It has been associated with the precipitation of cardiac ischemia, cerebral stroke ,pulmonary edema. various preemptive measures are used to attenuate this response ,mainly addressed by intravenous or local agents. Most commonly employed alfa -2 agonist agonist ,opioids, beta blockers and local anesthetics .All of them are associated with various systemic side effects such as opioids with reduced respiratory drive, sedation, and postoperative nausea and vomiting and selective alfa 2 agonists such as dexmedetomidine with hypotension and bradycardia. Most of these are used preemptively but very few are administered through the nebulisation route. Direct instillation through nebulisation is new area with lesser systemic effects, which needs to be explored.

Dexmedetomidine, an alpha 2 agonist, had been widely studied through the intravenous route where it has repeatedly proven itself to suppress the hemodynamic stress response, but systemic side effects such as hypotension and bradycardia are commonly associated, which may be troublesome. However, the recent literature has stated that the nebulization route has better bioavailability: nasal mucosa—65% and buccal mucosa—82%.

Nebulised dexmeditomidine has been reported with a very short distribution half life (6minutes) and elimination half-life(2hours) withoit being associated with systemic side effects.It has reported in literature that dexmedetomidine when administered through the nebulisation route had reduced stress response to laryngoscopy and intubation also reported that nebulised dexmeditomidine can attenuate the postoperative sore throat in patients.