Effect of Dexmedetomidine Nebulization on Attenuation of Haemodynamic Responses to Laryngoscopy: Randomized Controlled Study

Hussain, Mumtaz; Arun, Nidhi; Kumar, Sanjeev; Kumar, Arvind; Kumar, Rajesh; Shekhar, Saurav

doi:10.21088/ijaa.2349.8471.6419.27

Cited by 4 publications

(7 citation statements)

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“…Hussain et al also documented the effect of dexmedetomidine through nebulization on pressor response, but the dose of dexmedetomidine (2 mics/kg) was twice as that included in our study. [ 13 ] Shrivastava et al published in their study that nebulized dexmedetomidine at a dose of 1 mics/kg led to attenuation in the hemodynamic response to laryngoscopy and intubation, while avoiding hypotension, bradycardia, and sedation, which was similar to our study. [ 20 ]…”

Section: Discussionsupporting

confidence: 91%

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Comparison of nebulized ropivacaine (0.75%) with nebulized dexmedetomidine on the hemodynamic response on intubation in patients undergoing surgery under general anesthesia: A comparative randomized double-blind placebo-controlled study

Saxena,

Gill,

Saroa

et al. 2024

Saudi Journal of Anaesthesia

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Background: Laryngoscopy and tracheal intubation lead to sympathetic stimulation resulting in hemodynamic fluctuations. We compared local anesthetic ropivacaine 0.75% with alpha agonist dexmedetomidine through ultrasonic nebulization for direct local action of the drug in the airway. Methods: In our randomized study, 180 patients were prospectively assigned to three groups of 60 each: group R (0.75%), group D (1 microgram/kg), and group C (control). The primary objective was to determine whether nebulized ropivacaine or nebulized dexmedetomidine can cause a reduction in stress response to laryngoscopy and intubation. The secondary objectives were to compare the hemodynamic parameters at extubation, cough response at extubation, and postoperative sore throat. Results: A total of 165 patients were analyzed. Demographically, all the groups were similar. Group R and group D were found to significantly attenuate the heart rate (HR) at intubation and extubation when compared to group C (P < 0.05). A significant reduction in mean arterial pressure (MAP) was seen (P < 0.05; group D: 90 ± 18.4 mmHg, group C: 99.5 ± 15.9 mmHg, group R: 92.4 ± 16.1 mmHg). There was a significant reduction in cough response in both groups in comparison with group C at 0 minutes (P value; group C vs group D: <.0001; group C vs group R:.01) and 5 minutes (P value; group C vs group D: <.0001; group C vs group R: <.0001). Conclusion: Preinduction topical use of ropivacaine or dexmedetomidine, through the nebulization route, effectively attenuated the pressor responses when compared to placebo.

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Section: Discussionsupporting

confidence: 91%

“…[ 9 10 11 12 ] Hussain et al have reported in the literature that dexmedetomidine when administered through the nebulization route had reduced stress response to laryngoscopy and intubation. [ 13 ] Thomas D et al also reported that nebulized dexmedetomidine can attenuate the postoperative sore throat in patients. [ 14 ]…”

Section: Introductionmentioning

confidence: 99%

Comparison of nebulized ropivacaine (0.75%) with nebulized dexmedetomidine on the hemodynamic response on intubation in patients undergoing surgery under general anesthesia: A comparative randomized double-blind placebo-controlled study

Saxena,

Gill,

Saroa

et al. 2024

Saudi Journal of Anaesthesia

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“…Sensitivity analysis was performed after excluding Hussain et al as this study differed from other RCTs in terms of dose of nebulized dexmedetomidine [ 16 ]. The dose used was 2 μg /kg dexmedetomidine whereas in other studies the dose used was 1 μg/kg dexmedetomidine, without any other methodological differences.…”

Section: Resultsmentioning

confidence: 99%

“…1) [23]. A total of seven studies were selected [12,13,[16][17][18][19][20]. However, Kumar et al did not mention effect on HR which was the primary outcome of the study and data for BP (SBP, DBP and MBP) was provided only in graphical figures in the article from which the exact mean (SD) values at each time point could not be extracted for meta-analysis [13].…”

Section: Search Resultsmentioning

confidence: 99%

Nebulized dexmedetomidine for attenuating hemodynamic response to laryngoscopy and endotracheal intubation in adult patients undergoing surgeries under general anaesthesia: a systematic review and meta-analysis of randomized controlled trials

