Cherian Mathai, Melchisedec Singh, Valsamma Abraham

ABSTRACT

Laryngoscopy and intubation frequently induces a cardiovascular stress response. In susceptible patients, this can evoke life threatening complications. Esmolol and labetalol have shown effectiveness in attenuating these responses at high doses but with a propensity for adverse effects like bradycardia and hypotension. This study was designed to compare the efficacy of labetalol with esmolol at lower doses, so as to get the best response with minimum side effects. Method: This study was conducted as prospective, randomized, controlled and double blind. 90 Patients of either sex, ASA grade I and II and aged between 18-60 years were randomly divided into three groups, E, L and P receiving 10 ml solution of 0.5mg/kg Esmolol, 0.1mg/kg Labetalol and normal saline respectively. Intubation was done five minutes after administration of drug and haemodynamic response and adverse events were recorded and analysed using appropriate statistical tests. Results: Placebo group showed significant rise in all parameters from intubation till 3 to 5 minutes post intubation with values reaching baselines between 5 to 10 minutes. Labetalol was more successful for control of heart rate, while esmolol was more useful in attenuation of SBP. Both esmolol and labetalol were equally successful in attenuation of DBP, MAP and RPP. Only labetalol group reported one episode of bradycardia and two episodes of hypotension. Conclusion: Esmolol (0.5mg/kg) and labetalol (0.1mg/kg) were successful in attenuating this response with equal efficacy during period of maximum stress with minimal adverse effects.