Evaluation of the Effect of Nebulized Dexmedetomidine on Attenuating the Hemodynamic Response to Intubation during Entropy-Targeted Anesthesia

Shivangi Sharma; Geetashu Duggal; Lalit Kumar; Lakesh  Kumar Anand; Tania Ghosh

doi:10.18502/aacc.v12i1.20535

Shivangi Sharma Department of Anaestheisology, MM Institute of Medical Science and Research, Ambala, India.
Geetashu Duggal Department of Anaestheisology, MM Institute of Medical Science and Research, Ambala, India.
Lalit Kumar Department of Anaesthesiology, Lok Nayak Hoapital, New Delhi, India.
Lakesh Kumar Anand Department of Anaestheisology, MM Institute of Medical Science and Research, Ambala, India.
Tania Ghosh Department of Anaesthesiology, Lok Nayak Hoapital, New Delhi, India.

DOI: https://doi.org/10.18502/aacc.v12i1.20535

Keywords: Dexmedetomidine; Entropy; Laryngoscopy response; Nebulization; General anesthesia

Abstract

Background: Laryngoscopy and intubation cause transient hemodynamic changes within thirty seconds after intubation. Dexmedetomidine, a selective alpha 2 adrenoceptor agonist, has been used to blunt this response via routes like intravenous, intranasal, and nebulization. The efficacy of nebulized dexmedetomidine in reducing the response to laryngoscopy and tracheal intubation with the additional benefit of reducing the propofol dose was evaluated during this study. Entropy monitoring was used to achieve adequate anesthetic depth.

Methods: This prospective, randomized, and comparative study was conducted on 120 ASA 1-2 patients. Patients were nebulized with dexmedetomidine 1 μg/kg body weight in 5 ml normal saline in group D and only 5 ml normal saline in group C twenty minutes before induction of anesthesia. Anesthesia was induced with an injection of propofol under entropy guidance. Hemodynamic parameters were noted at baseline, after nebulization, immediately after intubation, and up to 10 minutes. The incidence and severity of sore throat were noted in the postoperative period.

Results: Demographics were comparable. After laryngoscopy and intubation, the increase in heart rate and blood pressure was much lower in the dexmedetomidine group compared to the saline group. Furthermore, the requirement of propofol to achieve an entropy of 40–50 and the incidence and severity of postoperative sore throats in the dexmedetomidine group were significantly lower than in the normal saline group.

Conclusion: Administration of nebulized dexmedetomidine 1 µg/kg preoperatively effectively attenuates the hemodynamic response to laryngoscopy and intubation, with more stable hemodynamics and no side effects.