Attenuation of Hemodynamic response to tracheal extubation: Comparison of esmolol and lidocaine
Abstract
Introduction: Tracheal extubation causes 10% to 30% transient increase in blood pressure and heart rate. This hemodynamic instability can cause various deleterious effects like myocardial infarction, cerebrovascular hemorrhage etc. So we did a study to compare the efficacy of esmolol and lidocaine in blunting the hemodynamic response during extubation.
Methods: Sixty patients aged between 20 to 60 years, ASA I and II scheduled for elective surgery requiring general anesthesia were enrolled in this randomized, double blind study. At the end of surgery Isoflurane was discontinued and patients were reversed. Two minutes later Group I received a bolus dose of esmolol 1.5 mg/kg and Group II received lidocaine 1 mg/kg. After 1 minute of study drug administration oropharyngeal suctioning was done and after 3 min the tracheal tube was extubated. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP) and heart rate (HR) were recorded at different time intervals before and after extubation. Intra and intergroup comparison were done to determine the effectiveness of the study drugs.
Result: There was no significant increase in HR, SBP, DBP and MAP in Group I at the time of extubation when compared with the values at the end of surgery as their p values were > 0.05. In Group II there was significant increase in SBP at the time of extubation as compared to the value at the end of surgery (p=0.000) When comparing between the two groups, there was a significant increase in HR at the time of oropharyngeal suctioning and 1 min after extubation where as a significant increase in SBP at the time of oropharyngeal suctioning, at the time of extubation and 3 min after extubation in Group II as compared to Group I (p<0.05).
Methods: Sixty patients aged between 20 to 60 years, ASA I and II scheduled for elective surgery requiring general anesthesia were enrolled in this randomized, double blind study. At the end of surgery Isoflurane was discontinued and patients were reversed. Two minutes later Group I received a bolus dose of esmolol 1.5 mg/kg and Group II received lidocaine 1 mg/kg. After 1 minute of study drug administration oropharyngeal suctioning was done and after 3 min the tracheal tube was extubated. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP) and heart rate (HR) were recorded at different time intervals before and after extubation. Intra and intergroup comparison were done to determine the effectiveness of the study drugs.
Result: There was no significant increase in HR, SBP, DBP and MAP in Group I at the time of extubation when compared with the values at the end of surgery as their p values were > 0.05. In Group II there was significant increase in SBP at the time of extubation as compared to the value at the end of surgery (p=0.000) When comparing between the two groups, there was a significant increase in HR at the time of oropharyngeal suctioning and 1 min after extubation where as a significant increase in SBP at the time of oropharyngeal suctioning, at the time of extubation and 3 min after extubation in Group II as compared to Group I (p<0.05).