Evaluation of Nebulised Dexmedetomidine Given Pre-operatively to Attenuate Hemodynamic Response to Laryngoscopy and Endotracheal Intubation: A Randomised Control Trial

Background and aim A variety of medications have been studied to reduce the hemodynamic response to laryngoscopy and intubation. Dexmedetomidine has been used intravenously in many studies to reduce the hemodynamic response to laryngoscopy and intubation. In high-risk patients, this pressor response can increase morbidity and mortality. As dexmedetomidine has a good bioavailability via the nebulisation route, we formulated this study to evaluate the effect of nebulised dexmedetomidine on the hemodynamic response to laryngoscopy and endotracheal intubation. Methods This is a prospective, randomised controlled trial conducted on 100 patients with the American Society of Anesthesiologists grade I and II. The primary objective of the study was to see if nebulised dexmedetomidine at a dose of 1 microgram/kg could reduce the stress reaction to laryngoscopy and intubation. The secondary objective was to study the dose sparing effect of nebulised dexmedetomidine on the amount of propofol used during induction of general anaesthesia. The study population was randomly divided into two groups: group A (n = 50) included patients nebulised with dexmedetomidine 1 microgram/kg and group B (n = 50) included patients nebulised with 5 ml saline 30 minutes before induction of anaesthesia in a sitting position. Results The demographics were similar in both groups. Following laryngoscopy and intubation, the systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate showed a significant increase in the control group B as compared to the treatment group A. In group A, there was attenuation in SBP (one minute = 113.2 ± 14.503, P < 0.001; five minutes = 109.86 ± 8.342, P < 0.001; 10 minutes = 114.24 ± 7.797, P = 0.010), DBP (one minute = 73.72 ± 10.986, P = 0.011; five minutes = 71.62 ± 9.934, P = 0.005; 10 minutes = 76.1 ± 8.006, P = 0.009), MAP (one minute = 86.80 ± 11.86, P = 0.001; five minutes = 84.44 ± 8.97, P = 0.006; 10 minutes = 88.72 ± 7.44, P = 0.018), and heart rate (one minute = 83.34 ± 12.325, P = 0.001; five minutes = 81.56 ± 13.33, P = 0.003; 10 minutes = 80.16 ± 14.086, P = 0.013) following laryngoscopy and intubation. Induction dose of propofol was significantly lower in the dexmedetomidine group (73 ± 19.509, P < 0.001). Conclusion Nebulised dexmedetomidine effectively blunts the hemodynamic response to laryngoscopy and intubation and also has a dose sparing effect on the induction dose of propofol.