Comparative Study Between Intravenous Dexmedetomidine And Fentanyl For Attenuation Of Haemodynamic Response To Laryngoscopy And Endotracheal Intubation: A Randomized Control Trial

Abstract

Background: The degree of haemodynamic changes that are observed may vary depending on a number of factors, including the level of anaesthesia, the kind of anaesthetic drug used, whether any safety measures are followed prior to airway manipulation, the duration of the laryngoscopy or intubation, and others The main mechanism generating hypertension and tachycardia, the sympathetic response, may be heightened by catecholamine activity. Pressor response has been linked to intraoperative myocardial infarction, abrupt left ventricular failure, dysrhythmias, or intracranial haemorrhage in patients with end organ decompensation. Dexmedetomidine is a highly selective and specific α-2 adrenoceptor agonist with an α2:α1 binding selectivity ratio of 20:1, whereas clonidine has a ratio of 220:1. Clonidine and dexmedetomidine bind to and activate α-1 and α-2 receptors, respectively.Additionally, a plethora of studies has shown that dexmedetomidine reduces the haemodynamic response to laryngoscopy and intubation. One of the most powerful analgesics is fentanyl, a synthetic opioid that, when given before induction, lowers the haemodynamic response to intubation. A comparative study between dexmedtomidine and fentanyl is necessary to determine whether medicine is more beneficial, as both medications have the ability to decrease the sympathetic response to endotracheal intubation and laryngoscopy. Materials and Methods: A prospective randomized, and double-blind study was conducted in 60 ASA Grade I and II patients of either gender, aged between 18 and 65 years, undergoing various surgical procedure under spinal-anesthesia and developing shivering. The patients were randomized into two groups of n = 30 each to receive either dexmedetomidine - 0.6 µg/kg (Group D) Fenatnyl- 2 µg/kg (Group F) as an intravenous just before intubation. Blood pressures (systolic, diastolic and mean) recordings. Apart from general physical and systemic examination, routine investigations, blood urea, serum creatinine, serum electrolytes, ECG and X- Ray chest was performed in all patients SPSS-20 was used for statistical analysis, unpaired t-test for numerical data and chisquare test for categorical data. Results: The mean age was between 39 to 40 years and mean BMI was around 26. Similarly, the mean duration of surgery was 70 minutes for both the groups. Total males in study were 29 and females were 31. There was statistically significant difference in Mean arterial blood pressure (MAP) in both study groups after intubation and at 1 minute. The mean MAP in F group was more than D group at all the time intervals. The mean heart rate was statistically higher in F group as compared to D group at all time after intubation. The frequency of bradycardia was nil in F group as compared to 20% in D group. Frequency of hypotension was13% in D group and nausea or vomiting was 20% in F group. Conclusion: Our research shows that a single intravenous dose of Fentanyl (2µg/kg body weight) given over 2 minutes prior to induction and Dexmedetomedine 0.6µg/kg body weight infused over 10 minutes are both effective at obstructing the hemodynamic stress response to laryngoscopic endotracheal intubation without causing any appreciable side effects. On the other hand, when it comes to reducing the hemodynamic stress response following laryngoscopic endotracheal intubation, IV Dexmedetomidine works better and more efficiently than Fentanyl