comparative evaluation of dexmedetomidine and repository- laryngoscopy, endotracheal intubation and

Download COMPARATIVE EVALUATION OF DEXMEDETOMIDINE AND repository- laryngoscopy, endotracheal intubation and

Post on 16-Aug-2020

6 views

Category:

Documents

0 download

Embed Size (px)

TRANSCRIPT

  • COMPARATIVE EVALUATION OF DEXMEDETOMIDINE

    AND ESMOLOL FOR ATTENUATION OF INTUBATION

    STRESS RESPONSE IN WELL CONTROLLED

    HYPERTENSIVE PATIENTS – A DOUBLE BLIND

    RANDOMIZED CONTROL STUDY

    A STUDY OF 60 CASES

    DISSERTATION SUBMITTED FOR THE DEGREE OF

    DOCTOR OF MEDICINE

    BRANCH – X (ANAESTHESIOLOGY)

    APRIL 2017

    THE TAMILNADU DR. M.G.R. MEDICAL UNIVERSITY

    CHENNAI

  • CERTIFICATE

    This is to certify that the dissertation entitled “COMPARATIVE

    EVALUATION OF DEXMEDETOMIDINE AND ESMOLOL FOR

    ATTENUATION OF INTUBATION STRESS RESPONSE IN WELL

    CONTROLLED HYPERTENSIVE PATIENTS – A DOUBLE BLIND

    RANDOMIZED CONTROL STUDY” submitted

    byDr.M.SUKUMARAN,REGISTER NO. 201420303in partial fulfillment for

    the award of the degree of Doctor of Medicine in Anaesthesiology by The

    TamilnaduDr.M.G.R. Medical University, Chennai, this is a bonafide original

    research work done by him in The Department of Anaesthesiology and Critical

    Care, Tirunelveli Medical College Hospital, under the guidance and supervision of

    Prof.Dr.A.BALAKRISHNAN, M.D.,D.A during the academic year 2014-2017.

    DATE : Dr.SITHY ATHIYA MUNAVARAH, MD.,

    PLACE: TIRUNELVELI DEAN,

    TIRUNELVELI MEDICAL COLLEGE,

    TIRUNELVELI-627011

  • CERTIFICATE

    This is to certify that the dissertation entitled “COMPARATIVE

    EVALUATION OF DEXMEDETOMIDINE AND ESMOLOL FOR

    ATTENUATION OF INTUBATION STRESS RESPONSE IN WELL

    CONTROLLED HYPERTENSIVE PATIENTS – A DOUBLE BLIND

    RANDOMIZED CONTROL STUDY” submitted by

    Dr.M.SUKUMARAN,REGISTER NO. 201420303in partial fulfillment for the

    award of the degree of Doctor of Medicine in Anaesthesiology for the April 2017

    examination by The Tamilnadu Dr.M.G.R. Medical University, Chennai, this is a

    bonafide original research work done by him in the Department of

    Anaesthesiology and Critical Care, Tirunelveli Medical College Hospital, under

    my guidance and supervision.

    DATE: Prof.Dr.A.BALAKRISHNAN, M.D.,D.A

    PLACE: TIRUNELVELI PROFESSOR AND HOD,

    DEPARTMENT OF ANAESTHESIOLOGY,

    TIRUNELVELI MEDICAL COLLEGE,

    TIRUNELVELI.

  • CERTIFICATE

    This is to certify that the dissertation entitled “COMPARATIVE

    EVALUATION OF DEXMEDETOMIDINE AND ESMOLOL FOR

    ATTENUATION OF INTUBATION STRESS RESPONSE IN WELL

    CONTROLLED HYPERTENSIVE PATIENTS – A DOUBLE BLIND

    RANDOMIZED CONTROL STUDY” submitted by

    Dr.M.SUKUMARAN,REGISTER NO. 201420303in partial fulfillment for the

    award of the degree of Doctor of Medicine in Anaesthesiology for the April 2017

    examination by The Tamilnadu Dr.M.G.R. Medical University, Chennai, this is a

    bonafide original research work done by him in the Department of

    Anaesthesiology and Critical Care, Tirunelveli Medical College Hospital, under

    my guidance and supervision

    DATE: DR.G.VIJAY ANAND, MD,

    PLACE: TIRUNELVELI SENIOR ASSISTANT PROFESSOR,

    DEPARTMENT OF ANAESTHESIOLOGY,

    TIRUNELVELI MEDICAL COLLEGE,

    TIRUNELVELI.

  • DECLARATION

    I, Dr.M.SUKUMARAN, declare that the dissertation

    entitled“COMPARATIVE EVALUATION OF DEXMEDETOMIDINE AND

    ESMOLOL FOR ATTENUATION OF INTUBATION STRESS RESPONSE

    IN WELL CONTROLLED HYPERTENSIVE PATIENTS – A DOUBLE

    BLIND RANDOMIZED CONTROL STUDY”has been prepared by me. This is

    submitted to The Tamil Nadu Dr. M.G.R. Medical University, Chennai, in partial

    fulfilment of the requirement for the award of M.D., Degree, BranchX

    (ANAESTHESIOLOGY) degree Examination to be held in April 2017.

    Date :

    Place : TIRUNELVELI Dr.M.SUKUMARAN.

  • ACKNOWLEDGEMENT

    I am extremely thankful to Dr.SITHYATHIYA MUNAVARAH,

    MD,Dean, Tirunelveli Medical College, for her permission to carry out this study.

    I am immensely grateful to Prof.Dr.A.BALAKRISHNAN,

    M.D.,D.A.Professor and Head of the Department, Department of Anaesthesiology

    and Critical Care, for his concern and support in conducting the study.

