Comparison of Dexmedetomidine, Lidocaine, and Fentanyl in Attenuation Hemodynamic Response of Laryngoscopy and Intubation in Patients Undergoing Cardiac Surgery (original) (raw)
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2016
Introduction: The process of Laryngoscopy and intubation are deleterious stimuli which causes a period of haemodynamic stress and is related with extreme sympathetic activity marked by increased in heart rate and blood pressure. The aim of the study was to evaluate and compare the efficacy of single premedication dose of dexmedetomidine 01micro gram/kg i/v in attenuation of haemodynamic responses to laryngoscopy and endotracheal intubation. Material and Methods: After institutional ethical committee clearance, 120 patients between the age group of 20 and 50 years, belonging to ASA class 1 and 2, and scheduled for general surgeries under general anaesthesia, were randomized into groups-D and N, having 60 patients each. Groups-D and N were premedicated with Inj.dexmedetomidine and 0.9% Normal saline respectively and their haemodynamic parameters measured before and after intubation and thereafter, at regular intervals noted. Any intra operative adverse effects were noted. Results: No ...
Anesthesia, essays and researches
Laryngoscopy and endotracheal intubation lead to strong sympathetic response which may precipitate arrhythmias, myocardial ischemia and cerebrovascular accidents in patients with preexisting cardiovascular disease. This study was aimed to compare the effect of dexmedetomidine and esmolol on hemodynamic response to laryngoscopy and endotracheal intubation in patients undergoing elective surgery under general anesthesia. This was a prospective, randomized controlled double-blinded study. A total of ninety patients were selected and randomized into three groups of thirty patients each: Group C received infusion of 20 mL 0.9% normal saline (NS) over 10 min, Group D received infusion of dexmedetomidine 1 μg/kg diluted in 20 mL NS over 10 min, and Group E received infusion of esmolol 1.5 mg/kg diluted in 20 mL NS over 10 min. Three minutes after the completion of infusion, patients were induced with general anesthesia. Baseline parameters such as heart rate (HR), systolic blood pressure (...
Background & Aims: Laryngoscopy and endotracheal intubation are noxious stimulus causing intense cardiovascular reflex due to sympathoadrenal discharge. The aim of this study was to compare effect of dexmedetomidine, fentanyl and lignocaine in attenuation of haemodynamic response to laryngoscopy and intubation. Methods: This hospital based, randomized, double blinded, comparative study was conducted after obtaining approval from the Institutional Ethics Committee and written informed consent from all patients. Ninety patients of ASA physical status I/II scheduled for elective surgical procedure under general anaesthesia were included in this study. These patients were randomized into three groups by chit in box method, patients in Group D received dexmedetomidine 0.6 mcg/kg diluted up to 10 ml in normal saline; in Group F received fentanyl 2 mcg/kg diluted up to 10 ml in normal saline and in Group L received 2% lignocaine 1.5 mg/kg diluted up to 10 ml in normal saline. Primary outcome variable haemodynamic response was measured at 1,3,5,7 &10 minutes after intubation. Secondary outcome variable was any adverse effects. Results:All groups were comparable with regards to demographic profile and baseline haemodynamic parameters. A statistically significant reduction (p <0.05) in heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure was observed in group D when compared to group F & group L. Conclusion: Intravenous dexmedetomidine (0.6µg/kg) showed better attenuation of haemodynamic response to laryngoscopy and intubation as compared to i.v. fentanyl (2µg/kg) and i.v. lignocaine (1.5 mg/kg 2%) when given 5 minutes prior to intubation without causing any adverse effect.
Background: Dexmedetomidine is a centrally acting alpha-2 adrenoceptor agonist. In this study, we compared dexmedetomidine to fentanyl in attenuating sympathetic response to laryngoscopy and tracheal intubation. Methods: Eighty ASA grade I-II patients requiring tracheal intubation were included in this prospective study and were randomly assigned to the dexmedetomidine (Group D) and fentanyl group (Group F) (40 patients in each group). Both the drugs were given at 1 µg/kg dose prior to laryngoscopy. We assessed heart rate, blood pressures and complications (bradycardia, hypotension and sedation). Results: The two groups were comparable in demographic parameters. The baseline mean heart rate (P=0.94) was not significantly different between Group F and Group D. Increase in heart rate after laryngoscopy and intubation was significantly lower in Group D compared to Group F (P=0.039). Mean heart rate remained lower at one minute after intubation in Group D but it was not statistically significant (94.64 s vs 86.28 sec). The difference in mean heart rate between two groups was comparable at three, five, ten and fifteen minutes after intubation. The baseline Mean arterial pressure was comparable between the groups (P=0.83) and remained similar throughout 15 minutes after intubation. Group D showed significant hypotension compared to Group F (P=0.03), whereas there was no significant bradycardia between these groups (P=0.19). Mean sedation score is higher in Group D compared to Group F. Conclusion: At 1 µg/kg dose, both dexmedetomidine and fentanyl cause partial attenuation of sympathetic response to laryngoscopy and intubation but dexmedetomidine blunts this response more effectively than fentanyl.
