Objective: The aim of the study was to determine the role of nebulized dexmedetomidine in attenuating the stress response to laryngoscopy and intubation and to observe any adverse effects of the drug such as cough, bradycardia, hypotension, and dose-sparing result of propofol. Methods: A prospective and observational study was conducted in a tertiary care teaching hospital for 12 months. A total of 62 patients (ASA 1 and 2) in the age group of 18–65 years scheduled for elective surgery under general anesthesia received either nebulized dexmedetomidine 10 min before intubation (Group A) or Inj. Lignocaine 90 s before intubation (Group B). Post-intubation hemodynamic parameters were compared in both groups. Data collected remained analyzed using SPSS version 16. Results: Both groups were comparable with respect to demographic variables. Nebulization with Inj. Dexmedetomidine showed statistically significant blunting of hemodynamic response in the 1st min following intubation, in Group A. This was seen in the variables such as heart rate, diastolic blood pressure, and mean arterial blood pressure. There was no significant difference in the systolic blood pressure at all points of time. Furthermore, there was no significant change in the variables at 5 and 10 min following intubation. There was a significant decrease in the dose of propofol required for induction in Group A compared to Group B. Conclusion: Nebulization with dexmedetomidine before laryngoscopy and intubation significantly reduced the hemodynamic response to intubation, immediately after intubation.

Objective: The aim of the study was to study the effects of melatonin in attenuation of hemodynamic responses such as heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean blood pressure (MBP) to laryngoscopy and intubation (L&I) in general anesthesia. Methods: This was a prospective and observational study conducted in a tertiary care teaching hospital on 120 patients aged 20–45 years belonging to American Society of Anaesthesiologists Grade I, undergoing elective surgery under general anesthesia. Selected patients were allotted into Group A (control group) and Group B (patients who took tablet melatonin 6 mg, 120 min before induction) of 60 patients each. Hemodynamic parameters such as HR, systolic, diastolic, and MBPs were recorded before the administration of drug (baseline), 120 min after administration of study drug (just before induction), immediately after induction, at L&I, just after L&I and at 1, 3, 5, and 10 min thereafter. Results: The gender distribution and mean age of both groups were comparable. Both the groups were also comparable with respect to baseline values of HR, systolic, diastolic, and mean arterial pressure. The control group showed significant increases in HR, SBP, DBP, and mean arterial blood pressure after L&I and this increase persisted for the next 10 min. In the melatonin group, there was no significant increase in HR, systolic, diastolic, or MBP at any point of measurement after L&I. Conclusion: Pre-treatment with 6 mg oral melatonin 120 min before induction of anesthesia is effective for attenuating hemodynamic responses to L&I without significant side effects.

Direct laryngoscopy and endotracheal intubation is associated with reflex cardiovascular responses

BACKGROUND: Spine surgeries are usually associated with excessive blood loss, which increases morbidity and mortality due to hemodynamic instability and subsequent blood transfusions. Tranexamic acid (TXA), an antibrinolytic drug, inhibits the activation of plasminogen, is found to be useful in reducing blood loss. METHODOLOGY: A prospective observational study conducted in Government Medical College, Kottayam for a period of twelve months, randomly assigned forty-eight adult patients (ASA I or II) undergoing thoracolumbar spine surgery into two groups, who received either a bolus of 10 mg/kg IV TXA after induction followed by an infusion of 1 mg/kg/h of TXA up to closure of skin, or an equivalent volume of normal saline. Blood investigations, surgical parameters, perioperative blood loss and blood transfusions were assessed. RESULTS: Both groups in the study were comparable with respect to demographic variables, baseline laboratory indices and surgical parameters. The mean perioperative blood loss was 44% less (P<0.05) and blood transfusion requirements were 71% reduced (P<0.05) in patients who received TXA. Mean surgical duration as well as postoperative hemoglobin drop was signicantly reduced in TXA group compared to Normal Saline group (NS). CONCLUSION: Tranexamic acid reduces perioperative blood loss and blood transfusion.