“Comparison of The Effect of Diltiazem and Esmolol in Attenuating The Cardiovascular Responses To Endotracheal Extubation and Emergence From Anaesthesia”

Abstract

INTRODUCTION: Endotracheal extubation is almost always associated with haemodynamic changes. This increase in sympatho-adrenal activity may result in hypertension, tachycardia and arrhythmias and is more hazardous to the patients with hypertension, myocardial insufficiency or cerebro-vascular disease. AIMS: To compare the effects of diltiazem and esmolol in attenuating the cardiovascular responses to tracheal extubation. MATERIAL AND METHOD: After ethical committee's approval, this observational study was carried out on ASA class I-II patients. After pre-anaesthetic checkup, 60 patients were randomly allocated to 3 equal groups by using chit method. Patients were given 10 ml saline in Group – S, 0.1mg/kg of diltiazem diluted in 10 ml saline in Group – D and 1mg/kg of esmolol diluted in 10 ml saline in Group – E. These drugs were given 3 minutes after reversal and 2 minutes before extubation. STATISTICAL ANALYSIS: The results were analyzed using ANOVA, student's paired t-test and chi-square test. 'p' value of <0.05 was statistically significant and <0.001 was highly significant. RESULTS: Both drugs had greater attenuating effects on haemodynamic changes than control group. Attenuation on changes of heart rate was greater with esmolol whereas of blood pressure was greater with diltiazem. CONCLUSION: Diltiazem 0.1mg/kg or esmolol 1mg/kg i.v. given at 2 min before extubation was of value in attenuating the cardiovascular changes during tracheal extubation & emergence from anaesthesia. Esmolol is more effective in attenuating the heart rate changes while Diltiazem is more effective in attenuating the systolic blood pressure changes.