Volume: 4 Issue: 1
Year: 2016, Page: 23-26,
Introduction: Laryngoscopy and intubation are associated with massive hemodynamic changes which can be detrimental to patients with cardiac disease. Very few studies tried to compare Dexmedetomidine and Esmolol for prevention of this response in off pump coronary artery disease. The designs of the study are biased towards one agent as these two drugs have to be given by different forms. We tried to compare these two agents with different design so as to take advantage of most appropriate dosage form.
Material and Methods:The present study is a prospective, double blind, parallel group, randomized study done on eighty patients divided in two groups. After randomization, patients received Dexmedetomidine 0.5 microgram/kg vs. Esmolol 2 mg/kg. Anaesthesia was induced in routine manner after invasive monitoring. Blood pressure, heart rate were assessed prior to induction and at the time of induction,1 min,3 min,5 min and 10 minute post induction and intubation.
Results: Demographic characters were comparable in both the groups with non significant p values. Both the drugs controlled heart rate, systolic blood pressure and diastolic blood pressure well in first 3 minutes indicating effectiveness. Dexmedetomidine scored over Esmolol after 3rd minute and prevented the heart rate and blood pressure from rising in a sustained manner even at 10th minute.
Conclusion: Dexmedetomidine and Esmolol are appropriate for attenuation of hemodynamic control in off pump coronary artery bypass patients for up to 3rd minute. Dexmedetomidine provides more sustained hemodynamic stability up to 10th minute and suitable for long term control.
Keywords: Dexmedetomidine, Esmolol,intubation, coronary artery bypass grafting
1. Kautto UM. Attenuation of the circulatory response to laryngoscopy and intubation by fentanyl. Acta Anaesthesiol Scand. 1982; 26(3):217-21.
2. Dahlgren N, Messeter K. Treatment of stress response to laryngoscopy and intubation with fentanyl. Anaesthesia 1981; 36(11):1022-6.
3. Kautto UM. Attenuation of the circulatory response to laryngoscopy and intubation by fentanyl. Acta Anaesthesiol Scand. 1982; 26(3):217-21.
4. S. Bansal, M. Pawar.Haemodynamic responses to laryngoscopy and intubation in with pregnancy-induced hypertension; effect of intravenous esmolol with or without lidocaine Int J Obstet Anesth, 11 (2002), pp. 4–8.
5. Vanden Berg AA, Savva D, Honjol NM. Attenuation of the haemodynamic responses to noxious stimuli in patients undergoing cataract surgery. A comparison of magnesium sulphate, esmolol, lignocaine, nitroglycerine and placebo given IV with induction of anaesthesia. Eur J Anaesthesiol. 1997; 14(2):134-47.
6. Ebert TJ, Bernstein JS, Stowe DF, Roerig D, Kampine JP. Attenuation of haemodynamic responses to rapid sequence induction and intubation in healthy patients with a single bolus of esmolol. J Clin Anesth 1990; 2(4): 243-52.
7. Wang L, Luo A, Wu X. Bolus administration of esmolol for preventing the hemodynamic response to tracheal intubation: a multicentric study. Zhonghua Yi Xue Za Zhi 1999; 79(11): 828-31.
8. Hussain AM, Sultan ST. Efficacy of fentanyl and esmolol in the prevention of haemodynamic response to laryngoscopy and endotracheal intubation. J Coll Physicians Surg Pak 2005; 15(8): 454-7.
9. Keniya VM, Ladi S, Naphade R. Dexmedetomidine attenuates sympathoadrenal response to tracheal intubation and reduces perioperative anaesthetic requirement. Indian J Anaesth. 2011;55:352–54.
10. Menda F, Köner O, Sayin M, Türe H, Imer P, Aykaç B. Dexmedetomidine as an adjunct to anesthetic induction to attenuate hemodynamic response to endotracheal intubation in patients undergoing fast-track CABG. Ann Card Anaesth. 2010;13:16–21.
11. Bajwa SJ, Kaur J, Singh A, Parmar S, Singh G, Kulshrestha A, et al. Attenuation of pressor response and dose sparing of opioids and anaesthetics with pre-operative dexmedetomidine. Indian J Anaesth.2012;56:123–8.
12. Ramsay MA, Saha D, Hebeler RF. Tracheal resection in the morbidly obese patient: The role of dexmedetomidine. J Clin Anesth. 2006;18:452–4.
13. Alagol A, Arar C, Kaya G, Colak A, Turan N, Gunday I. Effects of dexmedetomidine and esmolol on hemodynamic response to tracheal intubation. Eur J Anaesthesiol. 2005;22:134–5. A514.
14. Yavascaoglu B, Kaya FN, Baykara M, Bozkurt M, Korkmaz S. A comparison of esmolol and dexmedetomidine for attenuation of intraocular pressure and haemodynamic responses to laryngoscopy and tracheal intubation. Eur J Anaesthesiol. 2008;25:517–9.
15. Uysal HY, Tezer E, Türkoglu M, Aslanargun P, Basar H. The effects of dexmedetomidine on hemodynamic responses to tracheal ntubation in hypertensive patients: A comparison with esmolol and sufentanyl. J Res Med Sci. 2012;17:22–31.
Mudgalkar N, Reddy, Prasad L. The effect of Dexmedetomidine versus Esmolol on attenuation of stress response to endotracheal intubation in patients undergoing elective off pump Coronary artery bypass grafting. Perspectives in medical research 2016;4:1:23-26.