Comparison of Intravenous versus Nebulised Lignocaine for Suppression of Haemodynamic Responses to Tracheal Intubation

Abstract

Background: Laryngoscopy and tracheal intubation are noxious stimuli associated with transient haemodynamic changes which can be deleterious, especially in patients with cardiovascular or intracranial disease. Different pharmacological techniques are used to suppress this response. We designed this study to evaluate whether nebulised lignocaine can attenuate haemodynamic responses to intubation. Patients and Methods: Forty patients were enrolled for the study and randomly allocated into one of two groups, Group LN (nebulised lignocaine) and Group LI (intravenous [IV] lignocaine). Group LN and Group LI received nebulisation respectively with 5 mL of 2% lignocaine or 5 mL of normal saline 15 min before shifting the patient to the operation theatre. General anaesthesia with endotracheal intubation was provided as per institutional protocol. Participants in Group LN received 5 mL saline intravenously while Group LI received 5 mL of 2% lignocaine IV 90 s after muscle relaxant and were intubated 90 s later. Patients were monitored for the first 10 minutes postintubation without any additional drug or any surgical stimulus. Results: In our study, we found a statistically significant suppression of haemodynamic responses following intubation in the nebulised lignocaine group in comparison with the IV lignocaine group. Conclusion: Significant attenuation of haemodynamic responses to intubation was observed with nebulised lignocaine group as compared to IV lignocaine group. We believe that nebulisation of lignocaine is a simple, cost-effective and safe procedure to attenuate haemodynamic responses to intubation. This novel technique could replace the use of other pharmacological interventions for the same purpose, thereby avoiding polypharmacy.