Control of blood pressure during anesthesia is very crucial. Laryngoscopic manipulation and endotracheal intubation are always a matter of concern which capable of producing tachycardia, arrhythmias and hypertension which is generally well tolerated in healthy patient. In hypertensive patient cardiovascular response to laryngoscopy and intubation is exaggerated.  This study was conducted to assess the efficacy of different doses of dexmedetomidine in reduction of blood pressure during laryngoscopy and intubation in controlled hypertensive patient. This prospective Randomized controlled trial was carried out among 60 patients belonging to American Society of Anesthesiologists (ASA) Physical Status II posted for elective general anesthesia. Patients were randomly divided into three groups where each groups contain twenty with fixed card sampling. Group A consisted of twenty (20) patients who were received IV dexmedetomidine 0.5 µg/kg diluted to 50 ml with normal saline.  Group B consisted of twenty (20) patients who were received IV dexmedetomidine 0.75 µg/kg diluted to 50 ml with normal saline. Group C consisted of twenty (20) patients who were received IV dexmedetomidine 1 µg/kg diluted to 50 ml with normal saline. Each infusions were started 10 minutes prior induction of general anesthesia and were given over 10 minutes. Baseline systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial blood pressure (MAP) were measured by one volunteer anesthesiologists by non-invasive blood pressure monitor. Following laryngoscopy and endotracheal intubation, the parameters recorded were SBP, DBP and MAP at 1, 3 and 5 min after intubation by non-invasive blood pressure monitor. The primary outcome measures were blood pressure responses after intubation and secondary outcome measures were to note down any adverse effects associated with drugs.  In this study baseline readings of SBP, DBP and MAP were almost similar in all three groups and statistically not significant. Maximum intubation response was seen at 1 min post intubation in all the three groups. The mean SBP of group A varied from 144.8±8.4 mmHg to 118.5±4.4 mmHg that of group B varied from 134.8±4.1 to 122.0±4.2 mmHg and then group C varied from 126.5±15.5 mmHg to 103.8±8.4 mmHg during different evaluation period (p<0.05). The mean DBP of group A varied from 91.8±7.6 mmHg to 72.4±5.8 mmHg that of group B varied from 81.3±5.2 to 70.3±2.5 mmHg and then group C varied from 80.9±6.7 mmHg to 63.4±2.4 mmHg during different evaluation period (p<0.05). The mean MAP of group A varied from 109.0±5.6 mmHg to 87.5±4.4 mmHg that of group B varied from 98.7±2.5 to 86.3±3.4 mmHg and then group C varied from 95.5±9.2 mmHg to 76.5±3.4 mmHg during different evaluation period (p<0.05). The mean SBP at 1st hour was found 127.9±6.5 in group A, 131.6±6.4 group B and 131.5±7.1 group C. The DBP at 1st hour was found 126.8±6.4 in Group A, 131.4±6.8 in Group B and 131.8±6.1 in Group C. The mean MAP at 1st hours was found 93.2±3.7 in group A, 95.4±3.4 in Group B and 96.2±4.9 in Group C(p>0.05). Dexmedetomidine in doses of 0.75 µg/kg was more effective compared to 0.05 µg/kg and 1µg/kg in attenuating blood pressure response to laryngoscopy and endotracheal intubation without producing adverse effects in control hypertensive patients. Bangladesh Med J. 2019 Sep; 48 (3): 1-8

Background: Laryngoscopic manipulation and endotracheal intubation are always a matter of concernwhich capable of producing tachycardia, arrhythmias and hypertension which is generally well tolerated inhealthy patient. In Hypertensive patient cardiovascular response to laryngoscopy and intubation is exaggerated. Aims: To assess the effectiveness in attenuation of haemodynamic responses to laryngoscopy andendotracheal intubation with different doses of intravenous dexmedetomidine in controlled hypertensivepatients with no adverse effects. Methods: This prospective Randomized controlled trial was carried out with 60 patients belonging toAmerican Society of Anesthesiologists (ASA) Physical Status II posted for elective general anaesthesia.Patients were randomly divided into three groups with fixed card sampling, where, patients who receivedIV dexmedetomidine 0.5 μg/kg diluted to 50 ml with normal saline as infusion over 10 min was consideredas group A, patients who received IV dexmedetomidine 0.75 μg/kg diluted to 50 ml with normal salinewas considered as group B and patients who received IV dexmedetomidine 1 μg/kg diluted to 50 ml withnormal saline was considered as group C. The primary outcome measures were haemodynamic responseat 1, 3 and 5 min after intubation. The secondary outcome measures were to note down any adverseeffects associated with drugs. Result: The groups were well matched for their demographic data . Male to female ratio was 1:1 in allthree group. The mean height, weight and BMI were almost similar among three groups. In this studybaseline readings of SBP, DBP, MAP and HR were almost similar in all three groups and statistically notsignificant. Maximum intubation response was seen at 1 min post intubation in all the three groups. Themean SBP of group A varied from 144.8±8.4 mmHg to 118.5±4.4 mmHg that of group B varied from134.8±4.1 to 122.0±4.2 mmHg and then group C varied from 126.5±15.5 mmHg to 103.8±8.4 mmHgduring different evaluation period (p<0.05). The mean DBP of group A varied from 91.8±7.6 mmHg to72.4±5.8 mmHg that of group B varied from 81.3±5.2 to 70.3±2.5 mmHg and then group C varied from80.9±6.7 mmHg to 63.4±2.4 mmHg during different evaluation period (p<0.05). The mean MAP of groupA varied from 109.0±5.6 mmHg to 87.5±4.4 mmHg that of group B varied from 98.7±2.5 to 86.3±3.4mmHg and then group C varied from 95.5±9.2 mmHg to 76.5±3.4 mmHg during different evaluationperiod (p<0.05). The mean heart rate of group A varied from 94.5±12.7 bpm to 75.2±10.5 bpm that ofgroup B varied from 87.3±8.3 to 75.0±6.6 bpm and then group C varied from 81.1±7.2 bpm to 66.2±8.1bpm during different evaluation period (p<0.05). Conclusion: Dexmedetomidine in doses of 0.75 μg/kg was more effective compared to 0.05 μg/kg and1μg/kg in attenuating haemodynamic response to laryngoscopy and endotracheal intubation withoutproducing adverse effects in control hypertensive patients. JBSA 2020; 33(2): 69-77