Title: Dexmedetomidine: A Novel Premedicant in RSI - A Clinical Study Conducted in a Tertiary Care Institution in South India
Authors: Beula G, Rajani Gandha Venkitachalam, Raman Naresh Kumar
DOI: https://dx.doi.org/10.18535/jmscr/v5i4.78
Abstract
Background: Patients often require a rapid sequence induction (RSI) endotracheal intubation technique during emergency ophthalmic surgeries which is often a nightmare to the anaesthesiologists as patients with penetrating eye injury often present with full stomach. Traditionally succinylcholine has been the most commonly used muscle relaxant for this purpose because of its fast onset and short duration; unfortunately, it can have serious side effects like increased intraocular pressure. Various drugs like sufentanil and clonidine has been studied in an attempt to use as a premedicant for blunting the rise in intraocular pressure with varying results. Dexmedetomidine is a selective alpha-2 adrenergic agonist that has IOP-lowering properties along with sedative and analgesic effects. Studies have shown dexmedetomidine reduces intraocular pressure, intubation responses and anaesthetic requirements in patients undergoing ophthalmic surgery.
Aim: To determine the effect of dexmedetomidine in the prevention of rise of IOP by succinylcholine during RSI intubation
Methods: 70 patients who are undergoing elective non ophthalmic surgery have been enrolled in this study. Adult patients in the age group 20-65 years weighing 60-80 kg of either sex falling under ASA I / II of American Society Of Anaesthesiologists (ASA) physical status classification. We collected the data using structured proforma and interpreted using Ramsay sedation scale, Schiotz tonometry for measuring IOP.
Results: Dexmedetomidine as a premedicant in patients undergoing surgeries under GA was found to reduce the IOP by 34% after a single i.v. dose of dexmedetomidine ( 0.6 mg/kg). Additionally, the pressor response to laryngoscopy and endotracheal intubation was also significantly attenuated
Conclusions: Premedication with intravenous Dexmedetomidine under the dose given in the present study design attenuates the rise in intraocular pressure following succinylcholine and intubation. The attenuation of haemodynamic stress response to laryngoscopy and intubation is an additional advantage. Hence dexmedetomidine could be used as a premedicant in situations where an increase in intraocular pressure following succinylcholine and intubation is prejudicial for patients.
Keywords-Anaesthesia; ophthalmic, RSI, Dexmedetomidine, increased intra-ocular pressure.
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