A Comparative Study Between Intravenous Dexmedetomidine Versus Nebulized Dexmedetomidine in Attenuating Laryngoscopy and Intubation Induced Sympathetic Response and Hemodynamic Changes in Coronary Artery Disease Patients Posted for Elective CABG Procedure

Background: Laryngoscopy and intubation trigger sympathetic surges that increase heart rate (HR) and blood pressure (BP), posing significant risks for patients with coronary artery disease (CAD). Dexmedetomidine, a sympatholytic alpha-2 agonist, may mitigate these stress responses. Aim: To compare the effectiveness and safety of intravenous (IV) versus nebulized dexmedetomidine in attenuating hemodynamic stress responses during laryngoscopy and intubation in CAD patients undergoing elective coronary artery bypass grafting (CABG). Materials and Methods: Seventy-eight elective CABG patients were randomized into two groups (n=39 each). Group A received nebulized dexmedetomidine (1 µg/kg) over 10 minutes, while Group B received IV dexmedetomidine (1 µg/kg) over 10 minutes. HR, systolic BP, diastolic BP, and mean arterial pressure (MAP) were monitored at baseline and peri- intubation. Results: Both routes effectively blunted the pressor response to laryngoscopy. However, the IV group experienced a more precipitous decline in MAP and a significantly higher incidence of bradycardia and hypotension. Nebulized administration maintained superior cardiovascular stability and was associated with a lower incidence of postoperative sore throat. Post-operative recovery times were comparable between groups. Conclusion: While both routes attenuate hemodynamic responses during laryngoscopy and intubation in CAD patients, nebulized dexmedetomidine is a clinically advantageous, non- invasive alternative for high-risk CAD patients. Its superior safety profile—specifically the reduced risk of cardiovascular instability—makes it a viable and attractive option for perioperative management.