Comparison of Esmolol and Diltiazem in Attenuating the Hemodynamic Response at Extubation.
Journal Title: International Journal of Medical Science and Innovative Research (IJMSIR) - Year 2019, Vol 4, Issue 1
Abstract
Background and Aims: Emergence from anesthesia and tracheal extubation can be associated with hemodynamic circulatory responses characterized by tachycardia and hypertension. This sympatho-adrenal response results in increased cardiac workload and myocardial contractility leading to increased myocardial oxygen demand and may prove detrimental for patients with coronary artery disease. Methods: We conducted a randomized double-blind study to examine the effects of single bolus dose of esmolol (1 mg/kg) and diltiazem (0.15 mg/kg) on hemodynamic changes during extubation in 60 ASA grade I and II patients undergoing major surgery under general anesthesia. Anesthesia was induced with propofol 2 mg/kg and fentanyl 2 µg/kg and tracheal intubation was facilitated with vecuronium 0.1 mg/kg i.v. Anesthesia was maintained with 0.6% - 1% isoflurane and 60% N2O in O2. The patients were randomly assigned to one of the two groups (n=30 for each group). Group E received esmolol 1 mg/kg IV and Group D received diltiazem 0.15 mg/kg IV. These medications were given 1 min after reversal and extubation performed 2 min later. Changes in HR, MAP and RPP was measured during and after tracheal extubation. Incidence of adverse events was also noted. Results: Esmolol 1 mg/kg IV bolus effectively controlled HR, MAP and RPP during extubation. Diltiazem 0.15 mg/kg IV bolus effectively controlled MAP but was not effective in controlling HR or RPP. No significant bradycardia, hypotension, arrhythmia occurred in any of the patients. Airway events like coughing, bucking, laryngospasm, excessive secretions were comparable in both the groups. Conclusion: Esmolol 1mg/kg was more effective in controlling the hemodynamic response to extubation than Diltiazem 0.15 mg/kg in patients undergoing surgery under general anesthesia with tracheal intubation.
Authors and Affiliations
Laxmi Narayan Dash
Keywords
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