Volume : 3
Online ISSN : 2394-4994
Print ISSN : 2394-4781
Article First Page : 427
Article End Page : 431
Introduction: Laryngoscopy and tracheal intubation is associated with profound adverse hemodynamic changes. Coronary artery disease patients have compromised myocardial blood flow and usually have associated hypertension. If the stress response to tracheal intubation is not controlled, it may lead to severe hypertension, arrhythmias and myocardial ischemia. Dexmedetomidine is a new alpha agonist with high potency to control the stress response, pain and tachyarrhythmia. Hence, impact of dexmedetomidine on hemodynamic parameters during tracheal intubation in coronary artery bypass grafting (CABG) surgery patients was evaluated in the study.
Methods: Sixty patients undergoing CABG were enrolled in the study. They were divided into 3 groups. Group 1 received thiopentone 3-5mg/kg, group 2 received thiopentone plus lignocaine 1mg/kg and group 3 received thiopentone plus dexmedetomidine 0.5µg/kg prior to laryngoscopy and tracheal intubation. Heart rate (HR), mean arterial pressure (MAP) and cardiac index (CI) were measured before induction, after anaesthetic induction, at laryngoscopy, and 1min, 3min, 6min and 10min after tracheal intubation. The extra amount of fentanyl and thiopentone required controlling hypertension to laryngoscopy and intubation was noted. The values were analyzed with SPSS 20 software with a P value of <0.05 considered as significant difference.
Result: Demography variables of patients were similar among the groups. The values of MAP, HR and cardiac index were similar at base line in all three groups. The increase in the heart rate and cardiac index was less in dexmedetomidine group compared to thiopentone only group (p<0.05) at all-time points. Dexmedetomidine group also had lower rise in MAP after base line in comparison to group 1 and significantly less at laryngoscopy (p< 0.0001). Lignocaine group had better control on hemodynamic changes during intubation compared to group 1, but less attenuation compared to dexmedetomidine group. Group 3 patients required less thiopentone (23.2±27mg vs 52.5±29.1mg vs 107.5±53.8mg, p=0.0001) and fentanyl (26.2±30.8µg vs 58.7±39.9µg vs 108.7±35.6µg, p=0.0001) in comparison to group 1 and group 2.
Conclusion: Dexmedetomidine is an effective drug in attenuating the hemodynamic response to tracheal intubation in patients undergoing CABG. Dexmedetomidine reduced the requirement of rescue doses of thiopentone and fentanyl.
Keywords: Coronary artery bypass grafting surgery; dexmedetomidine; hemodynamic response; lignocaine; thiopentone; tracheal intubation