A PROSPECTIVE RANDOMIZED STUDY TO COMPARE THE EFFICACY OF TWO DIFFERENT DOSES OF INTRAVENOUS DEXMEDETOMIDINE IN ATTENUATING HEMODYNAMIC RESPONSES DURING LARYNGOSCOPY AND ENDOTRACHEAL INTUBATION

SARA MARY THOMAS; HARSH RATHOD; JIGISHA MEHTA; KALPESH PATIL

doi:10.22159/ajpcr.2025v18i12.56252

Authors

SARA MARY THOMAS Department of Anaesthesiology, Dhiraj Hospital, Smt. Bhikhi ben Kanji bhai Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India.
HARSH RATHOD Department of Anaesthesiology, Dhiraj Hospital, Smt. Bhikhi ben Kanji bhai Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India. https://orcid.org/0000-0003-4499-1734
JIGISHA MEHTA Department of Anaesthesiology, Dhiraj Hospital, Smt. Bhikhi ben Kanji bhai Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India. https://orcid.org/0000-0002-0909-095X
KALPESH PATIL Department of Anaesthesiology, Dhiraj Hospital, Smt. Bhikhi ben Kanji bhai Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India. https://orcid.org/0000-0003-4499-1734

DOI:

https://doi.org/10.22159/ajpcr.2025v18i12.56252

Keywords:

Dexmedetomidine, Hemodynamic response, Laryngoscopy,, Endotracheal intubation, General anesthesia.

Abstract

Objectives: The objective of this study was to compare the efficacy of two different doses of intravenous dexmedetomidine (0.75 mcg/kg vs. 1 mcg/kg) in attenuating the hemodynamic responses during laryngoscopy and endotracheal intubation in adult patients undergoing elective surgeries under general anesthesia. The study aimed to evaluate the optimal dose that balances effective cardiovascular stabilization with minimal adverse effects.

Methods: This prospective randomized study included 60 adult patients (American Society of Anesthesiologists I and II) aged 18–60 years undergoing elective surgeries under general anesthesia. Patients were randomly allocated into two groups: Group A (n=30) received dexmedetomidine 0.75 mcg/kg IV, and Group B (n=30) received dexmedetomidine 1 mcg/kg IV as an infusion in 100 mL normal saline over 15 min 30 min before induction. Hemodynamic parameters (heart rate [HR], systolic blood pressure, diastolic blood pressure, and mean arterial pressure [MAP]) were recorded at baseline before drug administration, at 15 and 30 min following administration of the study drug until induction, after induction, during laryngoscopy and intubation, and subsequently at 1, 3, 5, and 7 min after intubation. Post-operative sedation was assessed using the Ramsay Sedation Score.

Results: Both groups showed significant attenuation of hemodynamic responses during laryngoscopy and endotracheal intubation. Group B (1 mcg/kg) demonstrated significantly better control of HR and blood pressure during laryngoscopy and intubation compared to Group A (0.75 mcg/kg). The mean percentage increase in HR from baseline during laryngoscopy and intubation was 11.8±3.2% in Group A compared to 5.8±2.0% in Group B (p<0.001). Similarly, the mean percentage increase in MAP was 9.7±2.8% in Group A versus 4.5±1.8% in Group B (p<0.001). Group B showed a higher incidence of bradycardia (20.0% vs. 6.7%) and hypotension (10.0% vs. 0.0%) compared to Group A, though these were easily managed. Post-operative sedation scores were significantly higher in Group B for the first 90 min after extubation.

Conclusion: Dexmedetomidine at a dose of 1 mcg/kg IV provides more effective attenuation of hemodynamic responses to laryngoscopy and endotracheal intubation compared to 0.75 mcg/kg. However, it is associated with a higher incidence of bradycardia and hypotension, requiring vigilant monitoring. The choice of dose should be individualized based on the patient’s cardiovascular status and clinical requirements.

