CAN DEXMEDETOMIDINE BE A BETTER ALTERNATIVE TO ESMOLOL IN ATTENUATING THE IMMEDIATE STRESS RESPONSE TO DIRECT LARYNGOSCOPY AND TRACHEAL INTUBATION? – A PILOT STUDY
Dr. Shaji K R, Dr. Asish Karthik* and Dr. Sruthi Ramachandran,
Background & Objectives: Laryngoscopy and tracheal intubation trigger reflex sympathetic response often amounting to cardiovascular collapse in susceptible individuals. Perioperative physicians are in constant quest for measures to attenuate the same. Dexmedetomidine, a newer α2 agonist having titrable effects on heart rate and blood pressure, can be a better alternative to the nonselective β blocker esmolol. Methods: Fifty patients receiving general anesthesia and endotracheal intubation were randomly divided into two groups (n= 25). Group D received 0.8 mcg/kg of dexmedetomidine and group E received 2.0 mg/kg of esmolol before intubation of trachea. All patients were uniformly premedicated, induced and intubated as per standard protocol. Hemodynamic parameters were recorded at various time intervals. Statistical analysis was carried out using IBM SPSS statistics 20.0 software. A p value of 0.05 or less was set for statistical significance. Results: The decline in heart rates were highly significantat the following time intervals, ie Ti, T0B, T0A and T1 (p<0.05) and insignificant during T3(p>0.05). There was a transient rise in SBP (8% increase in group D and 6.7% increase in group E), DBP (2.9% rise in group D and 2.7% rise in group E) and MAP (5.2% increase in MAP in group D and 2.7% increase in group E) immediately following intubation. The difference between the groups was not statistically significant. Conclusion: Dexmedetomidine 0.8 mcg/kg was more effective in prevention of tachycardia compared to esmolol 2.0mg/kg.
Keywords: Direct laryngoscopy and Tracheal intubation, Stress response, Dexmedetomidine, Esmolol.
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