Comparative assessment of efficacy of lignocaine (1.5 mg/kg), esmolol (300 µg/kg), and dexmedetomidine (0.5 µg/kg) in minimizing the pressor response to laryngoscopy and intubation


  • Prashant Dass Department of Pharmacology, M.R. Medical College, Gulbarga, Karnataka, India
  • Michell Gulabani Department of Anesthesiology, Dr. Ram Manohar Lohia Hospital, New Delhi, India
  • Banderao V. Patil Department of Pharmacology, M.R. Medical College, Gulbarga, Karnataka, India
  • Shrenik H. Vardhamane Department of Pharmacology, M.R. Medical College, Gulbarga, Karnataka, India


Dexmedetomidine, Lignocaine, Esmolol, Pharmacoeconomics, Pressor response


Background: The objectives of the present study were to compare the effect of lignocaine (1.5 mg/kg IV given 3 mins before laryngoscopy and intubation), esmolol (300 µg/kg as a bolus 2 mins before intubation), and dexmedetomidine (0.5 µg/kg IV over 10 mins) on the pressor response in non-hypertensive American Society of Anesthesiologists (ASA) Grade I and II patients posted for elective surgery and the pharmacoeconomic and pharmacoepidemiological inferences drawn on comparison of these drugs.

Methods: After approval by the Institutional Ethics Committee, 90 consenting adult patients aged 18-65 years of age of either sex of non-hypertensive ASA Grade I or II undergoing elective surgery under general anesthesia with endotracheal intubation were included in this randomized, prospective study protocol. (1) Group L: Patients were given IV lignocaine 1.5 mg/kg. (2) Group E: Patients were given IV esmolol 300 µg/kg. (3) Group D: Patients were given IV dexmedetomidine 0.5 μg/kg. Adequate monitoring, oxygenation, and hydration were established on the entry in the operating room (OR). All hemodynamic data were measured on arrival in OR, before induction, before intubation, and at 1, 3, 5 mins after intubation by an independent observer. Anesthesia was induced with thiopental sodium and fentanyl 2 μg/kg; intubation was performed with cuffed oral endotracheal tube of appropriate size for airway management. Surgery was allowed to start only after 5 mins of intubation.

Results: Esmolol effectively blunted the blood pressure response to intubation, but incompletely attenuated the increase in heart rate (HR). Dexmedetomidine was more effective than lignocaine in minimizing the increase in HR, systolic blood pressure (SBP), and diastolic blood pressure (DBP) subsequent to endotracheal intubation.

Conclusion: Dexmedetomidine 0.5 µg/kg has manifested to maintain hemodynamic stability associated with intubation and hence may prove beneficial for cardiac patients where the stress response to laryngoscopy and intubation is highly undesirable.


Rathore A, Gupta HK, Tanwar GL, Rehman H. Attenuation of the pressure response to laryngoscopy and endotracheal intubation with different doses of esmolol. Indian J Anaesth. 2002;46(6):449-52.

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(3):163-8.

Fox EJ, Sklar GS, Hill CH, Villanueva R, King BD. Complications related to the pressor response to endotracheal intubation. Anesthesiology 1977;47(6):524-5.

Dalton B, Guiney T. Myocardial ischemia from tachycardia and hypertension in coronary heart disease-Patients undergoing anesthesia. Annual Meeting. Boston: American Society of Anesthesiologists; 1972: 201-2.

Donegan MF, Bedford RF. Intravenously administered lidocaine prevents intracranial hypertension during endotracheal suctioning. Anesthesiology. 1980;52(6):516-8.

Lev R, Rosen P. Prophylactic lidocaine use preintubation: a review. J Emerg Med. 1994;12(4):499-506.

Laferty KA, Kulkarni R, et al. Medications used in tracheal intubation. Int J Anaesth. Updated on 16 May 2011.

