A Comparative Study of Haemodynamic Response During Endotracheal Intubation Between Injection Dexmeditomedine Versus Combination of Paracetamol+Tramadol+ Lignocaine+ Magnesium Sulphate in Patients Undergoing Abdominal Laparoscopic Surgeries

Abstract

Background:Direct laryngoscopy and tracheal intubation frequently provoke sympathetic surge that can destabilize cardiovascular parameters. Several pharmacologic agents are used to blunt this stress response and improve perioperative analgesia. Dexmedetomidine, a selective α₂-agonist, provides predictable hemodynamic control as well as analgesia, whereas a practical multimodal mixture containing paracetamol, tramadol, lignocaine, and magnesium sulfate (“Shivmix”) is often employed in resource-limited environments. This research assessed comparative effectiveness of dexmedetomidine and this multimodal combination in patients undergoing elective laparoscopic abdominal procedures.Methods:In total, 120 adults between ages of 18-50, who have been scheduled for an elective laparoscopic cholecystectomy and classified as ASA I–II were divided into 2 groups of 60 each for this prospective, randomized, double-blind research. Group B received an infusion of paracetamol 20mg/kg, tramadol 2mg/kg, lignocaine 1.5mg/kg, and magnesium sulfate 40mg/kg in 100 mL saline for the same duration as Group A, which received intravenous dexmedetomidine 1μg/kg over ten minutes. Infusions were both finished 15 minutes before laryngoscopy. All patients had the same anesthetic technique. Hemodynamic variables were monitored at preset intervals, and pain has been assessed by using the VAS scale for 24 hours post-surgery.Results:Groups' baseline characteristics were similar. There was no difference between the groups, and neither regimen caused an increase in HR during intubation. Systolic and diastolic blood pressure increases during and after intubation were more effectively prevented by dexmedetomidine (P<0.05). In contrast, the combination of multimodal was consistently associated with lower postoperative VAS scores at the majority of time points and significantly lower rates of rescue analgesia (30% vs 63%, P<0.05). Dexmedetomidine group experienced transient bradycardia only. Other adverse effects have been comparable and minimal.Conclusion:Dexmedetomidine has been more effective in suppressing the pressor response to intubation, and multimodal infusion “Shivmix” was more effective and maintained postoperative analgesia. The multimodal approach is a viable alternative when access to opioids and/or dexmedetomidine is limited. Selection of therapy may thus be influenced by the clinical need for immediate haemodynamic control or for long-term analgesia.