Efficacy of a bolus dose of esmolol and bolus dose of lignocaine for attenuating the pressor response to laryngoscopy and endotracheal intubation in general anesthesia: A comparative study

Mulimani, Sridevi M; Talikoti, D. G.; Vastrad, Vinuta Vidyanand; Sorganvi, Vijaya

doi:10.4103/aer.aer_31_19

Cited by 6 publications

(4 citation statements)

References 25 publications

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“…These findings go in hand with previous studies that reported significant blunting of pressor reflexes to LTI with esmolol injection compared to placebo,[22] diltiazem[23] and lidocaine. [2425] In support of the efficiency of the priming dose of esmolol, Thiruvenkatarajan et al [26] screened the published databases for randomized controlled trials comparing the effect of esmolol and placebo on the corrected QT (QTc) interval prolongation associated with LTI in patients undergoing cardiac and noncardiac surgeries and found esmolol significantly reduced the QTc and protected the heart against intubation-induced arrhythmias.…”

Section: Discussionmentioning

confidence: 99%

Esmolol infusion reduces blood loss and opiate consumption during fertility preserving myomectomy

Hamed

Ataalla

2019

Anesth Essays Res

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Objectives:The objective of this study is to evaluate the effect of esmolol-induced hypotensive anesthesia (EIHA) on intra-operative (IO) bleeding during open myomectomy.Patients and Methods:Eighty-eight women were randomly divided into the study group received EIHA without uterine tourniquet and control group who received normotensive anesthesia with uterine tourniquet. EIHA was provided as priming dose of esmolol (0.5 mg.kg-1) before the induction of anesthesia and esmolol infusion (0.05-0.3 mg.kg-1.min-1) to maintain mean arterial pressure at 60–70 mmHg that was stopped on completion of myomectomy. Fentanyl was used as IO analgesia (loading dose: 1.0 μg.kg-1 then infusion of 0.2-0.4 μg.kg-1.h-1). All patients received 6% hydroxyethyl starch (HES; initially, 3 mL.kg-1 over 5-10 minutes and supplemental doses according to requirements) and Lactated Ringer's solution (LR; 5 mL.kg-1.h-1). Trigger for blood transfusion was hemoglobin concentration (HBC) <7 g.dL-1. Study outcomes included the extent of postoperative (PO) HBC deficit in relation to preoperative HBC, frequency of tourniquet application for the study patients, and total fentanyl consumption.Results:EIHA significantly reduced blood pressure measures since laryngoscopy and tracheal intubation till the end of surgery in the study group compared to control group. Eight study patients (18.9%) required tourniquet application for control of bleeding; however, amount of IO blood loss; total field visibility score and PO HBC deficit were non significantly lower in the study group. EIHA allowed significant reduction of the IO amount of LR and additional amounts of HES infusions. Study patients group consumed significantly lower IO fentanyl doses with significantly longer duration till the 1st PO request and the number of additional fentanyl, and lower numeric rating scale scores in study group compared to controls.Conclusion:Open myomectomy under EIHA is feasible and safe and allows fertility-sparing with minimal risk of blood transfusion. The applied procedure of EIHA allowed blunting of pressor reflexes secondary to LIT, surgical stresses and extubation, and allowed reduction of IO and PO opioid doses.

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Section: Discussionmentioning

confidence: 99%

Esmolol infusion reduces blood loss and opiate consumption during fertility preserving myomectomy

Hamed

Ataalla

2019

Anesth Essays Res

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“…The dose of esmolol used in this study is lower than that of previous studies. 13,14 Through the comparison of several studies, we believe that a low dose of esmolol could already significantly improve the increase in blood pressure caused by intubation. The main reason is that enough analgesics are given in anesthesia induction, and propofol itself has an antihypertensive effect, so combining with In previous studies, most of them are about the influence of single-dose of esmolol on extubation response, 15,16 while articles of the effect of continuous esmolol administration during the operation on extubation are little.…”

Section: Discussionmentioning

confidence: 97%

Effect of Different Concentrations of Esmolol on Perioperative Hemodynamics and Analgesia in Patients Undergoing Colectomy: A Prospective, Randomized Controlled Study

Song¹,

Yan-wu²,

Peng³

et al. 2021

DDDT

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Purpose The aim of this study was to investigate the efficacy of esmolol on intraoperative hemodynamic and perioperative analgesic management. Methods Totally, 125 patients undergoing colectomy were randomly divided into three groups. Group S (saline group) was administered 0.75 mL/kg/h of normal saline for 5 min before anesthesia induction and maintenance of 0.25 mL/kg/h; Group E 1 and Group E 2 were administered 0.5 mg/kg and 1.0 mg/kg esmolol for 5 min before anesthesia induction, and maintained of 0.5 mg/kg/h and 2.0 mg/kg/h, respectively. Several parameters including indexes of hemodynamics variation (primary outcome), intra- and postoperative analgesic usage, and pain score were measured. Results Group E 1 and Group E 2 had significantly lower intubation response than Group S (P = 0.007, P = 0.001), and extubation response of Group E 2 was significantly lower than Group S (P = 0.007). The opioid consumption in Group E 1 and Group E 2 was significantly lower than in Group S intraoperatively (P = 0.020 and 0.007). The incidence of postoperative adverse reactions among the three groups was not statistically significant (P = 0.368 and 0.772). Conclusion Esmolol 0.5 mg/kg and 1.0 mg/kg infusion before intubation both can effectively inhibit the intubation response, while only maintenance with 2.0 mg/kg/h of esmolol can reduce the incidence of extubation response. At the same time, esmolol can decrease intraoperative opioid requirement without increasing the risk of adverse reactions. Trial Registration ChiCTR1900024538 and the date of registration was July 15, 2019 at http://www.chictr.org.cn .

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“…Different doses of esmolol ranging from 0.5 to 2 mg/kg have been used in the earlier studies. Mulimani et al [16] compared the efficacy of Esmolol and Lignocaine given as bolus dose, to 60 participating patients, for attenuating the sympathomimetic response. They observed a substantial increase in HR, and MAP at intubation and at 1, 2, 3, and 5 min post-intubation in lignocaine group, but study parameters readings were comparable with baseline in esmolol group.…”

Section: Discussionmentioning

confidence: 99%

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

Tripathi

KHUSHRAM

MERAVI

et al. 2023

Asian J Pharm Clin Res

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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.

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Efficacy of a bolus dose of esmolol and bolus dose of lignocaine for attenuating the pressor response to laryngoscopy and endotracheal intubation in general anesthesia: A comparative study

Cited by 6 publications

References 25 publications

Esmolol infusion reduces blood loss and opiate consumption during fertility preserving myomectomy

Esmolol infusion reduces blood loss and opiate consumption during fertility preserving myomectomy

Effect of Different Concentrations of Esmolol on Perioperative Hemodynamics and Analgesia in Patients Undergoing Colectomy: A Prospective, Randomized Controlled Study

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

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