Mahendran, M (2010) A Comparative study on three doses of Esmolol to attenuate the Hemo Dynamic Stress Response during Laryngoscopy and Endo Tracheal Intubation. Masters thesis, Chengalpattu Medical College, Chengalpattu.
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Abstract
INTRODUCTION: In 1940, Reid and Brace first described hemodynamic response to laryngoscopy and intubation. Laryngoscopy and endotracheal intubation are mandatory for most patients undergoing general anaesthesia, which is invariably associated with certain cardiovascular changes such as tachycardia or bradycardia, rise in blood pressure and a wide variety of cardiac arrhythmias. These effects are deleterious in susceptible individuals culminating in perioperative myocardial ischemia, acute heart failure and cerebrovascular accidents. The hemodynamic response to laryngoscopy and endo tracheal intubation has been recognized since 1951. The induction of anaesthesia, laryngoscopy and intubation and surgical stimulation often evoke cardiovascular response characterized by alterations in systemic arterial pressure, pulse rate and cardiac rhythm. The response following laryngoscopy and intubation peaks at 1.2 minute and returns to normal within 5 – 10 minutes. Though these sympathoadrenal response are probably of little consequence in healthy individuals, it is hazardous to those patients with hypertension, coronary heart disease, intra cranial pathology and hyper reactive airways. In such cases, reflex circulatory response such as increase in heart rate, systemic arterial blood pressure and disturbances in cardiac rhythm needs to be suppressed. Prof. King et al (1951) documented myocardial ischemic changes due to reflex sympthoadrenal response immediately following laryngoscopy and intubation with a mean rise in systemic pressure of 40 mm Hg even in normotensive individuals. Various systemic as well as topical agents were used to reduce these untoward hemodynamic responses due to laryngoscopy and intubation. Those technique which require prior laryngoscopy to the local anaesthetic solution are likely to be of limited value. The common strategies adopted are narcotics, vasodilators, beta blockers, calcium channel blockers, lidocaine other sympatholytics. IV Esmolol due to its ultra short action seem to be ideal to control intense but brief sympathetic stimulation following endotracheal intubation. Hence, the above study was done in the Department of Anaesthesiology, Chengalpattu Medical College, Chengalpattu. AIM OF THE STUDY: The hemodynamic response during laryngoscopy and intubation should be abolished to balance the myocardial oxygen supply and demand for the safe conduct of anaesthesia. This study was done to compare the varying doses of IV Esmolol in attenuating the hemodynamic stress response to laryngoscopy and endo tracheal intubation. MATERIALS AND METHODS: Sixty ASA I & II patients undergoing elective surgical procedure under general anaesthesia with endotracheal intubation were included in this study. Patients belonging to age group 20-50 years of both the sexes were included. It is a prospective double blind randomized controlled study. The study was approved by the Ethical Committee and were randomly grouped into three groups. Group A (Esmolol 0.5 mg/kg) = Twenty patients were given Esmolol 0.5 mg/kg IV 2 minutes before intubation. Group B (Esmolol 1.0 mg/kg) = Twenty patients were given Esmolol 1 mg/kg IV 2 minutes before intubation. Group C (Esmolol 1.5 mg/kg) = Twenty patients were given Esmolol 1.5 mg/kg IV 2 minutes before intubation. The surgeon was also duly informed of the study. The study was done during the period from May 2009 to August 2009 in the Department of Anaesthesiology, Chengalpattu Medical College, Chengalpattu. Inclusion Criteria : 1. ASA I & II, 2. Age 20 – 50 yrs, 3. All cases requiring GA, Exclusion criteria : 1. Known and difficult airways, 2. Esmolol contraindications, 3. Not meeting inclusion criteria, 4. Patients on beta blockers, 5. Patients with full stomach, 6. Patients posted for Emergency surgery, 7. Hypertension, Diabetes, Ischemic heart disease. Randomization was done by draw of lots. The follow up of the patient and analysis of data were done by personnel blinded to which group belonged to. Drawing of lots for randomization and preparation of study was prepared by a consultant who took no further part in the study, the rest of the study was conducted by investigator who was blinded to the drug injected. MATERIALS: 1. Inj.Thiopentone Sodium 2.5%, 2. Inj. Succinylcholine Chloride, 3. Inj. Glycopyrrolate, 4. Inj. Fentanyl citrate, 5. Inj. Esmolol HCl 100mg/10 ml, 6. Disposable 20 ml syringe, 7. Laryngoscope with blades 3 and 4, 8. Endotracheal tubes of varying sizes, 9. Emergency drugs, 10. Difficult Intubation strategies. Statistical Analysis: Heart rate, Systolic blood pressure, Diastolic blood pressure, Mean arterial pressure. All recorded data were entered using MS Excel software and analysed using STATA software for determining the statistical significance. ANOVA test was used to determine the significance among three groups. Student’s t test was used to compare the two groups on mean values of various parameters. The p-value taken for significance is <0.05. RESULTS: The Groups are: Group A (Esmolol 0.5 mg/kg): Twenty patients were given Esmolol 0.5mg/kg IV 2 minutes before intubation as a bolus. Group B (Esmolol 1.0 mg/kg): Twenty patients were given Esmolol 1mg/kg IV 2 minutes before intubation as a bolus. Group C (Esmolol 1.5 mg/kg): Twenty patients were given Esmolol 1.5mg/kg IV 2 minutes before intubation as a bolus. Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were measured before premedication, after premedication, during administration of the study drug, during induction, during intubation, after intubation and following for about 7 minutes after laryngoscopy and intubation for every minute. CONCLUSION: On taking into consideration the criteria which I chose to study the hemo dynamic changes expected, I found that the dose of Esmolol 1.5 mg/kg (Group C) to be effective in attenuating the hemo dynamic responses during laryngoscopy and endo tracheal intubation with no major adverse effects of Esmolol.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Three doses of Esmolol ; attenuate ; Hemo Dynamic Stress Response ; Laryngoscopy ; Endo Tracheal Intubation ; Comparative study. |
| Subjects: | MEDICAL > Anaesthesiology |
| Depositing User: | Subramani R |
| Date Deposited: | 30 Apr 2018 03:07 |
| Last Modified: | 30 Apr 2018 03:51 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7352 |
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