A comparative study of intramuscular dexmedetomidine alone and intramuscular dexmedetomidine with intravenous fentanyl on hemodynamic response to laryngoscopy and endotracheal intubation for ear surgery under general anesthesia

Abstract

Dexmedetomidine, a potent α2-adrenergic agonist with its sedative, anxiolytic, analgesic and sympatholytic property ; is an ideal agent for premedication. The intravenous bolus is associated with bradycardia and hypotension; hence we studied the intramuscular route for hemodynamic stability.: Sixty adult patients of ASA physical status I and II, aged between 18-60 years, posted for ear surgery received intramuscular dexmedetomidine 2.5µg/kg 60 minutes prior to induction of anesthesia as premedication in recovery room with either injection saline bolus in group D (n=30) or intravenous fentanyl 1.5 μg/kg group DF (n=30) 2 mines before induction in operation theatre. Standard induction technique was used. Sedation score and hemodynamic changes during laryngoscopy were recorded. During laryngoscopy and intubation, transient rise in Heart Rate and Mean arterial pressure seen in Group D as compared to Group DF; (p <0.05); Heart Rate and MAP in group D returned to pre-induction values within 3 minutes of laryngoscopy. No patient suffered from profound sedation at any point of observation. This study provides evidence that intramuscular dexmedetomidine alone acts as effective premedication agent with attenuation of stress response; and combination of Intramuscular dexmedetomidine and intravenous fentanyl not only attenuate but also prevents stress response to laryngoscopy and tracheal intubation.