Attenuation of Haemodynamic Responses to Laryngoscopy and Intubation with Three Different Doses of Dexmedetomidine - A Randomised Prospective Control Trial

BACKGROUND We wanted to study the attenuation of haemodynamic stress responses during laryngoscopy and intubation using safe and effective dose of dexmedetomidine. METHODS In this prospective double-blind placebo control interventional study, 120 patients of ASA-I and ASA-II scheduled for elective surgeries under general anaesthesia were divided randomly into four equal groups. Group A, group B, and group C received 0.5 mcg / Kg, 0.75 mcg / Kg and 1 mcg / Kg of dexmedetomidine intra venous (IV) respectively and Group D received 10 mL normal saline (NS) IV as bolus prior to induction of anaesthesia. Haemodynamic parameters were recorded before administration of the study drug, at 5 min with ongoing infusion of study drug, after completion of the study drug (at 10 min.), immediately after induction, during intubation, every minute thereafter up to 5 mins then 10 min after intubation. Data was analysed using SPSS. RESULTS Groups were well matched for their demographic data. There was a statistically significant difference (p < 0.05) among different doses of dexmedetomidine and normal saline in haemodynamics from infusion of drugs to tracheal intubation and up to 10 minutes after intubation. There were no such adverse effects (hypotension, bradycardia, respiratory depression and fall in oxygen saturation) in any of the patients. CONCLUSIONS Dexmedetomidine 0.5 mcg / Kg loading dose is the safe and effective dose to attenuate haemodynamic response to laryngoscopy and endotracheal intubation. KEYWORDS Haemodynamic Responses, Laryngoscopy, Intubation, General Anaesthesia, Dexmedetomidine

Comparison of central venous oxygen saturation and serum lactate clearance as predictors of outcome in septic shock patients: a prospective control trial

Background: Sepsis is the leading causes of mortality and morbidity in ICU. Early recognition and intervention ensures speedy recovery and early discharge. It’s possible only if good predicting parameters indicating optimum resuscitation are available. Lactate level reduction and ScvO2 level in the jugular vein can be utilized as predictors.Methods: In this prospective study after applying exclusion inclusion criteria, 99 patients were selected and randomized into 2 groups. In one group reduction in lactate levels and in other ScVo2 levels were used as a predictor of resuscitation. Therapeutic interventions, Hospital stay, ICU Stay and 28-day mortality were compared in both groups. Statistical analysis was carried out by SPSS software.Results: On comparison of demographic profile, morbidity, SOFA score and hemodynamic parameters, there was insignificant difference (P >0.05). No significant difference in the number of vasopressors, Average Hospital or ICU Stay (Group A is 10.68±21.46 while Group B is 9.49±17.22) and 28-day mortality rate (in Gp A 60% vs group B 57.1) was observed. Mean crystalloids administered in group A was 4.93±1.11 liters, significantly more than group B i. e. 4.19±1.17 liters. (P<0.05) which was statistically significant.Conclusions: Although both parameters of resuscitation are used widely and sometimes simultaneously, in this study lactate and ScvO2 both used and compared in a similar set of patients, appeared to be equivocal in term of 28-day mortality, except the volume of crystalloids required was more in ScvO2 Group.