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References

1. Kumar S, Singh A, Patel R. Comparative evaluation of dexmedetomidine and propofol for attenuation of hemodynamic response to laryngoscopy: A randomized controlled trial. Int J Appl Pharm. 2023;15(3):142-8. doi: 10.22159/ijap.2023v15i3.47521

2. Sharma P, Mehta N, Verma K. Efficacy of different doses of dexmedetomidine in attenuating cardiovascular responses: A systematic review and meta-analysis. Int J Appl Pharm. 2022;14(5):89-95. doi: 10.22159/ijap.2022v14i5.45632

3. Patel M, Kumar A, Singh D, Rastogi B. Alpha-2 agonists in anesthesia practice: Current perspectives and future applications. Int J Pharm Clin Res. 2023;15(8):567-74.

4. Verma S, Gupta R, Sharma A. Pharmacological strategies for blunting hemodynamic responses during intubation: A comprehensive review. Int J Curr Res. 2023;15(2):234-41.

5. Niyogi S, Biswas A, Chakraborty I, Chakraborty S, Acharjee A. Attenuation of haemodynamic responses to laryngoscopy and endotracheal intubation with dexmedetomidine: A comparison between intravenous and intranasal route. Indian J Anaesth. 2019;63(11):915-23. doi: 10.4103/ija.IJA_320_19, PMID 31772400

6. Joshi A, Patel N, Shah M. Comparison of esmolol and dexmedetomidine for attenuation of sympathomimetic response to laryngoscopy: A randomized clinical trial. Int J Pharm Pharm Sci. 2023;15(4):28-33. doi: 10.22159/ijpps.2023v15i4.47251

7. Singh RK, Kumar P, Mehta S. Recent advances in alpha-2 adrenergic agonists: Focus on dexmedetomidine. Int J Curr Pharm Res. 2024;16(1):45-52. doi: 10.22159/ijcpr.2024v16i1.3085

8. Koivusalo AM, Scheinin M, Tikkanen I, Yli-Suomu T, Ristkari S, Laakso J, et al. Effects of esmolol on haemodynamic response to CO2 pneumoperitoneum for laparoscopic surgery. Acta Anaesthesiol Scand. 1998;42(5):510-7. doi: 10.1111/j.1399-6576.1998.tb05159.x, PMID 9605365

9. Feig BW, Berger DH, Dougherty TB, Dupuis JF, Hsi B, Hickey RC, et al. Pharmacologic intervention can reestablish baseline hemodynamic parameters during laparoscopy. Surgery. 1994;116(4):733-9; discussion 739-41. PMID 7940173

10. Sebastian B, Talikoti AT, Krishnamurthy D. Attenuation of haemodynamic responses to laryngoscopy and endotracheal intubation with intravenous dexmedetomidine: A comparison between two doses. Indian J Anaesth. 2017;61(1):48-54. doi: 10.4103/0019-5049.198404, PMID 28216704

11. Yildiz M, Tavlan A, Tuncer S, Reisli R, Yosunkaya A, Otelcioglu S. Effect of dexmedetomidine on haemodynamic responses to laryngoscopy and intubation: perioperative haemodynamics and anaesthetic requirements. Drugs R D. 2006;7(1):43-52. doi: 10.2165/00126839-200607010- 00004, PMID 16620136

12. Shin HW, Yoo HN, Kim DH, Lee H, Shin HJ, Lee HW. Preanesthetic dexmedetomidine 1 μg/kg single infusion is a simple, easy, and economic adjuvant for general anesthesia. Korean J Anesthesiol. 2013;65(2):114-20. doi: 10.4097/kjae.2013.65.2.114, PMID 24023992

13. Pathak A, Paranjpe J, Kulkarni R. Comparison of two doses of dexmedetomidine on haemodynamic stability in patients undergoing laparoscopic surgeries. Jou Kriins Med Sci Uni. 2016;5(3):36-43.

