Effect of Preoperative Dexmedetomidine Nebulisation on the Hemodynamic Response to Laryngoscopy and Intubation - A Prospective Observational Study

Abstract

Background: Laryngoscopy and endotracheal intubation are known to trigger sympathetic stimulation, resulting in increased heart rate and blood pressure. These hemodynamic responses can be detrimental in patients with limited cardiovascular reserve. Dexmedetomidine, an α2-adrenergic agonist, has shown promise in attenuating these responses, with the nebulized form offering a non-invasive alternative to intravenous administration. Objective: To evaluate the effect of preoperative nebulized dexmedetomidine on heart rate and blood pressure changes following laryngoscopy and intubation. Methods: A randomized study was conducted on ASA I and II adult patients aged 18–60 years undergoing elective surgeries under general anesthesia. Patients were divided into two groups: one received nebulized dexmedetomidine (1 μg/kg) 30 minutes before induction, and the other received nebulized saline. Hemodynamic parameters (HR, SBP, DBP, SpO2) were recorded at baseline, post-nebulization, before induction, and at 1, 5, and 10 minutes after intubation. Mixed-effects statistical modeling was used for analysis. Results: There was a significantly lower increase in heart rate in the dexmedetomidine group after laryngoscopy compared to the saline group (P = 0.015). No significant difference in systolic blood pressure was observed between the groups. The dexmedetomidine group also required lower doses of propofol and fentanyl intraoperatively, without notable adverse effects or excessive sedation. Conclusion: Nebulized dexmedetomidine at 1 μg/kg effectively attenuates the heart rate response to laryngoscopy and intubation without significant side effects, making it a viable, non-invasive premedication alternative in adult surgical patients.