The larynx is a structure richly innervated with abundant neurovascular supply. In general

anaesthesia, while laryngoscopy and endotracheal intubation is done, it triggers significant

hemodynamic response which is pressor response. This can lead to hypertension and tachycardia.

This is due to activation of somatovisceral reflex. Sympatho adrenal stimulus leads to the

release of catecholamines which results in increase in hemodynamics. This can cause

potential complications like cardiac ischaemia, irregular heart rhythm, cerebral bleed etc.

Duration and intensity of intubation directly affects the body catecholamine response

typically begins within 5 to 10s and peeks at 1 to 2 mins and returns to baseline within 5 mins.

These are tolerated by healthy individuals and can cause complications in susceptible

patients.

Ropivacaine is a long-acting amide local anaesthetic has its ability to block nociceptive

stimuli at peripheral nerves. Using Ropivacaine as a local anaesthetic during intubation can

help mitigate hemodynamic fluctuations and cough response during extubation due to its

longer duration of action.

Dexmedetomidine is a highly selective centrally acting alpha 2 agonist with sedative,

anxiolytic, hypnotic, perioperative sympatholytic, and anaesthetic sparing effects that reduce

central sympathetic outflow and attenuate the stress response associated with surgery

providing good perioperative hemodynamic stability. Its commonly associated with systemic

side effects such as hypotension, bradycardia.

Nebulization offers increased bioavailability. 65 percent nasal mucosa absorption and 82 percent via 

buccal mucosa absorption. Nebulized Dexmedetomidine has a short half life of 6 mins and

elimination half life of 2hrs without being associated with systemic side effects.

In the present study, our primary aim is to evaluate and compare the hemodynamic response

during intubation following the pre treatment with nebulised Ropivacaine alone versus a

combination of nebulised Ropivacaine and Dexmedetomidine.

In the present study we hypothesise that combining Dexmedetomidine and Ropivacaine

results in a more effective suppression of the pressor response than using Ropivacaine by

itself.