Efficacy of esmolol and magnesium sulphate in attenuation of haemodynamic response during laryngoscopy and intubation: a clinical comparative study
Keywords:Attenuating hemodynamic response, Esmolol, Laryngoscopy and intubation, Magnesium sulphate
Background: Hypertension and tachycardia accompanying laryngoscopy and tracheal intubation are deleterious, especially in patients with cardiovascular or intracranial diseases. The aim of the present study was to compare and evaluate the efficacy of magnesium sulphate and esmolol in attenuating the hemodynamic response to laryngoscopy and endotracheal intubation.
Methods: A prospective study was conducted with ninety patients undergoing elective surgery under general anaesthesia who were randomized into three groups of thirty patients each. Group I received 10 ml of 0.9% normal saline, group II received magnesium sulphate 50mg/kg body weight and group III received esmolol 2mg/kg body weight. The study drugs were administered intravenously over 30 seconds, 3 minutes prior to laryngoscopy. Induction was done with sodium thiopentone and endotracheal intubation was performed after one minute of administration of succinylcholine 1.5mg/kg. Heart rate and blood pressure were recorded from preinduction up till 10 minutes after intubation.
Results: There was a significant rise in heart rate and blood pressure in group II as compared to group I.
Conclusions: Esmolol is a better agent than magnesium sulphate to attenuate hemodynamic response to laryngoscopy and intubation.
Sheppard S, Eagle CJ, Strunin L. A bolus dose of esmolol attenuates tachycardia and hypertension after tracheal intubation. Can J Anaesth. 1990 Mar;37(2):202-5.
Rashkin MC, Davis T. Acute complications of endotracheal intubation. Relationship to reintubation, route, urgency, and duration. Chest. 1986 Feb;89(2):165-7.
Stauffer JL, Olson DE, Petty TL. Complications and consequences of endotracheal intubation and tracheotomy. A prospective study of 150 critically ill adult patients. Am J Med. 1981;70(1):65-76.
Elder JD, Proctor DF, Dripps RD. Anesthesiology. J American Society Anesthesiologists. 1954;15:231-8.
James MF, Beer RE, Esser JD. Intravenous magnesium sulfate inhibits catecholamine release associated with tracheal intubation. Anesth Analg. 1989 Jun;68(6):772-6.
Iseri LT, French JH. Magnesium: nature’s physiologic calcium blocker. Am Heart J. 1984 Jul;108(1):188-93.
Menigaux C, Guignard B, Adam F, Sessler DI, Joly V, Chauvin M. Esmolol prevents movement and attenuates the BIS response to orotracheal intubation. Br J Anaesth. 2002 Dec 1;89(6):857-62.
Puri GD, Marudhachalam KS, Chari P, Suri RK. The effect of magnesium sulphate on hemodynamics and its efficacy in attenuating the response to endotracheal intubation in patients with coronary artery disease. Anesth Analg. 1998;87(4):808-11.
Gupta S, Tank P. A comparative study of efficacy of esmolol and fentanyl for pressure attenuation during laryngoscopy and endotracheal intubation. Saudi J Anaesth. 2011 Jan;5(1):2-8.
Sharma J, Sharma V, Gupta S. Comparative study of magnesium sulphate and esmolol in attenuating the pressor response to endotracheal intubation in controlled hypertensive patients. J Anaesth Clin Pharmacol. 2006:22(3):255-59.