Saurabh Bhargava1 , Deepak Kumar2 , Ravindra Singh Sisodia3 , Mehmood Uz Zafar4 , Deepak Tiwari5
BACKGROUND Laryngoscopy and intubation of the trachea causes increases in pulse rate and blood pressure. This is due to sympathoadrenal discharge caused by epipharyngeal and parapharyngeal stimulation. Unfortunately, the complete answer to this seemingly simple co-occurrence of laryngoscopy and tracheal intubation remains elusive. We wanted to compare the effects of three drugs namely lignocaine, fentanyl, esmolol for obtunding the haemodynamic response to laryngoscopy and intubation. METHODS A total of 60 adult patients undergoing elective spinal surgical procedures were included in the study. The patients were randomised to receive pre-intubation bolus of fentanyl (2 mcg / Kg), esmolol (0.5 mg / Kg) and lignocaine (1.5 mg / Kg) 3, 2 and 1.5 minutes before intubation, respectively. We measured pulse rate, SBP, DBP, and MAP prior to intubation and then subsequently at 1, 2, 3, 5, and 10 minutes after intubation. Data was analysed with SPSS 19 software. RESULTS The pulse rate, blood pressure and the MAP were found to be effectively controlled in the fentanyl group. The increase in pulse rate in the lignocaine group was found to be highly significant at all points of time as compared to the pre-intubation rate (p < 0.0001). In the fentanyl group, we observed a fall in the pulse rate; however, this fall in pulse rate was not significant (p > 0.05). An increase in the pulse rate was observed in the Esmolol group. When compared to pre-intubation, this rise was found to be significant in the 1st to 5th minute, after which the change in rate in the 10th min was not significant when compared to the pre intubation rate. CONCLUSIONS Fentanyl, in a dose of 2 µgm / Kg I.V., was a safe and effective agent in controlling the increase in heart rate and blood pressure in response to laryngeal stimulation and airway instrumentation.
