Shrivastava Priyanka, Kumar Mukesh, Verma Saket, Sharma Ridhima, Kumar Raman, Ranjan Ravi, Prakash Jay
Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, IND.
Biochemistry, Trauma Centre, Rajendra Institute of Medical Sciences, Ranchi, IND.
Cureus. 2022 May 22;14(5):e25223. doi: 10.7759/cureus.25223. eCollection 2022 May.
Background and aim A variety of medications have been studied to reduce the hemodynamic response to laryngoscopy and intubation. Dexmedetomidine has been used intravenously in many studies to reduce the hemodynamic response to laryngoscopy and intubation. In high-risk patients, this pressor response can increase morbidity and mortality. As dexmedetomidine has a good bioavailability via the nebulisation route, we formulated this study to evaluate the effect of nebulised dexmedetomidine on the hemodynamic response to laryngoscopy and endotracheal intubation. Methods This is a prospective, randomised controlled trial conducted on 100 patients with the American Society of Anesthesiologists grade I and II. The primary objective of the study was to see if nebulised dexmedetomidine at a dose of 1 microgram/kg could reduce the stress reaction to laryngoscopy and intubation. The secondary objective was to study the dose sparing effect of nebulised dexmedetomidine on the amount of propofol used during induction of general anaesthesia. The study population was randomly divided into two groups: group A (n = 50) included patients nebulised with dexmedetomidine 1 microgram/kg and group B (n = 50) included patients nebulised with 5 ml saline 30 minutes before induction of anaesthesia in a sitting position. Results The demographics were similar in both groups. Following laryngoscopy and intubation, the systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate showed a significant increase in the control group B as compared to the treatment group A. In group A, there was attenuation in SBP (one minute = 113.2 ± 14.503, P < 0.001; five minutes = 109.86 ± 8.342, P < 0.001; 10 minutes = 114.24 ± 7.797, P = 0.010), DBP (one minute = 73.72 ± 10.986, P = 0.011; five minutes = 71.62 ± 9.934, P = 0.005; 10 minutes = 76.1 ± 8.006, P = 0.009), MAP (one minute = 86.80 ± 11.86, P = 0.001; five minutes = 84.44 ± 8.97, P = 0.006; 10 minutes = 88.72 ± 7.44, P = 0.018), and heart rate (one minute = 83.34 ± 12.325, P = 0.001; five minutes = 81.56 ± 13.33, P = 0.003; 10 minutes = 80.16 ± 14.086, P = 0.013) following laryngoscopy and intubation. Induction dose of propofol was significantly lower in the dexmedetomidine group (73 ± 19.509, P < 0.001). Conclusion Nebulised dexmedetomidine effectively blunts the hemodynamic response to laryngoscopy and intubation and also has a dose sparing effect on the induction dose of propofol.
人们已经对多种药物进行了研究，以降低喉镜检查和气管插管时的血流动力学反应。在许多研究中，右美托咪定已被静脉使用，以降低喉镜检查和气管插管时的血流动力学反应。在高危患者中，这种升压反应会增加发病率和死亡率。由于右美托咪定通过雾化途径具有良好的生物利用度，我们开展了本研究，以评估雾化右美托咪定对喉镜检查和气管插管时血流动力学反应的影响。方法：这是一项对100例美国麻醉医师协会I级和II级患者进行的前瞻性随机对照试验。该研究的主要目的是观察剂量为1微克/千克的雾化右美托咪定是否能减轻喉镜检查和气管插管时的应激反应。次要目的是研究雾化右美托咪定对全身麻醉诱导期间丙泊酚用量的剂量节省效应。研究人群被随机分为两组：A组（n = 50）包括接受1微克/千克右美托咪定雾化的患者，B组（n = 50）包括在麻醉诱导前30分钟坐位接受5毫升生理盐水雾化的患者。结果：两组的人口统计学特征相似。喉镜检查和气管插管后，与治疗组A相比，对照组B的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）和心率显著升高。在A组中，喉镜检查和气管插管后SBP（1分钟 = 113.2 ± 14.503，P < 0.001；5分钟 = 109.86 ± 8.342，P < 0.001；10分钟 = 114.24 ± 7.797，P = 0.010）、DBP（1分钟 = 73.72 ± 10.986，P = 0.011；5分钟 = 71.62 ± 9.934，P = 0.005；10分钟 = 76.1 ± 8.006，P = 0.009）、MAP（1分钟 = 86.80 ± 11.86，P = 0.001；5分钟 = 84.44 ± 8.97，P = 0.006；10分钟 = 88.72 ± 7.44，P = 0.018）和心率（1分钟 = 83.34 ± 12.325，P = 0.001；5分钟 = 81.56 ± 13.33，P = 0.003；10分钟 = 80.16 ± 14.086，P = 0.013）均有下降。右美托咪定组的丙泊酚诱导剂量显著更低（73 ± 19.509，P < 0.001）。结论：雾化右美托咪定可有效减轻喉镜检查和气管插管时的血流动力学反应，并且对丙泊酚的诱导剂量具有剂量节省效应。