Journal of evolution of medical and dental sciences, 2018
BACKGROUND Laryngoscopy and tracheal intubation after the induction of anaesthesia are nearly always associated with a sympathetic hyperactivity. To attenuate the pressor response various drugs have been tried, but these drugs were either partially effective or they produced undesirable effects. This study aims to compare the effects of Dexmedetomidine (0.5 µg/kg) and Clonidine (0.5 µg/kg) on haemodynamic responses to endotracheal intubation, effect on anaesthetic requirements and effect on sedation. MATERIALS AND METHODS In this prospective, randomised, clinical trial, 100 patients of either sex, aged 20-60 years of ASA grade I and II scheduled for elective surgeries under general anaesthesia were randomly divided into two groups Group D (Inj. Dexmedetomidine dose 0.5 μg/kg IV in 100 mL normal saline) and Group C (Inj. Clonidine dose 0.5 μg/kg IV in 100 mL normal saline). Haemodynamic parameters (HR, SBP, DBP, MAP, SpO2) were monitored continuously and recorded before the start of infusion, at the start of infusion, at 5 mins of start of infusion, at 10 mins of start of infusion, at intubation and then at 1, 3, 5 and 10 minutes after intubation. RESULTS Magnitude of increase in heart rate at intubation and 1 min after intubation was higher in Group C as compared to Group D and this was statistically significant. Group C had significant rise in SBP and DBP during intubation and at 1, 3, 5 and 10 mins after intubation as compared to Group D. Significant reduction in dose is required for induction in Group D than in Group C. CONCLUSION Dexmedetomidine significantly attenuated the sympathetic response of laryngoscopy and intubation as compared to clonidine.
IP innovative publication pvt. ltd, 2019
anaesthesia cause noxious stimuli and are associated with laryngo- sympathetic stimulation manifested by hypertension, tachycardia and arrhythmias. This study compares the efficacy of dexmedetomidine and fentanyl in attenuating haemodynamic stress responses to laryngoscopic endo-tracheal intubation in adult patients undergoing surgeries under general anaesthesia. Materials and Methods: 90 adult participants of any sex aged between 18-55yrs undergoing elective surgeries under general endo-tracheal anaesthesia were divided into 3 groups of 30 patients in each group. Group C: Control group – received 10ml of normal saline (NS) intravenously (IV) over 10 minutes (min), 10min before induction. Group D: Dexmedetomidine group - received IV Dexmedetomidine 0.6mg/kg body weight diluted to 1 0ml of NS IV over 10min using a syringe pump and 3ml of NS IV 2min before induction. Group F: Fentanyl group - received 10ml of NS IV over 10min using a syringe pump and IV Fentanyl 2mg/kg body weight diluted to 3ml of NS IV 2min before induction. Anaesthesia was induced with IV Thiopentone sodium 5 mg/kg body weight and IV Vecuronium 0.1mg/kg body weight to facilitate endotracheal intubation. Lignocaine 1.5mg/kg IV was given 90seconds before intubation in all the groups. Anaesthesia was maintained with Oxygen, Nitrous Oxide, 1-2% Sevoflourane and IV Vecuronium. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded at various time intervals. Results: In group C, 1min after laryngoscopy and intubation, the rise in HR, SBP, DBP and MAP were 42bpm, 30mmHg, 22 mmHg and 24mmHg respectively compared to basal values. In group F, 1min after laryngoscopy and intubation, the rise in HR was 14bpm, rise in SBP, DBP and MAP each by 2mmHg compared to basal values. In group D, HR, SBP, DBP and MAP were decreased by 4bpm, 23 mmHg, 25mmHg and 24 mmHg respectively compared to basal values at 1min after laryngoscopy and intubation which was statistically highly significant (p=0.000). Interpretation and Conclusion: Both IV Dexmedetomedine 0.6mg/kg body weight administered over 10min and IV Fentanyl 2mg/kg body weight administered over 2min prior to induction are effective in obtunding the haemodynamic stress response to laryngoscopy and intubation without any significant side effects. However IV Dexmedetomidine is more effective and superior than Fentanyl in attenuating haemodynamic response to laryngoscopy and endotracheal intubation.
