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An observational study to compare intranasal dexmedetomidine with clonidine as premedication via mucosal atomization device to decrease hemodynamic stress response during direct laryngoscopy procedure

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Original Article

Author Details : Jatin B Patel, Avani Sunil Nadkarni*, Charmi Hitenbhai Shah, Richa Mukeshbhai Tailor, Sara Mary Thomas

Volume : 12, Issue : 1, Year : 2025

Article Page : 59-65

https://doi.org/10.18231/j.ijca.2025.009

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Abstract

Background: Direct Laryngoscopy stimulates protective reflexes that trigger the sympathetic nervous system, which can have detrimental effects on the cardiovascular system. ?2-agonists such as clonidine and dexmedetomidine directly reduce sympathoadrenal responses and maintain hemodynamic stability during Direct Laryngoscopy. Administering these premedications intranasally has the advantage of better patient compliance and tolerance, and they can be delivered using a mucosal atomiser device (MAD).
Objectives: This study aimed to compare the intranasal administration of two ?2-agonists, clonidine and dexmedetomidine, as alternatives to parenteral premedication routes that can increase pain and anxiety. The primary objective was to evaluate their effects on hemodynamic stability and stress response during diagnostic direct laryngoscopy, while the secondary objective focused on assessing associated side effects.
Materials and Methods: In this randomized prospective observational study, 80 patients were divided into two equal groups of 40. The participants, aged 18 to 65 years and of any gender, were classified as American Society of Anaesthesiologists (ASA) physical status 1 or 2 and were scheduled for elective surgeries requiring general anaesthesia. Group C received intranasal clonidine (3 µg/kg) via Mucosal Atomiser Device, while Group D received intranasal dexmedetomidine (1.5 µg/kg). Hemodynamic monitoring was performed from baseline through the completion of the diagnostic laryngoscopy procedure.
Results : During the intraoperative period, once laryngoscopy commenced, significant differences were observed in heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) (p = 0.001). However, oxygen saturation showed no significant difference (p = 0.06). The sedation level measured 30 minutes after premedication was significantly higher in the dexmedetomidine group compared to the clonidine group (p = 0.001).
Conclusion: Both Dexmedetomidine and Clonidine effectively reduce sympathetic responses during direct laryngoscopy, but Dexmedetomidine offers superior control. Intranasal administration of Dexmedetomidine at a dose of 1.5 µg/kg via a Mucosal Atomiser Device effectively suppresses sympathetic activity without adverse effects, providing a safe and painless option for patients.
 

Keywords: Clonidine, Dexmedetomidine, Direct laryngoscopy, Mucosal atomiser device.

How to cite : Patel J B, Nadkarni A S, Shah C H, Tailor R M, Thomas S M, An observational study to compare intranasal dexmedetomidine with clonidine as premedication via mucosal atomization device to decrease hemodynamic stress response during direct laryngoscopy procedure. Indian J Clin Anaesth 2025;12(1):59-65

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