Attenuation of Laryngoscopy and Endotracheal Intubation-Induced Sympathomimetic Responses With Intravenous Esmolol and Lignocaine: A Comparative Study

Abstract

Introduction: Direct laryngoscopy and endotracheal intubation are a noxious stimulus and induces sympathomimetic responses. Although properly tolerated in normal and healthy subjects, it can impose serious arrhythmias, left ventricular failure, myocardial ischemia, or rupture of cerebral aneurysm in vulnerable patients. Various techniques are currently working to attenuate this response, but, so far, none of them have been proven to be superior. Esmolol and Lignocaine; attenuate those responses however are related to some untoward outcomes such as bradycardia and hypotension. In low doses, the chances of those expected untoward outcomes are relatively low. Aim and Objectives: We designed this prospective clinical education to assess and compare the efficacy of intravenous Esmolol and Lignocaine in attenuating sympathomimetic responses to laryngoscopy and endotracheal intubation. Methods: After the Institutional Ethics Committee approval, 52 consenting patients of ASA physical repute I or II of age between 20 and 60 years, scheduled for surgeries requiring general anesthesia, remained randomly owed to two groups; Group E and Group L, given 2 mg/kg of inj. Esmolol intravenously and inj. Lignocaine 2 mg/kg, respectively, 2 min before intubation. Final outcome variables such as heart rate (HR), systolic blood pressure (BP), diastolic BP, and mean arterial pressure (MAP) had been recorded and compared between the two groups immediately after intubation (AI) and then at 1, 3, and 5 min AI. Results: There was no statistically huge distinction regarding the demographic profiles of both the study groups. There has been a substantial rise in mean HR in the lignocaine group all through laryngoscopy and intubation, which did not settle to baseline level even after 5 min (p<0.0001). In the esmolol group, a significant attenuation of HR was observed immediately AI and 1, 3, and 5 min following intubation. MAP was well controlled in the esmolol group. Throughout the study period, readings of mean arterial pressure were much higher in esmolol group. In the lignocaine group, the values of study parameters were higher than the baseline at every point of time. Diastolic BP was elevated in both groups. Conclusion: Esmolol was found to be more effective for attenuation of hemodynamic tension response to laryngoscopy and intubation when compared with Lignocaine. However, Lignocaine is also safe and effective to some extent.