Comparative study of intravenous lignocaine, esmolol, and magnesium sulphate for attenuation of sympathoadrenal response to endotracheal intubation - a controlled randomised comparative study
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0009-0003-1667-689X Date
2025-09-30
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Towarzystwo Pomocy Doraźnej
Abstract
INTRODUCTION: Laryngoscopy and endotracheal intubation, essential for general anaesthesia, often trigger a sympathetic response. Afferent signals through the glossopharyngeal and vagus nerves activate the autonomic nervous system, causing the release of catecholamines. The resulting hypertension and tachycardia can be harmful, especially in patients with cardiovascular risk. Attenuating this response is therefore clinically important. This study aims to compare the effects of intravenous lignocaine, esmolol, and magnesium sulphate on the attenuation of the sympathoadrenal response to endotracheal intubation in patients undergoing elective surgeries under general anaesthesia. MATERIALS AND METHODS: This prospective, randomised, comparative study included 87 patients, randomly assigned into three groups (n=29 each) using a computer-generated sequence: Group E: Received 50 ml of IV normal saline plus 10 ml of esmolol (1 mg/kg) in saline. Group L: Received 50 mL IV normal saline plus 10 ml of lignocaine (1.5 mg/kg) in saline. Group M: Received 50 ml of magnesium sulphate (30 mg/kg) in saline plus 10 ml of normal IV saline. Two minutes after vecuronium administration, the study drug was administered. One minute later, laryngoscopy and intubation were performed using a cuffed endotracheal tube of appropriate size. Heart rate (HR) and mean arterial pressure (MAP) were recorded at baseline and 1, 3, and 5 minutes post-intubation. Venous samples of serum norepinephrine and blood glucose were collected at baseline and 5 minutes after intubation. RESULTS: At baseline, MAP, HR, serum norepinephrine, and blood glucose levels were comparable between all groups (p>0.05). A statistically significant difference in mean HR was observed at 1 minute (p=0.031) and 3 minutes (p=0.019) after intubation, but this difference was not significant at 5 minutes (p=0.607). MAP values differed significantly between groups at all time intervals: 1-, 3-, and 5-minutes after intubation (p<0.001). Furthermore, at 5 minutes, both serum norepinephrine and blood glucose levels showed significant differences between the groups (p<0.05). CONCLUSIONS: Esmolol, lignocaine, and magnesium sulphate are effective in attenuating the sympathoadrenal response to laryngoscopy and endotracheal intubation under general anaesthesia. Among them, esmolol demonstrated superior efficacy in blunting the hemodynamic response compared to lignocaine and magnesium sulphate.
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Dahiya V, Chaudhary L, Yadav R. Comparative study of intravenous lignocaine, esmolol, and magnesium sulphate for attenuation of sympathoadrenal response to endotracheal intubation - a controlled randomised comparative study. Crit. Care Innov. 2025; 8(3): 12-21.