Dexmedetomidine For Attenuation Research Articles

Effects of Intravenous Clonidine and Intravenous Dexmedetomidine in Attenuation of Hemodynamic Response to Direct Laryngoscopy and Tracheal Intubation

Effects of Intravenous Clonidine and Intravenous Dexmedetomidine in Attenuation of Hemodynamic Response to Direct Laryngoscopy and Tracheal Intubation

Role of Dexmedetomidine in Attenuation of Hemodynamic Response to Laryngoscopy - A Dose-Finding Study

Aim: Determining efficacy of pre-operative bolus dose of dexmedetomidine 0.75 and 0.5µg/kg as an infusion and compare it with placebo in attenuation of hemodynamic response to laryngoscopy and tracheal intubation (LTI). Design: Double-blind randomized control. Place & duration: Sindh Institute of Urology & Transplantation, Karachi, Pakistan, from August 2019 to August 2021. Methodology: Patients were stratified into three groups. Group A received normal saline (NS), Group B received dexmedetomidine 0.5 μ/kg and Group C received dexmedetomidine 0.75 μ/kg as an infusion over 10 minutes followed by standardized general anaesthesia. Primary outcome measures were hemodynamic variables at 1, 3, 5 and 10 minutes post LTI. Secondary outcome measures were adverse effects related to dexmedetomidine. Results: Both dexmedetomidine groups showed better attenuation of hemodynamic response to LTI thansaline group. Dexmedetomidine 0.75 µg/kg attenuated hemodynamic response to LTIsignificantly better thandexmedetomidine 0.5 μ/kgand placebo without causing any statistically significant adverse effects. Practical implication: The function of dexmedetomidine in attenuating hemodynamic response to laryngoscopy has several practical implications, including improved patient safety, optimal dosing, reduced anaesthetic requirements, cost-effective treatment, and enhanced patient comfort. Conclusion: Dexmedetomidine 0.75 µg/kg efficient than 0.5 µg/kg and placebo in attenuating hemodynamic response to LTI when given as a pre-induction bolus. Keywords: Anesthesia; Dexmedetomidine, Laryngoscopy, Intubation, Stress Response.

A COMPARATIVE STUDY BETWEEN MAGNESIUM SULPHATE AND DEXMEDETOMIDINE FOR ATTENUATION OF HAEMODYNAMIC PRESSOR RESPONSE DURING LARYNGOSCOPY AND ENDOTRACHEAL INTUBATION

Backround:Direct laryngoscopy followed by endotracheal intubation is prone to haemodynamic fluctuations which may be detrimental in subjects with coronary artery disease, hypertension, and cerebral vascular disease. The aim is we wanted to compare Dexmedetomidine with Magnesium sulphate to determine the better drug with regard to attenuation of the haemodynamic responses during laryngoscopy and endotracheal intubation Objectives: 1. To study the effects of magnesium sulphate and dexmedetomidine in attenuation of haemodynamic response to laryngoscopy and intubation . 2. To study the side effects of the above drugs Methodology: This study was conducted among 60 subjects aged between 20 and 60 years belonging to ASA grade IandII, posted for elective surgeries under general anaesthesia. The study subjects were included randomly in 2 groups of 30 each. Group A received intravenous Dexmedetomidine 0.75µg/kg body weight and Group B received intravenous Magnesium sulphate 50%, 25 mg/kg body weight, both diluted in 20 ml of normal saline. Both were administered intravenously over 10 minutes. Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), Heart Rate (HR) were noted at baseline, after study drug infusion, before induction, before intubation,1,2,3,4,6,8,10 and 15th min after intubation. If any sideeffects present, were also noted and treated. Result: Data was compared using paired t-test,chi-square test,Fisher exact probability test and the reduction in the heart rate was found to be statistically significant (p<0.05) at all intervals. There was also significant decrease in systolic,diastolic and MAP during the immediate post intubation period. Conclusion:Dexmedetomidine 0.75 μg/kg IV infusion is more effective than Magnesium sulphate 25mg/kg IV infusion for attenuating the haemodynamic response to laryngoscopy and intubation in elective general surgical patients.

