Comparative Study of Verapamil versus Lignocaine for Attenuation of Pressor Response during Laryngoscopy and Endotracheal Intubation


Shrey Ashok Kakodker* and Sharmila Borkar


Tachycardia and systolic hypertension are considered the usual circulatory responses to laryngoscopy and tracheal intubation, occurring by virtue of sympathetic response accompanied by catecholamine activity. Hence suppression of this response is beneficial. The aim of this study was to compare the efficacy of Intravenous verapamil in two different doses with intravenous lignocaine in attenuating the hemodynamic responses to endotracheal intubation.


Ninety patients belonging to American Society of Anesthesiologists (ASA) class I and II, normotensive, in the age group of 18-60 years, who were scheduled for various elective surgical procedures, were included in the study and randomly allocated into 3 groups of 30 patients each; group I received verapamil (0.1 mg/kg), group II received verapamil (0.2 mg/kg) and group III received lignocaine (1.5 mg/kg), 90 seconds preceding laryngoscopy and intubation. Heart rate, systolic and diastolic blood pressure, mean arterial pressure and rate pressure product were recorded at different intervals. Statistical analysis was performed using ANOVA (Analysis of Variance) with repeated measures for comparison of above variables within and between groups for p-value. Setting and design the present prospective, randomised, double blind, controlled clinical study was carried out in a tertiary care teaching hospital.


Greatest attenuation of measured parameters measured after laryngoscopy namely heart rate, systolic and diastolic pressures and mean arterial pressures was seen in group 2 (verapamil 0.2 mg/kg) and as a result comparatively lower rate pressure product at 1, 3, 5 and 10 minutes post intubation providing greater cardio protective effect during laryngoscopy and endotracheal intubation.


The verapamil in a dose of 0.2 mg/kg showed superior attenuation than verapamil administered in a dose of 0.1 mg/kg and lignocaine in a dose of 1.5 mg/kg. The study establishes that the hemodynamic outcomes of laryngoscopy and tracheal intubation are short lasting and soon normalcy returns.