Attenuation of pressor response and dose sparing effect on opioids with the use of dexmedetomidine in spine surgeries

Abstract

Background: The pressor response, which is part of a huge spectrum of stress response, results from the increase in sympathetic and sympathoadrenal activity, as evidenced by increased plasma catecholamines concentrations in patients undergoing surgery under general anaesthesia. Various drug regimens and techniques have been used from time to time for attenuating the stress response to laryngoscopy and intubation, including opioids, barbiturates, benzodiazepines, beta blockers, calcium channel blockers, vasodilators, etc. The dose of opioids required for effective attenuation of stress response is fairly high and numerous drugs have been used as adjuncts in decreasing the dose of opioids with a varied level of success, but are not absolutely free from side-effects. This study was conducted to investigate the ability of pre-operative intravenous dexmedetomidine in decreasing the dose of opioids and anaesthetics for attenuation of haemodynamic responses during laryngoscopy and tracheal intubation in spine surgery.Methods: Fifty patients belonging to ASA I and II physical status were included in this study. Twenty five patients received 1μg/kg each of dexmedetomidine and Fentanyl pre-operatively (group D) and other twenty five patients received 2microg/kg of Fentanyl preoperatively (group F). Results:- Statistically significant changes in heart rate, blood pressure, sedation score, reduction in dose of induction agent, opioids demonstrated.Conclusion: Dexmedetomidine is not only an excellent drug for attenuation of pressor response to laryngoscopy and intubation and during extubation, but also decreases the dose of opioids and propofol in achieving an adequate analgesia and anaesthesia, respectively.