A double blind randomised study to determine the efficacy of dexmedetomidine nebulisation in attenuating the stress response to laryngoscopy and intubation

Aims and Objectives: During the induction of general anaesthesia, direct laryngoscopy and intubation often cause intense sympathetic stimulation leading to transient, unpredictable haemodynamic changes. Dexmedetomidine, a specific agonist of the α - 2 adrenergic receptors, can prevent these haemodynamic changes by its sympatholytic effects. Our objective was to assess whether nebulised dexmedetomidine would be effective in reducing the stress response associated with laryngoscopy and intubation. Material and Methods: In this randomised controlled trial, 90 patients scheduled for elective surgeries under general anaesthesia and fulfilling the inclusion criteria were divided into two equal groups. Study group patients (Group D) received dexmedetomidine 1µg/kg nebulisation 10minutes before the induction of anaesthesia, and the control group patients (Group N) received 0.9% saline nebulisation instead of dexmedetomidine. Results: Demographic characteristics were similar between the groups. After laryngoscopy and intubation, the control group exhibited a significant increase in systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP), whereas in group D, there was a decrease in SBP (at 1 min-116.7 ± 8.2; p <0.001, 5 min-104.7 ± 6.5; p <0.001, 10 min-101.5 ± 6.5; p <0.001), DBP (at 1 min-71.0 ± 7.9; p< 0.001, 5 min-64.4 ± 8.2; p <0.001, 10 min- 62.1 ± 8.1; p<0.001) and MAP (at 1 min-85.9 ± 5.8; p< 0.001, 5 min-78.4 ± 6.3; p <0.001, 10 min- 75.7 ± 6.4; p <0.001). Group D showed a dose-sparing effect on propofol, with comparable sedation scores between the two groups. Conclusion: Nebulised dexmedetomidine used as premedication effectively reduces the stress response to laryngoscopy and intubation, and is associated with no adverse effects.