Intravenous dexmedetomidine versus magnesium sulphate for attenuation of hemodynamic response to laryngoscopy and endotracheal intubation in adults undergoing cardiac valve replacement surgery at a tertiary care hospital in Udaipur, Rajasthan

Arpit Baman; Ashish Patyal; Ram Vilas  Meena; Archana Devtara; Sanjay Gandhi; Alka Chhabra; Anjana Verma

doi:10.18203/2319-2003.ijbcp20263776

Authors

Arpit Baman Department of Anaesthesiology, Geetanjali Medical College and Hospital, Udaipur, Geetanjali University, Rajasthan, India
Ashish Patyal Department of Anaesthesiology, Geetanjali Medical College and Hospital, Udaipur, Geetanjali University, Rajasthan, India
Ram Vilas Meena Department of Anaesthesiology, Geetanjali Medical College and Hospital, Udaipur, Geetanjali University, Rajasthan, India
Archana Devtara Department of Anaesthesiology, Geetanjali Medical College and Hospital, Udaipur, Geetanjali University, Rajasthan, India
Sanjay Gandhi Department of CTVS, Geetanjali Medical College and Hospital, Udaipur, Geetanjali University, Rajasthan, India
Alka Chhabra Department of Anaesthesiology, Geetanjali Medical College and Hospital, Udaipur, Geetanjali University, Rajasthan, India
Anjana Verma Department of Community Medicine, Geetanjali Medical College and Hospital, Udaipur, Geetanjali University, Rajasthan, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20263776

Keywords:

Dexmedetomidine, Magnesium sulphate, Laryngoscopy, Endotracheal intubation, Haemodynamic response, Cardiac valve replacement surgery

Abstract

Background: Laryngoscopy and endotracheal intubation induce sympathetic activation (increased heart rate, blood pressure), which may be hazardous in patients undergoing cardiac valve replacement. This study aimed to compare intravenous dexmedetomidine (1 mcg/kg) and magnesium sulphate (20 mg/kg) in attenuating the hemodynamic response to laryngoscopy and intubation during elective cardiac valve replacement surgery.

Methods: This prospective, randomized, double-blind, parallel-group trial enrolled 66 adult patients (ASA II–III, aged 18–70 years) undergoing elective cardiac valve replacement surgery under general anaesthesia at a tertiary care centre. Patients were allocated to Group D (dexmedetomidine 1 mcg/kg, n =33) or Group M (magnesium sulphate 20 mg/kg, n =33), each infused over 10 minutes in 100 ml normal saline commencing 20 minutes before anticipated intubation. Haemodynamic parameters (heart rate [HR], systolic blood pressure [SBP], diastolic blood pressure [DBP], mean arterial pressure [MAP]) were recorded at baseline, after drug infusion, after induction, and at 1, 3, 5, 8, 10, and 15 minutes following intubation.

Results: Following drug infusion, dexmedetomidine reduced HR (84.3 ± 4.5 to 78.2 ± 4.3 bpm), whereas magnesium sulphate was associated with a paradoxical mild increase (85.8 ± 5.3 to 87.4 ± 5.1bpm; p < 0.001 intergroup). At one-minute post-intubation, HR (99.4 ± 4.6 vs 104.5 ± 5.3 bpm), SBP (125.0 ± 5.7 vs 135.5 ± 6.2 mmHg), DBP (81.3 ± 3.9 vs 89.9 ± 4.0 mmHg), and MAP (95.9 ± 4.2 vs 105.1 ± 4.8 mmHg) were all significantly lower in Group D (p < 0.001 for all). These differences were sustained through 15 minutes.

Conclusions: Intravenous dexmedetomidine (1 mcg/kg) provides significantly superior attenuation of the haemodynamic response than magnesium sulphate 20 mg/kg in adults undergoing cardiac valve replacement surgery.

References

Shribman AJ, Smith G, Achola KJ. Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation. Br J Anaesth. 1987;59(3):295–9.

Khan FA, Ullah H. Pharmacological agents for preventing morbidity associated with the haemodynamic response to tracheal intubation. Cochrane Database Syst Rev. 2013;(7):CD004087.

