• Ramyavel Thangavelu, Ranjan R Ventakesh, and Kandasamy Ravichandran.
• Department of Anaesthesiology, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry, India.
• Anesth Essays Res. 2018 Apr 1; 12 (2): 338-343.

ContextBoth intubation and extubation are associated with pressor response.AimsWe aimed to evaluate if ropivacaine 0.25% nebulization would prevent hemodynamic and cough responses to intubation and extubation and compared it with lignocaine 2% and saline group.Settings And DesignThis was a randomized double-blind clinical trial.Materials And MethodsA total of 75 patients classified as the American Society of Anaesthesiologists physical status Classes I and II belonging to 18-60 years were included in the randomized double-blind trial and divided into three groups; Group 1: received 5 ml of normal saline, Group 2: received 5 ml of 0.25% ropivacaine, Group 3: received 5 ml of 2% lignocaine through nebulization before the induction. Patients were then administered general anesthesia. Mean arterial pressure (MAP), heart rate (HR), and saturation were recorded at baseline (T1), at intubation (T2), upon anesthetic withdrawal (T3), upon eye opening (T4), upon extubation (T5), and 2 min after extubation (T6). Cough response was recorded at emergence and extubation.Statistical Analysis UsedRepeated measures analysis of variance were used to compare hemodynamic variables and Chi-square test to compare the grades of cough between the two groups.ResultsThe drug ropivacaine was found to be effective in reducing the hemodynamic responses to both intubation and extubation when compared to saline (P < 0.05). At extubation, though the mean values of HR and MAP were lower in ropivacaine compared to lignocaine group, the difference did not achieve statistical significance (P = 0.103 and 0.153 respectively). Only 40% of patients who received ropivacaine had cough at extubation (P < 0.001).ConclusionRopivacaine when used through nebulization preinduction effectively reduced both intubation and extubation responses when compared to saline. However, there was no significant difference between the ropivacaine and lignocaine on extubation response.

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