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Effect of Dexmedetomidine Nebulization on Attenuation of Haemodynamic Responses to Laryngoscopy

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Introduction: Dexmedetomidine is a potent and highly selective alpha (2)-adrenoreceptor agonist. It has sympatholytic and antinociceptive effects which allow hemodynamic stability during stressful condition e.g. Laryngoscopy and surgical stimulation. This study has been done to assess the efficacy of nebulization of Dexmedetomidine to obtund the sympathetic response of laryngoscopy and tracheal intubation. Material and Methods: The present study was conducted on 70 patients of ASA physical status I and II, aged between 18 and 50 years of either sex, scheduled for elective surgeries under general anaesthesia. The preoperative vitals of each patient [HR, SBP, DBP and MAP] was recorded in waiting room of operation theatre. The patients were randomly divided into two groups. In preoperative room/ waiting area, Group-N (Normal saline group) patients were nebulized with normal saline (5 ml) and in Group-D (Dexmedetomidine group) patients were nebulized with Dexmedetomidine solution (2 mcg/kg) 30 minutes prior the induction of anaesthesia. All patients were induced with Inj. Fentanyl 2 mcg/kg, Inj. Propofol 2 mg/kg and paralyzed with Inj. Vecuronium 0.1 mg/kg. After confirming adequate neuromuscular blockade HR, SBP, DBP and MAP were recorded; Laryngoscopy was done [keeping laryngoscopy timing < 15 seconds] & patients were intubated with standard/ adequate size endotracheal tube. Heart rate and blood pressure were recorded after intubation at 1minute interval for 5 minutes. During this time no other stimuli were given to the patient (e.g. surgical drape, catheterization, Ryle’s tube etc.). The comparison was made between hemodynamic parameters obtained at pre-laryngoscopy and post laryngoscopy time period. Result: We found that in Group- D, the parameters were lower than the baseline value at 3 min time after intubation. However, hemodynamic variables never reached the baseline by 5 minutes time in case of Group- N. Neither bradycardia nor hypotension was observed in any of the patients. The sedation score was more in Group- D when compared to Group- N. This indicates that nebulization with Dexmedetomidine in a dose of 2 mcg/kg is effective and safe in attenuating the laryngoscopy & tracheal intubation sympathetic response.

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Introduction: Dexmedetomidine is a potent and highly selective alpha (2)-adrenoreceptor agonist. It has sympatholytic and antinociceptive effects which allow hemodynamic stability during stressful condition e.g. Laryngoscopy and surgical stimulation. This study has been done to assess the efficacy of nebulization of Dexmedetomidine to obtund the sympathetic response of laryngoscopy and tracheal intubation. Material and Methods: The present study was conducted on 70 patients of ASA physical status I and II, aged between 18 and 50 years of either sex, scheduled for elective surgeries under general anaesthesia. The preoperative vitals of each patient [HR, SBP, DBP and MAP] was recorded in waiting room of operation theatre. The patients were randomly divided into two groups. In preoperative room/ waiting area, Group-N (Normal saline group) patients were nebulized with normal saline (5 ml) and in Group-D (Dexmedetomidine group) patients were nebulized with Dexmedetomidine solution (2 mcg/kg) 30 minutes prior the induction of anaesthesia. All patients were induced with Inj. Fentanyl 2 mcg/kg, Inj. Propofol 2 mg/kg and paralyzed with Inj. Vecuronium 0.1 mg/kg. After confirming adequate neuromuscular blockade HR, SBP, DBP and MAP were recorded; Laryngoscopy was done [keeping laryngoscopy timing < 15 seconds] & patients were intubated with standard/ adequate size endotracheal tube. Heart rate and blood pressure were recorded after intubation at 1minute interval for 5 minutes. During this time no other stimuli were given to the patient (e.g. surgical drape, catheterization, Ryle’s tube etc.). The comparison was made between hemodynamic parameters obtained at pre-laryngoscopy and post laryngoscopy time period. Result: We found that in Group- D, the parameters were lower than the baseline value at 3 min time after intubation. However, hemodynamic variables never reached the baseline by 5 minutes time in case of Group- N. Neither bradycardia nor hypotension was observed in any of the patients. The sedation score was more in Group- D when compared to Group- N. This indicates that nebulization with Dexmedetomidine in a dose of 2 mcg/kg is effective and safe in attenuating the laryngoscopy & tracheal intubation sympathetic response.

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This page is a summary of: Effect of Dexmedetomidine Nebulization on Attenuation of Haemodynamic Responses to Laryngoscopy: Randomized Controlled Study, Indian Journal of Anaesthesia and Analgesia, January 2019, Red Flower Publication Private, Ltd.,
DOI: 10.21088/ijaa.2349.8471.6419.27.
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