Comparison of Esmolol and Lignocaine in Attenuation of Stress Response to Laryngoscopy and Intubation – A Study in Kerala, South India

Context: Hypertension and tachycardia occurring during laryngoscopy and intubation could be deleterious to certain patients. Esmolol at doses of 100mg and 200mg have been studied extensively to attenuate the stress response to laryngoscopy and intubation. But this may produce undue bradycardia and hypotension. Using Esmolol at a lower dose of 1 mg/kg to attenuate the stress response will decrease its side effects. Aims: To compare Esmolol at a low dose of 1 mg/kg and Lignocaine 1.5 mg/kg in attenuation of the stress response to laryngoscopy and intubation Settings and Design: The study was a randomized, parallel group, active controlled trial conducted at SGMCRF. Methods and Material: 60 healthy patients requiring general anesthesia were randomly allocated to two groups of 30 each. Group L received intravenous Lignocaine without preservative 1.5 mg/kg and Group E received intravenous Esmolol 1.0 mg/kg 3 minutes prior to laryngoscopy and intubation. Patients were premedicated with intravenous Midazolam 1 mg , induced with 2 mg/kg of intravenous Propofol and intubation facilitated by intravenous Vecuronium 0.1 mg/kg . No surgical stimulation, analgesics or inhalational agents were allowed till 5 minutes after intubation and haemodynamic parameters were noted. There were no arrhythmias. The results were statistically analyzed. Statistical analysis used: Statistical analysis was done by Student’s t test for quantitative data and Chi Square test and Fischer’s exact test for qualitative data. Results: Compared with the Lignocaine group, the attenuation of the stress response variables was better in the Esmolol group. The difference in the mean Heart Rate ,Systolic Blood Pressure, Diastolic Blood Pressure and Mean Arterial Pressure between the two groups was significant statistically (P