COMPARISON OF HEMODYNAMIC RESPONSE TO LARYNGOSCOPY AND INTUBATION WITH PROPOFOL AND PROPOFOL PLUS INTRAVENOUS LIGNOCAINE IN KNOWN HYPERTENSIVE PATIENTS

Authors

  • Aqib Usman
  • Abdus Salam
  • Hidayat Ur Rehman
  • Laila Khan
  • Mehreen Khalid
  • Raheel Ahmad

Abstract

ABSTRACT
INTRODUCTION: Endotracheal intubation is a stressful stimulus, which is responsible for the complications mostly in patient with high BP and cardiovascular diseases. Propofol is an ideal intravenous (I.V) anesthetic agent that decreases cardiovascular response to laryngoscopy and endotracheal intubation. However mere use of Propofol has not shown complete satisfactory results and a need of further attenuation is felt. Various studies have been conducted on Lignocaine to check its effects on hemodynamic response to intubation. Aim of this study was to see effects of Lignocaine on cardiovascular response to intubation, when used as adjunct to Propofol.
Objective: To evaluate the attenuation of hemodynamic response to laryngoscopy and intubation in response to I.V lignocaine in known hypertensive patients.
Material and Methods: Following Institutional Review Board approval, data of 60 patients who went under general anesthesia was collected. Patients with ASA (American Society of Anesthesiologist) physical status grade II and III (known hypertensive) belonging to any gender ranging from 30 to 65 years of age were included. These Patients were randomly divided into two groups, group P and group PL. Patients in group P received injection of propofol with a dosage of 2mg/kg and group PL patients received injection of lignocaine 1.5mg/kg in addition to propofol dosed at 2mg/kg. Hemodynamic indicators (HR, SBP and DBP) were noted down before induction, three minutes before intubation, thirty seconds and 5 minutes after intubation followed by statistical analysis performed on the obtained data.
Results: A significant increase in haemodynamic response (Increased HR, SBP, DBP and MAP) was seen after the insertion of ETT in group P. On the contrary, response to intubation was less significant, in fact quite diminished in group PL. It was also observed that the haemodynamic response to ETT insertion is significantly greater than that to laryngoscopy alone.
Conclusion: Lidocaine is an effective medication to minimize hemodynamic responses (HR, SBP and DBP) in patients undergoing intubation for general Anesthesia.
KEYWORDS: Hemodynamic response, Laryngoscopy, Intubation, Propofol, Propofol plus, Intravenous lignocaine, Hypertensive patients

References

Aitkenhead AR, Smith G, Rowbotham DJ. Textbook of anaesthesia: Elsevier Health Sciences; 2007.

Morgan GE, Mikhail MS, Murray MJ, Larson CP. Clinical anesthesiology: Lange Medical Books/McGraw-Hill New York; 2006.

Gulabani M, Gurha P, Dass P, Kulshreshtha N. Comparative analysis of efficacy of lignocaine 1.5 mg/kg and two different doses of dexmedetomidine (0.5 μg/kg and 1 μg/kg) in attenuating the hemodynamic pressure response to laryngoscopy and intubation. Anesthesia, essays and researches. 2015;9(1):5.

Benumof J, Hagberg CA. Benumof’s airway management: principles and practice: Elsevier Health Sciences; 2007.

Miller RD. Miller’s anesthesia: Elsevier/Churchill Livingstone; 2005.

Shribman A, Smith G, Achola K. Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation. British journal of anaesthesia. 1987;59(3):295-9.

Qi D, Wang K, Zhang H, Du B, Xu F, Wang L, et al. Efficacy of intravenous lidocaine versus placebo on attenuating cardiovascular response to laryngoscopy and tracheal intubation: a systematic review of randomized controlled trials. 2013.

Schofer JM. Premedication during rapid sequence intubation: a necessity or waste of valuable time? The California Journal of Emergency Medicine. 2006;7(4):75.

Singh H, Vichitvejpaisal P, Gaines GY, White PF. Comparative effects of lidocaine, esmolol, and nitroglycerin in modifying the hemodynamic response to laryngoscopy and intubation. Journal of clinical anesthesia. 1995;7(1):5-8.

Casati A, Fanelli G, Albertin A, Deni F, Danelli G, Grifoni F, et al. Small doses of remifentanil or sufentanil for blunting cardiovascular changes induced by tracheal intubation: a double-blind comparison. European journal of anaesthesiology. 2001;18(2):108-12.

Abou-Madi M, Keszler H, Yacoub O. A method for prevention of cardiovascular reactions to laryngoscopy and intubation. Canadian Anaesthetists’ Society Journal. 1975;22(3):316-29.

Ali QE, Siddiqui OA, Khan YA. Effects of Xylocard pretreatment on hemodynamics in patients undergoing laparoscopic cholecystectomy. Rawal Medical Journal. 2010;35(2):188-91.

Malde AD, Sarode V. Attenuation of the hemodynamic response to endotracheal intubation: fentanyl versus lignocaine. Internet J Anesthesiol. 2007;12(1).

Salihoglu Z, Demiroluk S, Demirkiran O, Kose Y. Comparison of effects of remifentanil, alfentanil and fentanyl on cardiovascular responses to tracheal intubation in morbidly obese patients. European Journal of Anaesthesiology (EJA). 2002;19(2):125-8.

Downloads

Published

2020-11-19