Effect of haemodynamic response to laryngoscopy and endotracheal intubation with intravenous lornoxicam-a double blinded control study

Abstract

Aim: To observe the variations in sympathetic response to laryngoscopy and intubation in patients without measures to attenuate sympathetic response. To study the effectiveness of lornoxicam in attenuating pressor response to laryngoscopy and intubation. Materials and Methods: A clinical comparative study of attenuation of sympathetic response to laryngoscopy and intubation was done posted for elective surgery. 60 cases are divided in to two groups 30 in each group. Group-1 was Control group. In this group placebo i.e (Normal saline-4ml) was administered 30 min before intubation. Group-2 was Lornoxicam group. In this group patients received lornoxicam 16mg ntravenous 30 min before intubation to attenuate pressor response to laryngoscopy and intubation. Results: Sympathoadrenal response to direct laryngoscopy and tracheal intubation invariably results in increases in heart rate and elevation in mean arterial pressure. In some instances arrhythmias can be precipitated. These potentially harmful responses may prove to be detrimental in patient at risk. Many techniques and various drugs have been employed to attenuate these haemodynamic responses. No single drug or technique is totally satisfactory. Thus there is a need to find a simple efficient and reliably consistent method. The present study is a double blinded comparative study conducted in 60 patients belonging to ASA-I and II. One group received placebo(5ml of normal saline )and the other group received Lornoxicam 16mg intravenously half an hour before induction preoperatively. All cases were
premedicated with oral diazepam 10mg the night before surgery. Inj Midazolam 0.05mg/kg IM and was administered 45 minutes before laryngoscoopy. Anaesthesia was induced with Inj thiopetone 5mg/kg IV. Succinylcholine was used for relaxation at a dose of 2mg/kg IV. Laryngoscopy and intubation was limited to 20 seconds in all case. Anaesthesia was maintained with O2 (33%), N2O (67%), sevoflurane and intermittent vecuronium 0.05 mg/kg IV and IPPV using Bain’s circuit. Hemodynamic parameters recorded include heart rate, systolic and diastolic blood pressure before induction, post induction and after 1,3,5 7 and 10 minutes from the onset of laryngoscopy. In the control group heart rate, systolic, diastolic and mean arterial blood pressures showed wide fluctuation, a maximal increase at 1 minute post laryngoscopy and returned gradually to basal values over 10 minutes. In Lornoxicam group significant suppression of heart rate and blood pressure was observed when compared to control group which returned to baseline at the end of 10min. Conclusion: Lornoxicam significantly attenuates the sympathetic response to laryngoscopy and tracheal intubation.