Comparison of dexmedetomidine, lidocaine and fentanyl in attenuation of haemodynamic response to laryngoscopy and intubation in cardiac surgery patients

Objective: Laryngoscopy and intubation produce sympathoadrenal response posing risk especially in cardiac patients due to arrhythmias, myocardial ischemia increasing morbidity and mortality. Our aim is to compare lidocaine, fentanyl and dexmedetomidine in attenuation of this response in cardiac surgery patients. Material and Methods: Ninety patients were allocated into 3 groups of 30 participants each. Group A obtained 1µg/kg Dexmedetomidine for 10 minutes before laryngoscopy. Group B 1.5mg/kg of Lidocaine and Group C 2µg/kg Fentanyl 90 seconds before intubation. Hemodynamic parameters like Heart rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP) and Rate Pressure Product (RPP) were noted before intubation and 1,3,5,10 and 15 minutes after intubation. Statistical analysis was done using Epi info version 7.2.1.0 statistical software (Chi square test, ANOVA test). Results: Dexmedetomidine had significant reduction in SBP at 1st (p-value=0.003), 5th, 10th and 15th (p-value<0.001) minute and in DBP at 3rd, 5th, 10th and 15th (p-value< 0.001). MAP was significantly reduced with dexmedetomidine at 1st, 3rd, 5th, 10th and 15th minute (p-value</ = 0.001) and RPP at 1st (p-value=0.040), 3rd (p-value=0.001), 5th (p-value=0.001), 10th (p-value<0.001) and 15th(p-value=0.002) minute. Dexmedetomidine had higher fall in HR at 1st, 3rd, 5th, 10th mins which was not statistically significant(p-value>0.05). Conclusion: Dexmedetomidine 1µg/kg given as 10 min infusion before laryngoscopy was more effective than fentanyl and lidocaine in blunting hemodynamic response to laryngoscopy and intubation in cardiac surgery patients. However due to significant hypotension associated with dexmedetomidine, it has to be used with caution in these patients.

Efficacy of dexmedetomidine in attenuating pressor response to laryngoscopy and endotracheal intubation under bispectral index controlled anesthesia: a prospective randomized double-blinded study

BackgroundLaryngoscopy and endotracheal intubation may lead to a remarkable hemodynamic pressor response. Dexmedetomidine, an α2-adrenergic receptor agonist, can be effectively used to attenuate this pressor effect. This study was aimed to compare the efficacy of two different doses of dexmedetomidine (0.5 µg/kg and 1.0 µg/kg) in attenuation of hemodynamic pressor response to largyngoscopy and endotracheal intubation under bispectral index (BIS) monitoring. One hundred twenty adult patients with American Society of Anesthesiologists (ASA) physical status I or II posted for various elective surgeries under general anesthesia were enrolled to receive an intravenous (IV) infusion of dexmedetomidine 0.5 μg/kg (group D1; n = 40), 1.0 μg/kg (group D2; n = 40) or normal saline over 15 min (group C; n = 40). The primary outcome measure was to assess the hemodynamic changes while the secondary outcome measures were to assess sedation, dose of propofol required for induction and side effects.ResultsThe mean HR, SBP, DBP, and MAP remained significantly lower in both dexmedetomidine groups as compared to control group after study drug infusion, after induction, at and after intubation (P < 0.05). Group D2 also had significantly lower mean HR, SBP, DBP, and MAP in comparison to group D1 (P < 0.05). The induction dose of propofol was significantly less in dexmedetomidine groups as compared to control group (P < 0.05). Ramsay sedation scale (RSS) score was found to be significantly more in both groups D1 and D2 after study drug infusion (P<0.001). No significant difference was noted in incidence of side effects (P = 0.907).ConclusionsDexmedetomidine (0.5 µg/kg and 1.0 µg/kg) was found to be effective in attenuating the hemodynamic pressor response to laryngoscopy and endotracheal intubation with BIS monitoring.Trial registrationCTRI, CTRI/2020/03/024088. Registered 19 March 2020.

