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Laryngoscopy, tracheal intubation, surgical stimulation, and extubation unleash remarkable sympathetic activity and are associated with transient but significant hemodynamic changes. The need to blunt these noxious responses effectively has led to using several techniques and pharmacological agents, local anesthetics, beta-adrenergic-blockers, calcium channel antagonists, and opioids with varied success. This study aims to evaluate the effect of nebulized and intravenous either dexmedetomidine or lidocaine for attenuating the hemodynamic responses to laryngoscopy and intubation.
Hemodynamic responses to laryngoscopy and intubation are a significant concern for the anesthesiologist. Laryngoscopy, tracheal intubation, surgical stimulation, and extubation unleash remarkable sympathetic activity and are associated with transient but significant hemodynamic changes. These hemodynamic derangements can be lethal in patients with multiple comorbidities. The need to blunt these noxious responses effectively has led to using several techniques and pharmacological agents, local anesthetics, beta-adrenergic-blockers, calcium channel antagonists, and opioids with varied success. This study aims to evaluate the effect of nebulized and intravenous either dexmedetomidine or lidocaine for attenuating the hemodynamic responses to laryngoscopy and intubation.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Dexmedetomidine nebulization | Active Comparator | The patient will receive nebulized dexmedetomidine via face mask nebulizer (1mcg/kg) 20 minutes before induction. |
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| Lidocaine Nebulization | Active Comparator | The patient will receive nebulized lidocaine 4% (3 mg /kg) added to 2 ml normal saline 0.9% 10 minutes before induction of general anesthesia. |
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| Dexmedetomidine IV | Active Comparator | The patient will receive an intravenous infusion of dexmedetomidine (1 ml= 4 mcg) via a syringe pump and will be started at a dose of 1 mcg/kg 20 minutes before induction of general anesthesia. |
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| Lidocaine IV | Active Comparator | The patient will receive 1.5mg/kg intravenous lidocaine 2% completed to 10 ml with normal saline 0.9% intravenous 90 seconds before induction of general anesthesia. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Dexmedetomidine nebulization | Drug | The patient will receive nebulized dexmedetomidine via face mask nebulizer 10 minutes before induction of general anesthesia. |
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| Measure | Description | Time Frame |
|---|---|---|
| Change in serum cortisol levels. | Base line blood sample will be drawn 45 minutes preoperative and 10 minutes post intubation for cortisol level measurements. | Measurement will be done 45 minutes preoperative and 10 minutes after endotracheal intubation. |
| Change in mean arterial blood pressure (MAP) in mmHg. | Mean arterial pressure (MAP) will be recorded 10 minutes before induction and at 1,3,5,7 and10 minutes after endotracheal intubation. | Measurement will be done 10 minutes before induction and at 1,3,5,7 and 10 minutes after endotracheal intubation. |
| Change in heart rate (HR) per minute. | Heart rate (HR) will be recorded 10 minutes before induction and at 1,3,5,7 and10 minutes after endotracheal intubation. | Measurement will be done 10 minutes before induction and at 1,3,5,7 and 10 minutes after endotracheal intubation. |
| Change in systolic blood pressure (SBP) in mmHg. | Systolic blood pressure (SBP)will be recorded 10 minutes before induction and at 1,3,5,7 and10 minutes after endotracheal intubation. | Measurement will be done 10 minutes before induction and at 1,3,5,7 and 10 minutes after endotracheal intubation. |
| Change in diastolic blood pressure (DBP) in mmHg. | Diastolic blood pressure (SBP)will be recorded 10 minutes before induction and at 1,3,5,7 and 10 minutes after endotracheal intubation. | Measurement will be done 10 minutes before induction and at 1,3,5,7 and10 minutes after endotracheal intubation. |
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Inclusion Criteria:
Mallampati grade I, II
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Zaki Saleh Taha, MD | Professor of Anesthesia, Intensive Care and pain management | Principal Investigator |
| Yasser Mohamed Nasr, MD | Professor of Anesthesia, Intensive Care and pain management | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Faculty of medicine, Zagazig University | Zagazig | Al-Sharkia | 055 | Egypt |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 37250266 | Background | Sriramka B, Warsi ZH, Sahoo J. Effects of adding dexmedetomidine to nebulized lidocaine on control of hemodynamic responses to laryngoscopy and intubation: A randomized clinical trial. J Anaesthesiol Clin Pharmacol. 2023 Jan-Mar;39(1):11-17. doi: 10.4103/joacp.JOACP_93_21. Epub 2022 Feb 10. | |
| 32434291 | Background |
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| ID | Term |
|---|---|
| D020927 | Dexmedetomidine |
| D008012 | Lidocaine |
| ID | Term |
|---|---|
| D007093 | Imidazoles |
| D001393 | Azoles |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
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| Lidocaine nebulization | Drug | The patient will receive nebulized lidocaine 4% (3 mg /kg) 10 minutes before induction of general anesthesia. |
|
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| Dexmedetomidine IV | Drug | The patient will receive intravenous infusion via a syringe pump of dexmedetomidine (1 ml= 4mcg) started at a dose of 1 mcg/kg 20 minutes before induction of general anesthesia. |
|
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| Lidocaine IV | Drug | The patient will receive 1.5 mg/kg lidocaine 2% (1 ml = 20mg) completed to 10 ml with normal saline 0.9% intravenous 90 seconds before induction of general anesthesia. |
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| Misra S, Behera BK, Mitra JK, Sahoo AK, Jena SS, Srinivasan A. Effect of preoperative dexmedetomidine nebulization on the hemodynamic response to laryngoscopy and intubation: a randomized control trial. Korean J Anesthesiol. 2021 Apr;74(2):150-157. doi: 10.4097/kja.20153. Epub 2020 May 20. |
| 29910490 | Background | Mahajan L, Kaur M, Gupta R, Aujla KS, Singh A, Kaur A. Attenuation of the pressor responses to laryngoscopy and endotracheal intubation with intravenous dexmedetomidine versus magnesium sulphate under bispectral index-controlled anaesthesia: A placebo-controlled prospective randomised trial. Indian J Anaesth. 2018 May;62(5):337-343. doi: 10.4103/ija.IJA_1_18. |
| 27247914 | Background | Soltani Mohammadi S, Maziar A, Saliminia A. Comparing Clonidine and Lidocaine on Attenuation of Hemodynamic Responses to Laryngoscopy and Tracheal Intubation in Controlled Hypertensive Patients: A Randomized, Double-Blinded Clinical Trial. Anesth Pain Med. 2016 Mar 27;6(2):e34271. doi: 10.5812/aapm.34271. eCollection 2016 Apr. |
| 32695159 | Background | Mahjoubifard M, Heidari M, Dahmardeh M, Mirtajani SB, Jahangirifard A. Comparison of Dexmedetomidine, Lidocaine, and Fentanyl in Attenuation Hemodynamic Response of Laryngoscopy and Intubation in Patients Undergoing Cardiac Surgery. Anesthesiol Res Pract. 2020 Jul 1;2020:4814037. doi: 10.1155/2020/4814037. eCollection 2020. |
| D000083 |
| Acetanilides |
| D000813 | Anilides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D000814 | Aniline Compounds |
| D000588 | Amines |