Effect of dexmedetomidine by nebulizer for blunting stress response to direct laryngoscopy and intubation

Abstract

Introduction: Direct laryngoscopy and intubation are noxious stimuli and are associated with transient, unpredictable and variable hemodynamic changes. Dexmedetomidine has the potential to produce bradycardia and hypotension when administered as a bolus; in a way to solve this problem, nebulization route chosen. Nebulized dexmedetomidine has a bioavailability of 65%. Nebulized drug preferred over intranasal administration to avoids adverse effects. Aim and objectives:The aim of this study to evaluate the role of nebulized dexmedetomidine as a premedication in attenuating the stress response to laryngoscopy and intubation along with any adverse effects of drug. Materials and methods: 50 patients of ASA grade I and II elective surgery undergoing general anesthesia were randomly divided in two groups N and D, who received nebulized normal saline(5ml) and nebulized dexmedetomidine (1ug/kg diluted in 5ml NS) respectively with a nebulizer face mask for 10 min before induction of anesthesia in sitting position. Result: Following laryngoscopy and intubation, stress response markedly increased in the group N where stress response markedly decreases in group D. Conclusions: Nebulized dexmedetomidine effectively blunts the stress response to laryngoscopy and intubation with no adverse effects.

Nebulized dexmedetomidine for attenuating hemodynamic response to laryngoscopy and endotracheal intubation in adult patients undergoing surgeries under general anaesthesia: a systematic review and meta-analysis of randomized controlled trials

“…All reported stress response to endotracheal intubation as the primary outcome. However, only three studies reported sample size calculation [ 12 , 17 , 19 ]. The primary outcome of the studies were effect on HR, SBP and secondary outcomes were effect on DBP, MAP and safety analysis.…”

“…6 ). All the included studies described the method of randomization and were considered low risk except Sheth et al and Kaila et al which although mentioned that patients were randomized into two groups but the method of randomization was not mentioned [ 17 , 20 ]. Suryawanshi et al describe lottery method to randomly allocate the groups which is not considered the recommended method of randomization [ 18 ].…”

“…The blinding of the participants and personnel was done in all the studies (double blinded), except Sheth et al which was judged to be at unclear risk of bias due to deviation from the intended interventions (Fig. 4 ) [ 17 ]. Except for Misra et al and Shrivastava et al, none of the included studies provided trial registration number and were considered to have unclear risk of bias in selection of reported results [ 12 , 19 ].…”

“…1) [23]. A total of seven studies were selected [12,13,[16][17][18][19][20]. However, Kumar et al did not mention effect on HR which was the primary outcome of the study and data for BP (SBP, DBP and MBP) was provided only in graphical figures in the article from which the exact mean (SD) values at each time point could not be extracted for meta-analysis [13].…”

“… Induction dose of propofol, intraoperative fentanyl consumption and mean isoflurane requirements were significantly less in dexmedetomidine group versus control group. Sheth 2021, India [ 17 ] 29 ± 7.52 27 Dexmed 1 μg /kg in 5 ml NS 10 min before shifting to OT 25 5 ml NS 25 Glycopyrrolate 0.005 mg/kg IM, Fentanyl 2 μg/kg, Propofol 2 -2.5 mg/kg, atracurium 0.5 mg/kg IV There was significantly reduced SBP, DBP, MAP at 1, 5 and 10 min after laryngoscopy and intubation in dexmedetomidine compared to control group. No difference between the two groups in terms of HR response.…”