Attenuation of pressor response and dose sparing of opioids and anaesthetics with pre-operative dexmedetomidine

Background and Aims: Alpha-2 agonists are being increasingly used as adjuncts in general anaesthesia, and the present study was carried out to investigate the ability of intravenous dexmedetomidine in decreasing the dose of opioids and anaesthetics for attenuation of haemodynamic responses during laryngoscopy and tracheal intubation. Methods: One hundred patients scheduled for elective general surgery were randomized into two groups: D and F (n= 50 in each group). Group D were administered 1 mu g/kg each of dexmedetomidine and fentanyl while group F received 2 mu g/ kg of fentanyl pre-operatively. Thiopental was given until eyelash reflex disappeared. Anaesthesia was maintained with 33: 66 oxygen: nitrous oxide. Isoflurane concentration was adjusted to maintain systolic blood pressure within 20% of the pre-operative values. Haemodynamic parameters were recorded at regular intervals during induction, intubation, surgery and extubation. Statistical analysis was carried out using analysis of variance, chi-square test, Student's t test and Mann-Whitney U test. Results: The demographic profile was comparable. The pressor response to laryngoscopy, intubation, surgery and extubation were effectively decreased by dexmedetomidine, and were highly significant on comparison (P< 0.001). The mean dose of fentanyl and isoflurane were also decreased significantly (> 50%) by the administration of dexmedetomidine. The mean recovery time was also shorter in group D as compared with group F (P = 0.014). Conclusions: Dexmedetomidine is an excellent drug as it not only decreased the magnitude of haemodynamic response to intubation, surgery and extubation but also decreased the dose of opioids and isoflurane in achieving adequate analgesia and anaesthesia, respectively.