Comparison Of Oral Clonidine And Intravenous Esmolol For Attenuation Of Stress Response To Laryngoscopy And Endotracheal Intubation In Middle Ear Surgeries

Comparison Of Oral Clonidine And Intravenous Esmolol For Attenuation Of Stress Response

Abstract

Background: Induction of anesthesia is recognized as a hazardous phase in management of the patient during operative procedure. Laryngoscopy and intubation being noxious stimuli produce cardiovascular stress response, which result in an increase in cardiac work load, may terminate in pre operative myocardial ischemia and acute heart failure in susceptible individuals. So, this study was conducted with an objective to compare the efficacy of oral Clonidine and intravenous Esmolol for attenuation of cardiovascular stress response following laryngoscopy and intubation. Method: This study was conducted among 50 patients of ASA I & II who were scheduled for middle ear surgery at SSG hospital, Vadodara, Gujarat. All patients were divided in 2 groups of 25 patients each, depending upon drug they received - Group C: Patients received Tab. Clonidine 4 fxg/kg 90 min before induction with sips of water and Group E: Patients received Inj. Esmolol 1.5 mg/kg bolus intravenous 5 min before induction. All patients were premedicated with Inj. Glycopyrrolate 10 g/kg intramuscular 45 min before induction. Anesthesia were induced with Thiopentone sodium 2.5% (4-7 mg/kg) followed by Succinylcholine 1.5 mg/kg intravenously. All parameters like pulse rate, systolic BP, diastolic BP, MAP and RPP were recorded at regular intervals. Complications (if any) were also observed during perioperative period. Result: Pulse rate, SBP, DBP, MAP and RPP were comparable at baseline, at time of induction, during laryngoscopy and intubation and throughout whole study period it was not statistically significant in both groups. However In Intergroup comparison, SBP was comparable at base line and after 5 min of laryngoscopy and intubation in both groups, but SBP was significantly higher after 1 and 3 min of laryngoscopy and intubation in Group E than Group C. Also, there was statistically significant increase in MAP in Group E following laryngoscopy and intubation at one min in Group E than Group C. RPP was significantly higher after 1 and 3 min of laryngoscopy and intubation in Group E than Group C. Postoperative complications like dryness of mouth, excessive sedation, PONV, hypotension, Bradycardia, bronchospasm were not observed in any case in both groups. Conclusion: Oral clonidine and intravenous esmolol both controls rise in pulse rate following laryngoscopy and endotracheal intubation. Intravenous esmolol is not effective in obtunding hypertensive response following laryngoscopy and intubation and associated with significant rise in SBP, MAP and RPP. So, oral clonidine (4 g/kg) is more effective in attenuating stress response than intravenous esmolol(1.5mg/kg). [Pander Kashmira B Natl J Integr Res Med, 2019; 10(6):66-71]