A COMPARATIVE EVALUATION OF ORAL MELATONIN, (I.V) DEXMEDETOMIDINE AND COMBINATION OF BOTH FOR ATTENUATION OF HAEMODYNAMIC RESPONSES TO LARYNGOSCOPY AND INTUBATION IN MIDDLE EAR SURGERY

Abstract

Introduction : Airway management is the evaluation, planning, and use of medical procedures and devices for the purpose of maintaining or restoring ventilation in a patient. Endotracheal intubation is required to provide a patent airway when patients are at risk for aspiration, when airway maintenance by bag mask is difficult, and for prolonged controlled ventilation. This research aimed to investigate the impact of Melatonin with Dexmedetomidine in mitigating cardiovascular responses to laryngoscopy and endotracheal intubation in candidate supporting voluntary operation.

Aim and Objective : To compare the role of Oral melatonin with (i.v) Dexmedetomidine alone and in combination of both for attenuation of haemodynamic responses during Laryngoscopy and intubation and compare the effect on haemodynamic parameters - Heart rate, Systolic blood pressure; Diastolic blood pressure; Mean arterial pressure and SpO2.

Methods and methods :  This study was a randomized prospective double blinded study conducted in Department of Anaesthesiology and Critical Care, MLB medical College, Jhansi (UP) in patients posted for elective middle Ear surgeries during the period of March 2018 to October 2019 and  minimum 150 patients were selected for the study. Following the approval from the Ethical committee, ASA I and II  patients between the age of 20 to 50 years of either gender and surgery requiring general anaesthesia for duration longer than 30 min, patients with normal airway with MPG I and MPG II, >90 degree neck movement, no buck teeth undergoing elective surgeries for middle EAR were included in this study. Exclusion criteria were diabetes, hypertension, psychiatric illness, intake of antipsychotics, sedatives and antiepileptic drugs, sleep disorders, obesity and drug allergy.

Result and Conclusion : Both Melatonin (6mg) and Dexmedetomidine (1mg/kg) can attenuate the haemodynamic changes during laryngoscopy and intubation.  In Dexmedetomidine large dose (1mg/kg) there were more cases of hypotension and bradycardia are seen, than in comparison of (0.5 mg/kg) of Dexmedetomidine. Combination of Melatonin (6mg) and Dexmedetomidine low dose (0.5mg/kg) can attenuate the haemodynamic changes during laryngoscopy and intubation better than alone use of melatonin(6mg) and Dexmedetomidine (1mg/kg).