Dexmedetomidine as a Substitute for Muscle Relaxants in Facilitating Endotracheal Intubation. A Randomized, Controlled Double-Blinded Study

Abstract

Introduction:

Endotracheal intubation is usually achieved by using neuromuscular blocking agents (NMBAs) which are one of the main drugs used in general anesthesia. Several researchers tried performing endotracheal intubation without using NMBAs. The main aim was to find the proper selection and optimum dose of the induction agent to provide suitable conditions for endotracheal intubation without adverse cardiovascular effects. Dexmedetomidine is an alpha-2 receptor agonist with analgesic, sedative, amnestic, and sympatholytic properties. It abolishes the pressor response associated with endotracheal intubation. It showed promising effects in awake fiber-optic, facial trauma, tempo-mandibular joint diseases, and pediatric fields.

Aim: This study evaluated the use of intravenous infusion of a single dose of dexmedetomidine (1.5 μg/ kg) in optimizing the intubating conditions and stress response of intubation.

Methodology:  74 ASA I and II patients were randomized into 2 groups. Group D received 1.5µg/kg of dexmedetomidine as a single IV infusion over 10 minutes. Group C received an IV infusion of normal saline. Intubating conditions were compared in both groups using the previously described scoring system. Hemodynamics was monitored to investigate the effect of dexmedetomidine in blunting the stress response of intubation.

Results: The current study showed that using 1.5 μg/ kg dexmedetomidine as a single IV infusion had a statistically insignificant successful incidence of endotracheal intubation 94.6% compared to 100% of atracurium. Laryngoscopy score, jaw relaxation, and limb movements were comparable between both groups. Incidence of coughing and vocal cord position were significantly different in the D group than C group. 

Conclusion:  1.5 µg/kg IV infusion of single-dose dexmedetomidine can be used as a substitute for atracurium in endotracheal intubation in adult patients undergoing GA.