Abstract
Background and Aim: Pressor response in relation to laryngoscope and tracheal intubation generally lead to rise in heart rate and blood pressure. This response needs to be controlled. The aim is to study efficacy of intravenous paracetamol infusion given before induction to control hemodynamic response at laryngoscopy and endotracheal intubation. Materials and Methods: It was prospective randomized study, after institution ethical committee clearance, Sixty patients of American society of Anaesthesiology class I and II undergoing elective surgery under general anaesthesia were selected and divided into two groups each comprising 30 patients.Group P received inj. Paracetamol -20mg/kg 30 min before induction and Group F received inj. Fentanyl 1mcg/kg before induction. The primary objective was to observe hemodynamic response at intubation and 1,3,5,10 min after intubation. The secondary objective was to measure rate pressure product and any side effects associated with drug. Results: There was no demographic difference found between two groups. Both the group showed decreased hemodynamic response, but it was highly significant with inj.fentanyl. Conclusion: IV Paracetamol administration 30 minutes before induction does attenuate hemodynamic response but not as significant as with inj. Fentanyl. Keywords: Endotracheal Intubation, Fentanyl, Laryngoscopy, Paracetamol
Highlights
Significant hemodynamic changes and unfavourable outcomes are associated with laryngoscopy and tracheal intubation which have hazardous effects on it, lasting for atleast 10 minutes
Sixty patients with American Society of Anaesthesiology class I and II, undergoing elective surgery under general anaesthesia were selected for this prospective randomized study and those with American Society of Anaesthesiology class III and IV, allergy to paracetamol, addiction with opioids and alcohol, any co-morbities or intake of any drug affecting cardiovascular system were excluded from the study
Patient was maintained on O2/N2O/Sevoflurane/Vecuronium top ups.Following vital parameters heart rate (HR), Mean Arterial Pressure (MAP), RPP were recorded before induction, at laryngoscopy/intubation and 1,3,5,10mins after intubation
Summary
Significant hemodynamic changes and unfavourable outcomes are associated with laryngoscopy and tracheal intubation which have hazardous effects on it, lasting for atleast 10 minutes. Efficacy of Intravenous Paracetamol Infusion for Attenuation of Hemodynamic Responses to Laryngoscopy and Tracheal Intubation such drug known-Paracetamol (acetaminophen) whose safety profile is already established[7] and is even safe during pregnancy[8]. It categorizes under Aniline Analgesic class of drugs. It is said that apart from its action on COX1 and COX2, it acts on discrete COX1 splice variant (which was initially thought to be COX3) which is found to be active in central nervous system rather than at the site of injured or inflamed tissue[11] and has antipyretic effects through hypothalamus It devoid of opioid related side effects. Paracetamol can be administered in three common modes-IV carries a faster time to peak plasma drug concentration (15 minutes after start of infusion), whereas, for oral it requires approximately 2 hours and rectal paracetamol at least 3 hours[15]
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