An Observational Study To Evaluate The Effects Of Preoperative Dexmedetomidine Nebulization On The Hemodynamic Response To Laryngoscopy And Intubation

Abstract

Introduction: Laryngoscopy and tracheal intubation are associated with hemodynamic changes such as tachycardia and hypertension due to increase in the plasma concentration of catecholamines subsequent to sympathetic stimulation.[1] This may be inconsequential in normal people but may lead to serious morbidity in patients with coexisting cerebrovascular or cardiovascular conditions. [2] The efficacy of Dexmedetomidine in decreasing the hemodynamic response to laryngoscopy and intubation has been studied through intravenous intranasal and intramuscular routes. Nebulized Dexmedetomidine, has been found to be an effective premedication in pediatric patients. [3, 4]

Method: A comparative observational study was conducted among 50 patients who underwent elective surgeries requiring general anesthesia and tracheal intubation. They were grouped into Group-D (Dexmedetomidine group) & Group-C (Control group) with 25 patients in each group. General anesthesia was given as per protocol under aseptic precautions. Group D received pre-operative nebulization with Dexmedetomidine (2μg/kg in 5 ml of 0.9% saline) while Group C received pre-operative nebulization with 5 ml 0.9% saline. Attempts and Duration of Intubation was noted. SBP, DBP and HR was also measured at specific intervals.

Results: In Group- D, the parameters were lower than the baseline value at 3 minutes time after intubation. However, hemodynamic variables never reached the baseline by 5 minutes time in case of Group- C. Neither bradycardia nor hypotension was observed in any of the patients. The sedation score was more in Group- D when compared to Group-C.

Conclusion: Pre-operative nebulization with Dexmedetomidine in a dose of 2 mcg/kg is effective and safe in attenuating the laryngoscopy & tracheal intubation sympathetic response.