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

摘要

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. Objectives Of Study To study the efficacy of intravenous esmolol, lidocaine, and diltiazem in attenuating haemodynamic response to laryngoscopy and intubation. To study safety of intravenous esmolol, lidocaine, and diltiazem in attenuating haemodynamic response to laryngoscopy and intubation. Introduction Hypertension and tachycardia have been reported since 1950 during intubation under light anesthesia (Burstein 1950, Forbes and Dally 1970)1. Tachycardia is the most common rhythm disturbance during anesthesia and surgery. Increase in blood pressure and heart rate occurs most commonly from reflex sympathetic discharge in response to laryngotracheal stimulation, which in turn leads to increase plasma norepinephrine concentration. Hill (1932)2 also concluded from ECG studies that arrhythmias were a feature of induction of anesthesia. Dingle (1966)3 and Forbes and Dally (1970)1 suggested that the hypertensive response of normal subjects to laryngoscopy and intubation might be enhanced and prove dangerous to hypertensive subjects. This sympathoadrenal response to laryngoscopy results in an increased cardiac work load which in turn may culminate in perioperative myocardial ischaemia and acute heart failure in susceptible individuals. This response is undesirable in any patient with heart disease undergoing surgery, irrespective of the nature of surgery. Various agents have been used to attenuate hypertensive response including :topical lignocaine – sprays, deeper plane of anesthesia – by inhalational agents, narcotics like fentanyl, alfentanil, sufentanil, remifentanyl, magnesium sulphate, ca-channel blockers, vasodilators like SNP and NTG. The topic of study was chosen because it has been noted previously by many workers that increase in blood pressure and heart rate that results from sympathetic discharge in response to laryngyotracheal stimulation may get further enhanced and prove dangerous to hypertensive and ischemic heart disease patients. Esmolol, (methyl 3-[4- [2 – hydroxyl – 3) isopropylamino) propoxyl] phenyl ] proprionate HCl) is a cardio selective water soluble ultrashort acting ?1 adrenergic receptor antagonist that can be administered only intravenously. Esmolol is rapidly hydrolysed by cytyoplasmic esterases in red blood cells, therefore has short elimination of approximatel