Attenuation of Haemodynamic Response To Laryngoscopy And Intubation With Nitroglycerin

Abstract

Background: Laryngoscopy and intubation are common procedures in anesthesia. Hemodynamic responses to mechanical stimulation of the laryngopharynx and tracheobronchial tree cause stimulation of sympathetic efferent fibres leading to an increased pressor response. We in the current study tried to evaluate the effect of nitroglycerine in the attenuation of hemodynamic responses due to laryngoscopy and intubation. Methods : Based on the inclusion and exclusion criteria n=80 cases were divided into two groups Group A (n=40) control group and group B (n=40) study group randomly by computergenerated number. A detailed history is taken and a complete physical examination is performed and the presence of any medical disorder and history of drug intake was ruled out. All patients were screened by radiological, biochemical, and histological investigations, in addition to routine pre-operative ECG.Pre-medication, induction agent and muscle relaxant to facilitate intubation was standardized for both groups. Results: The parameters recorded in the control group at one minute showed hemodynamic values were increased. The difference of SBP with the study group was 14.75 mm Hg, diastolic blood pressure by 5 mm Hg, mean blood pressure by 8.5 mm Hg, HR was 8 beats per minute al these values were pvalues <0.05 hence considered significant. At the end of three minutes, the comparison shows all the parameters SBP, DBP, MBP, HR, and RPP still increased significantly in the control group as compared to the test group. At the end of five minutes, all the parameters were found to still significantly higher in the control group (<0.05) as compared to the study group except for SBP change which was found not to be significant between both the groups. Conclusion: The study establishes the usefulness of intravenous Nitroglycerine to attenuate hemodynamic to laryngoscopy and tracheal intubation. The hemodynamic changes in the study group were well within the limits as compared to the control group. The study also shows that there were no incidences of adverse effects with nitroglycerine. Therefore, nitroglycerine must be considered for attenuation of hemodynamic responses to laryngoscopy in cases where it is indicated.