Abstract

Christy Pius Kaliyadan*, Bindu M. and Leeza Unwin

ABSTRACT

Expert airway management is an essential skill in anaesthetic practice because direct laryngoscopy and endotracheal intubation is associated with reflex cardiovascular responses mediated by the sympathetic nervous system. The harmful effects of laryngoscopy and intubation are well tolerated by healthy people, but hemodynamic stability is important in patients with cardiovascular or neurosurgical diseases undergoing anesthesia. Various groups of drugs can be used for attenuation of intubation stress response. Esmolol is an ultra short acting β blocker with rapid onset of action. Hence, in this study we compared the efficacy of two bolus dose of Esmolol in attenuating hemodynamic stress response during direct laryngoscopy and endotracheal intubation. A prospective comparitive study was done with 2 groups of 32 patients each presenting for elective surgery requiring general anaesthesia. Group A received intravenous Esmolol 0.5 mg/kg and Group B received intravenous Esmolol 1mg/kg, 2 minutes before intubation. Hemodynamic parameters such as heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were recorded before induction (baseline), 2 minutes, 4 minutes, and 6 minutes intervals after intubation. It was found that there was a significant reduction in hemodynamic response to laryngoscopy and intubation in both groups who received Esmolol. Furthermore, in Group B who received Esmolol 1mg/kg, had a better attenuation of hemodynamic stress response when compared to Group A, who received Esmolol 0.5mg/kg. Therefore it can be stated that Esmolol is an efficient drug to attenuate hemodynamic stress response following laryngoscopy and intubation, especially when its given at a dose of 1mg/kg, 2 minutes prior to intubation.