Intravenous Lignocaine and Sublingual Nitroglycerine to Attenuate Stress Response to Laryngoscopy

What is it about?

Intravenous Lignocaine and Sublingual Nitroglycerine to Attenuate Stress Response to Laryngoscopy

Featured Image

Photo by Elsa Olofsson on Unsplash

Photo by Elsa Olofsson on Unsplash

Why is it important?

Introduction: Laryngoscopy and intubation is associated with a reflex sympathetic pressor response resulting in elevated heart rate (HR) and blood pressures (BP). This may prove detrimental in high risk patients and may be in normal patients also. Several drugs Nitroglycerine (NTG), Lignocaine, Beta-blockers, Opioids, Calcium Channel blockers and Adrenergic agonists, have been used for attenuating the stress response. NTG sublingual spray is a new introduction to attenuate the stress response to intubation. Aims: Aim of this study was to compare the effects of sublingual NTG spray and intravenous (iv) Lignocaine on the haemodynamic response following laryngoscopy and intubation. Patients and Methods: Randomised control study involving sixty ASA I and II patients who are aged between 20 to 40 years posted for elective surgery were divided randomly into two groups of thirty each. ‘Z’ test was used for statistical analysis. All patients received premedication with Glycopyrrolate (0.01mg/ kg), Midazolam (0.02 mg/kg)iv. Patients were induced with Thiopentone 5 mg/kg iv and muscle relaxant was used in the form of Vecuronium (0.1 mg/kg)iv. First group received iv Lignocaine 1.5 mg/kg, 5 min before intubation and second group received two puffs of NTG sub lingual spray, 400mcg/spray. HR and BP were recorded noninvasively before induction, post-induction, at intubation (0 min), 1,3,5,7 and 10 min from the onset of laryngoscopy. Pair wise comparison between the groups was done by `z’ test. For all tests a `z’ value of 1.96 was considered significant and a `p’ value of 0.05 was considered significant. Results: In group N, the rise in systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) was not significant at 1, 3 and 5 min after laryngoscopy, the attenuation was statistically highly significant with p values of < 0.001. Where as in group L, there was significant increase in SBP, DBP and MAP till 7 min post laryngoscopy, after which the values reached the pre induction values. Conclusions: Pre-treatment with sublingual NTG spray provides a consistent and reliable attenuation of pressure response to laryngoscopy and intubation when compared to iv Lignocaine.

Perspectives