Attenuation of haemodynamic responses to endotracheal extubation-diltiazem versus lidocaine

Background: Endotracheal extubation is one of the frequently performed procedure in the practice of anaesthesia. This study was done to observe the haemodynamic responses during tracheal extubation and to compare the efficacy of IV diltiazem 0.2 mg/kg versus IV lidocaine 1 mg/kg in attenuating the hemodynamic response to tracheal extubation. Methods: 90 patients aged 20 to 60 yrs, belonging to ASA I and II, normotensive were included in the study and they were randomly allocated into 3 groups of 30 each. Group I received normal saline and served as control. Group II received 0.2 mg/kg of IV diltiazem 2 min before extubation. Group III received 1 mg/kg of lidocaine IV 2 min before extubation. At the end of the surgery, heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded served as base line values. Results: After tracheal extubation, all the haemodynamic parameters increase from the basal level in the control group and decreased in the study group. The change in HR, SBP and DBP were significantly less in group II and group III compared to group I. The change in HR, SBP and DBP were significantly less in group II compared to group III. Conclusions: Diltiazem hydrochloride, a calcium channel blocker belongs to the benzothiazepine group given in dose of 0.2 mg/kg IV 2 min before tracheal extubation in ASA grade I and grade II patients is a simple, effective and practical method of blunting cardiovascular responses to tracheal extubation. This suppressive effect of diltiazem was comparable to or even more potent than that of lignocaine 1 mg/kg IV 2 min before tracheal extubation.