Comparison of intravenous lignocaine versus combination of lignocaine with diltiazem on attenuation of haemodynamic responses to tracheal extubation in patients undergoing abdominal surgeries under general anaesthesia: A randomized double blind interventi

Authors

  • Kanchan Chauhan Department of Anaesthesiology and Critical Care, S.M.S. Medical College and Attached Group of Hospitals, Sawai Mansingh road, Jaipur, 302004
  • Vivek Gupta Department of Anaesthesiology and Critical Care, S.M.S. Medical College and Attached Group of Hospitals, Sawai Mansingh road, Jaipur, 302004 https://orcid.org/0000-0003-3203-2755
  • Sunil Chauhan Department of Anaesthesiology and Critical Care, S.M.S. Medical College and Attached Group of Hospitals, Sawai Mansingh road, Jaipur, 302004 https://orcid.org/0000-0002-0158-7427
  • Manoj Soni Department of Anaesthesiology and Critical Care, S.M.S. Medical College and Attached Group of Hospitals, Sawai Mansingh road, Jaipur, 302004 https://orcid.org/0000-0002-6011-4849

DOI:

https://doi.org/10.18231/j.joapr.2022.10.4.25.33

Keywords:

Lignocaine, diltiazem, attenuation, hemodynamic response, tracheal extubation

Abstract

Background: Tracheal intubation is frequently associated with cardiovascular stress response characterized by hypertension, tachycardia and increased serum concentration of catecholamines and similar phenomenon is also seen during extubation. During Endotracheal extubation increase in sympathoadrenergic activity is caused by epipharyngeal and laryngopharyngeal stimulation. Objective: The aim and objectives of this study are to compare the effect of combination of intravenous (i.v.) diltiazem 0.1 mg/kg and i.v lignocaine 1.0 mg/kg vs intravenous lignocaine alone to attenuate haemodynamic extubation responses and airway reflexes during extubation. Material and method: This study was undertaken with 72 patients belonging to the age group 20–60 years with physical status ASA Classes I and II of either sex. Group A received injection diltiazem 0.1 mg/kg and lignocaine 1 mg/kg. Group B received injection lignocaine 1 mg/kg with normal saline. In this study, the drug dosage was fixed based on the previous studies. Result: The baseline values of heart rate,systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were statistically comparable between the two groups. The heart rate, SBP, DBP, and MAP was significantly high in group A (lignocaine) as compared to group B (diltiazem with lignocaine) at extubation and  till 1 min, 3 min, 5 min,  and 10 min post extubation (pvalue<0.05). Conclusion: Combined diltiazem and lignocaine provides more effective prophylaxis than lignocaine alone for attenuating the cardiovascular responses to tracheal extubation

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References

Swamy SN, Madhusudhana R. Attenuation of Hemodynamic Responses to Endotracheal Extubation with Different Doses of Diltiazem with Lignocaine: A Placebo-Controlled Study. Anesth Essays Res 12, 428-433 (2018)

Dyson A, Isaac PA, Pennant JH, Giesecke AH, Lipton JM. Esmolol attenuates cardiovascular responses to extubation. Anesth Analg 71, 675-678 (1990)

Fuhrman TM, Ewell CL, Pippin WD, Weaver JM. Comparison of the efficacy of esmolol and alfentanil to attenuate the hemodynamic responses to emergence and extubation. J Clin Anesth 4, 444-447 (1992)

Nishina K, Mikawa K, Shiga M, Maekawa N, Obara H. Prostaglandin E1 attenuates the hypertensive response to tracheal extubation. Can J Anaesth 43, 678-683 (1996)

Hagberg CA, Artime CA. Airway management in the adult. In: Miller RD, ed. Miller’s anaesthesia, 8th edn, New York: Elsevier Churchill Livingstone

Mikawa K, Nishina K, Takao Y, Shiga M, Maekawa N, Obara H. Attenuation of cardiovascular responses to tracheal extubation: comparison of verapamil, lidocaine, and verapamil-lidocaine combination. Anesth Analg 85, 1005-10 (1997)

Mandai P. Lignocaine for prevention of laryngospasm during extubation in smokers. Indian Journal of Anaesthesia 49(5), 395-402 (2005)

Farooq SU, Rani BS, Acharya A. Attenuation of haemodynamic responses to endotracheal extubation-diltiazem versus lidocaine. International Journal of Clinical Trials 7(2), 77 – 82 (2020)

Baraka A. Intravenous lidocaine controls extubation laryngospasm in children. Anesth Analg 57, 506-507 (1978)

Lowrie A, Johnston PL, Fell D, Robinson SL. Cardiovascular and plasma catecholamine responses at tracheal extubation. Br J Anaesth 68, 261-263 (1992)

Nishina K, Mikawa K, Maekawa N, Obara H. Attenuation of cardiovascular responses to tracheal extubation with diltiazem. Anesth Analg 80, 1217-22 (1995)

Prys-Roberts C, Greene LT, Meloche R, Foëx P. Studies of anaesthesia in relation to hypertension. II. Haemodynamic consequences of induction and endotracheal intubation. Br J Anaesth 43, 531-547 (1971)

Bostan H, Eroglu A. Comparison of the Clinical Efficacies of Fentanyl, Esmolol and Lidocaine in Preventing the Hemodynamic Responses to Endotracheal Intubation and Extubation. Journal of Current Surgery 2(1), 24-28 (2012).

Bidwai AV, Bidwai VA, Rogers CR, Stanley TH. Blood-pressure and pulse-rate responses to endotracheal extubation with and without prior injection of lidocaine. Anesthesiology 51, 171-173 (1979)

Flood P, Rathmell JP, Shafer S (Editors). Stoelting’s Pharmacology & Physiology in Anesthetic Practice—5th Edition. Wolters Kluwer, Philadelphia, USA, 2015

Savitha KS, D’Souza JS, Kothari AN. Attenuation of haemodynamic response to extubation with i.v. lignocaine: A randomized clinical trial. Journal of Evolution of Medical and Dental Sciences 3(4), 838-846 (2014)

Thanvi A, Tak ML, Naithani U. Comparison of diltiazem and lignocaine in attenuating haemodynamic responses during extubation in patients undergoing laparoscopic cholecystectomy. International Journal of Health Sciences and Research 6(7), 82 – 89 (2016)

Eshak Y, Khalid A, Bhatti TH. Small dose propofol attenuates cardiovascular responses to tracheal extubation. Anesthesia & Analgesia 86(2S), 5S (1998)

Published

2022-12-31

How to Cite

Chauhan, K. ., Gupta, V. ., Chauhan, S., & Soni, M. . (2022). Comparison of intravenous lignocaine versus combination of lignocaine with diltiazem on attenuation of haemodynamic responses to tracheal extubation in patients undergoing abdominal surgeries under general anaesthesia: A randomized double blind interventi. Journal of Applied Pharmaceutical Research, 10(4), 25-33. https://doi.org/10.18231/j.joapr.2022.10.4.25.33

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