Comparison between pre-treatment with nalbuphine vis-a-vis dexmedetomidine for prevention of etomidate induced myoclonus

Background: Etomidate is considered as an excellent drug for induction in anesthesia, although it has an undesirable side effect like myoclonus. Aims and Objectives: The aims of this study were to compare the effect between pre-treatment with nalbuphine and dexmedetomidine for attenuation and severity of etomidate induced myoclonus and to assess their adverse drug reaction. Materials and Methods: A prospective, randomized, and single-blinded study was conducted on patients undergoing elective surgery under general anesthesia. After selection of patients according to inclusion/exclusion criteria, nalbuphine (0.2 mg/kg) and dexmedetomidine (0.5 μg/kg) were infused 10 min before the induction of anesthesia. The vital parameters and any incidences of myoclonus during operation were observed at fixed interval. Results: A total of 102 patients in the age group of 18–60 years of either sex were assessed. In Group D 7, out of 51 patients (13.7%) were found to have myoclonus, whereas, in Group N, it was observed in 21 out of 51 patients (41.2%). Difference between the two was found to be statistically significant (P&lt;0.001). In Group D, grade 3 myoclonus was observed in 0% patients. About 2% patients had grade 2 and 11.8% had grade 3 myoclonus. In Group N, grade 3, 2, and 1 myoclonus was recorded as 3.9%, 11.8%, and 25.5%, respectively. The difference between the two groups is statistically significant (P&lt;0.001). Conclusion: Incidence and severity of etomidate induced myoclonus were less in patients who received pre-treatment with dexmedetomidine than those who underwent pre-treatment with nalbuphine. Furthermore, more hemodynamic stability was achieved with use of dexmedetomidine as the agent for pre-treatment.

Comparison of the Efficacy of Intravenous Lignocaine and Intravenous Dexmedetomidine in Attenuation of Hemodynamic Stress Response to Laryngoscopy and Endotracheal Intubation

Objective: To study the effect of intravenous Lignocaine and Dexmedetomidine to attenuate cardiovascular stress reaction to laryngeal manipulation.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Department of Anesthesia, Combined Military Hospital, Peshawar Pakistan, from Oct 2019 to Apr 2020.&#x0D; Methodology: Patients were randomly divided into two Groups by lottery method. Seventy-three were in the intravenous Lignocaine-Group-(A), while 73 patients were in the intravenous Dexmedetomidine-Group-(B). Blood pressure, Pulse rate and ECG were documented at the start of general anaesthesia and after 1, 3 and 5 minutes of intubation. Efficacy was defined if systolic pressure and pulse remained within 20% of the patient's native findings between 1 and 5 minutes after endotracheal intubation.&#x0D; Results: A total of 146 patients were included in the stud. The mean baseline systolic BP of Group-A was 121.34±4.47mmHg and mean baseline diastolic BP was 80.31±3.57mmHg. While mean Baseline Systolic BP WAS 121.19±4.37mmHg in Group-B and mean baseline diastolic BP was 80.04±3.66mmHg. Efficacy was seen 74% patients of Group-A and 90.4% of Group-B (p=0.009).&#x0D; Conclusion: Dexmedetomidine 1 microgram/kg blunts the cardiovascular sympathetic reaction to laryngeal manipulation more pronounced than Lignocaine 1.5 milligram/kg without any harmful outcomes.

Comparison of two different doses of dexmedetomidine in attenuation of haemodynamic response during endotracheal extubation

The data in the published literature on the use of dexmedetomidine in various dosages during extubation from India is modest. We have compared the effectiveness of intravenous dexmedetomidine 0.5 µg/Kg body weight and 0.75 µg/Kg body weight during endotracheal extubation. Seventy-four patients aged more than 18 years posted for elective surgery under general anaesthesia were included in this randomised double- blind controlled study. Group D1 and Group D2 patients received 0.5 µg/Kg and 0.75 µg/Kg body weight intravenous dexmedetomidine respectively. The primary outcome measures were to compare haemodynamic parameters, whereas secondary outcome measures were to compare extubation quality, and post-extubation sedation. The mean heart rate at reversal, and after endotracheal extubation was considerably elevated in group D1 as compared to D2. The mean systolic blood pressure, diastolic blood pressure and mean arterial pressure after endotracheal extubation were considerably elevated in group D1 as compared to D2. The mean respiratory rate at reversal, and after endotracheal extubation were considerably elevated in Group D1 as compared to Group D2. The mean sedation score after endotracheal extubation was considerably elevated in Group D2 as compared to Group D1. The haemodynamic parameters were better in Group of patients who received intravenous dexmedetomidine 0.75 µg/Kg body weight as compared to Group of patients who received dexmedetomidine 0.50 µg/Kg during endotracheal extubation.

