Comparison of magnesium sulfate and lidocaine on hemodynamic response and cortisol levels after intubation in patients undergoing craniotomy

Abstract

Objective: Responses to stress following craniotomy can vary from elevated hemodynamics to elevated cortisol levels in the body. Intubation is a major factor that must be considered during the induction of neuroanesthesia. Magnesium sulfate has the advantage of maintaining the stability of brain autoregulation and is neuroprotective.

Methodology: The study was conducted after receiving ethical clearance from the Health Research Ethics Committee of the University of North Sumatra (No. 94/KEPK/USU/2024). The trial was registered at ClinicalTrials.gov under the identifier NCT06516861 on July 24, 2024. We included 30 patients, aged 18–65 years; body mass index (BMI) 18.5–29.9 kg/m², consecutively, undergoing craniotomy at our hospital. The patients were randomly divided into three equal groups; patients who received lidocaine, or MgSO₄ and a control group, who received normal saline as a placebo. Post-induction and intubation, hemodynamic parameters, including systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP), and heart rate, were measured at 3, 5, 7, and 10 min (T1, T2, T3, and T4) following intubation. Serum cortisol levels were assessed at baseline (T0) and post-intubation.

Results: There were significant differences between the three groups with hemodynamic and serum cortisol levels found to be lower in the lidocaine group. (P = 0.001). Significant differences were observed among the three groups, with the lidocaine group showing lower hemodynamic parameters (systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate) and serum cortisol levels (P = 0.001).

Conclusion: Intravenous administration of lidocaine 1.5 mg/kg is more effective in attenuating the stress response in the form of increased blood pressure, heart rate, and serum cortisol levels due to laryngoscopy and intubation in patients undergoing craniotomy than intravenous administration of MgSO₄ 30 mg/kg

Keywords: Craniotomy; Intubation; Lidocaine; MgSO₄

Citation: Irina RS, Radiansyah A, Kurniawan H. Comparison of magnesium sulfate and lidocaine on hemodynamic response and cortisol levels after intubation in patients undergoing craniotomy. Anaesth. pain intensive care 2025;30(1):88-94. DOI: 10.35975/apic.v30i1.3107

Received: May 09, 2025; Revised: October 26, 2024; Accepted: January 01, 2025