Online ISSN: 2515-8260

Keywords : laryngoscopy


A comparative study on fentanyl, morphine and nalbuphine in attenuating stress response and serum cortisol levels during endotracheal intubation

Henin Mohan, Sharan Rajkumar V, Vinodh Mani, Bharath S

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2585-2595

Background: The process of Laryngoscopy & Intubation is a noxious stimulus, therefore constituting a period of intense sympathetic activity. Various non-pharmacological & pharmacological methods have been used to attenuate this hemodynamic response. Opioids are potent agents that can attenuate pressor response by maintaining the proper depth of anaesthesia. Although there are few studies comparing opioids in attenuating hemodynamic response during intubation, none of them incorporated measuring serum cortisol levels during intubation. Henceforth, in our study, we have compared the efficacy of bolus administration of intravenous (IV) fentanyl, IV morphine and IV nalbuphine to suppress the pressor response and serum cortisol level during laryngoscopy and endotracheal intubation.
Objectives:
1) To evaluate the efficacy of Intravenous (IV) opioids in attenuating the stress response and serum cortisol levels during endotracheal intubation.
Materials and Methods: In our study, 60 ASA I and II patients, aged between 20 to 60 years were enrolled and randomly divided into three groups. Of the three groups group I (received Fentanyl 2 mcg/kg), group II (Received Morphine 0.1mg/kg), and group III (received Nalbuphine 0.2mg/kg). Patients who are pregnant, lactating or illicitly abusing centrally acting drugs, or allergic to the drug under study are excluded from the study After random group allocation hemodynamic parameters like heart rate, blood pressure, and mean arterial pressure were monitored at baseline followed by a 1-minute interval up to 4 minutes after intubation. Furthermore, Blood sampling was done in the preoperative ward followed by a 5- and 10-minutes period after intubation intraoperatively for measuring serum cortisol levels. Conclusion: Comparatively, fentanyl caused a significant reduction in stress response during laryngoscopy and intubation followed by morphine and nalbuphine.

A comparative study to evaluate the efficacy of dexmedetomidine with normal saline in attenuating sympathoadrenal response to laryngoscopy and tracheal intubation

Dr. Ashwini GS, Dr. Ranjith Kumar RT, Dr. Megha GH, Dr. Dharuni Priya

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2415-2420

Introduction: Laryngoscopy and endotracheal intubation often provoke an undesirable increase in arterial blood pressure and/or heart rate1,2,3. Alpha 2-adrenergic agonists like dexmedetomidine have been extensively used to suppress the hemodynamic response to laryngoscopy and endotracheal intubation.
Methods: The study was conducted among 60 ASA grade I and II patients between 18-60 years of age, scheduled for elective surgeries under general anaesthesia. The study population was subdivided randomly into 2 groups each consisting 30 patients. Group D received Dexmedetomidine 0.5mcg/kg IV diluted to 10 ml with normal saline. Group S received Normal saline 10 ml IV.
Results: There was a significant fall in HR in group D at 5 and 10 minutes after drug administration. The mean HR increase observed at 1, 3, 5 and 10 minutes after intubation in group NS was statistically significant. The mean SBP values at 5 and 10 minutes after drug administration were significantly low in group D. The increase in SBP in group NS at 1, 3, 5 and 10 minutes after intubation was statistically significant. The mean DBP values at 5 and 10 minutes after drug administration were significantly low in group D. The increase in DBP in group NS at 1, 3, 5 and 10 minutes after intubation was statistically significant. There was a significant difference in MAP values at 5 and 10 minutes after drug administration which was statistically significant. The increase in MAP in group NS was statistically significant at 1, 3, 5 and 10 minutes after intubation.
Conclusion: We conclude that Dexmedetomidine 0.5 μg/kg before laryngoscopy and endotracheal intubation effectively attenuates the hemodynamic response as compared to normal saline without major adverse effects.

Preanesthetic single dose intravenous dexmedetomidine versus intravenous for blunting of sympathetic response to laryngoscopy and endotracheal intubation: Clinical profile of patients

Dr. Nagendra Prasad, Dr. Shivakumar, Dr. Nandini

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2441-2445

The sensory unit consists of free nerve endings that lie between the mucosal cells of the airway epithelium. Sensory units appear to be particularly abundant over the arytenoid cartilages and are also found on the laryngeal side of the epiglottis. Study was undertaken in patients planned for elective surgeries under General Anaesthesia. Patient were selected between 18 to 60yrs of Age with ASA 1 and ASA 2 grades. They were divided into 2 groups of 30 each and allocated randomly. All patients were explained about the procedure and its complication and informed consent obtained. There were no significant differences between the two groups with regard to demographic data such as age and weight. The average age in Group-C (clonidine) was 31.90 years and average age in Group D (dexmedetomidine) was 34.80 years.

