Hemodynamic responses to laryngoscopy and intubation in patients with pregnancy-induced hypertension: effect of intravenous esmolol with or without lidocaine

ABSTRACT

The pressor response is known to be exaggerated in patients with pregnancy-induced hypertension, which can result in increased morbidity and mortality in both mother and newborn. Various pharmacological agents have been used before induction in an attempt to attenuate the adrenergic response but with varying degree of success. Esmolol, an ultra short-acting cardioselective beta-blocker with rapid onset and short elimination half-life, is an attractive choice for attenuating the adrenergic response in pregnant patients. In a prospective, randomized double blind study the efficacy of two bolus doses of esmolol with or without lidocaine, in patients with pregnancy-induced hypertension was evaluated. Eighty such patients undergoing lower segmental caesarean section were randomly divided into four groups and received the following study drugs before intubation group I received esmolol 1.0 mg/kg; group II received esmolol 2.0 mg/kg; group III received esmolol 1.0 mg/kg and lidocaine 1.5 mg/kg; and group IV received esmolol 2.0 mg/kg and lidocaine 1.5 mg/kg. In groups II, III and IV, the changes in maternal heart rate, systolic blood pressure and mean arterial pressure in response to laryngoscopy and intubation were attenuated to a comparable degree [P > 0.05]. No adverse effects were noticed in mother or baby. It was concluded that esmolol 1.0 mg/kg with lidocaine 1.5 mg/kg is effective in attenuating the adrenergic responses to laryngoscopy and intubation in patients with pregnancy-induced hypertension