Comparison of esmolol and lidocaine for attenuation of cardiovascular stress response to laryngoscopy and endotracheal intubation in a Ghanaian population

BACKGROUND: Direct laryngoscopy and endotracheal intubation always trigger powerful cardiovascular responses. Various attempts have been made to attenuate these responses. The aim of this study was to compare the efficacy and safety of esmolol and lidocaine for suppressing cardiovascular response to laryngoscopy and tracheal intubation in a normotensive African population. MATERIALS AND METHODS: A randomized controlled trial was conducted in 120 adult patients of American Society of Anaesthesiologists (ASA) physical status I or II undergoing various elective surgeries. The patients were randomly divided into three groups of 40 patients in each group - C, L, and E. Group - “C” received no drug (control) as placebo, group -“L” received 1.5 mg kg(-1) preservative free lidocaine and group -“E” received 2 mg kg(-1) esmolol IV 2 min before intubation. Mean arterial pressure (MAP) and rate-pressure product (RPP) were measured before induction as baseline and after tracheal intubation at minute 1, 3, and 5. The patients were randomly allocated to receive either saline (Group C), lidocaine 1.5 mg/kg (Group L), or esmolol 2 mg/kg (Group E) (n = 40, each group). After induction of general anesthesia with thiopental 6 mg/kg and vecuronium 0.12 mg/kg, the test solution was infused 2 min before tracheal intubation. Changes in heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), and rate-pressure product (RPP) were measured before induction of general anesthesia (baseline), 1, 3, and 5 min after tracheal intubation. Patients were also observed for any complications. RESULTS: There was a significant increase in HR, SBP, DBP, MAP, and RPP from the base line in control group “C” at 1 min with onward decreases at 3 and 5 min respectively after intubation. Percentage change in hemodynamic variables in groups C, L, and E at 1 min are as follows: HR = 30.45, 26.00, and 1.50%; MAP = 20.80, 15.89, and 10.20%; RPP = 61.44, 40.86, and 11.68%, respectively. Only patients receiving placebo had increased HR, MAP, and RPP values after intubation compared with baseline values (P < 0.05). CONCLUSIONS: Prophylactic therapy with 2 mg kg(-1) esmolol is more effective and safe for attenuating cardiovascular responses to laryngoscopy and tracheal intubation in a black population.