Dexmedetomidine 0.6 mcg/kg versus Magnesium Sulphate 50% 30 mg/kg for attenuation of Intubation Response

Velagalaburre Yalappa Srinivas, Mathikere Boregowda Sudarshan, Vivek Nayak, Kuzhippailil Vinod Kumar Harikrishnan, Narendra Babu Gowdagere Nagarajaiah

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 814-824

Background: Direct laryngoscopy followed by endotracheal intubation is prone to
haemodynamic fluctuations which may be detrimental in subjects with coronary artery
disease, hypertension, and cerebral vascular disease. The aim is we wanted to compare
Dexmedetomidine with Magnesium sulphate to determine the better drug with regard
to attenuation of the haemodynamic responses during laryngoscopy and endotracheal
intubation.

A Prospective Randomized Comparative Study of Hemodynamic Effects of Etomidate vs Propofol During Induction and Intubation Under General Anaesthesia

Sarpatwar Sailesh, Boini Chiranjeevi

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 4749-4756

Background:The aim of the study is to compare induction with etomidate and propofol
on hemodynamic response to laryngoscopy and intubation.
Materials and Methods: The study was conducted in 60 ASA I & II patients in the age
group of 18 to 60 years who were posted for elective surgeries under general
anaesthesia. Their baseline heart rate, systolic blood pressure, diastolic blood pressure,
SpO2 and ETCO2 were recorded. Both the groups were premedicated with iv
glycopyrrolate 5mcg/kg, iv midazolam 0.025mg/Kg, iv fentanyl 2mcg/Kg. Following
premedication, the above variables were again recorded. Group P patients were
induced with iv propofol at the dose of 2 mg/Kg and Group E patients received iv
etomidate at 0.4mg/Kg. In both the groups, Injection vecuronium was given at the dose
0.08mg/Kg and they were maintained with O2:N2O =33%:66% and Isoflurane 1% dial
concentration. Laryngoscopy was performed by trained anesthesiologists after 5 mins.
Duration of laryngoscopy was kept at a maximum of 10 seconds. Trachea was intubated
with appropriate size endotracheal tube. The variables (HR, SBP, DBP, MAP, SpO2)
were measured during induction, intubation and post intubation at intervals of 1,2,3,5
and 10 mins.
Results: On comparing the two groups, the following results were obtained – Age, Sex,
Weight and ASA status were comparable in both the groups. Propofol was found to
produce hypotension in more or less 20%- 30% of patients irrespective of the
underlying condition. Etomidate was found to maintain hemodynamic stability though
there were no significant difference in heart rate variability in both the groups during
laryngoscopy and intubation. Myoclonus was seen in 4 out of 30 patients induced with
Etomidate, pain on injection was more common with Propofol. Apnea occurred in 12
out of 30 patients induced with Etomidate,28 patients out of 30 in propofol group,
vomiting and nausea are more with Etomidate than propofol but the difference was
statistically insignificant.
Conclusion: As per the results of the study, Propofol produced more hemodynamic
changes than Etomidate. Thus, we conclude that Etomidate is more stable in terms of
hemodynamic stability.

Assessment of Correlation Between Mentohyoid Distance and Cormack- LehaneGrading in Airway Assessment: A Predictor of Tracheal Intubation

Meenal M, Rajiba Lochan Samal, Kasturi Nanda, Sheikh Mustak Ali

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 5748-5754

Background: Airway management is the basic responsibility of each and every
anaesthesiologist. The present study was undertaken to evaluate the relationship
between Mentohyoid distance and Cormac-Lehane Grading in predicting difficult
intubation.
Materials and Methods: The present study was carried among 200 patients belonging to
ASA I and II physical status undergoing elective surgery in IMS & SUM HOSPITAL.
During pre-anaesthetic check-up, patients were examined and mentohyoid distance was
measured. On the day of surgery after induction, during laryngoscopy Cormack-lehane
grading was observed, time taken for laryngoscopy and intubation was noted. The
results were statistically analysed using SPSS version 22 software. “A p-value of p <
0.05 was considered statistically significant and p-value of p<0.001 was considered
highly significant”.
Results: 12 % of the patients had CL Grade III, 45% had CL Grade I, 43% had Grade
II and 11 % had Mentohyoid distance of < 3.0 cm. and 1% had mentohyoid distance of
3 to 4 cm. The incidence of difficult intubation is around 12%. In patients who had
decreased mentohyoid distance (mandibular space), we faced difficulty during
laryngoscopy with poor CL grading III. Hence making it difficult for intubation and
more time taken for laryngoscopy.
Conclusion: Decrease Mentohyoid distance (mandibular space) has significant
association with difficult glottis exposure, hence making it difficult for intubation and
more time for laryngoscopy. Mentohyoid distance with cormack-lehane grading is a
good predictor of tracheal intubation

