Intranasal dexmedetomidine for attenuation of hemodynamic response to laryngoscopy and intubation in adults

Background : To evaluate effectiveness of intranasal dexmedetomidine for attenuation of hemo-dynamic response to laryngoscopy and intubation in adults. Design and setting : This prospective randomized study included 90 American Society of Anesthesiologists (ASA) status I, adult patients of either sex, aged between 18-60 years, and undergoing elective surgery under general anesthesia requiring endotracheal intubation. Methods : Patients were randomly assigned to one of three groups of 30 each, to receive either intranasal saline (Group C), intranasal dexmedetomidine 1µg/kg (Group D 1 ) or intranasal dexmedetomidine 2µg/kg (Group D 2) , administered 30 minutes before the induction of anesthesia. Anesthesia technique was standardized for all patients taking part in the study. Main outcome measures : Primary outcome studied was attenuation of hemodynamic response to laryngoscopy and intubation. Secondary parameters studied were sedation score and dose of propofol required at induction. Results : There was a statistically significant rise in heart rate and systolic, diastolic and mean arterial pressures at 1, 3, and 5 minutes of intubation in group C as compared to groups D 1 and D 2 . Sedation score was significantly higher in groups D 1 and D 2 (p<0.0001). Propofol requirement was significantly lower in groups D 1 and D 2 (p<0.0001). Intranasal dexmedetomidine 2µg/kg was associated with higher a incidence of bradycardia. Conclusion : Intranasal dexmedetomidine (1µg/kg and 2µg/kg) effectively diminishes hemodynamic changes associated with laryngoscopy and intubation in adult patients undergoing elective surgery. Intranasal dex-medetomidine 2µg/kg is associated with significant bradycardia. Intranasal dexmedetomidine also provides effective preoperative sedation and decreases the dose of propofol required for induction of anesthesia.