Gupta,

Rohilla,

Gupta

et al. 2023

BMC Anesthesiol

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Background Sympathetic stimulation associated with laryngoscopy and endotracheal intubation (ETI) may lead to adverse cardio-/cerebro-vascular events in susceptible patients. Nebulization is a novel route for dexmedetomidine administration providing a large surface area for absorption while avoiding bradycardia and hypotension associated with intravenous route. We aimed to evaluate the efficacy and safety of dexmedetomidine nebulization for attenuating hemodynamic response to ETI in adult patients undergoing surgery under general anaesthesia. Methods This systematic review was registered prospectively in the International Prospective Register of Systematic Reviews (CRD42023403624). PubMed, Embase (OvidSP), Cochrane library, Scopus (Elsevier), Web of Science (Clarivate) and Google Scholar were systematically searched from database inception until March 31, 2023. Two reviewers independently screened titles, abstracts and then full text against pre-specified eligibility criteria. Randomized controlled trials (RCTs) assessing effect of dexmedetomidine nebulization on hemodynamic response to ETI in adult patients undergoing surgeries under general anaesthesia were included. All studies reporting heart rate and systolic blood pressure at baseline and various time points after ETI were included. A pre-piloted data extraction form, Cochrane revised risk-of-bias tool (ROB 2) tool, GRADE approach and RevMan 5.4.1 (Cochrane Collaboration, Copenhagen, Denmark) were used for data extraction, risk of bias assessment, rating certainty of evidence and data synthesis respectively. Mean difference and relative risk with 95% Confidence Interval (CI) were used for continuous and dichotomous variables respectively. Results Six RCTs randomized 480 patients with ASA I/II patients aged < 60 years of age and undergoing elective surgeries to receive either dexmedetomidine (n = 240) or saline nebulization (n = 240). Except for one RCT which used 2 μg/kg, all other RCTs used dexmedetomidine dose of 1 μg /kg. Heart rate, systolic, diastolic and mean blood pressure were significantly lower in the dexmedetomidine group at all the measured time points after laryngoscopy and ETI with the only exception being systolic blood pressure at 3 min [mean difference -13.86 (95% CI -30.01 to 2.99), p = 0.09]. Bradycardia and hypotension as adverse effects were absent across the included studies. However, only one-third of the included studies had a low risk of bias and strength of evidence was very low according to the GRADE assessment. Conclusions Compared to placebo, premedication with dexmedetomidine nebulization was associated with lower HR and BP following ETI without any risk of bradycardia and hypotension. However, the strength of evidence was very poor and came from just one country. Future well designed and conducted studies in different populations are warranted. Trial registration PROSPERO Registration number: CRD42023403624

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“…Hence adverse events such as hypotension, bradycardia, desaturation, and transient hypertension though possible, are expected to be rare [ 11 , 13 ]. Although multiple studies have previously used nebulized dexmedetomidine in various procedures like flexible bronchoscopy, endotracheal intubation, dental procedures, tonsillectomy, and peripheral intravenous access, additional data is required to explore the potential benefits and thus bring it to the routine clinical practice as a pre-medication in FB [ [14] , [15] , [16] ]. Hence our study compares the patient comfort, tolerance and safety of nebulized dexmedetomidine and lignocaine local anesthesia with conventional lignocaine administered as spray as you go technique.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of nebulized dexmedetomidine as a premedication in flexible bronchoscopy in Indian patients -a prospective, randomized, double-blinded study

Antony¹,

Acharya²,

Acharya³

2023

Contemporary Clinical Trials Communications

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Effect of Dexmedetomidine Nebulization on Attenuation of Haemodynamic Responses to Laryngoscopy: Randomized Controlled Study

Cited by 4 publications

References 0 publications

Comparison of nebulized ropivacaine (0.75%) with nebulized dexmedetomidine on the hemodynamic response on intubation in patients undergoing surgery under general anesthesia: A comparative randomized double-blind placebo-controlled study

Comparison of nebulized ropivacaine (0.75%) with nebulized dexmedetomidine on the hemodynamic response on intubation in patients undergoing surgery under general anesthesia: A comparative randomized double-blind placebo-controlled study

Nebulized dexmedetomidine for attenuating hemodynamic response to laryngoscopy and endotracheal intubation in adult patients undergoing surgeries under general anaesthesia: a systematic review and meta-analysis of randomized controlled trials

Effectiveness of nebulized dexmedetomidine as a premedication in flexible bronchoscopy in Indian patients -a prospective, randomized, double-blinded study

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