1/8/2017 Comparativeanalysisofefficacyoflignocaine1.5mg/kgandtwodifferentdosesofdexmedetomidine(0.

5g/kgand1g/kg)inattenuatingthehemo

AnesthEssaysRes.2015JanApr9(1):514. PMCID:PMC4383101
doi:10.4103/02591162.150167

Comparativeanalysisofefficacyoflignocaine1.5mg/kgandtwodifferent
dosesofdexmedetomidine(0.5g/kgand1g/kg)inattenuatingthe
hemodynamicpressureresponsetolaryngoscopyandintubation
MichellGulabani,PavanGurha, 1PrashantDass, 2andNishiKulshreshtha1

DepartmentofAnesthesiologyandCriticalCare,Dr.RamManoharLohiaHospital,NewDelhi,India
1
DepartmentofAnesthesiologyandCriticalCare,BatraHospitalandMedicalResearchCentre,NewDelhi,India
2
DepartmentofPharmacology,M.R.MedicalCollege,Gulbarga,Karnataka,India
Correspondingauthor:Dr.MichellGulabani,C35,MalviyaNagar,NewDelhi110017,India.Email:michellgulabani@gmail.com

Copyright:Anesthesia:EssaysandResearches

ThisisanopenaccessarticledistributedunderthetermsoftheCreativeCommonsAttributionNoncommercialShareAlike3.0Unported,whichpermits
unrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkisproperlycited.

Abstract Goto:

Context:
Laryngoscopyandintubationcauseanintensereflexincreaseinheartrate,bloodpressure,duetoanincreased
sympathoadrenalpressorresponse.Lignoocainehasshownbluntingofpressorresponsetointubation.
Dexmedetomidinehassympatholyticeffects.

Aims:
Tothebestofourknowledgethereisnostudycomparingtheefficacyoflignocainewithtwodifferentdosesof
dexmedetomidineforattenuatingthepressorresponse.Withthisidea,weplannedtoconductthepresentstudy.

MaterialsandMethods:
AfterapprovalbytheHospitalEthicscommittee,90consentingadultsaged1865yearsofageofeithersexofnon
hypertensiveASAGradeIorIIwererandomlyallocatedintothreegroups.GroupD1IVDexmedetomidine
0.5g/kgover10minutesGroupD2IVDexmedetomidine1g/kgover10minutesGroupXIVLignocaine
1.5mg/kgin10mlnormalsaline

StatisticalAnalysisUsed:
ANOVAandStudent'sttestusedforanalysis.

Results:
Dexmedetomidine1g/kgwasmoreeffectivethan0.5g/kgandlignocaine1.5mg/kginattenuatingthepressor
response.

Conclusions:
Weconcludethatdexmedetomidine1g/kgadequatelyattenuatesthehemodynamicresponsetolaryngoscopyand
endotrachealintubationwhencomparedwithdexmedetomidine0.5g/kgandlignocaine1.5mg/kg.

Keywords:Dexmedetomidine,Lignocaine,Pressorresponse,Hemodynamicresponse,Catecholaminerelease

INTRODUCTION Goto:

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Mostpatientsundergoingsurgerywithgeneralanesthesiarequirelaryngoscopyandintubationasmandatory
procedures.Laryngoscopyandintubationcauseanintensereflexincreaseinheartrate(HR),bloodpressure,and
serumconcentrationofcatecholaminesleadingtohypertension,tachycardiaanddysrhythmias,whichareevoked
bystimulationoflaryngealandtrachealtissuesduringtheprocedure.[1,2,3,4]

Thesechangesduetoanincreasedsympathoadrenalpressureresponsecanleadtoadversitieslikemyocardial
infarction,acuteheartfailureandcerebrovascularaccidentsinsusceptibleindividuals.[5]

Thereforeinrecenttimes,attenuationofthispressureresponsetolaryngoscopyandintubationhasbecomeoneof
themostresearchedtopicsinthefieldofanesthesiology.

