Study of Attenuation of Hemodynamic Response to Laryngoscopy and Endotracheal Intubation using Intra-oral Ivabradine

CONTEXT: Endotracheal intubation is one of the most commonly performed procedures, where rapid and dramatic hemodynamic changes which adversely affect the patient may occur during the perioperative period. Various strategies have been applied to attenuate these responses in high-risk individuals. Ivabradine is a very unique cardiotonic drug in the medical literature which reduces the heart rate without jeopardizing hemodynamics in unhealthy, compromised patients. AIMS AND OBJECTIVE: The aim of this study is to evaluate the effect of oral ivabradine on the hemodynamics during laryngoscopy and endotracheal intubation in patients undergoing surgical procedure under general anesthesia and to note the side effects and complications. SETTINGS AND DESIGN: This was a prospective, randomized, and double-blind controlled study. SUBJECTS AND METHODS: A total of 50 American Society of Anesthesiologists physical status I patients between 20 and 50 years age comparable in demographic variables of either sex, undergoing surgery under general anesthesia were randomized into two groups, namely, Group T and Group C of 25 each. Group T (test group) received tablet ivabradine 5 mg 1 h before intubation. Group C (control group) received placebo 1 h before intubation. The pulse rate, systolic and diastolic blood pressures, and mean arterial pressure were recorded for around 10 min and surgery was not allowed to commence. These hemodynamic variables were measured preoperatively, at intubation, after 1 min, 5 min, 8 min and 10 min postintubation. STATISTICAL ANALYSIS USED: The Chi-square test and ANOVA test using INDOSTAT software for hemodynamics were used in this study. RESULTS: There was an increase in all parameters in the control group during and postintubation and was undisturbed in the test group as compared to base line. The increase was constant up to 3 min and got settled within 5 min in the control group. CONCLUSION: Ivabradine had better patient compliance in terms of blunting laryngoscopic pressor.