Effect of dexmedetomidine to attenuate the sympathetic response of laryngoscopy and intubation and perioperative hemodynamic stability in patients undergoing neurosurgery

Abstract

Background and Aims: Dexmedetomidine is a selective α2 agonist used as an adjuvant to attenuate sympathetic response to laryngoscopy and tracheal intubation in general anesthesia. Recent studies have shown that dexmedetomidine decreases brain flow and cerebrospinal fluid pressure without cerebral ischemia. Hence, it is beneficial in neurosurgical procedures. This study was undertaken to analyze the efficacy of dexmedetomidine in neurosurgery for good perioperative hemodynamic stability with blunt sympathetic response to laryngoscopy and intubation. Materials and Methods: Sixty, American Society of Anesthesiologists grades II-IV patients between 18 and 50 years of age undergoing craniotomy under general anesthesia were divided randomly into two groups (thirty patients in each group). Group D: Dexmedetomidine was given as a bolus dose of 1 μg/kg diluted to a total volume of 20 ml with normal saline (0.9%) for 10 min before the induction of anesthesia. Group C: The patients received a similar volume of normal saline. Results: We observed a decrease in blood pressure and heart rate (HR) after intubation by dexmedetomidine, and they were highly significant on comparison (P < 0.0001). During intraoperative period, the patients in Group D had lower HR and blood pressure than baseline value as compared to Group C (P < 0.0001). We also observed decreased requirement of sevoflurane (33%) and fentanyl (45%) in Group D compared to Group C. Data were expressed as mean values ± standard deviation. P <0.05 was considered to be significant. Conclusion: Dexmedetomidine blunted the hemodynamic stress response due to laryngoscopy and intubation and perioperative hemodynamic stability in patients undergoing neurosurgery.

Keywords

• Dexmedetomidine
• general anesthesia
• laryngoscopy and intubation
• neurosurgery