Intravenous dexmedetomidine 1µg/kg as premedication to attenuate hemodynamic response to laryngoscopy and endotracheal intubation in surgeries under general anesthesia

Authors

  • Dixitkumar B. Modh Associate Professor, Department of Anaesthesiology, GMERS Medical College and Hospital, Dharpur-Patan, Gujarat, India
  • Pratiti Gohil Assistant professors, Department of Anaesthesiology, GMERS Medical College and Hospital, Dharpur-Patan, Gujarat, India
  • Manthan Parmar Assistant professors, Department of Anaesthesiology, GMERS Medical College and Hospital, Dharpur-Patan, Gujarat, India

DOI:

https://doi.org/10.18203/2349-2902.isj20171923

Keywords:

Dexmedetomidine, Endotracheal intubation, Hemodynamic, Laryngoscopy, Premedication

Abstract

Background: Choice of premedication and hemodynamic stability are always remain important concerns during laryngoscopy and endotracheal intubation for Anesthesiologists. Dexmedetomidine offers anxiolytic, sedation, hypnosis, analgesia, antisialagogue action as well as sympatholysis which make most suitable drug as premedication. Our aims for this study to evaluate efficacy of Injection Dexmedetomidine 1µg/kg intravenously as premedication on attenuation of hemodynamic changes to laryngoscopy and intubation as well as requirement of injection Propofol as an induction agent.

Methods: In Present study, 60 patients of ASA I, II of age 18 to 45 years were randomly divided in to two groups of 30 each. In group NS, 10 ml normal saline and in group D1 injection Dexmedetomidine 1µg/kg diluted in 10 ml of normal saline was used. In both groups study solutions administered over 10 minutes. Both the groups were administered standard general anaesthesia and requirement of Propofol was noted as an induction agent. Heart rate, blood pressure (systolic, diastolic and mean arterial pressure) were compared at baseline, 2 min, 5 min, 10 minutes (SD2, SD5, SD10) after study drugs administration, before induction (BI), after induction (AI), 1 minute (T1), 2 minutes (T2), 5 minutes (T5) and 10 minutes (T10) after laryngoscopy and intubation in both groups.

Results: HR, SBP, DBP and MAP highly significantly reduced at 2 min, 5 min and 10 minutes after infusion of Dexmedetomidine in group D1 as compared to group NS. (P<0.01). After induction values are highly significant in group D1 than group NS from baseline (P<0.01). Highly significant mean rise in hemodynamic parameters (HR, SBP, DBP and MAP) from baseline were observed in group NS compared to group D1 after laryngoscopy and intubation (P<0.01). Induction dose requirement of inj. Propofol significantly reduced in group D1 compared to other group (P<0.01).

Conclusions: Injection Dexmedetomidine 1µg/kg provides effective and complete attenuation of pressure response to laryngoscopy and endotracheal intubation as premedication with decreased requirement of inj. Propofol for induction without any side effects.

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References

Prays RC, Green LT, Meloche R, Foex P. Studies of anaesthesia in relation to hypertension II. Haemodynamic consequences of induction and endotracheal intubation. Br J Anaesth. 1971;43(6): 531-47.

Fox EJ, Sklar GS, Hill CH, Villanue Var, King BD. Complications related to the pressure response to endotracheal intubation. Anaesthesiology. 1977; 47(6):524-25.

Bruder N, Ortega D, Granthil C. Consequences and prevention methods of hemodynamic changes during laryngoscopy and intratracheal intubation. Ann Fr Anesth Reanim. 1992;11(1);57-71.

Steeds C, Harris L, Greifenstein F, Elder J, Dripps RD. Reflex circulatory responses to direct laryngoscopy and intubation under general anaesthesia. Anaesthesiology. 1951;12(5):556-66.

Michael JS, Chang FL, Ho ST. Anaesthetic premedication: New horizons of an old practice. Acta Anesthesiologica Taiwainica. 2014;52(3):134-142.

Khan FA, Ullah H. Pharmacological agents for preventing morbidity associated with the haemodynamic response to tracheal intubation. Cochrane Database Syst Rev. 2013;7:CD004087.

Ebert JP, Pearson D, Gelman S, Harris C, Bradley EL. Circulatory response to laryngoscopy. The comparative effects of placebo, Fentanyl and Esmolol. Canadian J anaesthesia. 1989;36(3 pt. 1):301-6.

Gulabani M, Gurha P, Dass P, Kulshreshtha N. Comparative analysis of efficacy of lignocaine 1.5 mg/kg and two different doses of Dexmedetomidine (0.5 µg/kg and 1 µg/kg) in attenuating the hemodynamic pressure response to laryngoscopy and intubation. Anaesth essays Res. 2015;9(1):5-14.

