Intravenous lignocain 2% [plain] efficacy in attenuation of stress response to laryngoscopy and endotracheal intubation with impact on in-hospital morbidity and mortality

Objective: To evaluate the efficacy of plain lignocain in attenuation of stress response to laryngoscopy and endotracheal intubation with impact on in-hospital mortality or morbidity

Study Design: A randomized control trial

Place and Duration of Study: Our study was carried out from December 2013-14, at tertiary-care hospital

Material and Methods: Patients [n=100 total] were randomized, using non-probability convenient sampling, dividing the population in two groups. Group A [n=50] as control, and in group B [n=50] Injection lignocain plain 2% 1.5 mg/kg was used 3 minutes prior to intubation. Both the groups were observed for changes in hemodynamic parameters i.e. heart rate [HR] systolic and diastolic blood pressure, Mean Arterial Pressure for every minute after baseline [0] and for 5 consecutive minutes [1, 2, 3, 4, and 5]. Deviation of >20% from baseline was considered significant. The mortality [death within hospital, irrespective of cause] and morbidity [defined as emergence of 4 condition as hypertensive encephalopathy, Acute Coronary Syndrome, Lab proven Myocardial Infarction and negative pulmonary edema] within 10 days of hospitalization were noted

Results: Statistically significant [p-value extremely significant at confidence interval of 98 degrees] results were obtained in the effect of study drug; however, 10 days of hospitalization remained inconclusive for emerging morbidity categories strictly due to the intubation reflexes. We consider few technicalities in peri-operative management resulted in such events

Conclusion: Lignocain is effective in blunting the pressor response towards laryngoscopy and intubation. However the impact on mortality/ morbidity for four conditions remained inconclusive

Comparison of hemodynamic responses to use of laryngeal mask airway versus endotracheal tube in hypertensive patients

To compare hemodynamic responses to use of laryngeal mask airway [LMA] versus endotracheal tube [ETT] in hypertensive patients. A quasi-experimental study. Department of Anaesthesiology and Intensive Care, Combined Military Hospital Rawalpindi and Kharian from January 2008 to December 2008. Seventy hypertensive patients selected by non-probability convenience sampling technique were equally distributed in two groups ETT and LMA using alternate patient technique [n=35 each]. Patients in both groups were anaesthetised using common anaesthetic technique. Patients in ETT group underwent laryngoscopy and ETT intubation, whereas patients in LMA group received LMA without laryngoscopy for their airway maintenance. Hemodynamic variables, [pulse, systolic, diastolic and mean arterial pressures] were measured using non-invasive monitoring technique at various intervals before and after intubation or LMA placement, before and after extubation or LMA removal. In ETT group after intubation there was an increase both in, pulse from 69 +/- 9 to 75 +/- 8, and mean arterial pressure [MAP] from 89 +/- 10 to 104 +/- 4mm Hg, when compared to LMA group, in which pulse increased from 67 +/- 7 to 68 +/- 5 and MAP from 89 +/- 11 to 94 +/- 8 mm Hg. Before extubation pulse in LMA group patients was 73 +/- 10 and MAP was 93 +/- 9 whereas in ETT group mean pulse was 76 +/- 9 and MAP was 107 +/- 9 mm Hg. On ETT extubation pulse increased from 76 +/- 9 to 77 +/- 8 and MAP from 107 +/- 9 to 108 +/- 8 mm Hg, whereas in LMA group pulse changed from 73 +/- 10 to 69 +/- 7 and MAP from 93 +/- 9 to 95 +/- 9. All the hempdynamic responses were significantly lower in LMA group than in ETT group [p<0.05]. Use of LMA in hypertensive patients for control of ventilation showed significantly lower hemodynamic responses when compared to ETT at both intubation and extubation.