Nebulised Dexmedetomidine versus Nebulised Lignocaine in Blunting the Haemodynamic Response to Laryngoscopy and Endotracheal Intubation: A Randomised Control Study

Abstract

Introduction: Direct laryngoscopy followed by intubation induces a stress response leading to haemodynamic changes that are often transient, unpredictable, and variable. Both dexmedetomidine and lignocaine have been used in nebulised form successfully to blunt haemodynamic stress response, but they have never been compared previously. Aim: To compare nebulised dexmedetomidine and nebulised lignocaine in blunting the haemodynamic response to laryngoscopy and endotracheal intubation. Materials and Methods: This randomised, double-blinded study was conducted on 135 patients with American Society of Anesthesiologists (ASA) physical Status I and II, aged 18 to 60 years, planned for surgery under general anaesthesia with endotracheal intubation. Patients were divided into three groups of 45 each using a computer-generated random number table. Patients in group D were nebulised with dexmedetomidine 1 μg/kg, with lignocaine 1.5 mg/kg in group L, and with normal saline in group C. The primary objective was to compare nebulised dexmedetomidine and nebulised lignocaine in blunting the haemodynamic response to laryngoscopy and endotracheal intubation with respect to Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure, and Mean Arterial Pressure (MAP). The secondary objective was to study side-effects associated with the use of nebulised dexmedetomidine and lignocaine. Results: The demographic profile was found to be comparable in all three groups. The mean age was 40.44±11.77 years, 40.04±12.33 years, and 42.89±11.57 years in group D, group L, and group C, respectively, with a p-value of 0.4. The rise in HR during intubation and at all later time points was found to be less in group D and group L compared to group C. Additionally, the rise in HR was found to be higher in group L compared to group D. Similarly, the attenuation effect on SBP and Diastolic Blood Pressure (DBP) was greater in group D patients. Conclusion: Both nebulised dexmedetomidine and lignocaine were effective in attenuating the pressor response during laryngoscopy and intubation, with dexmedetomidine being more effective than lignocaine without any adverse haemodynamic effects.

Keywords

• cardiovascular
• endotracheal
• hypertension
• ischaemia