Bloor BC, Ward DS, Belleville JP, Maze M. Effects of intravenous Dexmedetomidine in humans II. Haemodynaemic changes. Anaesthesiology. 1992; 77(6):1134-42.

Anju G. Dexmedetomidine: New avenues. J anaesthesiol Clin Pharmacol. 2011;27(3):297-302.

Arcangeli A, Alo DC, Gaspari R. Dexmedetomidine use in general anesthesia. Curr Drug Targets. 2009;10(8):687-95.

Gertler R, Brown HC, Mitchell DH, Silvius EN. Dexmedetomidine: a novel sedative-analgesic agent. In Baylor University Medical Center. Proceedings 2001;14(1):13.

Smitha KS, Shukla D, Sathesha M, Rao NS, Sudheesh K. Comparison of two different doses of dexmedetomidine in attenuating hemodynamic changes during laryngoscopy. J Evol Med Dent Sci. 2014;3:13501-8.

Raval DL, Yadav VP. A comparative study of two different doses of Dexmedetomidine on haemodynamic response to induction of anesthesia and tracheal intubation. J Clin Exp Res. 2014;2(3): 163-8.

Sagiroglu AE, Celik M, Orthon Z, S. Yuzer, B. Sen. Different doses of Dexmedetomidine on controlling haemodynamic response to tracheal intubation. Int J Anaesthesiol. 2010;27:2.

Aho M, Lehtinen AM, Erkola O, Kallio A, Korttila K. The effect of intravenously administered dexmedetomidine on perioperative hemodynamics and isoflurane requirements in patients undergoing abdominal hysterectomy. Anesthesiology. 1991;74(6):997-1002.

Nath SS, Singh S, Pawar ST. Dexmedetomidine overdosage: an unusual presentation. Indian J of Anaesth. 2013;57(3);289-91.

Belleville JP, Ward DS, Bloor BC, Maze M. Effects of intravenous Dexmedetomidine in humans I. Sedation, ventilation and metabolic rate. Anaesthesiology. 1992;77(6):1125-33.

Ebert TJ, Hall JE, Barney JA, Uhrich TD, Colinco MD. The effects of increasing plasma concentrations of Dexmedetomidine in humans. Anaesthesiology. 2000;93(2):382-84.

Sulaiman S, Karthekeyan RB, Vakamudi M, Sundar AS, Ravullapalli H, Gandham R. The effects of dexmedetomidine on attenuation of stress response to endotracheal intubation in patients undergoing elective off-pump CABG. Ann Card Anaesth 2012;15(1):39.

Menda F, Koner O, Sayim M, Titre H, Imer P, Aykac B. Dexmedetomidine as an adjuvant to anesthetic induction to attenuate hemodynamic response to endotracheal intubation in patients undergoing fast track CABG. Ann Card Anaesth. 2010;13(1):16-21.

Keniya VM, Ladi S, Naphade R. Dexmedetomidine attenuates sympathoadrenal response to tracheal intubation and reduces perioperative anaesthetic requirement. Indian J Anaesth. 2011;55(4):352-7.

Bashir F, Rather MA, Bashir K. Dexmedetomidine decreases propofol requirement for induction of anaesthesia: A comparative study conducted on patients undergoing laproscopic cholecystectomy. J Evol Med and Dent Sci. 2015;4(32):5428-33.

Sen S, Chakraborty J, Santra S, Mukherjee P, Das B. The effect of dexmedetomidine infusion on propofol requirement for maintenance of optimum depth of anaesthesia during elective spine surgery. Indian J Anaesth. 2013;57(4):358.

Ghodki PS, Thombre SK, Sardesai SP, Harnagle KD. Dexmedetomidine as an anesthetic adjuvant in laproscopic surgery: An observational study using entropy monitoring. J Anesthesiol clin Pharmacol. 2012;28(3):334-8.

Sowbhagyalaxmi B, Manduri SR, Pothula K. Effect of Dexmedetomidine vs placebo on Propofol induction and savoflurane maintenance requirements in laproscopic cholycystectomies using BIS guided general anaesthesia. J Evol Med Dent Sci. 2015;1(4):608-15.

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Published

2017-05-24

How to Cite

Modh, D. B., Gohil, P., & Parmar, M. (2017). Intravenous dexmedetomidine 1µg/kg as premedication to attenuate hemodynamic response to laryngoscopy and endotracheal intubation in surgeries under general anesthesia. International Surgery Journal, 4(6), 1884–1888. https://doi.org/10.18203/2349-2902.isj20171923

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Original Research Articles