Comparison of IV magnesium sulphate and IV esmolol in attenuating hemodynamic extubation response after general anesthesia

Abstract

Tracheal extubation is associated with a 10–30% increase in arterial pressure and heart rate that could be detrimental in patients with hypertension, ischemic heart disease, and cerebrovascular disease. A reliable technique for rapid & smooth extubation with stable hemodynamics is still not fully evolved. To compare the effect of intravenous magnesium sulphate and esmolol for attenuating hemodynamic response to extubation after general anesthesia.Prospective, randomized, double blind study conducted at tertiary care hospital.Sixty adult subjects undergoing major surgery were randomly divided into 2 groups. Group M received magnesium sulphate 40 mg/kg & Group E received esmolol 0.6 mg/kg IV infusion over 5 minutes before extubation. Heart rate, systolic & diastolic blood pressure, mean arterial pressure, rate pressure product, pain score & sedation score were compared from extubation till 15 minutes after extubation. Students ‘t’ test used for continuous variables & Chi Square test for categorical data.21.82% fall in heart rate was observed in group M with a plateau at 10 -15 minutes compared to 37.07% in group E with a peak at 15 minutes (p=0.0150). Fall in Systolic blood pressure was 18.86% in group M & 21.15% in group E (p=0.4298). Rate pressure product was significantly lower in group E (50.40%) than group M (36.66%). Postoperative pain score was significantly less in group M compared to group E (p<0.0001). Magnesium sulphate provides better hemodynamic stability with postoperative analgesia compared to esmolol when used for attenuating hemodynamic response to extubation.