COMPARATIVE ASSESMENT OF EFFICACY OF LIGNOCAINE (1.5 mg/kg), ESMOLOL (300 µg/kg) AND DEXMEDETOMIDINE (0.5 µg/kg) IN MINIMIZING THE PRESSOR RESPONSE TO LARYNGOSCOPY AND INTUBATION

Abstract

In the 20 th century, surgery has seen a manifold increase in numbers across the whole world. Laryngoscopy and intubation are obligatory procedures for most patients undergoing surgery under general anesthesia. Despite the advent of new airway devices, rigid laryngoscopy and tracheal intubation are still considered the apogee. However, inevitably it is associated with certain cardiovascular changes such as tachycardia, escalation in blood pressure, and a plethora of cardiac arrhythmias. 1 The hemodynamic changes stemming from such airway instrumentation are due to sympathoadrenal discharge caused by epipharyngeal and parapharyngeal stimulations. 2 The sympathetic pressor response to laryngoscopy and intubation can lead to various adverse events like myocardial ischemia, pulmonary edema, acute heart failure, and cerebrovascular accidents, in susceptible individuals. 3-5 Lignocaine is one of the oldest pharmacological agents to be used for diminishing of the pressor response. 6 Esmolol, an ultra-short acting cardioselective β-blocker with rapid onset when administered intravenously is an attractive option for attenuating this pressor response. 7 α 2 adrenergic agonist dexmedetomidine possesses sympatholytic effects thereby preventing catecholamine release, hypertension, and tachycardia. 8

Ivabradine versus propranolol given orally in microlaryngoscopic surgeries in attenuating stress response: A comparative prospective double blind randomized study

“…Some studies evaluated the efficacy of beta-blockers including propranolol in decreasing stress response due to laryngoscopy [18][19][20][21].…”

Effects of Intubation on heart rate: Xylocard and Esmolol

“…produced reduction in heart rate (R), systlic Blood pressure (P) rate pressure product (RPR) Right and left ventricular ejection fraction, and cardiac index at rest. [6] Which is similar to propranolol 4mg. same results are reproduced during exercise also.…”