Magnesium sulfate versus Tramadol pretreatment in the attenuation of Hemodynamic Responses and Post-intubation Analgesia to laryngoscopy & Endotracheal Intubation

Abstract

Introduction: Cardiovascular stress secondary to endotracheal intubation during surgical procedures requiring general anesthesia, can be critical to manage per-operatively which mandates for pre-intubation stress attenuation preventive measures. The aim of the study was to observe the effects of two drugs as preemptive analgesia on hemodynamics and post-operative pain. Methods: This prospective observational study was conducted in the Department of Anesthesia, Analgesia, Palliative and Intensive care Medicine of a tertiary level govt. hospital of Dhaka, Bangladesh, during the period of July 2018 to June 2019. Total fifty (50) patients belonging to ASA physical status I were randomized into Group A and Group B where 25 patients in Group A received Inj MgSO4 (40mg/kg) & 25 patients in Group B received inj. Tramadol (0.6mg/kg). VAS score has been recorded. Result: The systolic and diastolic blood pressure among the groups showed that Group B patients exacerbated the immediate rise in BP after intubation followed by a fall in BP whereas Group A patients showed consistent fall in BP. These changes were statistically significant at the readings after 1 minute and after 3 minutes for systolic blood pressure and at all readings for diastolic blood pressure (p<0.05). On different readings at different time intervals, Group B showed a comparatively lower mean of VAS score than that of Group A, where this difference was statistically significant at T1 (p<0.05). First rescue analgesia within the 1st hour of reversal was demanded by 8.00% of the patients from Group A and no patients from Group B (p>0.05). Conclusion: Although I/V Tramadol was found to produce better postoperative analgesia, I/V Magnesium Sulfate was comparatively more compensatory to combat blood pressure increase after intubation during surgical procedures under general anesthesia.