Comparison of hemodynamic effects of nebulized dexmedetomidine versus nebulized magnesium sulphate on attenuation of stress response during laryngoscopy and tracheal intubation- A randomized control trial

The purpose of this study is to compare the effect of preoperative nebulised dexmedetomidine and nebulized magnesium sulphate  on hemodynamic responses to laryngoscopy and endobronchial intubation . Patients coming for elective  surgery meeting the required inclusion criteria will be enrolled for this study. Information about the study will be conveyed and consent obtained in the preoperative period. Patients will be divided into two groups by computer-generated block randomization: Group A will receive dexmedetomidine(1mcg/kg body weight diluted with normal saline 4ml administered over 10-15 minutes ) and Group B will receive nebulized magnesium sulphate (10mg/kg with normal saline 4ml administered over 10-15 minutes)

All patients will have standard ASA monitoring with one intravenous (IV) lines.

Five minutes after completion of nebulization with the study drug, all patients will be induced with IV propofol upto 2mg/kg, fentanyl 2 mcg/kg, lignocaine 1.5mg/kg and vecuronium 0.1 mg/kg, in accordance with the current standard of care given in our hospital.  Anesthesia will be maintained with isoflurane to get a MAC of 1 until tracheal intubation. After 3 minutes of mask ventilation, laryngoscopy and endotracheal tube insertion. Episodes of hypotension will be treated with a bolus of Ephedrine hydrochloride 5mg or Phenylephrine 25-50 mcg . Bradycardia will be treated with 0.3-0.6 mg atropine bolus. Any hypertension or tachycardia will be treated with additional doses of propofol and/or fentanyl. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR), will be recorded at baseline and regular intervals. All incidences of hypertension, hypotension , tachycardia and bradycardia will be documented and the number of doses of rescue medication administered will be noted.