European Journal of Molecular & Clinical Medicine

Background:Juvenile nasopharyngeal angiofibroma(JNA) is a locally invasive benign vascular tumor. Controlled hypotension is used to facilitate endoscopic resection to reduce the blood loss and stabilize the hemodynamics. Various agents are tried till now to achieve the goal.
Objective: To compare the effectiveness of Nitroglycerine withDexmedetomidine in terms of hemodynamics and blood loss during Endoscopic resection of Juvenile Nasopharyngeal Angiofibroma
Methods: Ethics Committee has approved this Randomized Controlled trial which was conducted among 40 patients randomly divided into two groups by simple randomization using computer generated random numbers.Informed consent was taken from all the eligible participants. Group D(n=20) receivedDexmedetomidine 1µg/kg over 15 min followed by a maintenance infusion at 0.5µg/kg/hourand GroupN (n=20)received (n=20), Nitroglycerine 0.5µg/kg/min and titrated in doses 0.5-5µg/kg/min for target blood pressure respectively. Standard guidelines were followed throughout the study protocol for data collection. Data was analyzed using mean and standard deviation in two groups.
Results:Both the groups were comparable for baseline parameters. There is statistically significant difference in mean pulse rate between two groups Group D: 66.09±2.83, Group N: 86.59±4.24 (p=0.0001). Blood loss was lower in Group D: 310.71±140.58 compared to Group N: 482.61±141.42, and is statistically significant (p=0.0004). SBP,DBPand MAP were lower in Group D throughout the surgery.
Conclusions:Dexmedetomidine is a better hypotensive agent with favorablehemodynamics and less blood loss when compared to Nitroglycerine. Hence we recommend use of Dexmedetomidine over nitroglycerine in patients during Endoscopic resection of Juvenile Nasopharyngeal Angiofibroma.

Background: Endotracheal intubation is a common mode of securing the airway for
administering general anaesthesia. Direct laryngoscopy and endotracheal intubation is almost
always associated with haemodynamic changes due to reflex sympathetic stimulation caused
by laryngopharyngeal stimulation.
Methods: A prospective, randomized controlled clinical study was undertaken to compare
the efficacy of oropharyngeal lignocaine spray (group L,n=30) and sublingual nitroglycerine
spray (group N, n=30) in blunting of haemodynamic response to laryngoscopy and intubation
belonging to ASA I, posted for surgery under general anaesthesia.
Results: There was statistically significant difference in the mean heart rate between the
groups for the first 3 minutes after intubation. Statistical evaluation between the groups
showed the mean SBP was statistically significant (p=0.036) for initial 3 mins after intubation
and also at 5th 6th & 10th minute. Statistical evaluation between the groups showed that
mean DBP 1st minute after intubation was statistically significant (p=0.008). The difference
was significant at 4, 5, 6 and 9 min after intubation. Statistical evaluation between the groups
did not show any statistical difference in the MAP except at 5th & 6th minute. However,
there was no clinically significant difference in any of the above groups.
Conclusion: Both sublingual NTG & lignocaine group successfully blunted the intubation
response, sublingual NTG spray was better in suppressing the BP response to laryngoscopy
and intubation than oropharyngeal lignocaine spray but lignocaine controlled the HR
response better than NTG.