Attenuation of haemodynamic responses of laryngoscopy and endotracheal intubation: An evaluation of efficacy of single intravenous dose of esmolol hydrochloride

Mitigating stress responses of laryngoscopy and endotracheal intubation is critical in management of general anesthesia patient undergoing surgical intervention. This becomes particularly detrimental and critical in patients with hypertension and cardiovascular cerebral disease affecting immediate and long-term outcomes. Role of beta blockade remained limited due to long duration, irreversibility and rebound withdrawal in acute care settings; which led to discovery of cardioselective short acting esmolol hydrochloride (t1/2- 2.5 to 9 min). In this randomized controlled double-blind prospective trial, we studied intravenous esmolol hydrochloride in 2 different single intravenous bolus doses (Group I - control, Group II - 1mg/Kg, Group III- 1.5mg/kg) in ASA 1 and 2 elective normotensive patients. Statistical analysis was done by using paired-t test. Study concluded that esmolol HCL pretreatment after induction with Thiopental Na before laryngoscopy and intubation allowed unique titration of esmolol doses and monitoring of side effects like bradycardia and hypotension and at the same time significantly attenuated sympatho-adrenal response of rise in pulse, mean arterial pressure (MAP), rate pressure product (RRP) and arrhythmia. Esmolol acts differently in different doses. In 1mg/Kg it effectively controls (P