Comparison between Nebulised versus Intravenous Lignocaine to Suppress the Haemodyamic Response to Laryngoscopy and Tracheal Intubation: A Randomised Control Study

Abstract

Introduction: During general anaesthesia, prevention of reflex sympathetic responses following direct laryngoscopy and intubation remains an important clinical goal during airway management. Aim: To compare efficacy of nebulised lignocaine and intravenous lignocaine to suppress haemodynamic response to laryngoscopy and tracheal intubation. Materials and Methods: This randomised control study was conducted, during January 2018 to June 2019, on 90 American Society of Anesthesiologists (ASA) grade I and II patients in the age group of 18 to 45 years of either sex, undergoing elective surgeries under general anaesthesia. Patients were randomly allocated into three groups with the sample size of 30 each. Group A was nebulised with Normal Saline (NS) 0.075 mL/kg and 10 mL NS intravenous (iv) given and served as control. Group B was nebulised with 3 mg/kg (0.075 mL/kg) of 4% lignocaine and iv normal saline 10 mL given. Group C was nebulised with 0.075 mL/kg of normal saline and iv 2 mg/kg of 2% lignocaine diluted to 10 mL. Descriptive statistical analysis was carried out in the present study. Analysis of variance (ANOVA) has been used to find the significance of parameters between three groups. Chi-square test was used to find the significance of parameters on categorical scale between three groups. Results: Statistical evaluation between the groups showed that the increase in Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP) observed at 1 minute after intubation in control group was highly significant (p<0.001) when compared to increase in group B and C. Both groups B and C were comparable in terms of SBP, DBP and MAP post-intubation. Increase in Heart Rate (HR) was statistically significant (p<0.05) between group C and group B during 7 seconds to 15 seconds post-intubation. Conclusion: It can be concluded that nebulised lignocaine can be an effective alternative to intravenous lignocaine in attenuating the cardiovascular responses to laryngoscopy and intubation. It is also a simple and safe technique to be used.