Comparative Study of Intravenous Esmolol & Magnesium Sulphate in Attenuating Hemodynamic Response during Laryngoscopy & Endotracheal Intubation in Patients Undergoing Valvular Heart Surgery: a Randomised Clinical Trial

The present study aimed to compare the effectiveness of esmolol & magnesium sulphate in attenuating the hemodynamic response
to endotracheal intubation and to note any signifi cant side effects caused by these drugs.
Background: Induction with endotracheal intubation in patients undergoing valvular heart replacement pose lot of hemodynamic
variations. Obtunding hemodynamic response which can be deleterious in such patients pose a challenge to the cardiac anaesthetist. We
hypothesized that using esmolol as compared to magnesium sulphate will attenuate the hemodynamic response during laryngoscopy &
endotracheal intubation in patients undergoing valvular heart replacement.
Methods: This was a double blind, randomised, single centre, interventional, prospective study. In this study 96 patients were divided
into two groups with 48 patients each (n = 48) by sealed enveloped method of randomisation. Group E received esmolol 1.5 mg/ kg i.v
and Group M received magnesium sulphate 50 mg/ kg i.v each diluted in normal saline to make up a volume of 50 ml & given via infusion
slowly over 5 minutes by a burette set. Hemodynamic parameters like Heart Rate (HR), Mean Arterial Pressure (MAP), Systolic Blood
Pressure (SBP), Diastolic Blood Pressure (DBP) at baseline, 5 minutes after premedication, just before intubation 3, 5, 10 & 15 minutes
post intubation were recorded. The last observation at the end of 15 minutes post intubation was considered as the end of study.
Results: All the enrolled patients were analyzed. The esmolol group showed a decrease in the H.R from baseline (86.13 ± 15.87)
as compared to magnesium sulphate (98.51 ± 16.81 with a 95% CI, 4.62-4.69, p value < 0.001) 5 minute after premedication. There was
statistically signifi cant difference in H.R between both groups 5 minutes after drug administration.
Conclusion: Administration of esmolol before intubation in valvular heart patients undergoing valve replacement surgery controls the
hemodynamic response much better as compared to magnesium sulphate.