Comparison of nebulized ropivacaine (0.75%) with nebulized dexmedetomidine on the hemodynamic response on intubation in patients undergoing surgery under general anesthesia: A comparative randomized double-blind placebo-controlled study

Puja Saxena; Ravneet Kaur Gill; Richa Saroa; Bharti Sidhu; John Alen; Parul Sood

doi:10.4103/sja.sja_391_23

Comparison of nebulized ropivacaine (0.75%) with nebulized dexmedetomidine on the hemodynamic response on intubation in patients undergoing surgery under general anesthesia: A comparative randomized double-blind placebo-controlled study

Saudi J Anaesth. 2024 Jan-Mar;18(1):31-39. doi: 10.4103/sja.sja_391_23. Epub 2024 Jan 2.

Authors

Puja Saxena¹, Ravneet Kaur Gill¹, Richa Saroa², Bharti Sidhu¹, John Alen¹, Parul Sood¹

Affiliations

¹ Department of Anaesthesia, Dr B R Ambedkar State Institute of Medical Sciences, Sector 56, Mohali, Punjab, India.
² Department of Anaesthesia, Government Medical College and Hospital, Chandigarh, India.

Abstract

Background: Laryngoscopy and tracheal intubation lead to sympathetic stimulation resulting in hemodynamic fluctuations. We compared local anesthetic ropivacaine 0.75% with alpha agonist dexmedetomidine through ultrasonic nebulization for direct local action of the drug in the airway.

Methods: In our randomized study, 180 patients were prospectively assigned to three groups of 60 each: group R (0.75%), group D (1 microgram/kg), and group C (control). The primary objective was to determine whether nebulized ropivacaine or nebulized dexmedetomidine can cause a reduction in stress response to laryngoscopy and intubation. The secondary objectives were to compare the hemodynamic parameters at extubation, cough response at extubation, and postoperative sore throat.

Results: A total of 165 patients were analyzed. Demographically, all the groups were similar. Group R and group D were found to significantly attenuate the heart rate (HR) at intubation and extubation when compared to group C (P < 0.05). A significant reduction in mean arterial pressure (MAP) was seen (P < 0.05; group D: 90 ± 18.4 mmHg, group C: 99.5 ± 15.9 mmHg, group R: 92.4 ± 16.1 mmHg). There was a significant reduction in cough response in both groups in comparison with group C at 0 minutes (P value; group C vs group D: <.0001; group C vs group R:.01) and 5 minutes (P value; group C vs group D: <.0001; group C vs group R: <.0001).

Conclusion: Preinduction topical use of ropivacaine or dexmedetomidine, through the nebulization route, effectively attenuated the pressor responses when compared to placebo.

Keywords: Airway management; cough; dexmedetomidine; perioperative care; ropivacaine; sore throat; tracheal extubation.