A comparative study of efficacy of intravenous dexmedetomidine and intravenous esmolol for attenuation of stress response during laryngoscopy and endotracheal intubation
Keywords:Dexmedetomidine, Endotracheal intubation, Esmolol, Hemodynamic response
Background: The present study compares the effects of I.V. dexmedetomidine and I.V. esmolol on hemodynamic response occurring due to laryngoscopy and endotracheal intubation in elective general surgery.
Methods: A total of 60 patients aged 18-60 years, American Society of Anesthesiologists physical status I or II, either sex, scheduled for elective surgical procedures were included in this study. Patients were randomly allocated by chit method into two equal groups of 30 each, comprising of group dexmedetomidine (group D) 1 μg/kg diluted with 0.9% saline to 10 ml I.V. over 10min and group esmolol (group E) 1 mg/kg diluted with 0.9% saline to 10 ml I.V. given just before induction. Heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure were recorded at baseline, after 5 min of infusion, after induction and at 1, 3, 5 and 10 min after endotracheal intubation.
Results: In group D, there was no statistically significant increase in HR and blood pressure after intubation at any time intervals, where as in group E, there was a statistically significant increase in blood pressure and heart rate after intubation at 1, 3, 5 and 10 min.
Conclusions: Dexmedetomidine 1 μg/kg is more effective than esmolol for attenuating the hemodynamic response to laryngoscopy and intubation in elective surgical patients.
Shribman AJ, Smith G, Achola KJ. Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation. Br J Anaesth, 1987;59:295-9.
Ebert TJ, Bernstein JS, Stowe DF, Roerig D, Kampine JP. Attenuation of hemodynamic responses to rapid sequence induction and intubation in healthy patients with single bolus of esmolol. J Clin Anesth. 1990;2:243-52.
Gurulingappa, Aleem MA, Awati MN, Adarsh S. Attenuation of cardiovascular responses to direct laryngoscopy and intubation-a comparative study between IV bolus fentanyl, lignocaine and placebo (NS). J Clin Diagn Res. 2012;6:1749-52.
Ko BJ, Oh JN, Lee JH, Choi SR, Lee SC, Chung CJ. Comparison of effects of fentanyl and remifentanil on hemodynamic response to endotracheal intubation and myoclonus in elderly patients with etomidate induction. Korean J Anesthesiol. 2013;64:12-8.
Firoozbakhsh F, Mohammadi FH, Safari S, Khashayar P. The effect of intravenous nitroglycerine on blood pressure during intubation. Middle East J Anesthesiol. 2008;19:859-67.
Moon YE, Lee SH, Lee J. The optimal dose of esmolol and nicardipine for maintaining cardiovascular stability during rapid sequence induction. J Clin Anesth. 2012;24:8-13.
Singh SP, Quadir A, Malhotra P. Comparison of esmolol and labetalol, in low doses, for attenuation of sympathomimetic response to laryngoscopy and intubation. Saudi J Anaesth. 2010;4:163-8.
Khan ZP, Ferguson CN, Jones RM. Alpha-2 and imidazoline receptor agonists their pharmacology and therapeutic role. Anaesthesia. 1999;54:146-65.
Grewal A. Dexmedetomidine: new avenues. J Anaesthesiol Clin Pharmacol. 2011;27:297-302.
Forbes AM, Dally FG. Acute hypertension during induction of anaesthesia and endotracheal intubation in normotensive man. Br J Anaesth. 1970;42(7):618-24.
Sharma S, Mitra S, Grover VK, Kalra R. Esmolol blunts the haemodynamic responses to tracheal intubation in treated hypertensive patients. Can J Anaesth. 1996;43(8):778-82.
Srivastava VK, Agrawal S, Gautam SS, Ahmed M, Sharma S, Kumar R. Comparative evaluation of esmolol and dexmedetomidine for attenuation of sympathomimetic response to laryngoscopy and intubation in neurosurgical patients. J Anaesthesiol Clin Pharmacol. 2015;31:186-90.
Reddy SV, Balaji D, Ahmed SN. Dexmedetomidine versus esmolol to attenuate the hemodynamic response to laryngoscopy and tracheal intubation: A randomized double-blind clinical study. Int J App Basic Med Res. 2014;4:95-100.
Lee JH, Kim H, Kim H-T, Kim M-H, Cho K, Lim SH, et al. Comparison of dexmedetomidine and remifentanil for attenuation of hemodynamic responses to laryngoscopy and tracheal intubation. Korean J Anesthesiol. 2012;63(2):124-9.
Bajwa SS, Kaur J, Singh A, Parmar SS, Singh G, Kulshrestha A, et al. Attenuation of pressor response and dose sparing of opioids and anaesthetics with pre-operative dexmedetomidine. Indian J Anaesth. 2012;56:123-8.
Efe EM, Bilgin BA, Alanoglu Z, Akbaba M, Denker C. Comparison of bolus and continuous infusion of esmolol on hemodynamic response to laryngoscopy, endotracheal intubation and sternotomy in coronary artery bypass graft. Braz J Anesthesiol. 2014;64(4):247-52.
Keniya VM, Ladi S, Naphade R. Dexmedetomidine attenuates sympathoadrenal response to tracheal intubation and reduces perioperative anaesthetic requirement. Indian J Anaesth. 2011;55:352-7.
Gandhi DSG. Comparision of dexmedetomidine with fentanyl in attenuation of pressor response during laryngoscopy and intubation. IOSR Journal Pharmacy. 2014;04(2):28-38.