Someofthewaysforattenuationofthispressureresponseinclude:Limitingdurationoflaryngoscopyto15s,use
ofblockerslikeesmolol,lignocaine,lowdoseopioids(510g/kg)offentanylandsufentaniloralfentanil80100
g/kg,morphine0.2mg/kg.[6]

Lignocaineisanaminoethylamideandprototypeofamidelocalanestheticgroup.[7]Introducedintheyear1948,it
isthemostwidelyusedlocalanesthetic.[8]In1961,Bromageshowedthatitsintravenous(IV)usebluntedpressure
responsetointubation.[9]AnIVdoseoflignocaine1.5mg/kggiven3minpriortointubationhasshownnear
optimalresults.[10]

Dexmedetomidine,a2adrenergicagonist,hasanestheticsparing,analgesic,sedative,anxiolyticandsympatholytic
effects.[11]Itdecreasescentralnervoussystemsympatheticoutflowinadosedependentmannerandhasanalgesic
effectsbestdescribedasopioidsparing.[12]Inviewofthefactthatdexmedetomidinehasshownminimalside
effects,itisfindingitswayintoeverysegmentofanesthesiapractice.[13]

Tothebestofourknowledge,thereisnostudycomparingtheefficacyofIVlignocainewithtwodifferentdosesof
dexmedetomidineforattenuatingthepressureresponse.Theappropriatedoseofdexmedetomidineisalsonotwell
established,especiallyintheIndianpopulationsubset.

Withthisidea,weplannedtoconductthepresentstudytocomparetwodifferentdosesofdexmedetomidinewith
lignocaineforattenuationofpressureresponse.

MATERIALSANDMETHODS Goto:

Ethics
AfterapprovalbytheHospitalEthicsCommittee,90consentingadultpatientsaged1865yearsofageofeither
sexofnonhypertensiveAmericanSocietyofAnesthesiologistsGradeIorIIundergoingelectivesurgeryunder
generalanesthesiawithendotrachealintubationwereincludedinthisrandomizedstudyprotocol.Randomization
wasdoneusingacomputergeneratedrandomnumbertable.Allocationconcealmentwasensuredwithsealed
opaqueenvelope.ThestudywasconductedfromDecember2012toJune2013.

Studydesign
Acompletepreanestheticcheckupofpatientswasperformedpriortotheirscheduledallotmentintothedifferent
studygroups.Adetailedhistorywhichincludesinformationregardingexercisetolerance,comorbidities,allergy,
pasthospitaladmissionsandsurgicalhistoryoranesthesiaexposure,addictionswereobtained.

Generalphysicalexaminationandsystemicexaminationwasperformedduringthistime.Patientswiththe
followingconditionswerehoweverexcludedfromourstudy,namely:Historyofcardiacandpulmonarydisease,
pregnancy,morbidobesity,allergytothestudydrug,hypertensivepatients,impairedkidneyorliverfunctionand
anticipateddifficultairway.

LignocainepreparationusedwasXYLOCARD2%50ml(AstraZenecaPharmaceuticals,Bengaluru,India)and
dexmedetomidinebythenameofDEXTOMID200g/2ml(NeonPharmaceuticals,Mumbai,India)for
conductingthisstudy.

Afterobtainingwrittenandinformedconsent,patientswererandomlyallocatedintooneofthethreegroups.

GroupD1PatientsweregivenIVdexmedetomidine0.5g/kgover10minaspremedicationbefore
inductionofgeneralanesthesia

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GroupD2PatientsweregivenIVdexmedetomidine1g/kgover10minaspremedicationbefore
inductionofgeneralanesthesia
GroupXPatientsweregivenIVlignocaine1.5mg/kgin10mlnormalsaline,3minbeforelaryngoscopy
andintubation.

Monitoring
Thefollowingparametersweremonitoredduringtheintraoperativeperiod:

Heartrateandrhythmbythreeleadelectrocardiogram
Noninvasivebloodpressure
Oxygensaturationbypulseoxymeter
Endtidalconcentrationofcarbondioxidelevelbycapnograph.

Anesthetictechnique
Onshiftingthepatienttotheoperationtheater,allthemonitoringdeviceswereattached.An18GIVinfusionline
wasstarted,andallpatientswerehydratedwithapproximately810ml/kgofnormalsalinebeforeinduction.
OxygenwasadministeredbyaHudsonfacemaskattherateof5l/min.Patientsweregiveninjectionmidazolam1
mgIVaspremedication.

