Role of Glucagon during rapid sequence intubation (RSI) in elderly patients on beta blocker: A randomised controlled trial

6 monRapid Sequence Intubation (RSI) is a critical intervention in emergency and critical care settings. However, elderly patients on chronic beta-blocker therapy duration more than ths are particularly vulnerable to peri-intubation hemodynamic instability, including significant hypotension and bradycardia. This is due to age-related physiological changes and the pharmacodynamic effects of beta-blockers, which blunt the body’s compensatory cardiovascular responses during stress. Current strategies, such as careful selection of induction agents like ketamine or etomidate, provide partial protection but may not fully address the underlying risks in beta-blocked patients.

Glucagon, known for its role in managing beta-blocker overdose, offers a unique mechanism to stimulate cardiac activity by increasing intracellular cyclic AMP through non-beta-adrenergic pathways. Its ability to bypass blocked beta-receptors suggests it may be a valuable prophylactic agent in preventing hemodynamic compromise during RSI in this high-risk population. Despite theoretical support and limited case-based evidence, robust clinical data from randomised controlled trials are lacking. Therefore, there is a pressing need to systematically evaluate the role of glucagon in this setting.

Objectives

Primary objective:

To determine whether pre-treatment with intravenous glucagon reduces the incidence of peri-intubation hypotension in elderly patients on chronic beta-blocker therapy undergoing RSI.

Secondary objectives:

Assessing the

incidence of bradycardia,

need for rescue vasopressors or atropine,

first-pass intubation success rates,

occurrence of arrhythmias, and

any adverse effects of glucagon.