To Study The Efficacy Of Intravenous Esmolol, Lidocaine And Diltiazem In Attenuating Haemodynamic Response To Laryngoscopy And Intubation

Abstract

Hypertension and tachycardia have been reported since 1950 during intubation under light anesthesia. Increase in blood pressure and heart rate occurs most commonly from reflex sympathetic discharge in response to laryngotracheal stimulation. Hypertensive response of normal subjects to laryngoscopy and intubation might be enhanced and prove dangerous to hypertensive subjects. Various agents have been used to attenuate hypertensive response. Seventy five patients fulfilling eligibility criteria were included in study. The patients were randomly assigned to one of three groups of twenty five each through a computer generated number. Group A = received 1mg/ kg of esmolol intravenously (n=25), Group B = received 1.5mg/ kg of lidocaine intravenously (n=25), Group C = received 0.2mg/ kg of diltiazem intravenously (n=25). These agents were administered three minutes prior laryngoscopy. Patients were premedicated with fixed dose of injection fortwin and phenergan according to body weight and anesthesia was induced with thiopentone, intubation facilitated by use of succinylcholine. No surgical stimulation, analgesics or inhalational anesthetics were allowed till five minutes after intubation and haemodynamic parameter noted. The results were statistically analyzed. We concluded that esmolol in dose of 1 mg/kg intravenously 3 min prior to laryngoscopy and intubation prevented the rise in heart rate effectively. Esmolol was also effective in attenuating systolic blood pressure increase, diastolic blood pressure increase and increase in mean blood pressure except at 1 min after intubation whereas in comparison lidocaine and diltiazem were not that effective.