Title: A Comparative Study of The Effect of I.V. Esmolol And Diltiazem In Attenuating Haemodynamic Response To Laryngoscopy and endotracheal intubation
Authors: Dr Hansraj Charan, Dr Chiranji Lal Khedia, Dr Manoj Singhal
DOI: https://dx.doi.org/10.18535/jmscr/v6i3.130
Abstract
Introduction: Laryngoscopy and tracheal intubation are noxious stimuli that evoke a transient but marked sympathetic response manifesting as hypertension and tachycardia.
They are particularly detrimental to patient with cardiovascular and intracranial diseases.
Aims and Objectives
- To study the effect of intravenous Esmolol (B-selective blocker) and Diltiazem (Calcium channel blocker) on hemodynamic change to laryngoscopy and intubation in comparison to control group Normal saline.
- To study the side effect and complications, if any.
Methodology: Randomized double-blind controlled study was conducted in the Department of Anesthesia, Govt. Medical College, KOTA including 111 patients.
Patients were divided in three groups of 37 each.
- Group A (Control)- (n=37) - Normal saline was given (Volume = 10ml)
- Group B (Esmolol) (n=37) - Injection Esmolol 1 mg/kg I.V. bolus (diluted to 10 ml with Normal Saline)
- Group C (Diltiazem) (n=37) - Injection Diltiazem 0.2 mg/kg I.V. bolus (diluted to 10 ml with Normal Saline)
Results: In control group there was significant rise in heart rate just after intubation (p<0.05). The value remained significantly raised during whole study period. In the esmolol group there was small rise in HR after intubation that was significant (p<0.05) but value touched the baseline within 5 min after intubation that was insignificant (p>0.05) there after there was fall in HR till 10 min. in diltiazem group there was significant. In control group there was significant rise in SBP just after intubation (p<0.05). The value remained significantly raised during whole study period. In the esmolol and diltiazem group there was significant rise in SBP after intubation but value touched the baseline within 3 min in diltiazem group and within 5 min.post intubation in esmolol group(p>0.05).no incidence of hypotension was observed in any of the study group.
In control group there was significant rise in MBP just after intubation (p<0.05). The value remained significantly raised during whole study period. In the esmolol and diltiazem group there was significant rise in MBP after intubation but value touched the baseline within 3 min in diltiazem group and within 5 min.post intubation in esmolol group(p>0.05).no incidence of hypotension was observed in any of the study group.
It was observed that mean baseline variables (HR, SBP, DBP and MBP) were similar in the three groups and no statistically significant difference was present (P value>0.05).
Conclusion: Highly significant hemodynamic response was observed just after laryngoscopy and intubation in control group which lasted for the entire 10 min of the study period after intubation. Esmolol was the most effective in controlling the heart rate but ineffective in attenuating the pressure response. Diltiazem was quite effective in controlling the pressure response but it failed to achieve any control over the heart rate. No ECG abnormality and hypotension was observed in any patients in any group.
