Attenuation of hemodynamic response to laryngoscopy and endotracheal intubation with dexmedetomidine: a randomized controlled trial
Keywords:
Anesthesiology, Intensive CareAbstract
Background: Laryngoscopy and endotracheal intubation causes marked increase in heart rate and blood pressure. Even though various agent tried to blunt the hemodynamic response but none of them proved to be an ideal. The aim of the study was to compare dexmedetomidine and placebo in blunting the hemodynamic response to laryngoscopy and endotracheal intubation.
Methods: A randomized placebo controlled study with total of 90 patients were included in the study of which 30 patients received dexmedetomidine (Group D) 10 minutes prior to endotracheal intubation and 30 patients received 3 ml Normal Saline (Group C) 10 minutes prior to endotracheal intubation. They were evaluated with change in heart rate and mean arterial pressure at 1, 3 and 5 minutes post laryngoscopy and endotracheal intubation. Any adverse effect of the drug was noted.
Results: Age, gender, physical status and weight were comparable between the groups. Heart rate and mean arterial pressure attenuated significantly in dexmedetomidine group (p<0.001 in 1, 3 and 5 minute intervals respectively), whereas placebo failed to attenuate hemodynamic response after laryngoscopy and intubation in any measured interval. No complications were noted.
Conclusions: Dexmedetomidine 1 mcg/kg given 10 min prior to endotracheal intubation significantly attenuates heart rate and mean arterial pressure at 1, 3 and 5 minutes compared to placebo.
References
http://dx.doi.org/10.1111/j.1365-2044.1992.tb03252.x
[PMID:1415971]
2. Shapiro HM, Galindo A, Wyte SR, Harris AB. Acute intracranial hypertension during anesthetic induction. Eur Neurol 1972;8:118-21.
http://dx.doi.org/10.1159/000114561
[PMID:5052132]
3. Amatya R. Evolution of Anesthesia in Nepal: A historical perspective. Journal of Society of Anaesthesiologists of Nepal (JSAN) 2014;1:3-6.
http://dx.doi.org/10.3126/jsan.v1i1.13580
4. Fox EJ, Sklar GS, Hill CH, Villanuava R, King BD. Complications related to endotracheal intubation. Anesthesiology 1977;47:524-5.
http://dx.doi.org/10.1097/00000542-197712000-00013
[PMID:337858]
5. Sulaiman S, Karthekeyan RB, Vakamudi M, Sundar AS, Ravullapalli H, Gandham R. The effects of dexmedetomidine on attenuation of stress response to endotracheal endotracheal intubation in patients undergoing elective off-pump coronary artery bypass grafting. Ann Card Anaesth 2012;15:39-43.
http://dx.doi.org/10.4103/0971-9784.91480
[PMID:22234020]
6. Afonso J, Reis F. Dexmedetomidine: Current Role in Anesthesia and Intensive Care. Rev Bras Anestesiol 2012;62:118-33.
http://dx.doi.org/10.1016/S0034-7094(12)70110-1
[PMID:22248773]
7. Shribman AJ, Smith G, Achola J. Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal endotracheal intubation. Br J Anaesth 1987;59:295-9.
http://dx.doi.org/10.1093/bja/59.3.295
[PMID:3828177]
8. Laha A, Ghosh S, Sarkar S. Attenuation of sympathoadrenal responses and anesthetic requirement by dexmedetomidine. Anesth Essays Res 2013;7:65-70.
http://dx.doi.org/10.4103/0259-1162.113996
[PMID:25885723] [PMCID:PMC4173498]
9. Saraf R, Jha M, Sunil Kumar V, Damani K, Bokil S, Galante D. Dexmedetomidine, the ideal drug for attenuating the pressor response. Pediatr Anesth Crit Care J 2013;1:78-86.
10. Menda F, Koner O, Sayin M, Ture H, Imer P, Aykac B. Dexmedetomidine as an adjunct to anesthetic induction to attenuate hemodynamic response to endotracheal endotracheal intubation in patients undergoing fast-track CABG. Ann Card Anaesth 2010;13:16-21.
http://dx.doi.org/10.4103/0971-9784.58829
[PMID:20075530]
11. Keniya VM, Ladi S, Naphade R. Dexmedetomidine attenuates sympathoadrenal response to tracheal endotracheal intubation and reduces perioperative anaesthetic requirement. Indian J Anaesth 2011;55:352-7.
http://dx.doi.org/10.4103/0019-5049.84846
[PMID:22013250] [PMCID:PMC3190508]
12. Feng XX, Feng KP, Yuan WX. The effects of pre-anesthetic single-dose dexmedetomidine on attenuation of stress response to endotracheal intubation. Beijing Medical Journal 2013;8:012.
13. Yildiz M, Tavlan A, Tuncer S. Effect of dexmedetomidine on haemodynamic responses to laryngoscopy and endotracheal intubation: perioperative haemodynamics and anaesthetic requirements. Drugs R D 2006;7:43-52.
http://dx.doi.org/10.2165/00126839-200607010-00004
[PMID:16620136]
14. Biccard BM, Goga S, de Beurs J. Dexmedetomidine and cardiac protection for non-cardiac surgery: a meta-analysis of randomised controlled trials. Anaesthesia 2008;63:4-14.
http://dx.doi.org/10.1111/j.1365-2044.2007.05306.x
[PMID:18086064]
15. Hanci V, Erdogan G, Okyay RD, Yurtlu BS, Ayoglu H, Baydilek Y, Turan IO. Effects of fentanyl-lidocaine-propofol and dexmedetomidine-lidocaine-propofol on tracheal intubation without use of muscle relaxants. The Kaohsiung journal of medical sciences 2010;26:244-50.
http://dx.doi.org/10.1016/S1607-551X(10)70035-8
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