Comparison the effect of intravenous dexmedetomidine, esmolol and combination of esmolol and dexmedetomidine for attenuation of hemodynamic stress response to laryngoscopy and endotracheal intubation.
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0009-0002-7525-6409 Date
2025-12-31
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Towarzystwo Pomocy Doraźnej
Abstract
INTRODUCTION: Laryngoscopy and endotracheal intubation trigger significant sympathetic stimulation, leading to tachycardia and hypertension, which can be harmful in susceptible patients. A range of pharmacological and nonpharmacological strategies have been explored to attenuate the sympatho-adrenal response. The aim of the study was to compare the effect of intravenous Dexmedetomidine, Esmolol and the combination of Esmolol and Dexmedetomidine for attenuation of the hemodynamic stress response to laryngoscopy and endotracheal intubation. MATERIALS AND METHODS: This prospective, randomised, comparative study included 63 patients, assigned equally into three groups (n=21) using a computer-generated sequence: Group D: Received an intravenous infusion of dexmedetomidine 1 μg/kg diluted in 50 ml of normal saline. Group E: Received an intravenous infusion of 1 mg/kg of esmolol diluted in 50 mL of normal saline. Group DE: Received an intravenous infusion of a combination of esmolol 0.5 mg/kg and dexmedetomidine 0.5 μg/kg diluted in 50 ml of normal saline. Heart rate (HR) and mean arterial pressure (MAP) were recorded at baseline and 1, 3, and 5 minutes after intubation. Venous blood samples for serum cortisol 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 significant difference in mean HR was observed at 1, 3, and 5 minutes after intubation (p<0.001 at 1 min p<0.001 at 3 min, and p<0.001 at 5 min). A significant difference in mean MAP was observed 1 minute and 5 minutes after intubation (p=0.004 at 1 minute and p=0.010 at 5 min) when compared among the three groups. Furthermore, at 5 minutes, both serum cortisol and blood glucose levels showed significant differences between the groups (p<0.05). CONCLUSIONS: The study concluded that dexmedetomidine, esmolol, and their combination attenuate the hemodynamic response to laryngoscopy and intubation. Dexmedetomidine (1 μg/kg) was most effective, while the combination did not offer additional benefit. It also reduced metabolic stress, with smaller increases in serum cortisol and blood glucose.
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Singh S, Chaudhary L, Yadav R. Comparison the effect of intravenous dexmedetomidine, esmolol and combination of esmolol and dexmedetomidine for attenuation of hemodynamic stress response to laryngoscopy and endotracheal intubation. Crit. Care Innov. 2025; 8(4): 1-11.