Attenuation of Pressor Response to Laryngoscopy in Severe Preeclampsia: Comparison the Efficacies Between Intravenous Nitroglycerine and Intravenous Hydralazine

Abstract

Introduction: Preeclampsia is one of the most commonly disorders of pregnancy. The pressor response to laryngoscopy is known to be exaggerated in patients with severe preeclampsia. The aim of this study was to assess the preoperative blood pressure control in severe preeclamptic mother with intravenous nitroglycerine is more effectively attenuate the haemodynamic response to laryngoscopy in comparison to treatment with intravenous hydralazine. Methods: This randomized fixed sealed envelope lottery method study was conducted in the Department of anaesthesiology of Dhaka Medical College Hospital, Dhaka, between October 2014 to March 2015 Total of 60 patients with severe preeclampsia and gestational age more than 36 weeks, who were presented for elective or urgent caesarean delivery under general anaesthesia were randomly divided into two groups, group A, n=30 received 50 mcg intravenous nitroglycerine. Group B received 5mg hydralazine intravenously very slowly. Heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and mean arterial pressure (MAP) were simultaneously recorded in the mother at pre-induction, pre-laryngoscopy, and at 1min, 3 min, and 5 min after laryngoscopy. Result: The patients in group A and group B showed no significant difference in HR, SAP, DAP and MAP at pre induction and pre laryngoscopy. But there is significant difference (P<0.05) at 1, 3, 5 min after laryngoscopy. The mean heart rate at 1, 3 and 5 minutes after laryngoscopy were significantly (p<0.05) higher in group B than group A. The mean SAP, DAP, MAP were also significantly (p<0.05) higher in group B than group A at 1, 3, 5 min after laryngoscopy. Conclusion: Women with severe preeclampsia who were preoperatively treated with intravenous nitroglycerine provides a safe and more effective prophylaxis for patients with severe preeclampsia undergoing cesarean delivery under general anesthesia, in attenuating haemodynamic responses to laryngoscopy.