Comparison Of Sublingual Nitroglycerin Spray Vs Normal Saline Spray In Attenuating The Pressor Response To Extubation: A One Year Hospital Based Randomised Controlled Trial

Abstract

Introduction The pressor response to extubation is seen in the form of increased HR, SBP, DBP and MAP. This effect may be well tolerated in ASA I patients but have deleterious effects on patient with history of cardiac diseases, CVA, Hypertensive individuals. Various methods have been tried to attenuate the response to extubation such as non pharmacological methods like extubation in deeper plane of anesthesia , using supra glottis airway devices and pharmacological methods such as Magnesium sulphate, dexmedetomidine, clonidine, fentanyl, remifentanyl, NTG etc. OBJECTIVES To compare the efficacy of one puff of sublingual NTG spray V/s one puff of NS spray to attenuate pressor response to extubation. METHODOLOGY The present study was conducted at, KLE’S Dr. Prabhakar Kore Hospital and Medical Research Centre, Nehru nagar, Belagavi 590010 on 60 patients between the age group of 18-60 years of either gender belonging to ASA I and II undergoing elective surgeries under GA were included in the study and randomized to 2 groups. Group A received one puff of Sublingual NTG spray (0.4 mg) and Group B received one puff of NS spray 1 minute after neuromuscular reversal was given. HR, SBP, DBP, MAP and SpO2 were recorded before reversal (TR) and at the time of reversal(To) and thereafter every minute till 10 minutes. Time of extubation was noted. Side effects like hypotension were noted. RESULTS It was observed that there was increase in heart rate, systolic blood pressor and diastolic blood pressure during extubation but NTG group had better hemodynamic stability as compared with NS group.This attenuation of pressor response to extubation ( SBP, DBP, MAP) in group A when compared to group B which was statistically highly significant with p value being <0.0001. Tachycardia was observed in both the groups. NTG is known to cause reflex tachycardia but in our study it was not that significant. CONCLUSION 1 puff(0.4 mg) of sublingual NTG spray is effective in attenuatingpressor response to extubation which is easy to administer,safe and cost effective.