Author(s): Priti Kolarkar1, Gunjan Badwaik2, Ajay Watve3, Kumar Abhishek4, Nupur Bhangale5,Amol Bhalerao6, Gopalji Gupta7, Anurag Giri8
BACKGROUND: Laryngoscopy and tracheal intubation causes intense autonomic reflex responses consisting of increased circulating catacholamines, tachycardia, hypertension, myocardial oxygen demand, and dysarrythmias. To obtund haemodynamic response lignocaine, opiods, nitroprusside, nitroglycerine, vearpamil, nifedipine, esmolol, clonidine and recently, dexmedetomidine have been studied.
AIMS AND OBJECTIVES: We investigated whether dexmedetomidine a α2 agonist could attenuate sympathoadrenal response (Heart rate and MAP) to laryngoscopy and intubation.
MATERIALS AND METHODS: Eighty patients, ASA grade I/II, undergoing routine general anesthesia were randomly premedicated by i. v. dexmedetomidine 0.6µg or saline. Heart rate (HR), mean arterial pressure (MAP), were measured before, after the premedication, after thiopental, after succinylcholine at laryngoscopy, immediately after intubation and then 1 min. 3 min. and 5 min after intubation.
STATISTICAL ANALYSIS: Descriptive and inferential statistics using chi-square test, z-test and wilcoxon sign rank test was done. Software used in the analysis was SPSS 17.0 version and Graph Pad Prism 5.0. Data was reported as mean value ± SD & p-value <0.05 is considered as level of significance.
RESULTS: The demographic profile was comparable. After intubation the MAP in the control group (z=.5.35, p=<0.05 at laryngoscopy and z=9.95, p<0.05 after intubation) was higher than that in the dexmedetomidine group (z=8, p=0.000) and exceeded the baseline value(p<0.05) The heart rate also showed less fluctuation in the dexmedetomidine group than in the control group. Though there was rise in both the groups, it was more in control group than dexmedetomidine group (z=7.73, p<0.05 at laryngoscopy and z=9.22, p<0.05 after intubation). Thus the pressor response to laryngoscopy and intubation were effectively decreased by dexmedetomidine and were highly significant on comparison (p<0.05).
CONCLUSION: i v dexmedetomidine 0.6µg premedication is advantageous as it is found to be effective and beneficial in attenuating the haemodynamic response of laryngoscopy and intubation to prevent its consequences.