Hemodynamic Response, Laryngoscopy, Tracheal Intubation Morbidity
Conditions
Keywords
Direct laryngoscope, Dexmedetomidine, Melatonin, Tracheal Intubation, Hypertension, Hemodynamic response
Brief summary
The aim of this study is to compare the efficacy of oral melatonin versus nebulized dexmedetomidine in attenuating the hemodynamic response to direct laryngoscopy and endotracheal intubation in controlled hypertensive patients prepared for general anesthesia
Detailed description
Laryngoscopy and endotracheal intubation are associated with sympathetic stimulation and induce hemodynamic changes with consequent increase in heart rate (HR) and blood pressure (BP) which may lead to myocardial infarction, cardiac arrhythmias, cardiac failure and cerebrovascular accidents in patients with underlying cardiovascular or cerebrovascular diseases. Dexmedetomidine is a centrally acting α-2 adrenergic agonist with sedative, hypnotic, analgesic, anxiolytic, anti-sialagogue, antinociceptive and sympatholytic action. Premedication with dexmedetomidine through intravenous, intramuscular and intranasal route has been shown to effectively attenuate hemodynamic response to laryngoscopy and endotracheal intubation. Nebulization provides an alternative route of dexmedetomidine premedication with high bioavailability through both nasal (65%) and oral mucosa (82%) and avoids a venipuncture as a prerequisite. Recent studies have shown nebulization as a novel route of dexmedetomidine administration for attenuation of hemodynamic response to endotracheal intubation. Melatonin is a natural substance produced mainly in the pineal gland of all mammals and vertebrates. It is rapidly distributed and eliminated after intravenous administration. After oral administration, plasma concentration peaks after 60 min and is then eliminated. It exerts its hypnotic effects through the activation of the Melatonin receptors type I and II (MT1, MT2). It has shown potent analgesic effects in a dose dependent manner in experimental studies. It may induce relaxation of the arterial wall smooth muscle by increasing nitric oxide levels. Therefore, premedication with sublingual/oral Melatonin is associated with pre-operative anxiolysis and sedation without impairment of orientation, psychomotor skills, or impact on quality of recovery, moreover, it attenuates the hemodynamic stress response to laryngoscopy and tracheal intubation.
Interventions
DRUGDexmedetomidine
Nebulized Dexmedetomidine (1μg/kg)
DRUGMelatonin
Oral Melatonin tablet (5mg)
Sponsors
Tanta University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Investigator, Outcomes Assessor)
Masking description
A Research nurse who will not participate in the evaluation of sedation will give the drugs to all patients 60 minute before induction of general anesthesia. Outcome assessment will be conducted by an anesthesiologist who will be blinded
Intervention model description
Dexmedetomidine will be given in the form of nebulized dexmedetomidine (1μg/kg) one hour before induction of anesthesia. Melatonin will be given as melatonin oral tablet (5mg) one hour before induction of anesthesia.
Eligibility
Sex/Gender
ALL
Age
40 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* Age (40-60) years of both genders. * Controlled hypertensive patients. * Categorized as ASA physical status II. * Planning to do an elective surgery under General Anesthesia.
Exclusion criteria
* Patient refusal to participate in the study. * Patient with expected difficult intubation. * Body Mass Index (BMI) \> 30 kg/m2. * History of allergy to the drugs of the study. * Patients with Heart rate\<50 or Heart block. * End stage renal and hepatic disease. * Patients on beta blocker, oral hypoglycemics, anti-depressants, anti-convulsants, anti- psychotics and thyroid medications. * Pregnant or lactating females.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Heart Rate (HR) | Till the end of surgery (up to 2 hours) | Heart Rate will be assessed using pulse oximeter in pre-operative room (baseline), before the induction of anesthesia, immediately before laryngescopy or intubation, 1 minute after induction, 3 minutes after induction, 5 minutes after induction, every 30 minutes till the end of operation. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Systolic and Diastolic blood pressure | Till the end of surgery (up to 2 hours) | Systolic and diastolic blood pressure will be recorded in pre-operative room (baseline), before the induction of anesthesia, immediately before laryngescopy or intubation, 1 minute after induction, 3 minutes after induction, 5 minutes after induction, every 30 minutes till the end of operation. |
| Sedation levels using Ramsay Sedation Scale | Till 2 hours after the surgery | Sedation levels will be assessed using Ramsay Sedation Scale (1, Anxious and agitated, restless, or both; 2, Cooperative, oriented, and calm; 3 Responsive to commands only; 4 Exhibiting brisk response to light glabellar tap or loud auditory stimulus; 5, Exhibiting a sluggish response to light glabellar tap or loud auditory stimulus; 6, Unresponsive) before administration of the study drugs, before induction of anesthesia (60 minutes after drug taken), every 30 minutes post operative till 2 hours after surgery. |
| Intraoperative requirement of fentanyl | Intraoperatively | Additional fentanyl bolus dosages of 1 µg/kg IV will be administered if heart rate or mean arterial blood pressure elevated more than 20% of the baseline (after exclusion of other causes than pain). |
Countries
Egypt
Contacts
Primary ContactAya GAE Ismaeil, MBBCH
Backup ContactAlaa MF Abo Hagar, PHD
Outcome results
None listed