14. Agarwal S, Gupta K, Singh VP, Sharma M. Dexmedetomidine for perioperative sedation and analgesia in laparoscopic surgeries: A dose-finding study. Int J Appl Pharm. 2021;13(2):178-84. doi: 10.22159/ ijap.2021v13i2.40521

15. Singh M, Joshi P, Kulkarni S, Sasturkar V. A comparative study of two different doses of dexmedetomidine for attenuating the haemodynamic response to tracheal intubation. Int J Med Anesthesiol. 2020;3(4):70-3. doi: 10.33545/26643766.2020.v3.i4b.166

16. Kabara J, Meena S, Jain P, Gagrani V. Comparison between effect of two different doses of intravenous dexmedetomidine in attenuating hemodynamic response to laryngoscopy and endotracheal intubation in elective general surgeries under general anaesthesia. Int J Curr Pharm Res. 2024;16(3):52-5. doi: 10.22159/ijcpr.2024v16i3.4066

17. Jain K, Sethi SK, Harsha KN, Patodi V, Jain N, Meena D. Efficacy of dexmedetomidine in attenuating pressor response to laryngoscopy and endotracheal intubation under bispectral index controlled anesthesia: A prospective randomized double-blinded study. Ain Shams J Anesthesiol. 2023;15:15. doi: 10.1186/s42077-023-00312-1

18. Bhagat N, Yunus M, Karim HM, Hajong R, Bhattacharyya P, Singh M. Dexmedetomidine in attenuation of haemodynamic response and dose sparing effect on opioid and anaesthetic agents in patients undergoing laparoscopic cholecystectomy- a randomized study. J Clin Diagn Res. 2016;10(11):UC01-5. doi: 10.7860/JCDR/2016/21501.8815, PMID 28050479

19. Purohit A, Kumar M, Kumar N, Bindra A, Pathak S, Yadav A. Comparison between dexmedetomidine and lidocaine for attenuation of cough response during tracheal extubation: A systematic review and meta-analysis. Indian J Anaesth. 2024;68(5):415-25. doi: 10.4103/ija. ija_790_23, PMID 38764958

20. Kumari K, Gombar S, Kapoor D, Sandhu HS. Clinical study to evaluate the role of preoperative dexmedetomidine in attenuation of hemodynamic response to direct laryngoscopy and tracheal intubation. Acta Anaesthesiol Taiwan. 2015;53(4):123-30. doi: 10.1016/j. aat.2015.09.003, PMID 26510669

21. Uysal HY, Tezer E, Türkoğlu M, Aslanargun P, Başar H. The effects of dexmedetomidine on hemodynamic responses to tracheal intubation in hypertensive patients: A comparison with esmolol and sufentanil. J Res Med Sci. 2012;17(1):22-31. PMID 23248653

22. Swarnamba UN, Veena K, Shaikh SI. Comparative evaluation of dexmedetomidine versus clonidine as premedication for attenuation of hemodynamic response to laryngoscopy and intubation: A randomized controlled trial. Int J Pharm Pharm Sci. 2022;14(7):35-40. doi: 10.22159/ ijpps.2022v14i7.44852

23. Seangrung R, Pasutharnchat K, Injampa S, Kumdang S, Komonhirun R. Comparison of the hemodynamic response of dexmedetomidine versus additional intravenous lidocaine with propofol during tracheal intubation: A randomized controlled study. BMC Anesthesiol. 2021;21(1):174. doi: 10.1186/s12871-021-01395-2

24. Kunisawa T, Nagata O, Nagashima M, Mitamura S, Ueno M, Suzuki A, et al. Dexmedetomidine suppresses the decrease in blood pressure during anesthetic induction and blunts the cardiovascular response to tracheal intubation. J Clin Anesth. 2009;21(3):194-9. doi: 10.1016/j. jclinane.2008.08.015, PMID 19464613

25. Agrawal S, Agrawal K, Agrawal V, Agrawal UK. The evaluation of effects of single premedication dose of I.V dexmedetomidine in attenuating pressor response to laryngoscopy & endotracheal intubation in elective surgeries under general anaesthesia. Eur J Cardiovasc Med. 2023;13(1):1355-62.