A Comparative Study of the Efficacy of Intravenous Dexmedetomidine versus Intravenous Esmolol for Attenuation of Cardiovascular Response to Laryngoscopy and Endotracheal Intubation: A Randomized Double-Blind

Dr. Nishanth Immanuel, Dr. Valsamma Abraham

Abstract: Background: Laryngoscopy and endotracheal intubation trigger a reflex sympathetic discharge leading to tachycardia, hypertension, and arrhythmias. In patients with compromised cardiovascular reserve, these responses can precipitate myocardial ischemia, pulmonary edema, or cerebrovascular events. Pharmacological attenuation of this stress response is therefore essential. Objectives: To compare the efficacy of intravenous (IV) dexmedetomidine (0.6 μg/kg) versus IV esmolol (1 mg/kg) in attenuating hemodynamic responses to laryngoscopy and endotracheal intubation, and to document associated adverse effects. Methods: A randomized double-blind study was conducted on 60 ASA I-II adult patients (18-60 years) scheduled for elective surgery under general anaesthesia. Patients were randomly allocated into two groups of 30 each. Group D received dexmedetomidine 0.6 μg/kg and Group E received esmolol 1 mg/kg, each infused over 30 seconds beginning at the 7th minute of a 10-minute saline drip. Anaesthesia was induced with thiopentone and succinylcholine and intubation was performed at 90 seconds. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and oxygen saturation (SpO₂) were recorded at baseline, induction, and 1, 3, 5, and 10 minutes post-intubation. Adverse effects were monitored throughout the surgery. Results: Both groups were comparable at baseline for age, sex, ASA grade, and hemodynamic parameters. Group D demonstrated significantly lower HR from induction onwards through all post-intubation time points (P ≤ 0.002 at all intervals). SBP was significantly lower in Group D at 1 minute (113.87 ± 11.92 vs. 127.83 ± 10.73 mmHg; P < 0.0001), 3 minutes (P = 0.002), and 10 minutes (117.37 ± 9.21 vs. 135.37 ± 12.36 mmHg; P < 0.0001) post-intubation. DBP and MAP were also significantly lower in Group D at 1 minute (P = 0.013; P = 0.0005) and 10 minutes (P = 0.001; P < 0.0001). SpO₂ was comparable between groups at all time points. No adverse effects were recorded in either group. Conclusion: Intravenous dexmedetomidine (0.6 μg/kg) provides superior attenuation of cardiovascular responses to laryngoscopy and endotracheal intubation compared to IV esmolol (1 mg/kg), maintaining significantly lower HR, SBP, DBP, and MAP across multiple post-intubation time points, without adverse effects.

Keywords: cardiovascular stress response, dexmedetomidine, esmolol, endotracheal intubation, laryngoscopy, haemodynamic attenuation

How to Cite?: Dr. Nishanth Immanuel, Dr. Valsamma Abraham, "A Comparative Study of the Efficacy of Intravenous Dexmedetomidine versus Intravenous Esmolol for Attenuation of Cardiovascular Response to Laryngoscopy and Endotracheal Intubation: A Randomized Double-Blind", Volume 15 Issue 4, April 2026, International Journal of Science and Research (IJSR), Pages: 321-328, https://www.ijsr.net/getabstract.php?paperid=SR26404182302, DOI: https://dx.dx.doi.org/10.21275/SR26404182302

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