Key result
Dexmedetomidine at a dose of 1.0 µg/kg body weight administered before induction significantly obtunded hemodynamic responses to laryngoscopy and tracheal intubation compared to 0.5 µg/kg.
Why the study?
Procedures such as laryngoscopy and tracheal intubation trigger hemodynamic changes that increase the risk of fatality in high-risk patients with cardiovascular diseases.
Does dexmedetomidine 1 µg/kg better attenuate the pressor response during laryngoscopy and intubation compared to 0.5 µg/kg in adult patients?
RCT (n=60)
Partial double-blinded
Computer-generated random number table
No
Does dexmedetomidine 1 µg/kg better attenuate the pressor response during laryngoscopy and intubation compared to 0.5 µg/kg in adult patients?
A 1 µg/kg dose of dexmedetomidine is more effective than 0.5 µg/kg in attenuating the hemodynamic pressor response during laryngoscopy and intubation.
1 µg/kg dexmedetomidine superiorly attenuates intubation hemodynamics vs 0.5 µg/kg; confirms dose-dependent efficacy in airway management RCTs.
Background: Onset of hemodynamic changes is often associated with procedures such as laryngoscopy and tracheal intubation. This poses an increased risk of fatality in high-risk patients with diseases such as cardiovascular diseases. Several attempts utilizing singular parameters have been used to combat this clinical manifestation. In this study, we have used a holistic approach, in combination with the pre-recommended parameters, to attenuate the pressor responses during the procedure. Subjects and Methods: Sixty adult patients were randomized into two groups, receiving two different doses of dexmedetomidine (0.5 µg or 1 µg) per kilogram of the bodyweight. In addition, the quality of the intubation was also assessed using the scoring system adapted from McNeil et al., 2000. Longitudinal monitoring of various physiological parameters such as systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR) and O2 saturation (SpO2) was performed at four different time points during the procedure. Results: Our results revealed that dexmedetomidine administration results in a transient decrease in these parameters in the patients from both the groups, with more prominent effects in the Group I patients, received 1 µg/kg of dexmedetomidine. Moreover, at time-point T3 (60 sec after intubation), a transient increase was observed in almost all the tested parameters. The assessment of the intubating conditions revealed no significant differences among the groups. Conclusion: A higher dosage of dexmedetomidine (1 µg/kg) showed better management of hemodynamic responses during laryngoscopy and intubation.
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Varhney et al. (2020) conducted an RCT in Elective surgical procedures requiring general anesthesia (n=60). Dexmedetomidine vs. Dexmedetomidine 0.5 µg/kg was evaluated on Hemodynamic responses (heart rate, blood pressure) during laryngoscopy and intubation. Dexmedetomidine at a dose of 1.0 µg/kg body weight administered before induction significantly obtunded hemodynamic responses to laryngoscopy and tracheal intubation compared to 0.5 µg/kg.
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