Ananthappan, S (2006) Attenuation of Cardiovascular Stress response accompanying Laryngoscopy and Intubation: A Clinical Comparison of Lignocaine and Diltiazem in E.N.T. Surgeries. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Hypertension and tachycardia have been reported since 1950 during intubation in a light plane of anesthesia. Increase in blood pressure and heart rate occurs most commonly from reflex sympathetic discharge in response to laryngo tracheal stimulation, which in turn causes increased plasma norepinephrine concentration. These changes may be fatal in patients with ischeamic heart disease and hypertension. Tachycardia, hypertension and dysrythymias all occur during laryngoscopy and intubations. The consequent rise in rate/pressure product may result in a myocardial oxygen demand which exceeds the oxygen supply resulting in myocardial ischeamia. This response is sympathetically mediated and can be attenuated by calcium channel blocking drugs. Studies have documented myocardial ischeamic changes due to reflex sympatho adrenal response immediately following laryngoscopy and intubation with a mean increase in systemic pressure of 40mmHg even in normotensive patients. AIM OF STUDY: To compare the efficacy of IV lignocaine and IV Diltiazem in attenuating the cardiovascular stress response during laryngoscopy and intubation in E.N.T Surgeries. MATERIALS AND METHODS: A prospective study comparing Diltiazem and Lignocaine in attenuating the haemodynamic response to laryngoscopy and intubation in E.N.T. patients comprised of 40 patients aged between 20 to 50 years. Both male and female patients who were scheduled for E.N.T. procedures like FESS, mastoidectomy, myringoplasty, Stepedectomy etc. requiring endotracheal intubation were chosen for the study. All patients belonged to ASA I physical status. Patients with cardio-respiratory problems and patients suspected to have a difficult intubation were excluded from the study. All the patients were informed of the study and their consent was obtained. The surgeon was also informed of the study. Patients were assessed by a detailed examination, including, X-ray chest, ECG and routine laboratory tests. In this study, patients were randomlyassinged into 2 groups. Group `A' - 20 patients received Diltiazem by intravenous bolus administration in a dose of 0.2 mg/Kg body weight, 1 min prior to intubation. Group `B' - 20 patients received Lignocaine by intravenous administration in a dose of 1.5 mg/kg body weight, 3 mins prior to intubation. OBSERVATION AND RESULTS: 40 patients under this study were categorised into two groups. They comprised both sexes in the age group of 20 to 50 years. The age and sex distribution was equal in all the two groups. The groups are : 1. Diltiazem (Group- A) : Consisting of 20 patients who received inj. Diltiazem 0.2 mg/kg body weight, bolus 1 min. prior to laryngoscopy. 2. Lignocaine (Group `B') consisting of 20 patients who received Inj. Lignocaine 1.5 mg/kg body weight, 3 mins prior to Laryngoscopy.Heart rate and Blood pressure were recorded before induction, 1 min after test drug, at the time of intubation and every 1 min for 5 mins. SUMMARY: This study was done on patients undergoing E.N.T procedures to compare the efficacy of IV Lignocaine and IV Diltiazem for attenuating the haemodynamic response to laryngoscopy and intubation. A prospective study was carried out in 40 E.N.T patients in the age group 20-50 years requiring endotracheal intubation. The patients were randomly assigned into 2 groups. Group I received diltiazem 0.2 mg/kg body weight one minute prior to intubation and Group II received lignocaine 1.5 mg/kg body weight, 3 minutes prior to intubation. The pulse rate systolic and diastolic blood pressure were recorded every minute for 5 minutes following laryngoscopy and intubation. The study showed that diltiazem was better than lignocaine in attenuating the haemodynamic response to laryngoscopy and intubation in E.N.T procedures. The side effects associated with IV diltiazem are negligible hence the drug diltiazem is better alternative to lignocaine in attenuating the intubation response. CONCLUSION: From this study it is concluded that diltiazem, given as bolus in a does of 0.2 mg/kg body weight 1 minute prior to intubation, is a better alternative to lignocaine in attenuating the cardiovasuclar responses to laryngoscopy and intubation.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Attenuation of cardiovascular stress response ;Laryngoscopy ; Intubation ; Lignocaine ;Diltiazem; E.N.T. Surgeries. |
| Subjects: | MEDICAL > Anaesthesiology |
| Depositing User: | Subramani R |
| Date Deposited: | 16 Apr 2018 15:27 |
| Last Modified: | 16 Apr 2018 15:27 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7023 |
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