A comparative study of clonidine versus dexmedetomidine in attenuation of stress response to laryngoscopy and intubation

Background: Endotracheal intubation produces various cardio vascular complications. Sometimes these complications lead to mortality. Various anaesthetic drugs are tried before intubation to reduce the haemodynamic changes. The present study aimed to evaluate the clonidine versus dexmedetomidine in attenuation of stress response to laryngoscopy and intubation. Materials and Methods: The study was done in Department of Anaesthesia , Sree Gokulam Medical College and Research Foundation, Trivandrum, Kerala. A total of 50 patients included in the study based on the inclusion and exclusion criteria and divided into two group each of 25. G-I received Clonidine (2mcg/kg) and G-II Dexmedetomidine (0.5mcg/kg). Drugs are given to respective groups 10 min before induction. Demographic data (age and gender) and clinical data (heart rate, SBP, DBP and MAP) was recorded. SPSS (20.0) version was used for analysis. Results: Group-I and II not showed any significant difference on comparison of demographic data. Comparison of mean heart rate between the group-I and II not showed any significant difference. SBP (PI, AL), DBP (PI) and MAP (PI) showed significant difference when compared between the group-I and II. Conclusion: Dexmedetomidine in the dose of 0.5µg/kg, given 10 minutes before laryngoscopy and intubation is better choice than clonidine in attenuating the haemodynamic responses to laryngoscopy and intubation.

Comparative study between intravenous clonidine versus intravenous dexmedetomidine for attenuation of pressor response during endotracheal intubation

Comparative study between intravenous clonidine versus intravenous dexmedetomidine for attenuation of pressor response during endotracheal intubation

A comparative study between clonidine and dexmedetomidine in attenuation of pressor response during endotracheal intubation

Aims: 1.To study and compare efficiency of clonidine and dexmedetomidine to reduce haemodynamic response i.e. attenuation of pressor response to laryngoscopy and tracheal intubation with single premedication dose. 2. To evaluate dose sparing effect of clonidine and dexmedetomidine on induction agent. Materials and Methods: 60 patients physical status ASA grade I and II were randomized into two groups: C and D (n = 30 in each group). Group C received 1µg/kg of clonidine while group D received 1µg/kg of dexmedetomidine preoperatively over 10 minutes before induction through syringe infusion pump. Each patient was induced with injection Thiopentone sodium until loss of eyelash reflex. After check ventilation succinylcholine 2 mg/kg was given followed by tracheal intubation. Anaesthesia was maintained with O2+ N2O(50:50) and Vecuronium supplemented with isoflurane. Hemodynamic parameters were recorded. Results: We observed no statistical difference in heart rate, blood pressure (systolic, diastolic and mean arterial pressure) between the two groups from baseline up to induction between two groups. Group C had higher readings of HR, SBP, DBP and MAP compared to group D after intubation upto 3 min which was statistically significant. Induction dose of thiopentone was lower in dexmedetomidine group and was statistically significant. Conclusion: Dexmedetomidine attenuated the hemodynamic pressor response and also reduces the dose requirement of thiopentone sodium and was superior to clonidine. Keywords: Clonidine, Dexmedetomidine, Premedication, Pressor response.

Comparison of Intravenous Lignocaine and Dexmedetomidine for Attenuation of Hemodynamic Stress Response to Laryngoscopy and Endotracheal Intubation

Comparison of Intravenous Lignocaine and Dexmedetomidine for Attenuation of Hemodynamic Stress Response to Laryngoscopy and Endotracheal Intubation

Study Comparing the Effects of Fentanyl and Dexmedetomidine for Attenuation of the Haemodynamic Response During Endotrcheal Extubation in Patients Undergoing Elective Surgeries

Study Comparing the Effects of Fentanyl and Dexmedetomidine for Attenuation of the Haemodynamic Response During Endotrcheal Extubation in Patients Undergoing Elective Surgeries

A Comparative Study between Two Different Doses of Dexmedetomidine for Attenuation of Hemodynamic Response to Laryngoscopy and Tracheal Intubation.

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.

