Comparison of Intravenous Lignocaine and Intravenous Dexmedetomidine for Attenuation of Hemodynamic Stress Response to Direct Laryngoscopy and Endotracheal Intubation

Abstract

Background: The hemodynamic stress response to direct laryngoscopy and endotracheal intubation is a well-recognized phenomenon caused by sympathetic stimulation, which may lead to significant cardiovascular complications, especially in high-risk patients. Objective: To compare the effectiveness of intravenous dexmedetomidine versus intravenous lignocaine in attenuating the hemodynamic stress response to direct laryngoscopy and endotracheal intubation. Study Design & Setting: This randomized controlled trial was conducted at the Department of Anesthesia, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi from March 2025 to August 2025. Methodology: A total of 62 patients aged 18–60 years undergoing elective surgery under general anesthesia were included and randomly allocated into two groups (n=31 each). Group D received dexmedetomidine (1 µg/kg), while Group L received lignocaine (1.5 mg/kg). Hemodynamic parameters including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded at baseline, 1 minute, and 3 minutes after intubation. Data were analyzed using SPSS version 20, and a p-value ≤0.05 was considered significant. Results: Baseline hemodynamic parameters were comparable between both groups (p>0.05). At 1 and 3 minutes post-intubation, Group D showed significantly lower HR, SBP, DBP, and MAP compared to Group L (p<0.001). The percentage increase in all parameters was markedly higher in the lignocaine group. Stratified analysis demonstrated consistent results across different age groups and ASA status. Conclusion: Dexmedetomidine was more effective than lignocaine in attenuating the hemodynamic stress response to laryngoscopy and intubation, providing better hemodynamic stability.