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Volume 12 Issue 1 (January- March) 2023

Original Articles

Effect of pre-operative dexmedetomidine nebulisation on the hemodynamic response to laryngoscopy and intubation
Dr .Deeksha kaila, Dr .Shikha Sharma, Dr. Nandita Mehta, Dr. Junaid Jeelani Dr. Wani Arshid Rasool, Dr. Misger Mudasir Nazir

Introduction: Dexmedetomine is a highly potent alpha -2 receptor agonist.It has sympatholytic ,sedative and analgesic effects thus decreasing the sympathetic tone with attenuation of the hemodynamic responses to anesthesia i.e laryngoscopy and intubation.Various routes have been employed to attenuate the hemodynamic response to laryngoscopy and intubation.Nebulised dexmedetomidine provides an alternative to intravascular and intranasal routes due to its rapid absorption and better bio availability. We contemplated this study to evaluate the effect of nebulised dexmedetomidine in blunting the hemodynamic response to laryngoscopy and intubation. Methods: Randomized controlled study was done in 80 patients of ASA physical status 1,aged between 20-50 years of either sex, scheduled for elective surgeries under general anesthesia. Patients were assigned to two equal groups Group N: (Normal saline) patients received 0.9% saline nebulisation (3-4ml), 30 minutes before induction of anesthesia. Group D: (dexmedetomidine) patients received 1microgram/kg dexmedetomidine nebulisation diluted in 3-4ml of 0.9% saline, 30 minutes before induction of anesthesia.Hemodynamic parameters like HR and BP(SBP,DBP,MAP) was measured at various intervals:Before administration of nebulisation, after nebulisation but before induction of anesthesia (baseline),at every 2min interval until 10 min after laryngoscopy. Results: Nebulised dexmedetomidine was effective in blunting the haemodynamic response to laryngoscopy and intubation without any adverse effects. The increase in HR was significantly attenuated in the dexmedetomidine group versus saline following intubation .The mean heart rate immediately after intubation was 79.16±13 and at 2,4,6,8,and 10 minutes was76.08±5.89,74.08±4.83,74.2± 5.37,72.33± 4.84 respectively with p value <0.001. There was a statistically significant difference in SBP,DBP and MAP at 2,4,6 and 8 min after intubation in dexmedetomidine group.The decline in SBP was observed at (2min 98.28±12.28, 4min 99.18± 13.66, 6th min 98.9 ± 15.94 and 8th min 106.05± 13.56 with p value <0.001).Similarly, decline in DBP at 2,4,6 and 8 min was (61.15±9.88,63.2± 10.08,61.48 ±10.18 and 66.33± 10.4 with p value <0.001) and decline in MAP at similar time intervals was( 75.3 ± 9.87, 75.8 ± 9.66,75.48 ± 11.35 and 80.63 ± 10.75 with p value <0.001). Conclusion: Nebulised dexmedetomidine blunts the stress response to laryngoscopy and intubation. Hence in a dose of 1mcg/kg can be used in patients safely without any adverse effect.

 
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