Attenuation of haemodynamic responses to laryngoscopy and endotracheal intubation with intravenous dexmedetomidine: A comparison between two doses.

BACKGROUND AND AIMS: Laryngoscopic manipulation and endotracheal intubation are noxious stimuli capable of producing tachycardia, arrhythmias and hypertension. The aim of this study was to arrive at an optimal dose of dexmedetomidine by comparing two doses with placebo to attenuate stress response during laryngoscopy and endotracheal intubation. METHODS: It was a randomised, prospective, double-blind placebo-controlled study. After Institutional Ethical Committee clearance, ninety patients of American Society of Anesthesiologists Physical Status 1 were enrolled in the study and divided into three equal groups. Group A received normal saline, Group B received injection dexmedetomidine 0.5 µg/kg and Group C received injection dexmedetomidine 0.75 µg/kg as infusion over 10 min. The general anaesthesia technique was standardised for all three groups. The primary outcome measures were haemodynamic response at 1, 3 and 5 min after intubation. The secondary outcome measures were to note down any adverse effects associated with drugs. The statistical package used was SPSS version 15. RESULTS: Groups were well matched for their demographic data. There was a statistically significant difference (P < 0.05) between dexmedetomidine and normal saline in heart rate, systolic, diastolic and mean arterial pressures at all time points after tracheal intubation with dexmedetomidine 0.75 µg/kg being most effective. Sedation scores were more with dexmedetomidine. None of the patients had any adverse effects such as hypotension, bradycardia, respiratory depression and fall in oxygen saturation. CONCLUSION: Dexmedetomidine in a dose of 0.75 µg/kg intravenous is the optimal dose to attenuate stress response to laryngoscopy and endotracheal intubation.

Comparison of injection lignocaine (preservative free) 1.5 mg/kg i.v with oral pregabalin 150 mg for attenuation haemodynamic response to laryngoscopy and tracheal intubation.

Endotracheal intubation is sine quo non for safe conduct of general anaesthesia. Pregabalin, an anticonvulsant drug is being studied for control of haemodynamic response to laryngoscopy and intubation. Some authors have found that pregabalin 150 mg orally attenuates the haemodynamic response to laryngoscopy. The purpose of the present study was to compare injection lignocaine (preservative free) i.v. and oral pregabalin for attenuation of haemodynamic response to laryngoscopy and intubation. The study consisted of 60 patients of ASA class I, divided into two groups of 30 each. Group I received injection lignocaine (preservative free) 1.5 mg/kg i.v., 3 minutes prior to laryngoscopy. Group II received oral pregabalin 150 mg capsule 1 hour prior to induction. The parameters recorded were heart rate, systolic BP, diastolic BP, mean BP and rate pressure product was calculated at baseline before induction and at 1, 3 and 5 minutes following laryngoscopy. The data obtained was analysed using unpaired "t" test. Lignocaine was more effective than pregabalin in controlling the heart rate at one minute following laryngoscopy. Pregabalin was more effective than lignocaine in controlling diastolic blood pressure at 1, 3 and 5 minutes following laryngoscopy, and mean arterial pressure at land 3 minutes following laryngoscopy. There was no difference between two groups when systolic BP and rate pressure product were compared. Lignocaine (preservative free) thus, exerts better control over heart rate and pregabalin exerts better control over diastolic and mean blood pressure following laryngoscopy.

Alcoholic delirium tremens with hollow viscus perforation scheduled for emergency laparotomy.

Alcohol is a drug consumed at some time in life by up to 80% of the population according to western statistics. Wide differences in socioeconomic status in India contribute to various degrees and severity of alcoholism and its associated complications. The symptoms of alcohol withdrawal range from such minor ones as insomnia and tremulousness to severe complications such as withdrawal seizures and delirium tremens. Although alcohol withdrawal syndrome has been reported in the literature in post-operative periods and in Intensive Care Unit, there is paucity of information on treatment and preparation of a patient with alcohol withdrawal syndrome coming for emergency surgical procedures. The surgical stress and deranged liver function in such cases poses an additional challenge to the anaesthesiologist. Here, we report the successful management of a case of acute alcoholic delirium tremens who presented with hollow viscous perforation for emergency exploratory laparotomy.