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

Satyajeet Misra, Bikram Kishore Behera, Jayanta Kumar Mitra, Alok Kumar Sahoo, Sritam Swarup Jena, Anand Srinivasan
Korean Journal of Anesthesiology 2020 May 20

Background: Dexmedetomidine, an alpha-2 agonist, has been used for attenuation of hemodynamic response to laryngoscopy, but not through the nebulized route. The aims of this study were to evaluate the effect of preoperative dexmedetomidine nebulization on the hemodynamic response to laryngoscopy-intubation, intraoperative anesthetic-analgesic requirements and recovery outcomes.

Methods: 120 ASA I & II adult patients, of either gender, undergoing elective surgeries requiring tracheal intubation were enrolled and randomized to receive nebulized dexmedetomidine (1 µg/kg in 3-4 ml of 0.9% saline) or 0.9% saline (3-4 ml), 30 minutes before anesthesia induction. Heart rate and non-invasive systolic blood pressures were studied for 10 minutes following laryngoscopy.

Results: After laryngoscopy, linear mixed effect modelling showed significantly lower trend of increase in heart rate in the dexmedetomidine group versus saline (P = 0.01). However, there was no difference in the systolic blood pressure changes between the two groups (P= 0.90). Induction dose of propofol (P < 0.001), intraoperative fentanyl consumption (P = 0.007) and isoflurane requirements (P = 0.01) were significantly lower in the dexmedetomidine group. There was no difference in the 2-hr postoperative nausea and vomiting (PONV) (P = 0.61) or sore-throat (P = 0.74).

Conclusions: Nebulized dexmedetomidine 1 µg/kg attenuated the increase in heart rate but not systolic blood pressures following laryngoscopy; and reduced the intraoperative anesthetic and analgesic consumption. There was no effect on early PONV, sore-throat or increase in incidence of adverse effects. Nebulized dexmedetomidine may represent a favorable alternative to the intravenous route in short duration surgeries.

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