Allhemodynamicdatawasmeasuredonarrivalinobservedtime(OT),beforeinduction,beforeintubation,andat
1,3,5minafterintubationbyanindependentobserver.

Anesthesiawasinducedwithasleepdoseofthiopentalsodiumandfentanyl2g/kg.Aftergivinginjection
vecuroniumbromide0.1mg/kgIVandventilatingthepatientwithN2OandO2for3min,intubationwas
performedwithcuffedoralendotrachealtubeofappropriatesizeforairwaymanagement.Patientsarehaving
unanticipateddifficultairwaysrequiringmultipleattempts(twoormore)atintubationorlaryngoscopytimeofmore
than15swereexcludedfromthestudy.

Anesthesiawasmaintainedwithisofluraneandnitrousoxideinoxygen.Themechanicalventilatorwassetto
achieveanendtidalcarbondioxideof3540mmHg.Additionaldosesofvecuroniumbromideifnecessarywere
administeredtomaintainsurgicalrelaxation.Duringthemaintenanceofanesthesia,additionaldosesofinjection
fentanyl1g/kgwereadministeredaccordingtohemodynamicvariables.

Surgerywasallowedtostartonlyafter5minofintubation.Attheendofsurgeryneuromuscularblockadewas
reversedwithinjectionneostigmine0.04mg/kgandinjectionglycopyrrolate0.1mg/kg.IVondansetronwas
injectedtopatients30minbeforetheendofthesurgery.Thetrachealtubewasremovedafteradequatespontaneous
ventilationestablished.

Wehadplannedtotreathypotensionandbradycardiabydecreasingtheinhalationalagentconcentrationby50%or
byadministeringIVephedrine10mgorIVatropine0.5mgrespectively.

Statistics
ThemeanandstandarddeviationsofHR,systolicbloodpressure(SBP)anddiastolicbloodpressure(DBP)ineach
ofthegroupswereanalyzedbyanalysisofvariance(ANOVA)andusingthepairedStudent'sttestforintragroup
analysis.P<0.05wasconsideredassignificant.

RESULTS Goto:

Thevaluesmentionedbelowcorrespondedtotheseinstancesintime:

OnarrivalinOT
Beforetheinductionofanesthesia
Afterinductionandjustbeforeintubation
1minafterintubation
3minafterintubation
5minafterintubation[Charts1and2].

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Chart1
Sexdistributionofthethreegroups

Chart2
Agedistributioninthethreegroups

AccordingtoTable1,thedifferencebetweenthethreemeanswasnotfoundtobesignificantonapplicationof
ANOVA(0.194)whensignificanceimpliesaP<0.05incaseofHRa.Astatisticallysignificantdifference
betweenthethreemeanswasobtainedinalltheotherHRreadings,thatis,HRb(0.011),HRc(0.001),HRd
(0.001),HRe(0.000)andHRf(0.000)[Table2].

Table1
HRatdifferenttimesofpatientsbelongingtothethreegroups

Table2
ComparisonofHRinthelignocainegroupatdifferentinstancesoftime
takingHRonarrivalinOT(HRa)asthestandardbyemployingpairedttest

Besidesthereadingat1minafterintubationthatis,HRd(0.160),allotherreadingswereshowntobestatistically
significant(P<0.05)onapplyingpairedttestwhencomparedwiththereadingonarrivalinOT,thatis,HRa.

ThegeneraldeclineintheHRwhencomparedwiththebaselinewasobserved.However,at1minafterintubation
aslightincrementinHRwasencountered.MaximumreductioninHRwasseen3minafterintubation[Table3].

Table3
ComparisonofHRinthedexmedetomidine0.5g/kggroupatdifferent
instancesoftimetakingHRonarrivalinOT(HRa)asthestandardby
employingpairedttest

ReadingsasperGraph1werestatisticallysignificant(P<0.05)onapplyingpairedttestwhencomparedwiththe
readingonarrivalinOT,thatis,HRa.

Graph1
Comparisonofheartrateinthelignocainegroupatdifferenttimeintervals

Graph2depictsthevariationintheHRatdifferentinstancesoftimewiththeuseofdexmedetomidine0.5g/kg.A
generaldeclineintheHRwhencomparedwiththebaselinewasobserved[Table4].

