Effect of esmolol & dexmedetomidine in attenuating haemodynamic response to laryngoscopy and endotracheal intubation- A comparative study

Abstract

Background:Endotracheal intubation and laryngoscopy are very essential tools in the hands of anaesthesiologists in maintaining airway. The present study is undertaken to determine the efficacy of IV dexmedetomidine 0.5μg/kg bolus and IV esmolol 0.5mg/kg bolus in attenuating the sympathetic responses to laryngoscopy and tracheal intubation and to compare the effect of esmolol & dexmedetomidine in attenuating haemodynamic response to laryngoscopy and endotracheal intubation.Materials & Methods:150 cases undergoing various elective Orthopaedic, Gynecological and General surgical procedures were selected were divided into three groups with 50 cases in each group.Group-I was Control group. In this group 10 ml Normal Saline was administered 5 minutes before laryngoscopy and intubation.Group-II was Esmolol group. Here patients received 0.5 mg/kg esmolol IV diluted to 10 ml with distilled water, 5 minutes before laryngoscopy and intubation.Group-III was Dexmedetomidine group. All the patients in this group received 0.5μ/kg of Dexmedetomidine IV diluted with distilled water to make 10 ml, 5 minutes before laryngoscopy and intubation. Results: A non- significant difference in HR, SBP, DBP, MAP, duration of laryngoscopy, RPP, mean dose of propofol RSS and VAS. The difference was non- significant (P> 0.05).After start of trial drug, mean heart rate increased in comparison to baseline in control group after 60seconds of injecting the drug. However, in Gr. Esmolol the HR decreased by 10% of the baseline which was statistically significant (P< 0.05). In dexmedetomidine group the HR decreased by 2.95% from the baseline,which was still comparable to the baseline.The mean baseline heart rates are similar in both the groups, statistical difference being insignificant (P > 0.05). A baseline mean systolic blood pressures of both the groups were comparable (P > 0.05).After start of trial drug, mean systolic blood pressure decreased in control & esmolol groups after 60 seconds from giving the drug by 1.2% & 3.2% (P>0.05) respectively. However, in Gr. Dexmedetomidine the mean SBP. Conclusion: Intravenous dexmedetomidine given in a dose 0.5 mcg/kg body weight before induction of anaesthesia attenuates the stress response to laryngoscopy and intubation and maintains haemodynamic stability during the intraoperative period.When dexmedetomidine given in a dose of 0.5 mcg/kg, adverse effects like dryness of mouth hypotension and bradycardia may be observed.