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.
Overview
- Phase
- Not Applicable
- Status
- Not yet recruiting
- Sponsor
- GMERS medical college and hospital Gotri
- Enrollment
- 50
- Locations
- 1
- Primary Endpoint
- To evaluate Hemodynamic response that is pulse rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure & rate pressure product at baseline, 1 minute, 3 minutes & 5 minutes after laryngoscopy
Overview
Brief Summary
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.
Study Design
- Study Type
- Interventional
- Allocation
- Coin toss, Lottery, toss of dice, shuffling cards etc
- Masking
- Participant Blinded
Eligibility Criteria
- Ages
- 18.00 Year(s) to 60.00 Year(s) (—)
- Sex
- All
Inclusion Criteria
- •BMI less than 30 kg/m2 ASA 1-2 Pulse rate equal to or above 70/min with regular rhythm.
Exclusion Criteria
- •Patient Refusal Allergic to study drugs On chronic Medication for heart diseases like: AV Blocks, CHF, Brady-arrythmias, IHD, Hypertension.
- •Laryngoscopy time more than 20 seconds Difficult bag and mask ventilation Difficult intubation.
Outcomes
Primary Outcomes
To evaluate Hemodynamic response that is pulse rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure & rate pressure product at baseline, 1 minute, 3 minutes & 5 minutes after laryngoscopy
Time Frame: To evaluate pulse rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure & rate pressure product at baseline, 1 minute, 3 minutes and 5 minutes after laryngoscopy
Secondary Outcomes
- To note any adverse effects associated with drugs used in both the groups, any rescue medication needed for correction of over-attenuation of the response, such as use of sympathomimetic drugs(To note any adverse effects associated with drugs used in both the groups, any rescue medication needed for correction of over-attenuation of the response, such as use of sympathomimetic drugs till the first 5 minutes of laryngoscopy & intubation)
Investigators
Kinal Vyas
GMERS medical college and hospital, Gotri, Vadodara