Attenuation Of Cardiovascular Responses to Tracheal Extubation: A Comparative Study Between Intravenous Esmolol and Lignocaine

Background: Tracheal extubation is associated with significant sympathetic stimulation leading to tachycardia and hypertension, which may be detrimental in susceptible patients. Various pharmacological agents have been used to attenuate this hemodynamic stress response. This study aimed to compare the efficacy of intravenous esmolol and lignocaine in attenuating cardiovascular responses during tracheal extubation.

Methods: This observational comparative study was conducted on 60 adult patients aged 20–50 years, belonging to ASA physical status I and II, undergoing elective surgeries under general anaesthesia. Patients were divided into two groups of 30 each. Group L received intravenous preservative-free lignocaine 1.5 mg/kg, and Group E received intravenous esmolol 1.5 mg/kg at the end of surgery prior to extubation. Hemodynamic parameters including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded at baseline, after drug administration, and at 1, 5, 15, and 30 minutes post-extubation. Sedation was assessed using the Modified Observer’s Assessment of Alertness/Sedation (MOAAS) scale. Statistical analysis was performed using paired and independent t-tests, with p < 0.05 considered significant.

Results: Esmolol produced a significant reduction in heart rate and blood pressure immediately after administration and maintained hemodynamic stability during the early post-extubation period. In contrast, lignocaine failed to prevent transient increases in HR and BP at 1 and 5 minutes after extubation. Intergroup comparison demonstrated significantly better attenuation of HR, SBP, and DBP in the esmolol group during early post-extubation intervals. Sedation scores were significantly higher in the esmolol group at 5 and 15 minutes, indicating better early recovery. No clinically significant adverse events were observed in either group.

Conclusion: Intravenous esmolol is more effective than lignocaine in attenuating extubation-induced hemodynamic stress response while maintaining a favorable safety and recovery profile.