Background: To reduce laryngoscopy effects and risks of hemodynamic perturbations, nebulized dexmedetomidine (Neb-Dex) could be a useful alternative to conventional intravenous medications. This study compared the effects of intravenous versus nebulized, either dexmedetomidine or lidocaine, on attenuation of hemodynamic responses that follow laryngoscopy and endotracheal intubation.

Methods:

In a prospective double-blinded clinical study, 92 cases were allocated randomly into four groups, 23 cases in each group: Group 1: (ND) Nebulized Dexmedetomidine, Group 2: (NL) Nebulized Lidocaine, Group 3: (VD) IV Dexmedetomidine, and Group 4: (VL) IV Lidocaine. Changes in patients' serum cortisol levels before and after laryngoscopy were primary outcome, while secondary outcome parameters included changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rates (HR), as well as mean arterial pressure (MAP) basally and after laryngoscopy and endotracheal intubation.

Results:

There was a significant decrease of serum Cortisol level in groups (VD) & (ND) at ten minutes 13.35±1.7 & 13.59±2 mcg/dl in comparison to basal time 13.91±1.4 & 13.76±1.9 mcg/dl respectively, p<0.05. In comparison, there was a significant increase in serum Cortisol ug/dl in group (NL)&group (VL) at ten minutes 13.79±1.22 & 14.01±1.42 mcg/dl in comparison to basal time 13.49±1.07 & 13.66±1.52 mcg/dl respectively, p<0.05. There was a significant decline in heart rates systolic, diastolic, mean arterial pressures in group VD compared with groups NL, ND, and VL at different time intervals (p<0.05 in each).

Conclusion:

hemodynamic response to laryngoscopy and intubation can be mitigated, to varying degrees, by administering either intravenous or nebulized lidocaine or dexmedetomidine.