Sulaiman S, Karthekeyan RB, Vakamudi M, Sundar AS, Ravullapalli H, Gandham R. The effects of dexmedetomidine on attenuation of stress response to endotracheal intubation in patients undergoing elective off-pump coronary artery bypass grafting. Ann Card Anaesth. 2012;15(1):39–43.

Mahajan L, Kaur M, Gupta R, Aujla KS, Singh A, Kaur A. Attenuation of the pressor responses to laryngoscopy and endotracheal intubation with intravenous dexmedetomidine versus magnesium sulphate under bispectral index-controlled anaesthesia: a placebo-controlled prospective randomised trial. Indian J Anaesth. 2018;62(5):337–43.

De Cassai A, Boscolo A, Geraldini F, Zarantonello F, Pettenuzzo T, Pasin L, et al. Effect of dexmedetomidine on hemodynamic responses to tracheal intubation: a meta-analysis with meta-regression and trial sequential analysis. J Clin Anesth. 2021;72:110287.

Silpa AR, Koshy KA, Subramanian A, Pradeep KK. Comparison of the efficacy of two doses of dexmedetomidine in attenuating the hemodynamic response to intubation in patients undergoing elective cardiac surgery: a randomized double-blinded study. J Anaesthesiol Clin Pharmacol. 2020;36(1):83–7.

Barbosa FT, Gusmão HSBLB, Albuquerque LQT, Lima NO, Sousa-Rodrigues CF, Andrade RR. Is magnesium sulfate useful for tracheal intubation? A systematic review of randomized controlled trials. Rev Assoc Med Bras (1992). 2025;71(1):e20241237.

Choudhary N, Verma A, Verma J, Singh RP, Ray S, Sharma J. Comparison of infusion dexmedetomidine with magnesium sulphate for attenuation of the haemodynamic response during endotracheal intubation in adult patients. Int J Acad Med Pharm. 2023;5(2):1505–12.

Chandrashekhar Y, Narula J. Rheumatic fever. In: Cardiovascular medicine. London: Springer; 2007. p. 431–41.

Gertler R, Brown HC, Mitchell DH, Silvius EN. Dexmedetomidine: a novel sedative-analgesic agent. Proc (Bayl Univ Med Cent). 2001;14(1):13–21.

Weerink MAS, Struys MMRF, Hannivoort LN, Barends CMR, Absalom AR, Colin P. Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine. Clin Pharmacokinet. 2017 Aug;56(8):893–913.

Sridharan NK, Madhanlal PP, Damodaran K. A comparison between effectiveness of intravenous magnesium sulphate and dexmedetomidine on attenuation of haemodynamic stress response to laryngoscopy and endotracheal intubation: a randomised control trial. Asian J Med Health. 2024;22(11):40–9.

Chickmath SR, Gupta S, Patil GA, Yahya M, Wali R. A COMPARATIVE STUDY BETWEEN magnesium sulphate and dexmedetomidine for attenuation of haemodynamic pressor response during laryngoscopy and endotracheal intubation. Int J Adv Res. 2023;11(4):396-405.

Ghodki P, Sawle VM. Comparative study between magnesium sulphate and dexmedetomidine for attenuation of vasopressor stress response during laryngoscopy and endotracheal intubation. Int J Med Anaesthesiol. 2020;3(3):149–53.

Mohan A, Saha G. A comparative study of the efficacy of intravenous magnesium sulphate and intravenous dexmedetomidine in attenuating haemodynamic response to laryngoscopy and endotracheal intubation. Indian J Clin Anaesth. 2023;10(4):351–7.

Chaithanya K, Vaddineni J, Reddy N, Gandra S, Kumar C, Rao V, et al. A comparative study between I.V 50% magnesium sulphate and dexmedetomidine for attenuation of cardiovascular stress response during laryngoscopy and endotracheal intubation. J Evol Med Dent Sci. 2014 Aug;3(32):8741–9.

Chhaya J, Anilkumar G, Shilpa M. A comparative study between intravenous dexmedetomidine and magnesium sulfate in attenuation of cardiovascular response to laryngoscopy and endotracheal intubation. Intl J Clin Diag Res. 2016;4(3):7.

Chandrakala M, Chaithanya KK. Effect of magnesium sulphate and dexmedetomidine for attenuation of hemodynamic stress response to intubation. Narayana Med J. 2019;8:31–8.