Dalia Divakar1 , Arun Sahadevan Rajamma2
BACKGROUND Sudden changes in haemodynamic parameters is a major concern during laryngoscopy and intubation which can cause deleterious effects in patients with heart disease, intracranial aneurysm, and hypertension. We wanted to compare the efficacy of premedication with intravenous clonidine and esmolol to blunt the haemodynamic response to laryngoscopy and tracheal intubation. METHODS After approval from the ethics committee, 60 consenting adult patients of either gender undergoing surgeries at Amrita Institute of Medical Sciences, Kochi, Kerala, were studied from December 2009 to October 2011. The study was planned as a randomized, single blinded pilot study. These patients were divided into two groups : Group A and Group B by closed envelope technique. Group A - patients received intravenous clonidine 2 micrograms / Kg body weight as a bolus 10 minutes prior to induction. Group B - patients received injection esmolol 2 mg / Kg body weight IV bolus 2 minutes before laryngoscopy and tracheal intubation. RESULTS Both drugs effectively attenuated systolic, diastolic and mean arterial pressure responses to laryngoscopy and intubation. Esmolol was more effective than clonidine in suppressing heart rate response to laryngoscopy and intubation. Systolic blood pressure control immediately following intubation among the groups was better with esmolol. Maintenance of diastolic blood pressure and mean arterial pressure following intubation among the groups was also better with esmolol. CONCLUSIONS Esmolol can be recommended as a better agent for attenuation of pressor response to laryngoscopy and intubation in comparison with clonidine.
