Intravenous Dexmedetomidine versus Intravenous Esmolol in Blunting the Laryngoscopy Response in Adult Normotensives undergoing Elective Surgeries: A Randomised Clinical Trial
Introduction: A wide array of drugs are available for blunting the laryngoscopy response. Amongst them both dexmedetomidine, and esmolol belong to the non opioid group having least interference with the recovery process without causing significant respiratory depression, thus are suitable interventi...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2022-06-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://www.jcdr.net/articles/PDF/16502/49987_CE[Ra1]_F[SH]_PF1(SC_SS)_PFA(SC_SHU_KM)_PN(KM).pdf |
| Summary: | Introduction: A wide array of drugs are available for blunting the laryngoscopy response. Amongst them both dexmedetomidine, and esmolol belong to the non opioid group having least interference with the recovery process without causing significant respiratory depression, thus are suitable intervention for this purpose. Dexmedetomidine a sedative highly selective α2 adrenoceptor agonist and has an anaesthetic-sparing effect at induction. It suppresses the release of catecholamine in response to a noxious stimulant because of its central sympatholytic action. Esmolol with a different pharmacokinetic profile is a water soluble, cardio-selective, an ultrashort acting beta blocker has a short half-life (t1/2) thus suited for suppressing the transient pressor reflexes following acute noxious surgical or anaesthesia stimuli.
Aim: To compare the degree of attenuation of the laryngoscopy response following the use of single preinduction dose (Intravenous infusion at a dose of 1 μg/kg) of dexmedetomidine with that of esmolol (intravenous bolus at a dose of 0.5 mg/kg) in adult normotensives undergoing elective intubations.
Materials and Methods: The randomised clinical trial was conducted in Pondicherry Institute of Medical Sciences, Puducherry, India from September 2016 to March 2018, on 60 patients of either sex, aged between 20-60 years with American Society of Anaesthesiologist (ASA) physical status I or II requiring elective intubations for general surgical procedures. The patients were randomly divided into two groups (n=30 each). Prior to induction group A received 1 μg/kg dexmedetomidine Intravenous (i.v.) infusion over 10 minute, and group B received 100 mL IV infusion of normal saline over 10 minute. Also 2 minute before laryngoscopy group A received 10 mL of normal saline (IV) bolus, whereas, group B received esmolol 0.5 mg/kg IV diluted in 10 mL of normal saline as a bolus. Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Mean Arterial Pressure (MAP) were recorded at baseline i.e, preprocedure before the study drug infusion, preinduction, at laryngoscopy (0 min) and 1, 3, 5 minute after intubation. A rise of MAP and/or HR more than 20% from the baseline was considered as positive laryngoscopy response. Student’s unpaired t-test was used for analysis of intergroup variables. Intragroup variables were analysed using repeated measures Analysis of Variance (ANOVA).
Results: Mean age of patients in group A was 38.77±13.082 years and group B was 37.20±13.069 years (p-value=0.644). Results revealed that both the groups had an increase in HR and MAP at 1 minute after laryngoscopy and intubation. Mean readings of MAP showed a maximum rise of group A (2.15%) vs group B (7.25%) from the baseline readings at 1 minute following laryngoscopy which showed no statistical significance. The maximum HR increase following laryngoscopy was at 1 minute in group A (8.28%) vs group B (13.59%), which were below the positive laryngoscopy response. The mean HR, SBP, DBP and MAP recorded at preinduction, at laryngoscopy, 1, 3 and 5 minutes following intubation showed no statistical difference (p-value >0.05) between the two groups.
Conclusion: Usage of single dose preinduction dexmedetomidine iv infusion 1 μg/kg over 10 minute was found to be equally effective in blunting the pressor response to laryngoscopy and intubation when compared to bolus dose of iv esmolol 0.5 mg/kg given 2 minute prior to laryngoscopy. |
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| ISSN: | 2249-782X 0973-709X |