Effect of Esmolol on variation of rate-pressure product due to tracheal intubation An evaluation using invasive arterial pressure monitoring

Abstract

Introduction: Laryngoscopy and tracheal intubation produce sympathetic over drive by catecholamine release resulting in hypertension and tachycardia. This is usually tolerated by healthy individuals but susceptible patients are likely to succumb to the hemodynamic fluctuations. Various agents are being tried to combat the intubation response over years. This study is aimed at evaluating the efficacy of Esmolol in attenuating the rise in rate- pressure product secondary to laryngoscopy and tracheal intubation. Methodology: 60 patients scheduled for general anesthesia were divided into two groups, E and C with 30 patients in each group. Hypertension, diabetes mellitus, thyroid disease, treatment with beta blockers and difficult airway constituted the exclusion criteria. Group-E patients received Esmolol 0.5mg/kg and group-C patients received normal saline[placebo] as intravenous premedication over 5min before a rapid sequence induction and tracheal intubation. Blood pressure and heart rate were measured using invasive arterial line and rate pressure product[RPP] was calculated at various time points including baseline, before induction, before intubation, at every 5sec after intubation up to 1min and at 5, 10 and 15min. Mean change in RPPs from the baseline were compared between the groups at the said time points. Results: Mean fall in RPP in Esmolol group was significantly more than that in control group at almost all the time points of measurement. Conclusion: Esmolol is effective in attenuating the hemodynamic response to laryngoscopy and tracheal intubation.