Clinical Efficacy Of Combination Of Diltiazem And Lidocaine In Attenuating Hemodynamic Changes During Tracheal Intubation And Comparing The Response When They Are Used Alone.

Abstract

Background: Tracheal intubation produces transient hemodynamic pressor responses which may be unpredictable. Diltiazemlidocaine combination is hypothesized to attenuate these responses better that when they are used alone.Aims: To compare the clinical efficacy and safety of diltiazem-lidocaine combination in attenuating pressor response to tracheal intubation with lidocaine and diltiazem alone.Settings and Design : prospective double blind, randomised clinical trial of efficacy and safetyMethods and Materials: 120 ASA grade I&II patients were randomly divided in to four groups (using a random sequence generator) of 30 each according to the drug given before intubation to attenuate the hemodynamic response to intubation: saline in control group, diltiazem in D group, lidocaine in L group and both diltiazem and lidocaine in DL group. The person A prepared the drugs, B injected the drug and C evaluated the response; B and C were thus unaware of the drug given.Statistical analysis used : Demographic profiles were evaluated statistically using CHI square test. Changes in haemodynamic parameters were compared using paired t test within the group. Inter group comparison were done by one way analysis of variance (ANOVA). Results: The attenuation of hemodynamic response occurred maximal in DL group followed by lidocaine and diltiazem group respectively (P value< 0.001 till 5 minutes postintubation for BP and HR). Lidocaine controlled both heart rate and blood pressure better than Diltiazem as there was reflex tachycardia to some extent in D group due to reflex sympathoadrenal stimulation. Diltiazem-Lidocaine combination controlled both these parameter to optimal levels.Conclusions : The primary outcome of the study is that Diltiazem-Lidocaine combination is safe and effective in attenuating pressor response to tracheal intubation. We recommend its routine used before intubation