Dexmedetomidine or Lidocaine for Attenuating the Hemodynamic Responses to Laryngoscopy and Intubation
Study Details
Study Description
Brief Summary
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.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
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.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Active Comparator: Nebulized Dexmedetomidine The patient will receive nebulized dexmedetomidine via face mask nebulizer (1mcg/kg) added to 2 ml normal saline 0.9% 10 minutes before induction of general anesthesia, and to avoid bias normal saline infusion via 50 ml syringe pump will be started 20 minutes before induction, and 10 ml normal saline 0.9% bolus will be given 90 seconds before laryngoscopy. |
Drug: Nebulized Dexmedetomidine
The patient will receive nebulized dexmedetomidine via face mask nebulizer (1mcg/kg) added to 2 ml normal saline 0.9% 10 minutes before induction of general anesthesia.
Other Names:
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| Active Comparator: Nebulized Lidocaine 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, and to avoid bias normal saline infusion via 50 ml syringe pump will be started 20 minutes before induction, and 10 ml normal saline 0.9% bolus will be given 90 seconds before laryngoscopy. |
Drug: Nebulized Lidocaine
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.
Other Names:
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| Active Comparator: Intravenous Dexmedetomidine The patient will receive an intravenous infusion of dexmedetomidine (200 mcg/2ml) added to 48 ml normal saline 0.9% (1 ml= 4mcg) via syringe pump, and will be started at a dose of 1 mcg/kg 20 minutes before induction of general anesthesia, and to avoid bias 3 ml normal saline 0.9% via face mask nebulizer will be started 10 minutes before induction. Also, 10 ml normal saline 0.9% will be given as an IV bolus 90 seconds before laryngoscopy. |
Drug: Intravenous Dexmedetomidine
The patient will receive intravenous infusion via syringe pump of dexmedetomidine (200 mcg/2ml) added to 48 ml normal saline 0.9% ((1 ml= 4mcg)) started at a dose of 1 mcg/kg 20 minutes before induction of general anesthesia.
Other Names:
|
| Active Comparator: Intravenous Lidocaine The patient will receive intravenous lidocaine 2% ( 1.5mg/kg) completed to 10 ml with normal saline 0.9% (1 ml = 20mg) and will be given as intravenous bolus 90 seconds before induction of general anesthesia. To avoid bias, 3 ml normal saline 0.9% via face mask nebulizer will be started 10 minutes before induction. Also, normal saline 0.9% infusion will be started via a 50 ml syringe pump 20 minutes before laryngoscopy. |
Drug: Intravenous Lidocaine
The patient will receive intravenous lidocaine 2% (1 ml = 20mg) in a dose of (1.5mg/kg) completed to 10 ml with normal saline 0.9% given as intravenous bolus 90 seconds before induction of general anesthesia.
Other Names:
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Outcome Measures
Primary Outcome Measures
- Change in serum cortisol levels. [Measurement will be done 45 minutes preoperative and 10 minutes after endotracheal intubation.]
Base line blood sample will be drawn 45 minutes preoperative and 10 minutes post intubation for cortisol level measurements.
- Change in mean arterial blood pressure (MAP) in mmHg. [Measurement will be done 10 minutes before induction and at 1,3,5,7 and 10 minutes after endotracheal intubation.]
Mean arterial pressure (MAP) will be recorded 10 minutes before induction and at 1,3,5,7 and10 minutes after endotracheal intubation.
- Change in heart rate (HR) per minute. [Measurement will be done 10 minutes before induction and at 1,3,5,7 and 10 minutes after endotracheal intubation.]
Heart rate (HR) will be recorded 10 minutes before induction and at 1,3,5,7 and10 minutes after endotracheal intubation.
- Change in systolic blood pressure (SBP) in mmHg. [Measurement will be done 10 minutes before induction and at 1,3,5,7 and 10 minutes after endotracheal intubation.]
Systolic blood pressure (SBP)will be recorded 10 minutes before induction and at 1,3,5,7 and10 minutes after endotracheal intubation.
- Change in diastolic blood pressure (DBP) in mmHg. [Measurement will be done 10 minutes before induction and at 1,3,5,7 and10 minutes after endotracheal intubation.]
Diastolic blood pressure (SBP)will be recorded 10 minutes before induction and at 1,3,5,7 and 10 minutes after endotracheal intubation.
Eligibility Criteria
Criteria
Inclusion Criteria:
- ASA I & ASA II. BMI: ((≤ 35 kg/m2)). The patients are to be scheduled to undergo elective surgery under general anesthesia.
Mallampatti grade I ,II
Exclusion Criteria:
- Uncooperative patient. History of allergy to study drugs. Hemodynamically unstable patient. Renal or hepatic dysfunction or hypertensive patients.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Faculty of medicine, Zagazig University | Zagazig | Al-Sharkia | Egypt | 055 |
Sponsors and Collaborators
- Zagazig University
Investigators
- Principal Investigator: 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
Study Documents (Full-Text)
None provided.More Information
Publications
- 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.
- 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.
- 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.
- 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.
- 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.
- Stress Response to intubation