Attenuation of cardio-vascular response to laryngoscopy and intubation with 10% xylocaine spray during general anesthesia

Aims/ Background: Cardiovascular response was increase by direct laryngoscopy and endotracheal intubation. To study the hemodynamic changes associated with induction of general anesthesia and evaluate the efficacy of 100mg of 10% topical lidocaine spray for attenuating stress response during laryngoscopy and endotracheal intubation in normotensive patients undergoing plan routine surgeries.
Materials and Methods: This study was conducted during the period from June 2017 to May 2019, in the Department of Anesthesiology and Critical Care, Rama Medical College, Hospital and Research Centre, NH-9, Pilakhuwa, Hapur after approval by the hospital ethics committee on normotensive ASA Grade I & II.  All patients had enrolled our study are between the age of 20 years to 60 years and are scheduled for various elective surgical procedures. This study was a prospective, randomized, and clinical comparison study in rural tertiary referral health center. The Sample size for the study was 40 generated using a sample size calculator. The study participants were divided into two groups of 20 each lidocaine and control group. A study patient (Group B) who was received100 mg of 10% topical lidocaine sprays, (each puff of which delivers 10 mg of the drug). Patients received a total dose of 100 mg. half of which i.e. 50 mg. (5 puffs) was sprayed over laryngotracheal mucosa 10-15 minutes before induction by using tongue depressor, and the rest (5 puffs containing 50 mg. of drug) was given while doing laryngoscopy and intubation. In Group A, who was received only prescribed premedication and listed in control group (Group-A). All patients were monitored heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) with respect to time. All patients were kept unaware of the drug injected to enable double-blinding.
Results: In Group A (control group) the maximum increase in PR (P. Value-<0.001), blood pressure and MAP occurred at 1 min. post intubation and this gradually returned to baseline over the next 5-10 minutes. Group B (10% Lidocaine Spray) was very effective in obtunding the hypertension as well as tachycardia in response to laryngoscopy and intubation as compared with control group.   
Conclusion: In present study show the maximum increases in parameters occur at 1 minute post intubation with values returning to baseline at 10 min post intubation in case of pulse rate and at 5 minutes post intubation in case of systolic, diastolic and mean arterial pressure. 10% Lidocaine spray provided consistent and reliable protection from increases in pulse rate, blood pressure, & mean arterial pressure and is most reliable drug for attenuation of cardiovascular response to laryngoscopy and intubation under G.A. without any complication when used in proper doses and time.