Graph2
Comparisonofheartrateinthedexmedetomidine0.5g/kggroupat
differenttimeintervals

Table4
ComparisonofHRinthedexmedetomidine1g/kggroupatdifferent
instancesoftimetakingHRonarrivalinOT(HRa)asthestandardby
employingpairedttest

Allreadingswereshowntobestatisticallysignificant(P<0.05)onapplyingpairedttestwhencomparedwiththe
readingonarrivalinOT,thatis,HRa.

Graph3depictsthevariationintheHRatdifferentinstancesoftimewiththeuseofdexmedetomidine1g/kg.The
generaldeclineintheHRwhencomparedwiththebaselinewasobserved.
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Graph3
Comparisonofheartrateinthedexmedetomidine1g/kggroupatdifferent
timeintervals

Graph4comparestheHRsonemployinglignocaine1.5mg/kg,dexmedetomidine0.5g/kg,and
dexmedetomidine1g/kgrespectively.MaximumreductioninHRwasachievedinthegroupthatwas
administereddexmedetomidine1g/kg.

Graph4
Comparisonofheartrateinthethreegroupsatdifferenttimeinstances

AccordingtoTable5:InSBPa,SBPb,SBPcandSBPfthedifferencebetweenthethreemeanswasfoundtobe
significantonapplicationofANOVA,takingP<0.05.However,SBPd(0.403)andSBPe(0.021)werenot
significantonapplicationofANOVA[Table6].

Table5
SBPatdifferenttimesofpatientsbelongingtothethreegroups

Table6
ComparisonofSBPinthelignocaine1.5mg/kggroupatdifferentinstances
oftimetakingSBPonarrivalinOT(SBPa)asthestandardbyemploying
pairedttest

Allreadingswereshowntobestatisticallysignificant(P<0.05)onapplyingpairedttestwhencomparedwiththe
readingonarrivalinOT,thatis,SBPa.

Graph5depictsthevariationintheSBPatdifferentinstancesoftimewiththeuseoflignocaine1.5mg/kg.A
generaldeclineintheSBPwhencomparedwiththebaselinewasobserved.However,amarginalincrementinSBP
wasnoted1minafterintubation[Table7].

Graph5
Comparisonofsystolicbloodpressureinthelignocainegroupatdifferent
timeintervals

Table7
ComparisonofSBPinthedexmedetomidine0.5g/kggroupatdifferent
instancesoftimetakingSBPonarrivalinOT(SBPa)asthestandardby
employingpairedttest

Allreadingswereshowntobestatisticallysignificant(P<0.05)onapplyingpairedttestwhencomparedwiththe
readingonarrivalinOT,thatis,SBPa.TheSBPdecreasedafterthepatientreceivedthestudydrug.

Graph6depictsthevariationintheSBPatdifferentinstancesoftimewiththeuseofdexmedetomidine0.5g/kg.
ThegeneraldeclineintheSBPwhencomparedwiththebaselinewasobserved[Table8].

Graph6
Comparisonofsystolicbloodpressureinthedexmedetomidine0.5g/kg
groupatdifferenttimeintervals

Table8
ComparisonofSBPinthedexmedetomidine0.5g/kggroupatdifferent
instancesoftimetakingSBPonarrivalinOT(SBPa)asthestandardby
employingpairedttest

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Allreadingswereshowntobestatisticallysignificant(P<0.05)onapplyingpairedttestwhencomparedwiththe
readingonarrivalinOT,thatis,SBPa.

Graph7depictsthevariationintheSBPatdifferentinstancesoftimewiththeuseofdexmedetomidine1g/kg.
ThegeneraldeclineintheSBPwhencomparedwiththebaselinewasobserved.

Graph7
Comparisonofsystolicbloodpressureinthedexmedetomidine1g/kg
groupatdifferenttimeintervals

AsperGraph8Oncomparingallthethreegroups,maximumreductioninSBPwasachievedinthegroupthatwas
administereddexmedetomidine1g/kgandwasstatisticallysignificant.

Graph8
Comparisonofdiastolicbloodpressureofthethreegroupsatdifferenttime
instances

AccordingtoTable9.thedifferencebetweenthethreemeanswasfoundtobenotsignificantonapplicationof
ANOVAinDBPa(0.028),DBPc(0.095)andDBPd(0.581),takingP<0.05whereas,DBPb(0.008),DBPe
(0.000)andDBPf(0.001)werefoundtobestatisticallysignificant[Table10].

