An Observational Study To Compare Intravenous Esmolol And Oral Clonidine For Attenuation Of Stress Response To Intubation And Laryngoscopy In Ent Surgeries

Abstract

Background: Induction of anaesthesia is recognized as a hazardous phase in management of the patient   during   operative   procedure.   Laryngoscopy   and   intubation   being   noxious   stimuli   produce cardiovascular stress response, which result in an increase in cardiac work load, may terminate in pre operative myocardial ischemia and acute heart failure in susceptible individuals.  So, this study was conducted with an objective to compare the efficacy of oral Clonidine and  intravenous Esmolol for attenuation of cardiovascular stress response  following  laryngoscopy  and  intubation.

Method: This study was conducted among 50 patients of ASA I & II who were scheduled for ENT surgeries in Dhiraj hospital, Vadodara, Gujarat.  All patients were divided in 2 groups of 25 patients each, depending upon drug they received -Group C: Patients received Tab. Clonidine 4 mcg/kg 60 min before induction with sips of water and Group E:  Patients received Inj.  Esmolol 1.5 mg/kg bolus intravenous 10 min before induction. All patients were premedicated with Inj. Glycopyrrolate0.2mg, Inj. Ondansetron 4mg, Inj. Midazolam 1 mg and Inj. Tramadol 50 mg intravenously.  Anaesthesia were induced with Inj. Propofol 2 mg/kg followed by Succinylcholine 2mg/kg intravenously.  All parameters like pulse rate, systolic BP, diastolic BP and MAP were recorded at regular intervals. Complications (if any) were also observed during perioperative period.

Result: Pulse rate, SBP, DBP and MAP were comparable at baseline, at time of induction, during laryngoscopy and intubation and throughout whole study period it was not statistically significant in both groups. However, in intergroup comparison, SBP was comparable at base line and after 5 min of laryngoscopy and intubation in both groups, but SBP was significantly higher after 1 and 3 min of laryngoscopy and intubation in Group E than Group C. Also, there was statistically significant increase in MAP in Group E following laryngoscopy and intubation at one min in Group E than Group  C. Three patients had bradycardia after giving Esmolol while one patient had bradycardia after giving clonidine. They were treated with atropine 0.6 mg intravenously. Other postoperative complications like dryness of mouth, excessive sedation, PONV, hypotension, bronchospasm were not observed in any case in both groups.

Conclusion: Oral clonidine and intravenous esmolol both controls rise in pulse rate following laryngoscopy and endotracheal intubation. Intravenous esmolol is not effective in obtunding hypertensive response following laryngoscopy and intubation and associated with significant rise in SBP and MAP. So, oral clonidine (4 mcg/kg) is more effective in   attenuating stress response than intravenous esmolol(1.5mg/kg).