Comparison of Intravenous Lignocaine and Esmolol in Attenuating Hemodynamic Response and Cough Reflex during Extubation in Hypertensive Patients under General Anaesthesia
Attenuate Haemodynamic Responses
Abstract
Tracheal extubation carries higher complication rates compared to intubation during general anaesthesia (GA). Thus, various drugs are used to attenuate hemodynamic responses and cough reflex during extubation. We investigated if intravenous (IV) lignocaine and esmolol, given prior extubation, was able to achieve that in hypertensive patients under GA. In this prospective, double-blinded, randomised controlled study, 68 hypertensive patients on treatment undergoing GA were analysed. Group L received IV lignocaine 1 mg/kg while Group E received IV esmolol 1.5 mg/kg, 2 minutes before extubation. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded at the following interval: before study drug administration (T-0), prior extubation (T-1), 1 minute (T-2), 3 minutes (T-3), 5 minutes (T-4) and 10 minutes (T-5) post-extubation. Group L showed significantly increase in HR at T-2 while SBP and MAP increased significantly from T-1 until T-5. Group E showed a significant reduction in HR at T-1 up to T-5 and significantly lower HR at T-1 and T-2 compared to Group L. Group E showed stable SBP, DBP and MAP at all intervals. In conclusion, IV esmolol at 1.5 mg/kg was able to attenuate the hemodynamic response more pronounced when compared to IV lignocaine at 1 mg/kg from extubation stress in patients with hypertension on treatment. Both lignocaine and esmolol were equally effective in suppressing cough reflex during extubation.
Keywords :
airway extubation,
cough,
esmolol,
hypertension,
Lignocaine,
Abstrak
Ekstubasi trakea mempunyai kadar komplikasi yang lebih tinggi berbanding intubasi semasa anestesia umum (AU). Oleh itu, pelbagai ubat digunakan untuk mengurangkan tindak balas hemodinamik dan refleks batuk semasa ekstubasi. Kami mengkaji jika intravena (IV) lignocaine dan esmolol, yang diberikan sebelum ekstubasi, dapat mencapainya pada pesakit hipertensi di bawah AU. Dalam kajian prospektif, percubaan terkawal rawak berganda, seramai 68 pesakit hipertensi yang menjalani rawatan dengan AU dianalisis. Kumpulan L menerima lignocaine IV 1 mg/kg sementara Kumpulan E menerima IV esmolol 1.5 mg/kg, 2 minit sebelum ekstubasi. Denyut jantung (HR), tekanan darah sistolik (SBP), tekanan darah diastolik (DBP) dan purata tekanan arteri (MAP) dicatatkan pada selang waktu berikut; sebelum ubat diberi (T-0), sebelum ekstubasi (T-1), 1 minit (T-2), 3 minit (T-3), 5 minit (T-4) dan 10 minit (T-5) selepas ekstubasi. Kumpulan L menunjukkan peningkatan HR yang ketara pada T-2 sementara SBP dan MAP meningkat dengan ketara dari T-1 hingga T-5. Kumpulan E menunjukkan penurunan HR yang ketara pada T-1 hingga T-5 dan penurunan HR yang ketara pada T-1 dan T-2, jika dibandingkan dengan Kumpulan L. Kumpulan E menunjukkan SBP, DBP dan MAP yang stabil pada setiap selang waktu. Kesimpulannya, Esmolol IV pada kadar 1.5 mg/kg dapat mengurangkan tindak balas hemodinamik yang lebih ketara akibat tekanan ekstubasi, jika dibandingkan dengan lignocaine IV pada 1 mg/kg pada pesakit dengan hipertensi semasa rawatan. Kedua-dua lignocaine dan esmolol memberi kesan yang sama untuk mengekang refleks batuk semasa ekstubasi.
Kata Kunci :
batuk,
ekstubasi salur udara,
esmolol,
hypertensi,
lignocaine,
Correspondance Address
Rufinah Teo. Department of Anaesthesiology & Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +6012-4280835 Email: rufinah@ppukm.ukm.edu.my