Table9
DBPatdifferenttimesofpatientsbelongingtothethreegroups

Table10
ComparisonofDBPinthelignocaine1.5mg/kggroupatdifferentinstances
oftimetakingDBPonarrivalinOT(DBPa)asthestandardbyemploying
pairedttest

Besidesthereadingat1minafterintubation,thatis,DBPd(0.286),allotherreadingswereshowntobestatistically
significant(P<0.05)onapplyingpairedttestwhencomparedwiththereadingonarrivalinOT,thatis,DBPa.

Graph9depictsthevariationintheDBPatdifferentinstancesoftimewiththeuseoflignocaine1.5mg/kg.A
declineintheDBPwhencomparedwiththebaselinewasobserved.However,at1and3minafterintubationwe
noticedanincrementintheDBP[Table11].

Graph9
Comparisonofdiastolicbloodpressureinthelignocainegroupatdifferent
timeintervals

Table11
ComparisonofDBPinthedexmedetomidine0.5g/kggroupatdifferent
instancesoftimetakingDBPonarrivalinOT(DBPa)asthestandardby
employingpairedttest

Allreadingswereshowntobestatisticallysignificant(P<0.05)onapplyingpairedttestwhencomparedwiththe
readingonarrivalinOT,thatis,DBPa.

Graph10depictsthevariationintheDBPatdifferentinstancesoftimewiththeuseofdexmedetomidine0.5g/kg.
ThegeneraldeclineintheDBPwhencomparedwiththebaselinewasobserved[Table12].

Graph10
Comparisonofdiastolicbloodpressureinthedexmedetomidine0.5g/kg
groupatdifferenttimeintervals

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Table12
ComparisonofDBPinthedexmedetomidine1g/kggroupatdifferentinstancesoftime
takingDBPonarrivalinOT(DBPa)asthestandardbyemployingpairedttest

Allreadingswereshowntobestatisticallysignificant(P<0.05)onapplyingpairedttestwhencomparedwiththe
readingonarrivalinOTthatisDBPa.

Graph11depictsthevariationintheDBPatdifferentinstancesoftimewiththeuseofdexmedetomidine1g/kg.
AgeneraldeclineintheDBPwhencomparedwiththebaselinewasobserved.

Graph11
Comparisonofdiastolicbloodpressureinthedexmedetomidine1g/kg
groupatdifferenttimeintervals

Oncomparingallthethreegroups,maximumreductioninDBPwasachievedinthegroup,whichwas
administereddexmedetomidine1g/kgandwasstatisticallysignificant.

DISCUSSION Goto:

Thehemodynamicresponsecharacterizedbytachycardiaandhypertensiontomanipulationintheareaofthe
larynx,bymeansoflaryngoscopyandintubation,iswellrecognized.Stimulationofmechanoreceptorsinthe
pharyngealwall,epiglottisandvocalcords,isthoughttobethecauseforthishemodynamicresponse.

Shribmanetal.foundthatlaryngoscopyaloneorfollowedbytrachealintubationincreasesarterialpressureand
catecholaminelevelswhileintubationsignificantlyincreasesHR.[14]Thesechangeswerereportedtobegreatest
60safterintubationofthetracheathatlastsfor510min.Ifnospecificmeasuresaretakentopreventthis
hemodynamicresponse,theHRcanincreasefrom26%to66%dependingonthemethodofinductionandtheSBP
canincreasefrom36%to45%.[14,15]

Myocardialischemiamightoccurduringtheinductionintubationsequenceinpatientswithcoronaryarterydisease.
Intraoperativeischemiahasbeenassociatedwithahighrateofperioperativemyocardialinfarction.[16]
Interventionslikedirectlaryngoscopyinvolvingseveresympatheticstimuli,preventionoftachycardia,hypertension
andelevatedtotaloxygenconsumptionduetosympatheticactivitymayprovebeneficialinpatientswithlimited
cardiacreserve.[17]

