Abstract
Laryngoscopy and tracheal intubation are constantly connected with a reflex sympathetic reaction bringing about tachycardia, hypertension and dysrrhythmias. This may cause harm in high hazard patients. Different pharmacological methodologies have been utilized to limit or weaken such a reaction. This study aimed to assess the hemodynamic changes following laryngoscopy and endotracheal intubation following propofol induction utilizing a standard anesthesia procedure and to analyze the capability of lignocaine and fentanyl in lessening the cardiovascular reaction to laryngoscopy and intubation amid general anesthesia. Sixty patients aged between eighteen to fifty years, of either gender and ASA class I, weighing between forty to ninety kilograms were planned for elective procedures and were haphazardly allotted into three groups of 20 each. Induction of anesthesia was standard for all patients who received propofol 2mg/kg i.v. and were relaxed with succinylcholine 1mg/kg i.v. The first group received 10cc. normal saline, the second group had fentanyl 2µg/kg i.v. bolus and the third group got lignocaine 1.5mg/kg 3 minutes before laryngoscopy and intubation. Heart rate and blood pressure were recorded noninvasively on arrival to the theatre and considered as a base line record, just after induction and then 1,3,5,7 and 10 minutes following intubation. There were no difference in statistical analysis between the groups regarding number, gender, age, weight and ASA class. There is significant rise in heart rate, systolic BP, diastolic BP and MAP in control group particularly in the first 3 minutes following intubation (p<0.05). Both fentanyl and lignocaine gave minimal protection against rise in heart rate after laryngoscopy and intubation and there is no significant difference between the two drugs (p>0.05). Both fentanyl and lignocaine were equally effective in prevention of major rise in systolic blood pressure, diastolic blood pressure and mean arterial blood pressure. In conclusion, Fentanyl 2µg/kg and lignocaine 1.5mg/kg are both equally effective for attenuation of laryngoscopy and endotracheal intubation pressor response. Keywords: Attenuation, changes in hemodynamics, laryngoscopy, endotracheal intubation, propofol, fentanyl, lignocaine.
Highlights
TIntroduction he hemodynamic reaction to the act of laryngoscopy and intubation was first expressed by Reid and Brace in 19401
This study aimed to evaluate the hemodynamic changes happened after endotracheal intubation by means of a standard anesthesia technique and to contrast the efficacy of lignocaine and fentanyl for the attenuation of the hemodynamic reaction to direct laryngoscopy and intubation during general anesthesia
No statistical difference was noted between the groups in regard to gender, in the control group there was 12 (60%) males and 8 (40%) females, while in the fentanyl group there was 10 (50%) males and 10 (50%) females, in the lignocaine group there was 11(55%)
Summary
TIntroduction he hemodynamic reaction to the act of laryngoscopy and intubation was first expressed by Reid and Brace in 19401. The increase in heart rate and blood pressure is usually transient, variable, unpredictable and take place most frequently from reflex sympathetic & vagal discharge in response to laryngotracheal stimulation, which in sequence leads to rise in plasma norepinephrine concentration[2]. These changes are regularly tolerated by fit individuals, they may be deleterious in patients with hypertension, coronary artery disease, raised intracranial pressure, perioperative myocardial ischemia, cardiac arrhythmias, acute heart failure and cerebrovascular accident[3], sudden death can occur and has been reported[4]. This study aimed to evaluate the hemodynamic changes happened after endotracheal intubation by means of a standard anesthesia technique and to contrast the efficacy of lignocaine and fentanyl for the attenuation of the hemodynamic reaction to direct laryngoscopy and intubation during general anesthesia
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