    I am very grateful to Dr.R.AMUTHARANI M.D,Dr. R. SELVARAJ

    M.D, & Dr.E.EBENEZER JOEL KUMAR MD,DNB Associate Professors,

    Department of Anaesthesiology and Critical Care,for their constant motivation and

    valuable suggestions.

    I am greatly indebted to my guide DR.G.VIJAY ANAND, MD, for his

    inspiration, guidance, and comments on all stages of this study.

    I am thankful to all Assistant Professors and senior residents for their

    guidance and help.

    I am thankful to all my colleagues for the help rendered in carrying out this

    dissertation.

    Last, but not least, I thank all the patients for willingly submitting

    themselves for this study.

  • LIST OF ABBREVIATIONS

    1. ASA American Society of Anaesthesiologists

    2. AR Adrenoreceptor

    3. CAD Coronary Artery Disease

    4. COPD Chronic Obstructive Pulmonary Disease

    5. CNS Central Nervous System

    6. CT Computerized Tomography

    7. CVA Cereberovascular accident

    8. CVS Cardio vascular system

    9. DAP Diastolic Arterial Pressure

    10. DM Diabetes Mellitus

    11. ECG Electrocardiogram

    12. FDA Food and Drug Administration

    13. FRC Functional Residual Capacity

    14. GA General Anaesthesia

    15. GIT Gastrointestinal Tract

    16. HR Heart Rate

    17. ICU Intensive Care Unit

    18. IV Intravenous

  • 19. IVRA Intravenous Regional Anaesthesia

    20. MAC Minimum Alveolar Concentration

    21. MAP Mean Arterial Pressure

    22. MRI Magnetic Resonance Imaging

    23. PICU Paediatric Intensive Care Unit

    24. RBC Red Blood Cell

    25. RS Respiratory System

    26. SAP Systolic Arterial Pressure

    27. SHT Systemic Hypertension

    28. SPO2 Peripheral Oxygen Saturation

    29. SVT Supraventricular Tachycardia

    30. WHO World Health Organization

  • TABLE OF CONTENTS

    Sl. No. Contents PageNo. 1 Introduction 1

    2 Aim of the study 4

    3 Nerve Supply of Larynx 5

    4 Nerve Supply of Trachea 7

    5 Physiological and pathophysiological response to direct laryngoscopy and endotracheal intubation

    8

    6 Airway effects of endotracheal intubation 10

    7 Intubation and cardiovascular diseases 12

    8 Methods to attenuate circulatory responses during laryngoscopy and endotracheal intubation

    13

    9 Physiology of Beta receptors 17

    10 Beta receptor antagonist 21

    11 Pharmacology of Esmolol 23

    12 Pharmacology of Dexmedetomidine 31

    13 Review of Literature 44

    14 Materials 50

    15 Methods 54

    16 Statistical analysis 56

    17 Observation and results 57

    18 Discussion 87

    19 Summary 91

    20 Conclusion 92

    21 References 93

    22 Consent Form 104

    23 Proforma 105

    24 Master Chart 107

  • LIST OF TABLES

    Sl.no. Title Pageno.

    1 Characteristics of beta adrenergic receptors 19

    2 Site of beta 1 receptors & Response of effectors organs to autonomic nerve impulse

    20

    3 Beta adrenergic blocking drugs 22

    4 Age 58

    5 Sex 59

    6 Anti Hypertensive Medication 60

    7 Baseline parameters 61

    8 Heart Rate 63

    9 Systolic Arterial Pressure 65

    10 Diastolic Arterial Pressure 67

    11 Mean Arterial Pressure 69

    12 Comparison of Heart Rate in Group D 71

    13 Comparison of Systolic Arterial Pressure in Group D 73

    14 Comparison of Diastolic Arterial Pressure in Group D 75

    15 Comparison of Mean Arterial Pressure in Group D 77

    16 Comparison of Heart Rate in Group E 79

    17 Comparison of Systolic Arterial Pressure in Group E 81

    18 Comparison of Diastolic Arterial Pressure in Group E 83

    19 Comparison of Mean Arterial Pressure in Group E 85

  • LIST OF FIGURES

    Sl.no. Title Page no.

    1 Nerve Supply of Larynx 5

    2 Age 58

    3 Sex 59

    4 Anti Hypertensive Medication 60

    5 Baseline parameters 62

    6 Heart Rate 64

    7 Systolic Arterial Pressure 66

    8 Diastolic Arterial Pressure 68

    9 Mean Arterial Pressure 70

    10 Comparison of Heart Rate in Group D 72

    11 Comparison of Systolic Arterial Pressure in Group D 74

    12 Comparison of Diastolic Arterial Pressure in Group D 76

    13 Comparison of Mean Arterial Pressure in Group D 78

    14 Comparison of Heart Rate in Group E 80

    15 Comparison of Systolic Arterial Pressure in Group E 82

    16 Comparison of Diastolic Arterial Pressure in Group E 84

    17 Comparison of Mean Arterial Pressure in Group E 86

  • 1

    1. INTRODUCTION

    The hemodynamic responses to laryngoscopy and

    endotracheal intubation have been recognized since 1951. Though these

    pressor responses have been observed frequently they have been

    interpreted differently by many authors. The induction of anaesthesia,

    laryngoscopy, endotracheal intubation and surgical stimulation often

    evoke cardiovascular responses characterized by alterations in systemic

    blood pressure, heart rate and cardiac rhythm. The response following

    laryngoscopy and intubation peaks at 1-2 min and returns to baseline

View more >