Comparison of Intravenous Lignocaine and Dexmedetomidine for Attenuation of Hemodynamic Stress Response to Laryngoscopy and Endotracheal Intubation

Abstract

BACKGROUND The purpose of the present study was to evaluate the efficacy of intravenous lignocaine 1.5 mg / kg & intravenous dexmedetomidine 1 mcg / kg for attenuating the haemodynamic response to laryngoscopy & endotracheal intubation in patients undergoing elective surgery under general anaesthesia. METHODS In this prospective randomised, comparative, clinical study, 60 patients were randomly divided into 2 groups, among them 30 patients were given infusion of 1.5 mg / kg IV lignocaine, diluted to 10 ml with normal saline, 3 minutes before intubation & 30 patients were given infusion of dexmedetomidine 1 mcg / kg diluted to 25 ml in normal saline over 10 minutes through infusion pump before induction. The heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, rate pressure product, oxygen saturation were measured at baseline, after study drug intubation at L + 1, L + 3, L + 5, L + 7 & L + 10 (L is onset of laryngoscopy). Statistical analysis was done by using descriptive & inferential statistics using chisquare test, Students paired & unpaired t test to find out the significance of the five variables namely mean heart rate (HR), mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP), mean arterial pressure (MAP) and mean rate pressure product (RPP). RESULTS Dexmedetomidine provided better blunting of stress response during laryngoscopy and intubation without causing clinically significant respiratory depression, bradycardia or hypotension. It is better in achieving a low RPP, which is a good predictor of myocardial oxygen consumption. Dexmedetomidine provides better cardio-protection in patients against pressure response than lignocaine. CONCLUSIONS In these 60 patients, dexmedetomidine (1 mcg / kg) was found to be superior to lignocaine (1.5 mg / kg) for attenuation of pressor response. KEY WORDS Laryngoscopy, Endotracheal Intubation, Dexmedetomidine, Lignocaine, Rate Pressure Product

Comparison of dexmedetomidine, lidocaine and fentanyl in attenuation of haemodynamic response to laryngoscopy and intubation in cardiac surgery patients

“…Seangrung et al [14] found that difference in mean values of SBP, DBP and MAP were significantly lesser with dexmedetomidine at 4-10 min (p-value<0.05) compared to lidocaine with propopfol which is similar to our study. Anandani DN et al [15] observed that dexmedetomidine was better than lignocaine in attenuation of SBP and MAP after intubation as has been observed in our study. Samuel, H et al [16], Gurulingappa et al [6] and Thippeswamy RR et al [17] compared fentanyl vs lignocaine in reduction of pressor response and found fentanyl was better than lignocaine which is similar to our study.…”

“…than the other two groups in decreasing RPP at 1 st (p-value =0.040), 3 rd (p-value=0.001), 5 th (p-value =0.001), 10 th (p-value <0.001) and 15 th (p-value =0.002) minute which was highly statistically significant. Anandani DN and colleagues compared lignocaine and dexmedetomidine in reduction of sympathoadrenal response to intubation and concluded that dexmedetomidine had more significant reduction in RPP than lignocaine and hence has superior cardio-protection in patients against hemodynamic response than lignocaine [15] which was also seen in our study. Jain V et al [12] observed that the highest elevation in RPP occurred at 1 min post intubation in the fentanyl group, with a figure of 9758.43, which was statistically higher than that of the dexmedetomidine group with mean RPP of 8185.96 at 1 min after laryngoscopy which was in concordance with our study.…”