EFFECT OF INTRAVENOUS LIDOCAINE, INTRAVENOUS ESMOLOL AND INTRAVENOUS CLONIDINE ON HAEMODYNAMIC RESPONSES TO LARYNGOSCOPY AND ORO-TRACHEAL INTUBATION IN NORMOTENSIVE PATIENTS: A DOUBLE BLINDED, COMPARITIVE STUDY

BACKGROUND: The pressure response to laryngoscopy and endotracheal intubation is without sequel in healthy individuals. In patients with pre-existing diseases, may precipitate myocardial ischemia, arrhythmias, infarction and cerebral hemorrhage. In view of that, the objectives of our study was, to assess the hemodynamic variations to laryngoscopic intubation and to evaluate the comparative efficacy of I. V Lidocaine, I. V Esmolol and I. V Clonidine, in attenuating the sympathetic response to laryngoscopy and orotracheal intubation in normotensive patients. METHODS: In our double blind, randomized, clinical prospective study 105 Indian ethnicity patients of either sex requiring oral intubation, who met inclusion criteria, were considered. Randomly patients were stratified into three groups (n=35 patients each) Group C, Group E and Group L to receive inj Clonidine 1.5 mu g/kg, inj Esmolol 1.5 mg/kg and inj Lidocaine 1.5 mg/kg respectively at 15min, 3min and 3min prior to intubation as premedication. Two senior postgraduates who were not involved in patient care were responsible for blinding techniques. Data obtained were analyzed after decoding. Analysis of variance (ANOVA), Chi-square/Fisher Exact test has been used to find the significance of study parameters on categorical scale between the three groups. RESULTS: In our study there was strongly significant raise in heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) at one minute following intubation in all three groups (p<0.001). HR reached base line at 4min in group E which was statistically significant (p<0.001). In group C, SBP and DBP reached base line value in 2 min and 3 min Which is again statistically strongly significant (p<0.001). CONCLUSION: Esmolol 1.5 mg/kg I. V, 3 min prior to oro-tracheal intubation is a better drug of choice to control HR and Clonidine 1.5 mu g/kg I. V, 15 min prior to orotracheal intubation is preferred to attenuate hypertensive response to laryngoscopy and intubation in a normotensive patients.