Blunting Stress Response During Intubation in Hypertensive Patients; A Comparison Between Lidocaine and Magnesium Sulphate

Article Information

Title: Blunting Stress Response During Intubation in Hypertensive Patients; A Comparison Between Lidocaine and Magnesium Sulphate

Authors: Rehana Feroze, Aftab Hussain, Mehwish Naseer

Journal: Pakistan Armed Forces Medical Journal (PAFMJ)

HEC Recognition History

Category	From	To
Y	2024-10-01	2025-12-31
Y	2023-07-01	2024-09-30
Y	2021-07-01	2022-06-30
Y	2020-07-01	2021-06-30
Y	1900-01-01	2005-06-30

Publisher: Army Medical College, Rawalpindi.

Country: Pakistan

Year: 2022

Volume: 72

Issue: 6

Language: English

DOI: 10.51253/pafmj.v72i6.5374

Keywords: LidocaineMagnesium sulphatehemodynamic stabilityTracheal intubationHypertensive patientsStress response

Abstract

Objective: To compare blunting of hemodynamic stress response to intubation using Magnesium Sulphate versus Lidocaine in hypertensive patients.
Study Design: Prospective comparative study.
Place and Duration of Study: Anaesthesia Department Combined Military Hospital, Lahore Pakistan, from Jan to Jun 2019.
Methodology: A total of 232 hypertensive patients of the ASA status II, undergoing elective surgical procedures requiring intubation, were randomly divided into two groups, Group-L (Lidocaine) and Group-M (Magnesium Sulphate). Lidocaine 1.5mg/kg was given to Group-L 90 seconds before laryngoscopy, whereas Magnesium Sulphate 30mg/kg was given over ten minutes to Group-M before laryngoscopy. Baseline means arterial pressure was recorded. Mean arterial pressure was subsequently recorded each minute after intubation for five minutes.
Results: Both groups were similar with regard to demographic data. After intubation, both groups had an increase in mean arterial pressures. Blunting of stress response was observed in 78 patients (67.2%) in Group-L and 55 patients (47.4%) in Group-M. Two groups showed a significant statistical difference (p=0.003).Conclusion: Both drugs are effective in blunting hemodynamic stress response to intubation in hypertensive patients, but Lidocaine is more effective than Magnesium Sulphate.

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Research Objective

To compare the effectiveness of Magnesium Sulphate versus Lidocaine in blunting the hemodynamic stress response to intubation in hypertensive patients.

Methodology

Prospective comparative study conducted at Combined Military Hospital, Lahore, from January to June 2019. 232 hypertensive patients (ASA status II) undergoing elective surgery were randomly divided into two groups: Group-L (Lidocaine 1.5mg/kg) and Group-M (Magnesium Sulphate 30mg/kg). Lidocaine was administered 90 seconds before laryngoscopy, while Magnesium Sulphate was given over ten minutes before laryngoscopy. Mean arterial pressure (MAP) was recorded at baseline and each minute for five minutes after intubation.

Methodology Flowchart

                        graph TD
    A[Patient Selection Hypertensive, ASA II] --> B[Randomization];
    B --> C[Group-L: Lidocaine 1.5mg/kg];
    B --> D[Group-M: Magnesium Sulphate 30mg/kg];
    C --> E[Lidocaine Administration];
    D --> F[Magnesium Sulphate Administration];
    E --> G[Laryngoscopy & Intubation];
    F --> G;
    G --> H[MAP Recording Baseline + 5 minutes];
    H --> I[Data Analysis];
    I --> J[Conclusion: Lidocaine vs. Magnesium Sulphate];

Discussion

Both Lidocaine and Magnesium Sulphate are effective in blunting the stress response to intubation, but Lidocaine was found to be more effective in maintaining hemodynamic stability in hypertensive patients. The study's findings are compared with other studies with varying results, potentially due to different dosages of Magnesium Sulphate.

Key Findings

Both groups experienced an increase in mean arterial pressure after intubation. Blunting of stress response was observed in 67.2% of Group-L patients and 47.4% of Group-M patients. This difference was statistically significant (p=0.003).

Conclusion

Both Lidocaine and Magnesium Sulphate are effective in blunting the hemodynamic stress response to intubation in hypertensive patients, but Lidocaine is more effective than Magnesium Sulphate.

Fact Check

1. The study was conducted from January to June 2019. Confirmed by the Methodology section.
2. A total of 232 patients were evaluated. Confirmed by the Results section.
3. Blunting of stress response was observed in 67.2% of Group-L patients. Confirmed by the Results section.

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