Iftikhar Hussian, Khalid Zaeem.
Intubation; comparison of Glyceryl trinitrate with plain lignocaine in attenuating the hypertensive response.
Professional Med J Jan ;14(3):466-70.

Background: Endo-tracheal intubation causes hypertensive stress response and increase in blood pressure and heart rate. This increase in systolic blood pressure causes myocardial ischemia and dysrythmias in vulnerable patient. Different drugs are used intravenously to attenuate this hypertensive response during intubation. I compared glyceryl trinitrate with plain Lignocaine intravenous to obtund this hypertensive stress response. Material and method. In a randomized, double blind study, 60 patients were selected for this study and divided into two equal groups of I and II based on receiving intravenous glyceryl trinitate and plain lignocaine respectively. A bolus dose of Glyceryl trinitrate (Nitronal) 200 mcg, 20 seconds before intubation. And then titration at a rate of 2 pgm/kg/minute was started. Group II was given plain lignocaine 1.5 mg/kg body weight. The comparative study was carried out to know the effectiveness of each drug to blunt the hypertensive stress response and Heart Rate Variability (HRV) during intubation. Blood pressure and heart rate variability (HRV) immediately after intubation was assessed. Results: Blood pressure fall was more marked in patient receiving Glyceryl trinitrate (Nitronal) then those of receiving plain Lignocaine, but heart rate variability (HRV) was greater in patient receiving Glyceryl trinitrate (Nitronal). Conclusion: Glyceryltrinitrate (Nitronal) is more effective than plain lignocaine in blunting the hypertensive stress response of intubation .

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