Evaluation of nebulised dexmedetomidine in blunting haemodynamic response to intubation: A prospective randomised...

The process of laryngoscopy and endotracheal intubation is associated with intense sympathetic activity, which may precipitate intra-operative complications. Taking the advantage of dexmedetomidine's good bioavailability and rapid absorption through nasal mucosa; we contemplated this study to evaluate the effects of nebulised dexmedetomidine as a premedication in blunting the haemodynamic response to laryngoscopy and tracheal intubation.

This prospective, randomised, comparative study was conducted in 100 American Society of Anesthesiologists (ASA) I, II patients. The primary outcome was to evaluate the effects of dexmedetomidine nebulisation in blunting the stress response to laryngoscopy and intubation. The secondary outcome was to study its adverse effects. The study population was divided randomly into two groups. Control group C (n = 50) received nebulisation with 5 ml of normal saline and group D (n = 50) received 1 μg/kg dexmedetomidine 5 ml 10 min before induction in sitting position.

Demographics were comparable. Following laryngoscopy and intubation, systolic (SBP), diastolic (DBP) and mean arterial pressure (MAP), response entropy (RE) and state entropy (SE) were markedly increased in the control group whereas in group D there was a fall in SBP (at 1 min-126.64 ± 26.37; P 0.01, 5 min-109.50 ± 16.83; P 0.02, 10 min-106.94 ± 17.01; P 0.03), DBP (at 1 min-83.18 ± 17.89; P 0.001, 5 min-66.40 ± 13.88; P 0.001, 10 min- 62.56 ± 14.91; P 0.01) and MAP (at 1 min-99.68 ± 19.22; P 0.001, 5 min- 84.08 ± 13.66; P 0.003, 10 min- 81.74 ± 14.79; P 0.008), RE and SE which was statistically significant (P 0.002). There was a dose sparing effect of propofol in group D; sedation score was comparable.

Nebulised dexmedetomidine effectively blunts the stress response to laryngoscopy and intubation with no adverse effects.