Efficacy of dexmedetomidine in attenuation of haemodynamic response to laryngoscopy and endotracheal intubation

Dr CH Nagaraju, Dr Gajagouni Nagaraj Goud, Dr Madanmohan Shiraboina, Dr Narugula Sadanandam

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 10267-10277

Background and Aims: Laryngoscopy and endotracheal intubation are associated with
strong sympathetic responsein the form of tachycardia and hypertension. The aim of
this study was to evaluate the efficacy of intravenous Dexmedetomidine in attenuation
of haemodynamic response to laryngoscopy and endotracheal intubation.
Materials and methods: In this prospective, randomized, double blinded study,A total
of hundred patients of ASA grade I and II between 18 to 50 years of age scheduled for
various elective surgical procedures under general anesthesiawere selected and
randomized into two groups of fifty patients each. Group C received 10 ml of normal
saline intravenously over 10 min, 10 minutes prior to induction. Group D received
injection Dexmedetomidine 0.5μg/kg body weight diluted to 10 ml normal saline
intravenously over 10 min, 10 minutes prior to induction. Baseline parameters like
Heart rate [HR], Systolic blood pressure [SBP], Diastolic blood pressure [DBP] and
Mean arterial pressure [MAP] were recorded in all patients before giving studydrug, 2
,5 and 8 minutes after studydrug, just beforeinduction, immediately after induction,
1,3,4,10 minute after laryngoscopy andintubation.
Results: There was no significant difference in the Age, Gender, body weight of patients
between Group C and Group D. After induction, In group D, there was no statistically
significant increase in the mean HR, SBP, DBP and MAP compared to basal value
whereas in group C, there was a statistically significant increase in mean HR, SBP, DBP
and MAP compared to basal value in group C.
Conclusion: In the present study, Dexmedetomidine at a dose of 0.5μ/kg body weight
given 10 minutes before induction significantly attenuated the haemodynamic responses
to laryngoscopy and tracheal intubation without significant side effects.

Comparison of magnesium sulphate with lignocaine for blunting response to laryngoscopy andintubation

Dr. Swarna Horalali, Dr. Mohan Kumar Ramiah Mahadeva, Dr. Reshma Mulla,Dr. Nataraj MS,Dr. CGS Prasad

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 1201-1210

Background:Haemodynamic changes occurring during direct laryngoscopy and endotracheal
intubation are well tolerated by healthy individuals but can be fatal in patients with
hypertension, heart disease and intracranial hypertension. Many methods have been tried to
obtund these responses.
Methods: 60 consenting patients were randomised to receive 30 mg/kg of magnesium
sulphate (MgSO4) in 100 ml saline over 10 min before induction or preservative free 2%
lignocaine 1.5 mg/kg diluted to 5 ml with saline 90 secs before intubation. Heart rate,
systolic, diastolic & mean blood pressures and time taken to extubate were monitored.
Results: Hemodynamic parameters showed no significant rise at intubation in both the
groups. Time taken to extubate was similar in both the groups.
Conclusion: MgSO4 30 mg/kg given intravenously as infusionover 10 minutes prior to
induction and lignocaine 1.5 mg/kg given 90 seconds before intubation were comparable in
attenuating pressor response to laryngoscopy and intubation with no clinically significant
prolongation in time taken to extubate in MgSO4 group.

EVALUATION OF ORAL PREGABALIN PREMEDICATION FOR ATTENUATION OF PRESSOR RESPONSE DURING LARYNGOSCOPY AND ENDOTRACHEAL INTUBATION

Dhanshree Kale; Arachna Amol Gautam; Shraddha Naik; Avinash G. Bhosale; P. B. Patil; R. N. Mulla

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 1, Pages 4112-4117

A prospective, randomized study was performed after acceptance by the Ethics Committee and informed consent of 60 patients seeking elective surgery at the Krishna Hospital and the Medical Research Centre, Karad. The study objective is to evaluate haemodynamic consistency through attenuation of the pressure reaction during laryngoscopy and endotracheal intubation. Group A obtained pregabalin orally with water sips before induction and Group B served as control group, received multivitamin orally with sips of water 1hr before induction. Both groups were uniform in their distribution of age, weight and gender. They had similar physical status with no coexisting disease. Both groups were managed with same anesthetic protocol. It was concluded that the preoperative sedation before giving premedication in control and pregabalin groups are comparable, whereas pregabalin produced better preoperative sedation after one hour of premedication, as evidenced by higher Ramsay sedation score.