Dexmedetomidine versus Fentanyl on Intubation Stress Responses in Pre-eclamptic patients undergoing Caesarean delivery. - Trial PACTR201508001198128

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Summary

Laryngoscopy and intubation are associated with cardiovascular changes such as hypertension, tachycardia, dysrhythmias and even, myocardial ischemia and increased circulating catecholamines.Several techniques have been proposed to prevent or attenuate the hemodynamic responses following laryngoscopy and intubation, such as deepening of anaesthesia,pre-treatment with vasodilators (such as nitroglycerin, beta-blockers, calcium channel blockers and opioids. In women with pregnancy-induced hypertension, the cardiovascular response to tracheal intubation is exaggerated.The abrupt increase in arterial pressure, although transient, can lead to cerebral oedema and haemorrhage, and cardiac failure with pulmonary oedema, increasing morbidity and mortality in both the mother and child. an increase in maternal plasma catecholamine concentrations at the induction of anaesthesia for Caesarean delivery can cause uteroplacental vasoconstriction and hence adversely affect the neonate. Hence close control of stress responses during induction of anaesthesia for Caesarean delivery can have both fetal and maternal benefits in pre-eclamptic patients. Dexmedetomidine is a highly selective adrenoreceptor agonist, used as adjunctive anesthetic agent because of its hypnotic, sedative, anxiolytic, sympatholytic, and analgesic properties without producing significant respiratory depression. A section of pre-eclamptic patients do caesarean delivery under general anesthesia for several reasons, for these patients we hypothesized that the sympatholytic effects of dexmedetomidine may blunt the hemodynamic exaggerated response to tracheal intubation as a safe and effective substitute for fentanyl.The present study design as randomized controlled trial to evaluate the effects of dexmedetomidine and fentanyl on the changes in blood pressure and heart rate observed during laryngoscopy and tracheal intubation in pre-eclamptic patients, as a primary goal and the neonatal outcome as a second goal.

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