Attenuation of haemodynamic responses to laryngoscopy and endotracheal intubation with dexmedetomidine: A comparison between intravenous and intranasal route

Abstract

Background and Aims:Haemodynamic changes during endotracheal intubation are major concerns in general anaesthesia This study compared the efficacy of intranasal and intravenous dexmedetomidine (DEX) to attenuate the stress response of laryngoscopy and endotracheal intubation.Methods:In this prospective, randomised, double-blinded study, 70 adults were divided into two groups [Group DIV(n=35) and Group DIN(n=35)]. DIV group received intravenous dexmedetomidine (DEX) infusion (0.5 μg/kg) over 40 min and DIN group received intranasal dexmedetomidine (1 μg/kg) 40 min before induction. The primary objective was the comparison the mean arterial pressure (MAP) between two groups from 40 min before induction at every 10 min intervals till induction of anaesthesia, at the time of intubation, thereafter every 1 min interval till 5 min, at 7 min and 10 min after intubation. The secondary outcomes were comparison of heart rate, systolic and diastolic blood pressure along with sedation and other adverse effects. Statistical analysis was with Statistica 6.0 and Graph Pad prism version 5.Results:In both the groups, all the haemodynamic parameters were maintained within (20% of baseline values) throughout the study period. There was no statistically significant difference in MAP between two groups (P>0.05). Preoperative sedation score was significantly higher in the DIV group than the DIN group (P = 0.014).Conclusion:Like IV DEX, intranasal DEX can also attenuate the haemodynamic stress responses of laryngoscopy and endotracheal intubation without significant differences in MAP between two groups.

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

“…A dose of 1 μ/kg of dexmedetomidine was chosen in this study as it proved to be clinically effective both by the intranasal and IV routes in previous clinical studies. [ 7 18 19 20 ] The authors found a significant decrease in SBP, DBP and MAP at 1, 5 and 10 min after laryngoscopy and intubation in group D as compared to the control group. This significant decrease in BP from the baseline was due to the prevention of the stress response to laryngoscopy by dexmedetomidine.…”

Effect of preoperative dexmedetomidine nebulization on the hemodynamic response to laryngoscopy and intubation: a randomized control trial

“…It's pleiotropic effects have led to its increasing use in the perioperative period [10]. Dexmedetomidine has been studied through intravenous [11][12][13][14][15], intranasal [16,17], and intramuscular routes [18], to decrease the hemodynamic response to laryngoscopy and intubation. However, intravenous administration may cause bradycardia and hypotension and intranasal administration may be associated with irritation [19].…”

Comparative evaluation of oral melatonin and oral clonidine for the attenuation of haemodynamic response to laryngoscopy and tracheal intubation—A prospective randomised double blind study

“…[ 3 ] Various methods to attenuate the sympathetic response to laryngoscopy and achieve smoother manipulation of airway have been evaluated like topical anaesthesia of pharynx, superior laryngeal nerve block, intravenous lidocaine, beta blockers, opioids, calcium channel blockers, benzodiazepines, barbiturates, propofol, pregabalin, magnesium sulphate, nitroglycerin (intranasal and intravenous) and alpha2 adrenoceptor agonists like clonidine and dexmedetomidine (intravenous and intranasal). [ 4 5 6 ] However, the use of these agents is associated with the respective adverse effects like respiratory depression, hypotension, tachycardia, bradycardia, rebound hypertension or allergic reactions; hence, the quest for a better agent is always on.…”