Variousstudieshavereviewedtheeffectoflignocainetobluntthesympathoadrenalpressureresponse.Levand
Rosenintheirstudyreviewedtheuseofprophylacticlignocaineasapreintubationmedication.[10]Adoseof1.5
mg/kgintravenously3minpriortointubationwasemployedandwasfoundtobeoptimalforattenuationofthe
sympathoadrenalpressureresponsetolaryngoscopyandintubationwithoutanyovertharmfuleffects.Wealso
administeredlignocaine1.5mg/kg3minbeforeintubationinourstudyandobservedageneraldeclineinHR,SBP,
andDBPasisrepresentedbytheinterpretationofGraphs1,5and9.ThedecreaseinHRandbloodpressurein
ourstudymightalsobeattributedtotheuseofanestheticagentssuchasopioids(fentanyl)andinhalationalagents.

Wilsonetal.intheirstudystatedthatIVlignocaineisbeneficialinpreventingthehemodynamicchangesto
laryngoscopyandintubation.[18]Theirresultsarereiteratedbyourstudytooinwhichwehavedescribedsimilar
results.WenotedthemaximaldeclineofHRtobeat3minafterintubation[Graph1],whilethemaximaldeclinein
SBPandDBPisobservedat5minpostintubation[Graphs5and9].HoweverthisdeclineofHRandblood
pressurecanpossiblybeattributedtothecombinedeffectsoffentanylandinhalationalagentsadministeredduring
themaintenanceofanesthesia.Fromourstatisticalanalysiswealsoinferfrom[Table1]thatthoughthereisa
generaldeclineinHRafteradministrationoflignocaine,butatthetimeintervalcorrespondingto1min
postintubation,weobservedanincreaseinHR.Thisshowsthatthepressureresponsewasincompletelyabolished
bylignocaine.

MaldeandSarodeintheirstudyconcludedthatoncomparisonoflignocaineinadoseof1.5mg/kgandfentanyl2
g/kgforsuppressionofhemodynamicresponsetoendotrachealintubation,fentanylwasfoundtoberelatively
superior.[19]Lignocaineattenuatedtheriseinbloodpressurewhilefentanylpreventedittotally.Therisepersisted
for3mininthelignocainebut10mininthecontrolgroup.Thefentanylgroupalsoshowedasignificantdecrease
inSBPafteradministration,whichcamebacktonormalat13minfollowingintubation.Inourstudywefoundthat

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lignocainesufficientlyattenuatedtheabovementionedhemodynamicresponse,butthisattenuationwasnot
completeandaspikeinSBPwasobserved1minpostintubation[Graph5].Wealsowenoticed2spikesat1min
and3minintervalspostintubationintheDBPrecordings[Graph9]whichareinconcordancewiththeabove
study.Inourstudywealsodidnotencounteranysideeffectslikehypotensionorbradycardiawhenlignocaineata
doseof1.5mg/kgwasemployed.

Recentstudieshowever,havequestionedlignocaine'sefficacy.InstudiesbySinghetal.[20]vandenBergetal.
[21]andKindleretal.[22]IVlignocaine1.5mg/kgwasineffectiveincontrollingtheacutehemodynamicresponse
followinglaryngoscopyandintubation.InastudyconductedbyPathaketal.[23]itwasshownthatlignocaine1.5
mg/kgwasineffectiveinbluntingresponsesduringlaryngoscopyandtrachealintubationwhencomparedwithtwo
differentdosesofalfentanil(15g/kgand30g/kg).Howeverinourstudy,weusedfentanyluniversallyinallthe
threegroups.Fromtheinterpretationoftheresultsofourstudyweconcludedthatlignocaineattenuatedbutdidnot
completelyabolishthepressureresponsetolaryngoscopyandintubation.

Alphatwoadrenergicagonistsdecreasesympathetictoneandtheirpreoperativeusehasbeenshowntobluntthe
hemodynamicresponsestolaryngoscopyandintubation.[24]Theyalsoreducetheneedforanestheticsand
thereforecanbeusedasanadjuncttogeneralanesthesia.[25]Dexmedetomidineisahighlyselectiveandspecific
alphatwoadrenergicagonist.Therefore,itisincreasinglybeingusedasanagenttoattenuatethepressureresponse.

