Comparison of three different doses of intranasal dexmedetomidine in attenuation of haemodynamic response to laryngoscopy and endotracheal intubation: A randomised control trial

Background and Aims: Laryngoscopic manipulation and endotracheal (ET) intubation are noxious stimuli capable of producing tachycardia, arrhythmias, and hypertension. This study compared the efficacy of 3 different doses of intranasal dexmedetomidine (0.75 μg/kg, 1 μg/kg, and 1.5 μg/kg) in attenuating the hemodynamic responses to laryngoscopy and ET intubation. Methods: After taking informed written consent, a total of 90 patients were divided into 3 groups. Group-1 was given dexmedetomidine 0.75 μg/kg, Group-2 given 1 μg/kg and Group-3 was given 1. 5 μg/kg. In all the patients, drugs were diluted to 1 ml with 0.9%normal saline. Intranasal drug was dripped into both nostrils in equal volume using 1 ml syringe in a supine head-down position about 40 min before induction (T0). The primary objective of this study is to compare pressor response of laryngoscopy and ET intubation in the preoperative period among 3 groups. Secondary objectives are the observation of sedation status via Ramsay sedation scale and to document side effects. Results: Groups were well matched for their demographic data. Hemodynamics were stable in both Group 2 and 3, but significant hypotension and bradycardia were noted in Group 3 in two cases, which were treated with a fluid bolus and a single dose of mephenteramine. Patients who were given dexmedetomidine at a dose of 1.5 μg/kg were significantly sedated during intubation ( P = 0.013) as well as during extubation ( P < 0.001) compared to patients in Groups 1 and 2. Conclusion: Dexmedetomidine in the dose of 1.0 μg/kg administered as intranasal drops produced a more satisfactory attenuation of hemodynamic response during laryngoscopy and ET intubation with hemodynamic stability.