EFFECTS OF PERIOPERATIVE LIGNOCAINE INFUSION ON HEMODYNAMIC CHANGES TO INTUBATION

Abstract

Background: Laryngoscopy followed by tracheal intubation is known to trigger a significant sympathetic surge, often leading to acute hemodynamic alterations such as elevated heart rate and blood pressure. These responses typically persist for approximately ten minutes and may pose risks, especially in vulnerable patients. Various pharmacological interventions have been proposed to manage these responses, with differing levels of efficacy. Recent findings suggest that perioperative intravenous lignocaine infusion may effectively blunt these stress responses. However, existing literature remains limited, particularly within the local context, prompting the need for further investigation into its potential benefits.

Methods: A randomized controlled trial was conducted in the Department of Anesthesiology at Sir Ganga Ram Hospital, Lahore, over a six-month period from August 21, 2017, to February 20, 2018. Sixty adult patients aged 20 to 70 years, scheduled for elective surgery under general anesthesia requiring tracheal intubation, were enrolled and randomly assigned into two groups. Group A received conventional general anesthesia, while Group B was administered lignocaine infusion perioperatively. Key outcome measures included mean heart rate and mean arterial pressure, recorded immediately after intubation and at 3 and 5-minute intervals post-intubation. All participants provided informed written consent prior to enrollment.

Results: The study included 60 patients with a mean age of 45.3 ± 14.8 years and a mean BMI of 25.9 ± 2.7 kg/m². Of these, 61.7% were male and 18.3% had a history of hypertension. No statistically significant differences were observed in baseline heart rate (90.97 ± 6.56 vs. 90.33 ± 7.31 bpm; p = 0.725) or mean arterial pressure (82.57 ± 5.50 vs. 82.13 ± 5.31 mmHg; p = 0.757) between the two groups prior to intubation. However, patients in the lignocaine group demonstrated significantly lower heart rate and mean arterial pressure immediately after intubation (102.67 ± 5.73 vs. 122.77 ± 5.94 bpm; p < 0.001 and 106.57 ± 3.83 vs. 124.10 ± 4.66 mmHg; p < 0.001), at 3 minutes (87.47 ± 6.62 vs. 95.67 ± 7.83 bpm; p < 0.001 and 95.60 ± 4.21 vs. 106.53 ± 5.79 mmHg; p < 0.001), and at 5 minutes post-intubation (81.87 ± 6.69 vs. 89.93 ± 7.67 bpm; p < 0.001 and 93.73 ± 4.23 vs. 100.40 ± 6.21 mmHg; p < 0.001).

Conclusion: The administration of intravenous lignocaine during the perioperative period effectively mitigates the hemodynamic response to tracheal intubation, as evidenced by significantly lower heart rate and mean arterial pressure at critical time points. Its incorporation into anesthetic protocols may enhance patient stability during induction and is recommended for routine practice in suitable cases.