Title: Intravenous Dexmedetomidine to Obtund Stress Response to Laryngoscopy and Intubation
Authors: Dr Rakhi S.P, Dr Rommy Geever T.
DOI: http://dx.doi.org/10.18535/jmscr/v3i12.33
Background: In general anaesthesia, hypertension and tachycardia caused by endotracheal intubation may lead to cardiac ischemia and arrhythmias. Dexmedetomidine attenuates the hemodynamic response to endotracheal intubation and decreases anaesthetic requirement. The purpose of this study was to evaluate the effect of intravenous dexmedetomidine 1μg/kg given over 10 minutes before induction of anaesthesia, on haemodynamic stress response resulting from laryngoscopy and endotracheal intubation . Materials and Methods: Seventy patients scheduled for elective surgery were randomized into two groups each having thirty five patients-dexmedetomidine group (Group 1) and control group (Group 2). Heart rate, systolic blood pressure, and diastolic blood pressure were recorded at just before intubation, immediately after intubation, 1, 2, 3, 4, 5 minutes after intubation. Statistical Analysis: The data was analysed by SPSS 16.0 with independent t-test. Results: Pretreatment with dexmedetomidine 1 ug/kg attenuated the cardiovascular and catecholamine responses to tracheal intubation. Conclusions:Intravenous dexmedetomidine significantly attenuates sympathoadrenal response to laryngoscopy and endotracheal intubation, without affecting cardiovascular stability. Keywords: Dexmedetomidine, endotracheal intubation stress response, α2 adrenergic,laryngoscopy and hemodynamic changes. MeSH term: Dexmedetomidine Hydrochloride 1. Virtanen R, Savola JM, Saano V, Nyman L: Characterization of the selectivity, specificity and potency of dexmedetomidine as an alpha 2- adrenoreceptor agonist. European Journal of Pharmacology 1988; 150: 9-14. 2. Hall JE, Uhrich TD, Barney JA, Arain SR. Ebert TJ. Sedative, amnestic, and analgesic properties of small-dose Dexmedetomidine infusions. Anaesthesia Analgesia 2000; 90:699-705 3. Liu PL, Gatt S, Guigino LD, Mallampati SR, Convino BG. Esmolol for control of increases in heart rate and blood pressure during tracheal intubation after thiopentone and succinylcholine. Can Anaesthesia Soc. J 1986; 33;556-62. 4. Watwill M.Sundberg A, 01sson et al. Thoracolumbar epidural anaesthesia blocks the circulatory response to laryngoscopy and intubation. Acta. Anaesthesiol.Scand.l987; 529-531. 5. Thakker JM, Joshi GB, Shah RA. Sublingual nifedipine to attenuate response to laryngoscopy and intubation. Indian J Anaesthesia 1994; 42:209. King BD, Harris LC Jr, Brefenstein FE et al. Reflex circulatory response to direct laryngoscopy and tracheal intubation performed during general anaesthesia. Anesthesiology 1951; 1 6. King BD, Harris LC Jr, Brefenstein FE et al. Reflex circulatory response to direct laryngoscopy and tracheal intubation performed during general anaesthesia. Anesthesiology 1951; 1 7. James MF, Beer RE, Esser JD. Intravenous magnesium sulfate inhibits catecholamine release associated with tracheal intubation, Anaesth Analg 1989; 68:772-6. 8. Gallagher, Moore RA, Botors AB, Clark DL. Prophylactic nitroglycerine infusion during coronary artery bypasses surgery. Anaesthesiology 1986; 64;785-89. 9. Fassoulaki A and Kaniaris P. Intranasal administration of nitroglycerin attenuates the pressor response to laryngoscopy and intubation of the trachea. BrJAnaesth 1983; 55:49-52 10. Khan FA, Kamal RS. Effect of buprenorphine on cardiovascular response to tracheal intubation. Anaesthesia 1989; 44:394-7. 11. Dahlgren N, Messiter K. Treatment of stress response to laryngoscopy and intubation with fentanyl. Anaesthesia 1981; 36(11); 1022-1026. 12. Black TE, Kay B, HealyTEJ. Reducing the haemodynamic responses to laryngoscopy and intubation: A comparison of alfentanil with fentanyl. Anaesthesia 1984; 39:883-7. 13. Menkhaus PG, Reves JG, Kissin I et al. Cardiovascular effects of esmolol in anaesthetized humans. Anaesth Analg 1985; 64:327-34. Abstract
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