Comparison of intravenous lignocaine, esmolol and labetalol for attenuation of hemodynamic and stress response to laryngoscopy and endotracheal intubation under general anaesthesia.

PREANAESTHETIC EVALUATION:

A detailed pre-anesthetic checkup [PAC] including history, physical examination and

investigations as guided in accordance with the plan of surgery will be carried out in all patients.

The procedures will be explained to the patient and informed written consent will be obtained in a

language that is understood by the patient. The study drug will be administered according to the

group allocated to the patient. The observer will then collect the data.

ANAESTHETIC PROCEDURE:

On arrival in the operating room, standard monitors like pulse oximetry [SpO2],

electrocardiography[ECG] and non-invasive blood pressure[NIBP] are attached and

baseline hemodynamic parameters such as heart rate[HR] , systolic blood pressure [SBP],

diastolic blood pressure[DBP], mean arterial pressure[MAP] will be recorded in supine

position.

Intravenous line will be established by using 18 gauge or 20 gauge cannula and a venous

sample for Serum Cortisol levels and Blood Glucose will be taken at the same time.

Intravenous fluids will be started.

Based on the allocation of groups, patients will be pretreated with Lignocaine 1.5mg/kg,

Esmolol 1mg/kg, Labetalol 0.3mg/kg, 5 min prior to Laryngoscopy and oral Endotracheal

Intubation. Patients will be preoxygenated with 100% oxygen for 3 minutes. Anesthesia

will be induced with Propofol[2 mg/kg]. Following check ventilation, muscle relaxation

will be achieved with Vecuronium [0.1mg/kg] intravenously to facilitate Laryngoscopy

and Endotracheal intubation.

After 5 min of administration of study drugs, laryngoscopy and oral endotracheal

intubation will be performed using cuffed endotracheal tube of appropriate sizes and

hemodynamic parameters (HR, SBP, DBP, MAP) are recorded. Also on arrival in the

operating room, at 1 min, 3 min and 5 min following laryngoscopy and endotracheal

intubation hemodynamic parameters (HR, SBP, DBP, MAP) will be recorded. A venous

sample will be taken for serum cortisol and blood glucose levels on arrival in the operating

room and 5 minutes following Laryngoscopy and Endotracheal Intubation at the same time.

Anesthesia will be maintained with an inhalational agent and Oxygen: Nitrous Oxide

[50:50] throughout the surgery and ventilation adjusted to maintain EtCO2 of 30-40 mm

of Hg throughout the procedure.