Sagirogluetal.concludedthattheoverallcontrolofhemodynamicresponsestotrachealintubationwerebetterwith
dexmedetomidine1g/kgascomparedtodexmedetomidine0.5g/kg.[26]Inourstudywealsocomparedsimilar
dosesofdexmedetomidinewithlignocaineandweconcludedthat1g/kgofdexmedetomidinesignificantly
reducedtheincreaseinHRassociatedwithlaryngoscopyandintubationwhencomparedto0.5g/kgof
dexmedetomidine.WealsoinferthatbothdosesofdexmedetomidinebroughtuponagreaterdeclineinHRwhen
individuallycomparedwithlignocaine.ThisisrepresentedinGraphs14.

InthestudyconductedbySagirogluetal.[26]theresultsofSBP,DBPandmeanarterialpressurewere
significantlylowerinthegroupgivendexmedetomidine1g/kgthanthegroupgivendexmedetomidine0.5g/kg
at1minafterintubation.ThisisinagreementwithourstudyresultsasrepresentedinTables5and9,whichshowa
statisticallysignificantdeclineinsystolicandDBPsinthegroupadministereddexmedetomidine1g/kg.Wealso
observedageneraldeclineinthesystolicandDBPsinboththegroupsadministereddexmedetomidine(0.5g/kg
and1g/kg)whencomparedtothepressuresonarrivalintheOTwhichwereconsideredasbaseline[Tables5and
9].Oncomparingallthethreegroups,weconcludedthatdexmedetomidine1g/kgbroughtuponamaximal
reductioninsystolicandDBPsat1,3and5minpostintubation[Graphs11and12].Howeveramong
dexmedetomidine0.5g/kgandlignocaine,wenoticedagreaterdeclineinbothsystolicandDBPinthelignocaine
groupascomparedtodexmedetomidine0.5g/kggroupat1,3and5minafterintubation[Graphs11and12].

Graph12
Comparisonofsystolicbloodpressureofthethreegroupsatdifferenttime
instances

Lahaetal.[27]intheirstudycompareddexmedetomidine1g/kgwithcontrolandconcludedthat
dexmedetomidineeffectivelybluntedthehemodynamicresponsesduringlaryngoscopy,andreducedanesthetic
requirements.Ourstudyalsodenotessimilarfindingsandalsoprovidescomparisonbetweentwodifferentdosesof
dexmedetomidine.Fromourstudy,weadequatelyestablishthatdexmedetomidine1g/kgwascomparatively
superiortodexmedetomidine0.5g/kgforattenuationofthepressureresponsetolaryngoscopyandintubation.

Dexmedetomidineisfindingitswayintoeverysegmentofanesthesiapracticeanditssafetyandefficacyasan
agenttoattenuatethepressureresponsehasbeenreasonablywellestablished.

CONCLUSION Goto:

Weconcludethatdexmedetomidineinadoseof1g/kgover10minbeforeinductionofanesthesiaeffectively
attenuatesthehemodynamicresponsetolaryngoscopyandendotrachealintubation.Dexmedetomidine
administeredinadoseof0.5g/kgover10minbeforeinductionofanesthesiawaseffectiveinbluntingthe
tachycardicresponsetointubationbutincompletelyattenuatedtheincreaseinsystolicandDBP.Further,lignocaine
inadoseof1.5mg/kggiven3minbeforelaryngoscopyandintubationwasmoreeffectivethandexmedetomidine
0.5g/kginattenuatingtheincreaseinsystolicandDBPat3minand5minafterendotrachealintubation.
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1/8/2017 Comparativeanalysisofefficacyoflignocaine1.5mg/kgandtwodifferentdosesofdexmedetomidine(0.5g/kgand1g/kg)inattenuatingthehemo

Dexmedetomidine1g/kgwasmoreeffectivethandexmedetomidine0.5g/kginattenuatingthepressure
responsecompletelywithoutanysideeffect.Dexmedetomidine1g/kghasprovedtomaintainhemodynamic
stabilityassociatedwithintubationandhencemayprovebeneficialforcardiacpatientswherethestressresponseto
laryngoscopyandintubationishighlyundesirable.

Insummarydexmedetomidine,ahighlyselective2adrenoreceptoragonisthasmanydesirableclinicalbenefitsthat
encourageitsuseintheperioperativeperiod.

Footnotes Goto:

SourceofSupport:Nil

ConflictofInterest:Nonedeclared.

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