A prospective randomised single-blind observational study to assess the effect of IV dexmedetomidine vs. IV esmolol and lignocaine combination for attenuation of laryngoscopic response in patients undergoing otorhinolaryngologic surgeries under general anaesthesia.

Laryngoscopy and endotracheal intubation are integral components of general anaesthesia for airway management. However, these procedures are associated with intense sympathetic stimulation resulting in a transient but marked increase in heart rate and blood pressure, collectively known as the pressor response or laryngoscopic response. In patients with pre-existing cardiovascular conditions, this response may precipitate myocardial ischemia, arrhythmias, or cerebrovascular events. Hence, attenuating this hemodynamic response is critical for improving perioperative safety and outcomes.

Several pharmacological agents have been studied to mitigate the laryngoscopic response, including opioids, beta-blockers, alpha-2 agonists, calcium channel blockers, and local anaesthetics. Among these, dexmedetomidine, an alpha-2 adrenergic agonist, has gained attention due to its sedative, analgesic, and sympatholytic properties. It has been shown to blunt the stress response effectively while also providing perioperative sedation and analgesia without significant respiratory depression.

Esmolol, a short-acting cardioselective beta-1 adrenergic blocker, is another commonly used agent to suppress the tachycardia and hypertension associated with laryngoscopy. It has a rapid onset and brief duration of action, making it particularly suitable for short-term modulation of hemodynamics during induction and intubation. Lignocaine, a local anaesthetic, when given intravenously, has been used to suppress airway reflexes and blunt the pressor response due to its membrane-stabilizing and antiarrhythmic effects.

While each of these agents—dexmedetomidine, esmolol, and lignocaine—has demonstrated efficacy individually in attenuating the laryngoscopic response, comparative studies are essential to determine the most effective and safe option for clinical practice. The choice of agent may depend on factors such as patient comorbidities, drug onset and duration, side effect profiles, and anaesthetic goals.

Out of all the 3 drugs, dexmedetomidine (>esmolol >lignocaine) is found to be best for decreasing the pressor response, but there are very few studies comparing dexmedetomidine with combination of lignocaine and esmolol for attenuation of laryngoscopic response. So we design this study to ascertain whether attenuation of laryngoscopic response with combination of lignocaine and esmolol is comparable or better than that caused by dexmedetomidine.

The findings may contribute to optimizing anaesthetic management, particularly in patients at risk of hemodynamic instability during airway manipulation.