Abstract
Laryngoscopy and end tracheal intubation are stressful situation for the patients, as these procedures are capable of producing tachycardia, hypertension and arrhythmias. This study was conducted with the objective of arriving at an optimal dose of dexmedetomidine that can attenuate the hemodynamic response to laryngoscopy and intubation with minimal side effects. The current study was conducted in 60 patients, posted for elective surgery under general anesthesia withendotracheal intubation. The patients were divided into two groups: Group A and Group B. Group A received dexmedetomidine 0.5 μg/kg and group B received dexmedetomidine 1 μg/kg intravenously over 10 min prior to induction of anesthesia. The anesthesia technique was standardized in both the groups. Heart rate, systolic, diastolic and mean arterial pressure were monitored and recorded at 5min and 10 min of completion of infusion of study drug, after induction, and at 1 min, 2 min, 5 min after intubation. The baseline heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were statistically similar in both the groups. After the infusion of the study drug the mean heart rate, mean systolic blood pressure, mean diastolic blood pressure, mean arterial pressure at all times were comparable in both the groups. Episodes of hypotension and bradycardia were also statistically similar in both the groups. Attenuation of hemodynamic response to laryngoscopy and intubation by dexmedetomidine is similar with the two doses: 0.5 μg/kg and 1 μg/kg. Both the doses of dexmedetomidine were devoid of any significant adverse effects.
Highlights
Endotracheal intubation is the trans-laryngeal placement of a tube in the trachea via nose or mouth
Direct laryngoscopy and tracheal intubation leads to tachycardia, hypertension, and various types of arrhythmias which may prove fatal in patients with untreated hypertension, coronary artery disease, intracranial hypertension or aneurysm.[2]
The cardiovascular effects of laryngoscopy and intubation were first described by Reid and Brace in 1940.3 The peak rise in blood pressure and heart rate is usually transient, occurring 30 seconds after intubation and lasting for less than 10 min.[3]
Summary
Endotracheal intubation is the trans-laryngeal placement of a tube in the trachea via nose or mouth. The clinical benefits of endotracheal intubation are not without undesirable side effects. Direct laryngoscopy and tracheal intubation leads to tachycardia, hypertension, and various types of arrhythmias which may prove fatal in patients with untreated hypertension, coronary artery disease, intracranial hypertension or aneurysm.[2]. Dexmedetomidine has been reported to be very useful in blunting the hemodynamic effects of laryngoscopy and intubation. It has been studied in different doses. The dose of dexmedetomidine at which it blunts the stress response with minimal side effects is yet to be established in our population. In search of an optimal dose of dexmedetomidine for attenuation of stress response in Nepalese population, this study was planned
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