A Comparative Study To Evaluate The Effects Of Preoperative Dexmedetomidine Nebulization Vs Lignocaine and normal saline Nebulization On The Hemodynamic Response To Laryngoscopy And Intubation

Patients undergoing elective surgery requiring laryngoscopy and tracheal intubation will be recruited in this study. Pre -anesthetic check-up will be carried out in all patients. On arrival to operation  theatre, Standard intraoperative monitoring- electrocardiogram, pulse oximetry and  non-invasive blood pressure will be attached and baseline vitals will be noted. Participants will be allotted in to two groups.Group A will receive pre-operative nebulization with Dexmedetomidine at a dose of 0.75 mcg/kg in 2 ml of 0.9% saline,20 min before induction of anesthesia and Group B will receive pre-operative nebulization with Lignocaine 2% 2ml in 2 ml of 0.9% saline, 20 min before induction of anesthesia .The drugs for nebulization (dexmedetomidine or lignocaine) will be prepared and administered by an independent investigator in the preoperative holding area. Hemodynamic parameters such as Heart Rate, Systolic & Diastolic BP, pulse oximetry will be recorded before nebulization. Nebulization will be carried out with an electrical compressor nebulizer, capable of creating a fine mist until the entire volume is dispersed–usually within 15–20 min. Pre-oxygenation will be done with 100% O2 for 3 minutes. Hemodynamic parameters such as Heart Rate, Systolic & Diastolic BP, pulse oximetry will be recorded before induction of general anesthesia. After which induction agent as per choice in concentration approved and Hemodynamic parameters will be then recorded every 1 minute till 10 minutes after laryngoscopy. Intubation will be confirmed by EtCO2 and bilaterally equal air entry and then connected to a ventilator for intermittent positive pressure ventilation until completion of surgery. Patients will be kept in the postoperative care unit for an additional 1 hour and discharged to the ward once they met the criteria for discharge (i.e., Aldrete recovery scale). The presence of postoperative sore throat will be noted as present or absent. As per literature, Nebulization Dexmedetomidine has less systemic bioavailability hence incidence of side effects should be reduced, if any side effects happened like clinically relevant hypotension will be defined as decrease in mean arterial pressure 20% or more from base line. In that case inj. crystalloids bolus will be given and if required vasopressor support may be given. Nebulized lidocaine also appears to be well tolerated by patients with minimal side effects including dysphonia, oropharyngeal numbness, and bitter taste