Which is better - intravenous or nebulized dexmedetomidine as premedication?

Recently published research paper investigates the comparative effectiveness of nebulized dexmedetomidine versus traditional intravenous administration in attenuating hemodynamic responses associated with laryngoscopy and tracheal intubation. The study involved 60 patients undergoing surgery under general anesthesia, who were randomly allocated into two groups receiving either intravenous or nebulized dexmedetomidine as premedication. The study found that nebulized dexmedetomidine resulted in better obtundation of hemodynamic responses following laryngoscopy and maintained hemodynamics intraoperatively, compared to intravenous administration. Nebulized dexmedetomidine was associated with a lower sedation score and fewer adverse effects, such as bradycardia and hypotension, compared to intravenous administration. The study highlights the potential benefits of alternative administration methods for dexmedetomidine in improving perioperative outcomes and enhancing patient safety. The findings suggest that nebulized dexmedetomidine may offer a promising alternative to intravenous administration for attenuating hemodynamic responses during airway manipulation. The study also discusses the importance of assessing the mode of dexmedetomidine delivery on hemodynamic responses and emphasizes the need for further exploration and research in diverse clinical settings and patient populations.

Comparison of Administration Groups

The comparison of basic parameters between the two administration groups showed no significant differences in age, weight, or comorbidities, indicating that the randomization process was effective in creating homogeneous groups. The study also found no significant difference in the ASA grades between the groups. The comparison of baseline vitals showed no significant differences in heart rate, systolic and diastolic blood pressure, MAP, respiratory rate, and temperature between the groups. The study observed a statistically significant decrease in heart rate, blood pressure, and MAP in the intravenous group compared to the nebulized group at various time intervals after induction, highlighting the importance of vigilant monitoring during the post-induction period. Additionally, the study found that nebulized dexmedetomidine achieved a deeper level of sedation compared to intravenous administration.

Study Limitations and Conclusion

The research paper also discusses limitations, such as the evaluation of a single dose of dexmedetomidine and the exclusion of other routes of administration, suggesting the need for further research. Overall, the study presents valuable insights into the potential benefits of nebulized dexmedetomidine in achieving optimal sedation, minimizing hemodynamic fluctuations, and improving patient safety during perioperative care.

Reference –

Singla A, Saraswat R K, Bharadwaj A, et al. (February 23, 2024) Nebulized Versus Intravenously Administered Dexmedetomidine for Obtunding

Hemodynamic Responses to Laryngoscopy and Tracheal Intubation: A Randomized Double-Blind Comparative Study. Cureus 16(2): e54768. DOI

10.7759/cureus.54768