Dogru K, Arik T, Yildiz K, Bicer C, Madenoglu H, Boyaci A. The effectiveness of intramuscular dexmedetomidine on hemodynamic responses during tracheal intubation and anesthesia induction of hypertensive patients: a randomized, double-blind, placebo-controlled study. Curr Ther Res Clin Exp. 2007;68(5):292-302.

Honarmand A, Safavi MR. The comparability of second dose thiopental with lidocaine in the attenuation of cardiovascular response to endotracheal intubation. Iran Cardiovasc Res J. 2009;3(1):34-42.

Splinter WM, Cervenko F. Haemodynamic responses to laryngoscopy and tracheal intubation in geriatric patients: effects of fentanyl, lidocaine and thiopentone. Can J Anaesth. 1989;36(4):370-6.

Al-Sabbagh MS. Comparative effects of fentanyl, midazolam, lidocaine and propranolol on controlling the hemodynamic pressor response during laryngoscopy and intubation. Iraqi J Pharm Sci. 2010;19(2):24-30.

Malde AD, Sarode V. Attenuation of the hemodynamic response to endotracheal intubation: fentanyl vs lignocaine. Int J Anaesth. 2007;12:1.

Zargar JA, Imtiaz NA, Gurcoo AS, Din MU. Comparative evaluation of the effect of metoprolol and esmolol on rate pressure product and ECG changes during laryngoscopy and endotracheal intubation in controlled hypertensive patients. Indian J Anaesth. 2002;46(5):365-8.

Kindler CH, Schumacher PG, Schneider MC, Urwyler A. Effects of intravenous lidocaine and/or esmolol on hemodynamic responses to laryngoscopy and intubation: a double-blind, controlled clinical trial. J Clin Anesth. 1996;8(6):491-6.

Koivusalo AM, Scheinin M, Tikkanen I, Yli-Suomu T, Ristkari S, Laakso J, et al. Effects of esmolol on haemodynamic response to CO2 pneumoperitoneum for laparoscopic surgery. Acta Anaesthesiol Scand. 1998;42(5):510-7.

Menda F, Köner O, Sayin M, Türe H, Imer P, Aykaç B. Dexmedetomidine as an adjunct to anesthetic induction to attenuate hemodynamic response to endotracheal intubation in patients undergoing fast-track CABG. Ann Card Anaesth. 2010;13:16-21.

Bajwa SJ, Kaur J, Singh A, Parmar S, 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(2):123-8.

Isik B, Arslan M, Ozsoylar O, Akçabay M. The effects of alpha 2 adrenergic receptor agonist dexmedetomidine on hemodynamic response in direct laryngoscopy. Open Otorhinolaryngol J. 2007;1:5-11.

Keniya VM, Ladi S, Naphade R. Dexmedetomidine attenuates sympathoadrenal response to tracheal intubation and reduces perioperative anaesthetic requirement. Indian J Anaesth. 2011;55(4):352-7.

Kurnik D, Muszkat M, Li C, Sofowora GG, Friedman EA, Scheinin M, et al. Genetic variations in the a(2A)-adrenoreceptor are associated with blood pressure response to the agonist dexmedetomidine. Circ Cardiovasc Genet. 2011;4(2):179-87.

Jaakola ML, Ali-Melkkilä T, Kanto J, Kallio A, Scheinin H, Scheinin M. Dexmedetomidine reduces intraocular pressure, intubation responses and anaesthetic requirements in patients undergoing ophthalmic surgery. Br J Anaesth. 1992;68(6):570-5.




How to Cite

Dass, P., Gulabani, M., Patil, B. V., & Vardhamane, S. H. (2017). Comparative assessment of efficacy of lignocaine (1.5 mg/kg), esmolol (300 µg/kg), and dexmedetomidine (0.5 µg/kg) in minimizing the pressor response to laryngoscopy and intubation. International Journal of Basic & Clinical Pharmacology, 4(2), 306–311. Retrieved from



Original Research Articles