A comparative study of the efficacy of I.V. esmolol and megnesium sulphate in attenuating haemodynamic response to laryngoscopy and tracheal intubation
Journal Title: Medpulse International Journal of Anesthesiology - Year 2018, Vol 5, Issue 2
Abstract
Problem Statement: The tracheal intubation is a powerful noxious stimulus. During laryngoscopy and tracheal intubation these is cardiovascular stress response. It occurs frequently and results in increased serum concentration of catecholamine’s. This adrenergic response may result in transient but intense increase in blood pressure by 40% - 50% and heart rate by 20%, which in turn increases cardiac work load and thereby myocardial oxygen demand. As a result, perioperative myocardial ischaemia, acute heart failure, and arrhythmia may develop in susceptible individuals. Cardia arrhythmia which may follow endotracheal intubation are due to either vagal release following the escape of anaesthetic agent from the lungs or to atrial asphyxia as a result of bronchospasm precipitated by the insertion of tube into inadequately anaesthetized patients. Methods: 90 normotensive patients of either sex belonging to ASA physical status I and II, in age group 15-65 ears, weighing 30-80 kg, undergoing general anesthesia for various elective non-cardiac surgical procedures, were taken for this study. Results: The tracheal intubation is well known to invoke cardiovascular responses partly as a result of reflex sympatho-adrenal discharge char-acterised by increase in arterial blood pressure, change in heart rate and disturbance in the cardiac rhythm. The heniodynamic changes as a result of tracheal intubation might produce adeleterious effect in a patient wi compromised cardiac function. Several attempts have been made to blun the haemodynamic responses to tracheal intubation. So, in the view of above finding the present clinical study was undertaken to evaluate the effect of two drugs esmolol and magnesium sulphate on hemodynamic response to laryngoscopy and tracheal intubation. Study was done in 3 groups in. group 1 patients received normal saline as placebo. In group I patients received magnesium sulphate 60mgkg-1 and in group III patients received esmolol 2 mgkg-1. Findings of each groups are discussed in comparison with their pre-operative values and with control group with at different time interval with regard to heart rate, systolic blood pressure, diastolic blood pressure and other complications. Conclusion: The esmolol in bolus dose of 2 mgkg-1- body weight, more effectively attenuates the haemodynamic response to laryngoscopy and tracheal intubation than magnesium sulphate. Esmolol also shortens the time interval needed for the heart rate, blood pressure and rate-pressure product to come down to the normal or base line value more effectively than magnesium. However, the rise in blood pressure was suppressed and not prevented after intubation by this dose of esmolol. Complications found were insignificant. Thus use of esmolol is quite safe, reliable and free of side effects
Authors and Affiliations
Manzar Nadeem Kazmi, Athar Hussain
Keywords
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