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

Kumar, Nimmagadda R R; Jonnavithula, Nirmala; Padhy, Shibani; Sanapala, Virinchi; Naik, Vadithe Vasram

doi:10.4103/ija.ija_235_20

Cited by 29 publications

(39 citation statements)

References 24 publications

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“…It was found that inhalation of the drug effectively blunted the stress response to laryngoscopy and intubation with no adverse effects. 48 These promising outcomes provide an avenue for further exploration of the inhalational administration of dexmedetomidine.…”

Section: Route Of Administrationmentioning

confidence: 99%

Recent Advances in the Clinical Value and Potential of Dexmedetomidine

Liu¹,

Li²,

Kang³

et al. 2021

JIR

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Dexmedetomidine, a highly selective α2-adrenoceptor agonist, has sedative, anxiolytic, analgesic, sympatholytic, and opioid-sparing properties and induces a unique sedative response which shows an easy transition from sleep to wakefulness, thus allowing a patient to be cooperative and communicative when stimulated. Recent studies indicate several emerging clinical applications via different routes. We review recent data on dexmedetomidine studies, particularly exploring the varying routes of administration, experimental implications, clinical effects, and comparative advantages over other drugs. A search was conducted on the PubMed and Web of Science libraries for recent studies using different combinations of the words “dexmedetomidine”, “route of administration”, and pharmacological effect. The current routes, pharmacological effects, and application categories of dexmedetomidine are presented. It functions by stimulating pre- and post-synaptic α2-adrenoreceptors within the central nervous system, leading to hyperpolarization of noradrenergic neurons, induction of an inhibitory feedback loop, and reduction of norepinephrine secretion, causing a sympatholytic effect, in addition to its anti-inflammation, sleep induction, bowel recovery, and sore throat reduction effects. Compared with similar α2-adrenoceptor agonists, dexmedetomidine has both pharmacodynamics advantage of a significantly greater α2:α1-adrenoceptor affinity ratio and a pharmacokinetic advantage of having a significantly shorter elimination half-life. In its clinical application, dexmedetomidine has been reported to present a significant number of benefits including safe sedation for various surgical interventions, improvement of intraoperative and postoperative analgesia, sedation for compromised airways without respiratory depression, nephroprotection and stability of hypotensive hemodynamics, reduction of postoperative nausea and vomiting and postoperative shivering incidence, and decrease of intraoperative blood loss. Although the clinical application of dexmedetomidine is promising, it is still limited and further research is required to enhance understanding of its pharmacological properties, patient selection, dosage, and adverse effects.

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Section: Route Of Administrationmentioning

confidence: 99%

Recent Advances in the Clinical Value and Potential of Dexmedetomidine

Liu¹,

Li²,

Kang³

et al. 2021

JIR

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“…This response occurs after direct laryngoscopy and intubation and lasts less than 10 min. sometime they precipitate ischemia, arrhythmias, cerebrovascular stroke, pulmonary oedema, increase in intracranial pressure in the vulnerable group [1,7] . Use of various drugs and various routes such as opioids, vasodilators, beta-blockers, calcium channel blockers, intravenous lignocaine, topical sprays, volatile agents, α2 agonist, intravenous, intranasal, nebulizer have been used for prevention of this stress response [1,9] .…”

Section: Introductionmentioning

confidence: 99%

“…sometime they precipitate ischemia, arrhythmias, cerebrovascular stroke, pulmonary oedema, increase in intracranial pressure in the vulnerable group [1,7] . Use of various drugs and various routes such as opioids, vasodilators, beta-blockers, calcium channel blockers, intravenous lignocaine, topical sprays, volatile agents, α2 agonist, intravenous, intranasal, nebulizer have been used for prevention of this stress response [1,9] . Dexmedetomidine, a selective alpha2-adrenoceptor agonist, is short-acting and has sedative, hypnotic, anxiolytic, analgesic, anti-sialagogue, sympatholytic properties and promotes cardiac, respiratory and neurological stability [2] .…”

Section: Introductionmentioning

confidence: 99%

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

Sheth¹,

Hathiwala²,

Shah³

2021

Int. J. Med. Anesthesiology

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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.

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“…Dexmedetomidine and clonidine both have been used for blunting of haemodynamic response to laryngoscopy and tracheal intubation. [ 8 9 ] We designed this study to evaluate and compare the efficacy of dexmedetomidine and clonidine for producing controlled hypotension during FESS. The primary objective of the study was to assess and compare the hypotensive effectiveness and haemodynamic stability of dexmedetomidine and clonidine in FESS by comparing the haemodynamic parameters from the baseline at different time intervals within each group (intragroup) and between both the groups (intergroup).…”

Section: Introductionmentioning

confidence: 99%

Comparison of hypotensive properties of dexmedetomidine versus clonidine for induced hypotension during functional endoscopic sinus surgery: A randomised, double-blind interventional study

et al. 2021

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Background and Aims: Excessive bleeding is a major concern in functional endoscopic sinus surgery (FESS) under general anaesthesia; this can be decreased by various hypotensive agents. This study was conducted to compare the hypotensive effectiveness and haemodynamic stability of dexmedetomidine and clonidine in patients undergoing elective FESS. Methods: In this prospective double-blinded interventional study, 70 adult patients of either sex, 20–50 years of age, posted for elective FESS were randomly assigned to two groups. Group A received a loading dose of intravenous (IV) dexmedetomidine 1 μg/kg, followed by infusion of 1 μg/kg/h, and group B received a loading dose of IV clonidine 2 μg/kg, followed by 1 μg/kg/h infusion. Surgical field quality, emergence time, sedation score, visual analogue score, recovery profile and haemodynamic parameters were recorded. Statistical analysis was done by Student's unpaired t -test to evaluate the significance of normally distributed variables, whereas Mann–Whitney test and Chi-square test were used for ordinal data and categorical variables and proportions, respectively. Results: In both the groups, target mean arterial pressure (MAP) of 65–70 mmHg and improved surgical field quality were achieved. MAP and heart rate (HR) were statistically significantly lower in the dexmedetomidine group with a longer duration of post-operative analgesia ( P = 0.001). None of the groups showed any statistically significant adverse effects. Conclusions: Both dexmedetomidine and clonidine can be used for controlled hypotension to improve surgical field quality in FESS. Dexmedetomidine provides more haemodynamic stability and an additional benefit of post-operative analgesia and conscious sedation.

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

Cited by 29 publications

References 24 publications

Recent Advances in the Clinical Value and Potential of Dexmedetomidine

Recent Advances in the Clinical Value and Potential of Dexmedetomidine

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

Comparison of hypotensive properties of dexmedetomidine versus clonidine for induced hypotension during functional endoscopic sinus surgery: A randomised, double-blind interventional study

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