Authors : Satyendra Yadav, R S Verma
DOI : 10.18231/2394-4994.2019.0009
Volume : 6
Issue : 1
Year : 2019
Page No : 40-46
Mitigating stress responses of laryngoscopy and endotracheal intubation is critical in management of general anesthesia patient undergoing surgical intervention. This becomes particularly detrimental and critical in patients with hypertension and cardiovascular cerebral disease affecting immediate and long-term outcomes. Role of beta blockade remained limited due to long duration, irreversibility and rebound withdrawal in acute care settings; which led to discovery of cardioselective short acting esmolol hydrochloride (t1/2- 2.5 to 9 min). In this randomized controlled double-blind prospective trial, we studied intravenous esmolol hydrochloride in 2 different single intravenous bolus doses (Group I - control, Group II - 1mg/Kg, Group III- 1.5mg/kg) in ASA 1 and 2 elective normotensive patients. Statistical analysis was done by using paired-t test. Study concluded that esmolol HCL pretreatment after induction with Thiopental Na before laryngoscopy and intubation allowed unique titration of esmolol doses and monitoring of side effects like bradycardia and hypotension and at the same time significantly attenuated sympatho-adrenal response of rise in pulse, mean arterial pressure (MAP), rate pressure product (RRP) and arrhythmia. Esmolol acts differently in different doses. In 1mg/Kg it effectively controls (P<.001) post intubation rise in pulse. Higher dose of 1.5mg/kg is required to control (P<.001) MAP. Rate pressure product is attenuated in group II (P<.01) and group III (P<.001), indicating that esmolol effectively reduces oxygen consumption by heart and likely prevents ischemia in vulnerable patients. Bradycardia of transient nature is seen in some patients in both test groups, reversed by reducing halothane without any treatment. Perioperative side effects like hypotension and bronchospasm that require stopping the test drug esmolol, were not seen in any of test groups, indicating safety of esmolol in such settings.
Keywords: Anaesthesia, Laryngoscopy endotracheal intubation, Cardiovascular response, Attenuation, Esmolol, Efficacy.