Nebulised fentanyl, dexmedetomidine and magnesium sulphate for attenuation of haemodynamic response to laryngoscopy and tracheal intubation: A double-blinded, randomised comparative study

BACKGROUND AND AIMS: Direct laryngoscopy and tracheal intubation cause an increase in heart rate (HR) and blood pressure, called as pressor response. This study aimed to compare nebulised forms of fentanyl, dexmedetomidine and magnesium sulphate to attenuate the haemodynamic response to laryngoscopy and tracheal intubation. METHODS: This double-blinded, randomised study was conducted on 90 patients undergoing elective surgery requiring endotracheal intubation. Nebulisation was done with fentanyl 1 μg/kg (Group A), dexmedetomidine 1 μg/kg (Group B) and magnesium sulphate (MgSO(4)) (40 mg/kg) (Group C). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and HR were recorded before nebulisation (T(0)), post-nebulisation (T(1)) and at 2, 5 and 10 min after intubation (T(2), T(3), T(4)). The statistical analysis for comparing continuous variables between the groups was performed using analysis of variance (ANOVA), and a P value <0.05 was considered statistically significant. RESULTS: Compared to T(0), an increase in HR at T(2) and T(3) was seen in Group A only, which reached baseline values at T(4) (P values <0.0001 and 0.037, respectively). No HR value was higher than the baseline readings in groups B and C. The decreasing trend of SBP, DBP and MAP was seen in all three groups. Groups B and C had a statistically significant decrease in all the values from baseline (P values <0.0001). CONCLUSION: Nebulised form of dexmedetomidine (1 μg/kg) and magnesium (40 mg/kg) seems to be superior to fentanyl (1 μg/kg) in blunting the stress response to laryngoscopy and tracheal intubation.