DOI: 10.36347/sjams.2017.v05i01.039

Pages: 188-194

Increase in blood pressure and heart rate most commonly occurs from reflex sympathetic discharge in response to laryngotracheal stimulation during intubation and extubation. Hypertensive response to extubation might be enhanced and can be dangerous to hypertensive subjects. Various agents have been used to attenuate hypertensive response but none is ideal. 120 patients of ASA grade I/II were included in study. The patients were randomly assigned to four groups of thirty each through a computer generated number. Group A = received 1mg/ kg of esmolol intravenously (n=30), Group B = received 1µg/kg of nitroglycerine intravenously (n=30), Group C = received 0.2mg/ kg of diltiazem intravenously (n=30) and group D received normal saline (placebo). These agents were administered one minute after reversal. HR, SBP, DBP and MAP were monitored and analyzed. The HR, SBP, SBP, MAP increased significantly during tracheal extubation in the control group (p<0.001). Esmolol 1 mg/kg IV bolus effectively controlled HR and mean arterial BP during extubation. NTG 1 µg/kg IV bolus effectively controlled arterial BP but not effective in controlling HR. Diltiazem 0.2 mg/kg IV bolus showed similar response like NTG. Although it attenuated rise in arterial BP significantly at extubation, it failed to control rise in HR. No significant bradycardia, hypotension, arrhythmia occurred in any of the patients. We concluded that esmolol in dose of 1 mg/kg intravenously prevented the rise in both heart rate and blood pressure effectively. Esmolol was more effective in attenuating rise in systolic blood pressure, diastolic blood pressure and mean blood pressure when compared to nitroglycerine and diltiazem.