Comparative Evaluation of Intravenous Lignocaine and Esmolol for Attenuating the Hemodynamic Response to Laryngoscopy and Endotracheal Intubation: A Prospective Randomized Comparative Study

Open Access

Abstract

Background: Direct laryngoscopy and endotracheal intubation cause transient sympathetic stimulation, resulting in tachycardia, hypertension, and increased myocardial oxygen demand. Although generally tolerated by healthy individuals, these responses may cause serious cardiovascular complications in susceptible patients. Intravenous lignocaine and esmolol are commonly used to attenuate these hemodynamic changes. This study compared their effectiveness in controlling the hemodynamic response to laryngoscopy and intubation. Objective: To compare intravenous lignocaine and esmolol in attenuating hemodynamic responses to direct laryngoscopy and endotracheal intubation in adults undergoing elective surgery under general anaesthesia. Methods: This prospective randomized comparative study was conducted at the Department of Anaesthesiology, Chittagong Medical College Hospital, Chattogram, Bangladesh, from January to December 2025. One hundred ASA I-II patients aged 18-60 years were randomized equally into Group L (n=50), receiving intravenous lignocaine 1.5 mg/kg, and Group E (n=50), receiving intravenous esmolol 1.5 mg/kg, three minutes before laryngoscopy. Heart rate, systolic and diastolic blood pressure, mean arterial pressure, and rate pressure product were recorded at baseline, after induction, immediately after intubation and at 1, 3, 5, and 10 minutes. Adverse events were documented. Data were analyzed using SPSS version 26.0; p<0.05 was considered significant. Results: Baseline characteristics were comparable between groups (p>0.05). Immediately after intubation, esmolol produced significantly lower heart rate (88.4±8.7 vs. 101.7±10.5 beats/min) and systolic blood pressure (132.8±10.6 vs. 149.6±12.7 mmHg) than lignocaine (both p<0.001). Significant reductions in diastolic pressure, mean arterial pressure and rate pressure product were also observed with esmolol during the first five minutes (p<0.001). Excellent hemodynamic control was achieved in 76.0% versus 34.0% (p<0.001). Conclusion: Both agents attenuated intubation-related hemodynamic responses, but esmolol provided superior control with an acceptable safety profile.