designed to evaluate and study the efciency of intravenous midazolam, esmolol and their combination in the attenuation of cardiovascular response to laryngoscopy and intubation in normotensive individuals. METHOD: This randomized prospective double-blind study was performed on 90 patients of ASA physical status I and II undergoing various elective abdominal surgeries under general anaesthesia with endotracheal intubation. Patients were randomized in three groups, Group M (midazolam) 0.05mg/kg I.V, Group E (esmolol) 2mg/kg I.V and Group M/E (midazolam 0.05mg/kg + Esmolol 2mg/kg I.V) with 30 patients in each group. Hemodynamic parameters were recorded before the study drug and at specied intervals. RESULT:- All three groups showed less rise in heart rate and blood pressure during laryngoscopy and intubation. Haemodynamic parameters were signicantly less in Group-M/E than Group M and E alone just after intubation and 1 and 2 minutes intervals. CONCLUSION: Combination of both midazolam and esmolol effectively attenuated the cardiovascular stress response associated with laryngoscopy & intubation than single drug therapy with esmolol or midazolam.