Effect of Magnesium Sulphate and Dexmedetomidine for Attenuation of hemodynamic stress Response to Intubation

Effect of Magnesium Sulphate and Dexmedetomidine for Attenuation of hemodynamic stress Response to Intubation

Evaluation and Comparison of Intravenous Magnesium sulphate and Intravenous Dexmedetomidine for Attenuation of hemodynamic stress Response to Laryngoscopy and Intubation:A Randomized Controlled Study

Evaluation and Comparison of Intravenous Magnesium sulphate and Intravenous Dexmedetomidine for Attenuation of hemodynamic stress Response to Laryngoscopy and Intubation:A Randomized Controlled Study

A comparative study of esmolol versus dexmedetomidine in attenuation of cardiovascular response following laryngoscopy

A comparative study of esmolol versus dexmedetomidine in attenuation of cardiovascular response following laryngoscopy

Comparative study between Macintosh versus C-MAC laryngoscopic performance in airway management with dexmedetomidine as stress response attenuator in obese patients

Introduction Laryngoscopy as well as tracheal intubation causes changes in the hemodynamics of the patient owing to stress response. C-MAC videolaryngoscope (VL) is a relatively recent development that improves the success of tracheal intubation. Aim The aim of this study was to compare and evaluate the effects of dexmedetomidine for attenuation of hemodynamic responses during laryngoscopy using Macintosh laryngoscope versus C-MAC laryngoscope. Patients and methods A total of 60 patients, ASA II, 18–60 years old, scheduled for different surgeries under general anesthesia with BMI up to 40 kg/m2 were included in the study. Patients were divided into two groups (30 patients each) and were appropriately positioned, and intubation was done. Hemodynamic stress response to intubation was recorded, and plasma epinephrine level was estimated at baseline and at 1 and 5 min after intubation. Success rate, duration, attempts of intubation, and SpO2% were assessed. Results Plasma epinephrine level (ng/ml) at baseline and at 1 and 5 min after intubation showed no statistically significant difference in both groups, but there were highly significant differences at 1 and 5 min after intubation compared with baseline values (P Conclusion The stress response in both laryngoscopic techniques appears to be the same as detected by the nonsignificant difference in plasma epinephrine levels and hemodynamic changes in both groups, so 1 μg/kg dexmedetomidine is not enough to obtund the stress response completely. C-MAC VL is an efficient and suitable intubating device and provides excellent visualization of laryngeal structures in shorter time with less intubation attempts than Macintosh (Techron Surgical, Sialkot, P, Pakistan) laryngoscopy.

Efficacy of intravenous Dexmedetomidine in attenuation of hemodynamic response to laryngoscopy and endotracheal intubation

Efficacy of intravenous Dexmedetomidine in attenuation of hemodynamic response to laryngoscopy and endotracheal intubation

Prospective randomized study to compare between intravenous dexmedetomidine and esmolol for attenuation of hemodynamic response to endotracheal intubation.

Background:Esmolol has an established role in attenuation of hemodynamic response to laryngoscopy and endotracheal intubation. We studied the effect of dexmedetomidine compared to that of esmolol in this study.Aim:To study the role of dexmedetomidine in attenuation of hemodynamic response to laryngoscopy and oral endotracheal intubation compared to that of esmolol hydrochloride in patients posted for elective surgery under general anesthesia.Study Design:Prospective randomized study double-dummy blinding method.Materials and Methods:A total of 60 American Society of Anesthesiologists I patients, aged 18–60 years randomly divided into two groups; Group A patients received dexmedetomidine 1 mcg/kg diluted in 50 ml with normal saline and infused over 10 min before induction and also 20 ml of normal saline intravenous (IV) 2 min before endotracheal intubation. Group B patients received 50 ml IV infusion of normal saline over 10 min before induction and IV bolus of esmolol 0.5 mg/kg diluted in 20 ml with normal saline given 2 min before intubation. Standard induction technique followed. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded just before induction and after intubation at 1 min, 3 min, and 5 min after intubation.Statistical Analysis:Independent samples t-test and repeated measures of analysis of variance.Results:Dexmedetomidine group showed statistically significant reduction in all the study parameters at all study time intervals following intubation. While esmolol group showed significant attenuation of HR, SBP, and MAP following intubation but failed to produce significant reduction in DBP.Conclusion:Dexmedetomidine is more effective in attenuating the hemodynamic response to oral endotracheal intubation compared to that of esmolol hydrochloride.