1Postgraduate Resident, Department of Anaesthesiology, Sree Balaji Medical College and Hospital, Chromepet, Chennai, Tamil Nadu, India. Bharath Institute of Higher Education and Research (BIHER), Chennai, India.
2Professor, Department of Community Medicine, Regional Institute of Medical Sciences (RIMS), Imphal – 795004, Manipur, India.
3Final Year Student, B.Sc. Allied Health Sciences (Operation Theatre and Anaesthesia Technology), Department of Allied Health Sciences, Sree Balaji Medical College and Hospital, Chromepet, Chennai, Tamil Nadu, India. Bharath Institute of Higher Education and Research (BIHER), Chennai, India.
4Freelance Anaesthetist, Chennai, Tamil Nadu, India.
Background: Direct laryngoscopy and endotracheal intubation during induction of general anaesthesia are well-recognized stimuli that trigger marked sympathetic activation. This response is characterized by tachycardia, hypertension, and increased myocardial oxygen demand due to catecholamine release. Although these transient hemodynamic changes are usually tolerated by healthy individuals, they may lead to serious complications such as myocardial ischemia, arrhythmias, and cerebrovascular events in vulnerable patients. Several pharmacological agents have been investigated to attenuate these responses. Dexmedetomidine, a selective α2-adrenergic receptor agonist, and esmolol, a short-acting cardioselective β1-adrenergic blocker, are commonly used agents for controlling peri-intubation hemodynamic responses.
Objective: To evaluate and compare the effectiveness of intravenous dexmedetomidine and esmolol in attenuating hemodynamic and blood glucose responses associated with laryngoscopy and endotracheal intubation during general anaesthesia.
Methods: This prospective observational study included 60 adult patients aged 18–60 years belonging to ASA physical status I or II who underwent elective surgical procedures under general anaesthesia. Patients were divided into three groups of 20 each: control group (no study drug), dexmedetomidine group receiving intravenous dexmedetomidine 1 µg/kg before induction, and esmolol group receiving intravenous esmolol 50 µg/kg prior to induction. Hemodynamic parameters including heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure were recorded at baseline, after drug administration, immediately after intubation, and at 3, 5, and 10 minutes post-intubation. Capillary blood glucose levels were measured preoperatively and 30 minutes following intubation. Statistical analysis was performed using appropriate comparative tests, with p < 0.05 considered statistically significant.
Results: Baseline demographic and hemodynamic parameters were comparable among the groups. Immediately after intubation, heart rate increased significantly in the control group (102.5 ± 12.3 bpm) compared with the dexmedetomidine group (86.7 ± 9.4 bpm) and esmolol group (88.1 ± 9.2 bpm) (p < 0.001). Similarly, systolic blood pressure rose markedly in the control group (146.3 ± 13.5 mmHg) compared with dexmedetomidine (128.6 ± 11.4 mmHg) and esmolol (130.2 ± 10.9 mmHg) groups (p < 0.001). Diastolic blood pressure and mean arterial pressure also showed significantly smaller increases in both treatment groups. The incidence of tachycardia (>100 bpm) was highest in the control group (40%) compared with 10% in the dexmedetomidine group and 15% in the esmolol group. Blood glucose levels increased in all groups after intubation but were highest in the control group (118.6 ± 10.7 mg/dl) compared with dexmedetomidine (111.4 ± 9.6 mg/dl) and esmolol (106.3 ± 9.2 mg/dl) groups.
Conclusion: Both dexmedetomidine and esmolol effectively attenuate the hemodynamic responses associated with laryngoscopy and endotracheal intubation. These agents significantly reduce tachycardia and hypertension compared with the control group and contribute to improved perioperative hemodynamic stability. Esmolol also demonstrated a slightly greater reduction in the metabolic stress response as reflected by smaller increases in blood glucose levels.
Keywords: Dexmedetomidine, Esmolol, Laryngoscopy, Tracheal Intubation, Hemodynamic Stability, Blood Glucose, Adrenergic Antagonists, Sympathetic Nervous System, General Anesthesia.
How to cite this article: Shadokpam D, Sanayaima Devi H, Dharshini A, Sridhar V. Injection Esmolol Versus Infusion Dexmedetomidine In Attenuating Hemodynamic And Blood Glucose Response To Laryngoscopy And Intubation – An Observational Study. Int J Drug Deliv Technol. 2026;16(2): 732-740. DOI: 10.25258/ijddt.16.2.78
Source of support: Nil.
Conflict of interest: None