ATTENUATION OF HEMODYNAMIC RESPONSES TO ENDOTRACHEAL INTUBATION WITH INTRAVENOUS DEXMEDETOMIDINE, LIGNOCAINE AND FENTANYL : A RANDOMISED CONTROLLED TRIAL.

Dr. Narmada Padhy, Dr. Abhiruchi Patki, Dr. Srilata Moningi

Abstract


Laryngoscopy and intubation often leads to haemodynamic changes which is detrimental with certain subset of patients.
AIM OF THE STUDY : To compare the effect of intravenous dexmedetomidine, lignocaine and fentanyl for obtundation of the pressor response.
MATERIAL AND METHODS: Seventy eight patients were randomised into three groups to receive intravenous Dexmedetomidine (Group-D) ,
Lignocaine (Group-L) and Fentanyl (group-F) before intubation. After routine protocol of induction and intubation, haemodynamic parameters
were noted during different time points after intubation .The requirement for propofol for induction was also noted. Data was analyzed using
Student's t-test and Fisher's exact test.
RESULTS: Overall there was no significant haemodynamic changes in all the three groups except the SBP, DBP, MAP decreased significantly at 5
and 10 mins of intubation than baseline. (p<0.05) . Propofol requirement in group D was significantly less than the other groups.(p=0.01).
CONCLUSION: The effect of dexmedetomidine , lignocaine and fentanyl were comparable for attenuation of pressor response, while the
induction agent requirement was less in dexmedetomidine group.


Keywords


Pressor Response, Dexmedetomidine, Lignocaine, Fentanyl

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References


Derbyshire DR, Chmielewski A, Fell D, Vater M, Achola K, Smith G. Plasma catecholamine responses to tracheal intubation. Br J Anaesth 1983;55:855‑60.

Shribman AJ, Smith G, Achola KJ. Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation. Br J Anaesth 1987;59:295‑9.

Sulaiman S, Karthekeyan RB, Vakamudi M, Sundar AS, Ravullapalli H, Gandham R. The effects of dexmedetomidine on attenuation of stress response to endotracheal intubation in patients undergoing elective off -pump coronary artery bypass grafting. Ann Card Anaesth 2012;15:39-43.

Wilson IG, Meiklejohn BH, Smith G. Intravenous lignocaine and sympathoadrenal responses to laryngoscopy and intubation. The effect of varying time of injection. Anaesthesia 1991;46:177-80.

Tam S, Chung F, Campbell M. Intravenous lidocaine: optimal time of injection before tracheal intubation. Anesth Analg 1987;66:1036-8

Miller CD, Warren SJ. IV lignocaine fails to a enuate the cardiovascular response to laryngoscopy and tracheal intubation. Br J Anaesth 1990;65:216-9.

Talke P, Richard Chen, Brian Thomas- The hemodynamic and adrenergic effects of perioperativeDexmedetomidineinfusion in patients undergoing vascular surgery. Anesthesiology2000; 90: 834-839

Scheinin B, Lindgren L, Randell T, Scheinin H, Scheinin M. Dexmedetomidine attenuates sympathoadrenal responses to tracheal intubation and reduces the need for thiopentone and per operative fentanyl. British journal of anaesthesia. 1992;68(2):126-31.

Menda F, Köner O, Sayin M, Türe H, Imer P, Aykaç B. Dexmedetomidine as an adjunct to anesthetic induction to a enuate hemodynamic response to endotracheal intubation in patients undergoing fast-track CABG. Ann Card Anaesth 2010;13:16-21.

Keniya VM, Ladi S, Naphade R. Dexmedetomidine attenuates sympathoadrenal response to tracheal intubation and reduces perioperative anaesthetic requirement. Indian J Anaesth 2011;55:352-7.

Bajwa SJ, Kaur J, Singh A, Parmar S, Singh G, Kulshrestha A, et al. A enuation of pressor response and dose sparing of opioids and anaesthetics with pre-operative dexmedetomidine. Indian J Anaesth 2012;56:123-8.

Guler G, Akin A, Tosun Z, Eskitascoglu E, Mizrak A, Boyaci A. Singledose dexmedetomidine a enuates airway and circulatory refl exes during extubation. Acta Anaesthesiol Scand 2005;49:1088-91.

Sulaiman S, Karthekeyan RB, Vakamudi M, Sundar AS, Ravullapalli H, Gandham R. The effects of dexmedetomidine on attenuation of stress response to endotracheal intubation in patients undergoing elective off -pump coronary artery bypass grafting. Ann Card Anaesth 2012;15:39-43.

Scheinin B, Lindgren L, Randell T, Scheinin H, Scheinin M. Dexmedetomidine a enuates sympathoadrenal responses to tracheal intubation and reduces the need for thiopentone and peroperative fentanyl. Br J Anaesth 1992;68:126-31.

Pipanmekaporn T, Punjasawadwong Y, Charuluxananan S, Lapisatepun W, Bunburaphong P. The effect of prophylactic dexmedetomidine on hemodynamic disturbances to double-lumen endotracheal intubation: A prospective, randomized, double-blind, and placebo-controlled trial. Anesthesiol Res Pract 2013;2013:236089

Virendrakumar R Belekar J .Acomparison of pressor response to induction & endotracheal intubation with thiopentone and propofol - prospective, randomised study International Journal of Biomedical and advance 708 IJBAR (2012) 03(09)

Keniya VM, Ladi S, Naphade R. Dexmedetomidine attenuates sympathoadrenal response to tracheal intubation and reduces perioperative anaesthetic requirement. Indian J Anaesth 2011;55:352-7.

Scheinin B, Lindgren L, Randell T, Scheinin H, Scheinin M. Dexmedetomidine a enuates sympathoadrenal responses to tracheal intubation and reduces the need for thiopentone and peroperative fentanyl. Br J Anaesth 1992;68:126-31.

Singh S et al A comparative study of effect of dexmedetomidine in dose of 0.7µg/kg and clonidine in doses of 2µg/kg as premedication before general anaesthesia. Int.j med sci 2016 Aug;4(8) 3365-3369


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