International Journal of Medical Anesthesiology, 2019
Background: Hemodynamic variation during laryngoscopy and tracheal intubation with reflex increase in sympathetic and sympathoadrenal activity is always matter of major concern for anesthesiologist, which may result in catastrophic effect, such as tachycardia, hypertension, myocardial ischemia, cardiac arrhythmia or cerebrovascular accident. To attunate haemodynamic response various drug such as lignocaine, opioids, nitroprusside, nitroglycerine, verapamil, nifedipine, esmolol has been used. Αlpha-2 adrenergic agonist decrease sympathetic tone and obtunding hemodynamic response to noxious stimulation and prevent overall hemodynamic variability. Aims and objectives: To study the efficacy of iv dexmedetomidine for attenuating stress responses to laryngoscopy and intubation. Materials and Methods: Eighty patients, ASA grade I/II, undergoing routine general anesthesia were randomly premedicated by i.v. dexmedetomidine (1µg/kg in 50 cc NS) or saline via infusion pump over 10 min. Heart rate (HR), mean arterial pressure (MAP) were measured before, after the premedication, after propofol, after succinylcholine, at laryngoscopy, immediately after intubation and then 1 min, 3 min and 5 min after intubation. Results: The demographic data was comparable in both groups. After intubation the increase in heart rate was more in group C than group D (p<0.0001) at laryngoscopy and after intubation thus showed less fluctuation of HR in the group D than in the group C. The increase in MAP in the group C at laryngoscopy and intubation was higher than that in the group D (p<0.0001) and exceeded the baseline value (p<0.05) Thus the pressor response to laryngoscopy and intubation were effectively decreased by dexmedetomidine and were statistically highly significant on comparison to group C (p<0.05). Conclusion: A single preanesthetic dose of i v dexmedetomidine 1ug/kg is advantageous as it is found to be effective in attenuating the haemodynamic response of laryngoscopy and intubation and prevent its adverse effect.
2016
Background and aims: During general anaesthesia, maneuver of laryngoscopy and tracheal intubation is accompanied by varying degree of sympathetic stimulation. This may prove detrimental in patients with compromised cardiac and cerebrovascular reserve and hence many approaches have been tried to prevent the potentially adverse circulatory responses. In the present study, we compared dexmedetomidine with labetalol to assess and evaluate the haemodynamic responses to laryngoscopy and endotracheal intubation during induction of general anaesthesia and during extubation. Material and methods: This study was carried out in ninety patients who were posted for various surgeries requiring general anaesthesia with orotracheal intubation. They were allocated into three groups. Group D patients received 0.5mcg/kg dexmedetomidine, diluted to 5ml of 0.9% normal saline, group L received 0.25mg/kg labetalol diluted to 5 ml normal saline and group C received 5ml 0.9%normal saline. All study drugs were administered over 5 minutes followed by induction with IV Propofol 2mg/kg and suxamethonium 1.5 mg/kg. Maintenance of anaesthesia was done with 100% oxygen, sevoflurane and IV Atracurium. Haemodynamic monitoring of systolic and diastolic blood pressure, heart rate(HR), mean arterial pressure(MAP) were done. Calculation of rate pressure product(RPP) were done and all parameters were compared at intubation(I0), 1(I1), 3(I3), 5(I5), 10(I10) and 15(I15) minutes postintubation, intraoperatively and at extubation. Results: Group D and group L showed statistically significant fall in HR,SBP, DBP, MAP RPP at induction, at intubation(I0), I1, I3, I5, I10, I15 than group C(p<0.001). There were decrease in HR, SBP, RPP in group D than in group L (p<0.001), while at I10 and I15 fall in MAP was significant in group D(p<0.001). Group C showed incidence of tachycardia and hypertension to be 83% and 77% respectively. Group D showed bradycardia in three patients and hypotension in four out of thirty patients which were statistically insignificant when compared to group L.(p>0.05). Conclusion: The haemodynamic responses to laryngoscopy, endotracheal intubation and extubation are better controlled with dexmedetomidine than labetalol.
Evaluation of Dexmedetomidine on Hemodynamic Stress Response During Laryngoscopy and Intubation
PAFMJ, 2021
Objective: To compare the efficacy of Dexmedetomidine (Precedex) in addressing the mean haemodynamic stress response to laryngoscopy and endotracheal intubation (L&I). Study Design: Quasi-experimental study. Place and Duration of Study: Anesthesiology Department, Combined Military Hospital, Rawalpindi, from Jun 2019 Jun 2020. Methodology: The patients were divided into two groups. Group A was given Inj. Dexmedetomidine and group B (placebo). Operation theatre assistant randomly assigned the patients to either group A or group B each day. The second person administered the drug or placebo. The third person (researcher) recorded all the parameters mentioned in the proforma. Results: There were 100 patients with an age range of 18-60 years. The majority of the patients were ASA-I physical status. The main surgical procedure was laparoscopic cholecystectomy. Recording of heart rate and systolic blood pressure during laryngoscopy and intubation, after administration of drug or placebo, s...