Intravenous esmolol is superior than sublingual nifedipine and intravenous lignocaine for attenuation of haemodynamic responses during laryngoscopy and endotracheal intubation
Journal Title: Journal of the Indian Medical Association - Year 2018, Vol 116, Issue 10
Abstract
Catacholamines released during laryngoscopy and endotrachial intubation (ETI) puts the patients at risk of development of various tachy arrythmias which have a deleterious effect on compromised cardiac functions. During the induction of general anaesthesia the two important events take place. One of them is laryngoscopy and another is endotracheal intubation. During laryngoscopy, the blade of the laryngoscope presses against the base of tongue and lifts up the epiglottis. This incidence gives rise to certain impulses to proceed through the vagus, the result being intense sympathetic stimulation. The cardioaccelerator nerve stimulation gives rise to tachycardia. The increase level of catecholamine gives rise to hypertension. Laryngoscopy produce more intense effects than endotracheal intubation in respect to cardiovascular system. Fifteen patients placed in each group received intravenous (IV) lignocaine (1.5mg), sublingual nifedipine (10mg) and IV esmolol (2mg/kg) 90 seconds,10 minutes 2 minutes before laryngoscopy and ETI respectively. Changes in heart rate, SBP, DBP, MAP RPR were recoded just after ETI and then after 1minute, 2minutes, 5minutes 10 minutes ETI. Results were compared with the control group (n=15, received no study medication). Intravenous lignocaine was not so much effective in countering the cardiovascular responses to laryngoscopy and ETI. Sublingual nifedipine produces a significant attenuation of SBP, DBP and MAP but it was unable to attenuate the pulse rate significantly. Intravenous esmolol is the best attenuator amongst the three drugs studied over here to the cardiovascular responses during laryngoscopy and intubation.
Authors and Affiliations
Utpal Kumar Ray, Prasanta Kumar Mandal
Keywords
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