General anaesthesia is associated with haemodynamic responses which manifests as elevated heart rate and blood pressure. This occurs during direct laryngoscopy and intubation considered to be due to sympathetic stimulation. Although it lasts for a few seconds it may persist up to 10 minutes.

These short-term haemodynamic changes usually result in little to no harm in healthy individuals. However, they may be detrimental to patients with reactive airways, hypertension, cerebrovascular diseases, coronary artery disease and myocardial insufficiency. Hence, numerous drugs have been studied and used to attenuate these responses in the past, namely intravenous opioids, beta blockers, lignocaine etc.

One drug which has shown promise in this regard is Dexmedetomidine, which is a highly selective alpha-2 agonist with sympatholytic, sedative, amnesic and analgesic actions. Dexmedetomidine has been studied in several dosages and routes, namely intravenous, nebulized, intramuscular and intranasal in order to attenuate pressor response in both adult and paediatric population.

Nebulized dexmedetomidine has been shown to have high bioavailability (approximately 65% in nasal mucosa and 82% in buccal mucosa). It has also been theorized to be safer than intravenous and intranasal routes, since intravenous dexmedetomidine is associated with hypotension and bradycardia.

Hence, we undertook this trial of nebulization and intranasal administration of dexmedetomidine and attenuation of hemodynamic response to laryngoscopy and intubation.