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Year : 2018 | Volume : 6 | Issue : 1 | Page : 31 - 36  


Original Articles
Attenuation of hemodynamic response to laryngoscopy and intubation-The Effect of Diltiazem, A randomized controlled study

Swathi Appagalla1, Manjula V Ramsali2, Sarada Devi Vankayalapati3, Surender Pasupuleti 4

1Assistant professor, 2Assistant professor, 3Assistant professor, 4 Professor and HOD, Department of Anesthesia, Malla Reddy Medical college for women, Hyderabad

Corresponding Author

Email: manjularamsali@gmail.com

 

Abstract:

Background:  Direct laryngoscopy and tracheal intubation following induction of anesthesia is almost always associated with hemodynamic changes due to reflex sympatho-adrenal activity which may result in hypertension, tachycardia and arrhythmias. Various agents like lidocaine, opioids, esmolol, magnesium sulphate, alpha 2 agonists and propofol have been shown to attenuate these responses, but they have limitations and side effects. Recently several studies have shown that calcium channel antagonist Diltiazem   with its direct vasodilation, direct negative chronotropic and dromotropic properties is effective. Our study was designed to determine the efficacy of diltiazem 0.3mg/kg in attenuating the hemodynamic response to laryngoscopy and intubation in ASA I & II patients.

Objectives: The prospective randomized study was done to evaluate the efficacy of Diltiazem   in attenuation of hemodynamic response to laryngoscopy and intubation.

Methods: 50 patients aged between 22-55 yrs of either sex of ASA Grade I and II scheduled for elective surgeries were studied after randomization into two groups, Control and Study (Diltiazem) groups.  The anesthesia technique was standardized for both the groups.  All the patients were given either saline 2ml or diltiazem 0.3 mg/kg in 2ml 60 seconds before laryngoscopy and intubation. The parameters like HR, SBP, DBP, and MAP were recorded at pre-induction, at induction, during laryngoscopy and intubation and at 1min, 2min, 3min, and 5min after intubation. Patients were also observed for side effects like hypotension, bradycardia and bronchospasm.

Results: There was increase in the HR, SBP, DBP and MAP after induction and immediately after laryngoscopy and intubation in the control group but there was a fall in SBP, DBP and MAP in study group. There was no significant change in HR in the study group.

Conclusion: Our study concludes that diltiazem 0.3 mg/kg given IV 60 seconds before laryngoscopy and intubation can be safely employed to attenuate hemodynamic responses without any side effects.

Key words: Cardiovascular response, endotracheal intubation, diltiazem, laryngoscopy





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