THE COMPARATIVE STUDY BETWEEN FENTANYLAND LIGNOCAINE-TRAMADOLMAGNESIUM SULFATE COMBINATION ON INTRAOPERATIVE HEMODYNAMICS AND INTUBATION SURGE IN PATIENTS UNDERGOING SURGERY UNDER BALANCED GENERALANESTHESIA

Abstract

INTRODUCTION- Laryngoscopy and endotracheal intubation invariably cause hemodynamic changes associated with increased heart rate, increased blood pressure and occasional disturbance in cardiac rhythm. These hemodynamic changes arise as a form of autonomic reex and due to release of norepinephrine and to a lesser extent epinephrine. Effective attenuation of sympathoadrenal response is an important goal in anaesthesiology. Not only the intubation surge but the intraoperative hemodynamic maintenance is also a very challenging step for a successful balanced general anaesthesia. METHODOLOGY- 60 normotensive patients belonging to ASA1 and ASA2 (age between 18 to 60 yrs)scheduled for elective surgical procedure were divided randomly into two groups of 30 each. All patients received premedication with Midazolam. Group F will received Fentanyl 2ug/kg 3 minutes before intubation and group M received Tramadol 1mg/kg , Lignocaine 2% 1.5mg/kg and Mgso4 2gm over 10 minutes 15 minutes prior to intubation. Pre-oxygenation was done for 5 minutes before laryngoscopy. Induction of anaesthesia was done with Propofol. Intubation was done by using Succinylcholine. Intraoperative hemodynamics was maintained by O2, N20, Sevourane and Atracurium. Heart rate, SBP, DBP and MAP were documented non-invasively at baseline ,before induction,1 minute ,3,5,15 and 30 minutes after intubation. RESULT- There was no statistically signicant difference in the demographic characteristics between the two groups. Immediately after intubation heart rate, systolic blood pressure, diastolic blood pressure and mean blood pressure were better controlled in Fentanyl receiving patients. But thereafter intraoperative hemodynamics (HR,SBP,DBP,MAP) are better maintained in patients receiving the Three Drug Combination of Lignocaine-Tramadol-Magnesium Sulfate(statistically signicant). Moreover intraoperative requirement of Non-depolarising muscle relaxant is signicantly less frequent in the Three Drug Combination receiving patients as compared to Fentanyl receiving patients. Post-operative timing of receiving rst dose of rescue analgesic is also delayed in LignocaineTramadol-Magnesium Sulfate receivers.