Comparative Efficacy of Esmolol, Labetalol, and Lignocaine in Attenuating Hemodynamic Responses to Laryngoscopy and Intubation: A Randomized Double-Blind Study

Background Laryngoscopy and endotracheal intubation are associated with significant sympathetic stimulation resulting in tachycardia and hypertension. These hemodynamic changes may be harmful, particularly in patients with limited cardiovascular reserve. Various pharmacological agents have been used to attenuate this response, but an ideal agent remains debatable. Aim To compare the efficacy of intravenous esmolol, labetalol, and lignocaine in attenuating peri-intubation hemodynamic responses, assessed using heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and rate pressure product during laryngoscopy and endotracheal intubation Materials and methods Patients were randomly allocated into three equal groups (n = 25 each). Group ES received intravenous esmolol 1 mg/kg, Group LB received intravenous labetalol 0.25 mg/kg, and Group LG received intravenous lignocaine 1.5 mg/kg, administered two minutes prior to laryngoscopy and endotracheal intubation. Heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and rate pressure product were recorded at baseline, after drug administration, at intubation, and at one, three, five, seven, and 10 minutes following intubation. Data were analyzed using repeated-measures ANOVA, one-way ANOVA, chi-square test, and Tukey post hoc analysis, with p < 0.05 considered statistically significant. Results Baseline demographic parameters and hemodynamic variables were comparable among the three groups. All three drugs attenuated the hemodynamic response to laryngoscopy and intubation to varying extents. Labetalol demonstrated the most effective attenuation of heart rate, systolic blood pressure, mean arterial pressure, and rate pressure product at intubation and throughout the post-intubation period (p < 0.001). Esmolol showed better attenuation compared to lignocaine but was less effective than labetalol. Lignocaine was the least effective agent. No significant adverse effects were observed in any group. Conclusion Intravenous labetalol is more effective than esmolol and lignocaine in attenuating the hemodynamic responses to laryngoscopy and endotracheal intubation, with better overall cardiovascular stability and safety.