Efficacy of pre-operative nebulization with Dexmedetomidine, Lidocaine and a combination of dexmedetomidine and lidocaine for prevention of stress response to laryngoscopy and Intubation

Direct laryngoscopy and tracheal intubation following induction of anesthesia are associated with hemodynamic changes due to increased sympathoadrenal activity, which may result in hypertension and/or tachycardia. Although transient, this exaggerated response may precipitate hypertensive crises, myocardial ischemia, arrhythmias, or increase in intracranial pressure in susceptible individuals. Various drugs—including local anesthetics, beta-blockers, calcium channel blockers, and narcotic analgesics—have been tried to blunt the laryngoscopy and intubation response, with varied success.

Nebulisation with lignocaine has a direct inhibition of the airway reflexes and thus useful in prevention of stress response. Dexmedetomidine is a potent and highly selective alpha-2 receptor agonist with sympatholytic, sedative, amnestic, and analgesic properties. Its pleiotropic effects have led to its increasing use for reducing anaesthetic and analgesic requirements in the perioperative period. The efficacy of dexmedetomidine in decreasing the hemodynamic response to laryngoscopy and intubation has been studied through intravenous intranasal and intramuscular routes. Nebulized dexmedetomidine may offer an attractive alternative to both intravenous as well as intranasal routes of administration because drug deposition following nebulization takes place over nasal, buccal, as well as respiratory mucosa.

Multiple studies had compared intravenous dexmedetomidine and nebulized lignocaine for prevention of stress response to intubation, but limited literature had compared nebulized dexmedetomidine and lignocaine. The present study aims to compare the effect of pre-operative nebulization with dexmedetomidine and lignocaine on stress response to laryngoscopy and intubation.