A COMPARATIVE STUDY OF INTRAVENOUS LIDOCAINE AND INTRAVENOUS SUFENTANIL IN ATTENUATING THE HEMODYNAMIC RESPONSE TO LARYNGOSCOPY AND TRACHEAL INTUBATION

BACKGROUND AND OBJECTIVES : Laryngoscopy and tracheal intubation in adults cause stress response manifested by a rise in heart rate and blood pressure. Intravenous lidocaine has been used to suppress this stress response. Sufentanil a opioid, a fentanyl congener is being increasingly used to attenuate this response. In this clinical comparative study we compared these two drugs in attenuating the stress response to laryngoscopy and intubation. We compared the effects of intravenous lidocaine against sufentanil in attenuating the hemodynamic response to laryngoscopy and intubation in relation to Heart rate Blood pressure-systolic and diastolic Mean arterial pressure Rate pressure product-heart rate multiplied by systolic blood pressure METHODS : 100 patients belonging to ASA1 and ASA2 posted for surgeries under general anesthesia were randomly divided in a double blind fashion into 2 groups of 50 each. Both groups were premedicated with intravenous glycopyrolate 0.005mg/kg and midazolam 1mg. Group A received intravenous lidocaine 2% 1.5mg/kg and group B received 0.2 mu g/kg sufentanil 3 minutes before laryngoscopy and intubation. Both groups were induced with 2.5% thiopentone 5 mg/kg and 1.5mg/kg succinylcholine. Laryngoscopy was done and intubation accomplished within 20 seconds. Heart rate, blood pressure, mean arterial pressure were recorded before induction (baseline) and at 1, 3, 5 and 10 min after intubation. Statistical analysis was done using student't' test (paired) and P value obtained. RESULTS : Both groups showed attenuation of stress response. Maximum increase in heart rate in lidocaine group was at 3(rd) minute a 18.6% increase from baseline and maximum increase in sufentanil group was at 1(st) minute a 12.09% increase from baseline. It was clinically and statistically significant (P<0.001). Maximum increase in systolic blood pressure in lidocaine group was 22.8% from baseline and in sufentanil group it was only 12.15% (P<0.005). Sufentanil group showed a earlier fall in all the parameters to the baseline value compared to lidocaine group. INTERPRETATION AND CONCLUSION: Both sufentanil and lidocaine attenuate the stress response to laryngoscopy and intubation. When both these drugs were compared sufentanil attenuated the stress response to laryngoscopy and intubation better than lidocaine and afforded a good hemodynamic stability.