A Comparative Study between the Efficacy of Different Agents Used to Attenuate the Heamodynamic Response to Laryngoscopy and Intubation in Elderly Controlled Hypertensive Patients

Document Type : Original Research Papers

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Anesthesiology and Intensive Care, Faculty of Medicine, Benha University, Benha, Egypt

Abstract

Background: Endotracheal intubation (ETI) and mechanical ventilation control introduced a new era in the history of anaesthesia. This has led to improved airway and breathing management, making anaesthetic delivery safer. Stimulation of the autonomically innervated epipharynx, pharynx, larynx, and trachea as a result of laryngoscopy and intubation (L&I). The purpose of this work was to compare the efficacy of different agents used for attenuating the hemodynamic response to laryngoscopy and ETI in elderly controlled hypertensive patients scheduled for elective surgery.
Methods: This prospective interventional double blinded randomized clinical trial included 120 adult elderly controlled hypertensive (age > 65 years old) scheduled for elective surgery. Patients were randomly allocated into six equal groups. All participants received study medications according to their assigned group., before induction which were fentanyl, lidocaine, diltiazem, nitroglycerine (NTG), and esmolol. Further, all participants were subjected to suitable preoperative, intraoperative, and postoperative preparations in addition to serum cortisol level, and salivary alpha amylase (SAA) assessment.
Results: MAP before intubation, after intubation, 5 and 10 minutes after intubation was significantly lower in Dexmedetomidine and Esmolol groups compared to the other groups (P value <0.001) and in NTG and Diltiazem groups compared to Fentanyl and Lidocaine groups (P value <0.001). Serum cortisol before intubation, after intubation, 5 and 10 minutes after intubation was significantly lower in Dexmedetomidine and Esmolol groups compared to the other groups (P value <0.001) and in NTG and Diltiazem groups compared to Fentanyl and Lidocaine groups (P value <0.001).
Conclusions: In elderly controlled hypertensive scheduled for elective surgery, MAP, RBS, Serum cortisol, and SAA were lower significantly in Dexmedetomidine and Esmolol groups compared to the other groups, as well in NTG and Diltiazem groups compared to Fentanyl and Lidocaine groups before intubation, after intubation, 5 and 10 minutes after intubation

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