Abstract

Context: Laryngoscopy and intubation provoke sympathetic surges that can endanger hypertensive patients. Nebulised dexmedetomidine and lignocaine can be used to blunt this response, but their relative effectiveness remains uncertain. Aims: The study aimed to compare the effectiveness of preoperative nebulization with dexmedetomidine versus lignocaine in blunting the hemodynamic response to laryngoscopy and intubation in hypertensive patients undergoing general anaesthesia for elective surgeries. The changes in systolic blood pressure, anaesthetic, and analgesic requirements were also recorded. Settings and Design: Randomised, double-blind study with 100 ASA class II hypertensive patients (18–60 y) scheduled for elective surgery under general anaesthesia were allocated to receive either dexmedetomidine 1 µg/kg (n = 50) or 4 % lignocaine 1 mL (40 mg, n = 50) via jet-nebuliser 15 min before induction. Methods and Material: Heart rate (HR), systolic and diastolic blood pressure (SBP, DBP), mean arterial pressure (MAP) and SpO2 were recorded at baseline, after nebulization and every minute for 10 min post-intubation. Time to first rescue analgesia, intra-operative fentanyl and propofol consumption, time to extubation, and adverse events were documented. Statistical analysis used: Independent t-tests, χ² tests and repeated-measures ANOVA (SPSS v27;p < 0.05 considered significant). Results: Dexmedetomidine significantly prolonged analgesia (6.95 ± 0.06 min vs 4.94 ± 0.43 min) and lowered propofol use (100.1 ± 5.4 mg vs 104.7 ± 5.5 mg; both p < 0.001) without altering fentanyl requirement or time to extubation. HR, SBP, DBP, MAP and SpO2 trajectories did not differ between groups throughout the observation window (p > 0.05), indicating equivalent haemodynamic stability. Lignocaine showed numerically more instances of postoperative nausea, vomiting and sore throat compared to dexmedetomidine. Conclusions: Nebulised dexmedetomidine has an advantage over lignocaine in better haemodynamic stability, postoperative analgesia and anaesthetic needs, with a lower side-effect profile. Key Messages: Preoperative nebulisation with dexmedetomidine provides haemodynamic stability during laryngoscopy and intubation with fewer side effects.

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