2023, Vol. 6, Issue 3, Part A

Various clinical publications have already established tachycardia and hypertension as potential side effects of laryngoscopy and endotracheal intubation.

Notably, the exaggerated sympathetic response during laryngoscopy has been found to be a key factor in causing this more common than not desired complication. Although transient; such an exaggerated sympathetic response may lead to cardiac as well as CNS catastrophe in the sub-set of patients with known or unknown pre-existing cardiac or CNS disease. Not only such adverse events increase morbidity and mortality amongst patients they also increase the burden on health care infrastructure.

Various methods to attenuate this response including but not restricted to use of both intravenous and nebulized lidocaine have already been established in literature. However not many studies have been carried out in the Indian sub set population to compare the effect of intra venous lidocaine vs nebulized lidocaine. In view of study to compare the effect of 2 % preservative free intravenous lidocaine with 2% nebulized lidocaine in ASA I and II patients listed for elective surgeries under general anaesthesia in a service hospital of the armed forces was carried out between Jul 2022 to Jun 2023.

Materials and Methods: After taking approval of the institute ethical committee and informed consent we included seventy five ASA I & II patients of both the genders between ages 20-65 year who were posted for elective surgeries under general anaesthesia. Patients were then divided in three groups equally keeping the confounders of anthropology, ASA grade and obvious difficult airway same. In group A, standard anaesthesia technique was used to facilitate laryngoscopy and endotracheal intubation using Fentanyl @2 mcg/kg, Propofol 2mg/kg and Atracurium @ 0.5mg/kg Group B received nebulization with 2% lignocaine @ 1.5 mg/kg 10 minutes prior to the endotracheal intubation and Group C received 2% lignocaine @ 1.5 mg/kg intravenous 90 sec before induction.

The variables included in the study are heart rate, systolic and diastolic blood pressure and mean arterial pressure. Basal values and values subsequently at 1st, 3rd, 5th, and 10th minute after intubation were recorded.

Those patients who required laryngoscopy for more than 30 secs or requiring more than two attempts were excluded from the study.

Results: In all the 3 groups post endotracheal intubation demonstrated an increase in heart rate, systolic BP, Diastolic BP and mean arterial BP. However the minimum change in hemodynamic and thus most effective way of attenuating the sympathetic response to laryngoscopy and intubation was seen in the subgroup where lidocaine was administered intravenously.

Conclusion: In the present study we conclude that the use of lignocaine when used in combination with opioid for laryngoscopy and endotracheal intubations reduces the increase in heart rate and blood Pressure. However the attenuation of exaggerated sympathetic response was much more in the subset of patients where intravenous lidocaine was used.