Comparison of intravenous magnesium sulphate and lidocaine for attenuation of cardiovascular response to laryngoscopy and endotracheal intubation in elective surgical patients at Zewditu Memorial Hospital Addis Ababa, Ethiopia

Abstract

Background: Laryngoscopy and endotracheal intubation are essential components of general anesthesia. But it is always associated with side effects called reflex cardiovascular responses. Many methods have been identified to attenuate these responses like intravenous lidocaine, deep inhalational anesthesia, vasodilators, intravenous magnesium sulphate even though therapeutic superiority remains understudied.

Methods: An institutional-based cohort study on 112 adult patients aged between 18-60 years was applied. 37 patients in the non-exposed group (Group N), 37 in the lidocaine group (Group L), and 38 in magnesium sulphate (Group M) were included. The hemodynamic parameters like heart rate, systolic, diastolic and mean arterial blood pressure at various time points up to 7 minutes post-intubation were recorded and the effect of both drugs to reduce hemodynamic responses was compared. Parametric data were analyzed using ANOVA and nonparametric data using the Kuruska-Wallis H rank test. P-value < 0.05 considered statistically significant.

Results: In all three groups, there was a statistically significant rise in heart rate and blood pressure from baseline. There was a statistically significant difference in mean heart rate throughout study minutes among the groups (p<0.001). However, there was no statistically significant difference in mean heart rate between Groups M and L at all post-intubation time intervals. In blood pressure at all three parameters there was statistically significant difference among groups at all-time points except no difference at 7th minutes in DBP. There was significantly lower blood pressure in group M compared to both groups.

Conclusion: In conclusion, prophylactic administration of magnesium sulphate and lidocaine was effective in attenuating hemodynamic responses to the stress effect of laryngoscopy and intubation. But based on our finding prophylaxis of magnesium sulphate is associated with a more favorable hemodynamic response.

Fig 1. Within-the group change in heart rate at different time intervals in Zewditu Memorial Hospital, Addis Ababa, 2018/2019.

Fig 2. Within-the group change in SBP at different time intervals in Zewditu Memorial Hospital, Addis Ababa, 2018/2019.