Comparison of nebulisation 0.75% ropivacaine with 2% lignocaine for attenuation of haemodynamic response due to intubation: A prospective randomised study.

Abstract

INTRODUCTION Laryngoscopy and intubation are associated with the reflex response of hypertension, tachycardia and other intraoperative complications. Nebulised route drug administration and entropy-guided induction enable optimal intubating conditions. AIMS To compare pre-induction nebulisation between 0.75% ropivacaine and 2% lignocaine in blunting the nasotracheal intubation response. MATERIALS AND METHODS A total of 100 patients undergoing elective faciomaxillary surgeries were prospectively randomised to receive pre-induction nebulisation: 5mL of 2% lignocaine (100mg) (Group L) or 5mL of 0.75% ropivacaine (37.5mg) (Group R). Patients were induced and intubated (nasotracheal) with entropy monitoring. Observed parameters included systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, entropy at baseline, induction, intubation, post-intubation one, three and five minutes, propofol induction dose, electrocardiogram changes and peri-intubation cough reflex. RESULTS Ropivacaine aerosol proved significantly better than lignocaine aerosol on haemodynamics (systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate) and cough reflex (p < 0.05). Both groups experienced similar entropy changes and propofol induction dose requirements and no fresh electrocardiogram changes (compared with the baseline). CONCLUSION Pre-induction nebulised ropivacaine offers superior intubating conditions than lignocaine regarding haemodynamic response and cough reflex for faciomaxillary surgeries.