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Abstract

Background: Endotracheal intubation causes considerable cardiovascular stress response, comprising increased heart rate, blood pressure, and myocardial oxygen demand. Drug agents like lignocaine and esmolol are used commonly to minimize these hemodynamic variations, but their relative effectiveness continues to be tested. Objective: To compare esmolol and lignocaine for attenuation of cardiovascular stress response to laryngoscopy and endotracheal intubation. Study Design: Randomized controlled trial. Duration and Place of Study: This study was conducted between May 2023 and October 2023 in the operation theatres of MTI–Lady Reading Hospital, Peshawar. Methodology: Eighty patients, aged 18–60 years, ASA grade I–II, were randomly allocated to receive either lignocaine 1.5 mg/kg (Group L, n=40) or esmolol 0.75 mg/kg (Group E, n=40). Both drugs were administered intravenously over 10 minutes before induction. Hemodynamic parameters including heart rate, systolic and diastolic blood pressures, mean arterial pressure, and rate pressure product were recorded at baseline (T0), three minutes post-intubation (T3), and five minutes post-intubation (T5). Results: The mean age was 38.7 ± 10.2 years, with 56% male patients. At T3, Group L showed higher mean heart rate (102.4 ± 8.7 bpm vs 86.3 ± 7.9 bpm), systolic blood pressure (152.6 ± 12.1 mmHg vs 136.2 ± 10.4 mmHg), mean arterial pressure (108.5 ± 9.2 mmHg vs 96.4 ± 8.7 mmHg), and rate pressure product (15,630 ± 1,340 vs 11,740 ± 1,210) compared to Group E (p<0.001). At T5, heart rate (96.2 ± 7.4 bpm vs 82.1 ± 6.9 bpm) and rate pressure product (14,380 ± 1,250 vs 10,960 ± 1,080) remained significantly higher in Group L, while other parameters showed no significant differences. Conclusion: Esmolol demonstrated superior efficacy over lignocaine in blunting the hemodynamic responses to laryngoscopy and intubation.