A double blind, randomized, controlled trial to study the effect of dexmedetomidine on hemodynamic and recovery responses during tracheal extubation

Abstract

Background:The α2-adrenoreceptor agonist, dexmedetomidine, provides excellent sedation with minimal cardiovascular instability or respiratory depression and may be a useful adjunct to facilitate smooth tracheal extubation.Materials and Methods:Fifty American Society of Anesthesiologists grade I-II patients, aged 20-45 years, scheduled for elective general surgical, urological and gynecological surgeries were studied after randomization into two groups. Group A and B, received an intravenous infusion of dexmedetomidine 0.75 mcg/kg or placebo respectively, over 15 minutes before anticipated time of end of surgery, in a double blind manner. Anesthesia techniques were standardized. Heart rate, systolic, diastolic, mean arterial pressures were recorded while starting injection, at 1, 3, 5, 10, 15 minutes after starting injection, during extubation, at 1, 3, 5 minutes after extubation, and thereafter every 5 minutes for 30 minutes. Quality of extubation was evaluated on a 5 point scale and postoperative sedation on a 6 point scale. Any event of laryngospasm, bronchospasm, desaturation, respiratory depression, vomiting, hypotension, undue sedation was noted.Results:Heart rate, systolic, diastolic, mean arterial pressures were significantly higher in group B (P < 0.05). Extubation quality score of majority of patients was 2 in group A and 3 in group B. Sedation score of most patients was 3 in group A and 2 in group B. Bradycardia and hypotension incidences were higher in group A. One patient in group A, two patients in group B had vomiting. No patient had any other side effects.Conclusion:Dexmedetomidine 0.75 mcg/kg administered 15 minutes before extubation, stabilizes hemodynamics and facilitates smooth extubation.

The effectiveness of intravenous dexmedetomidine on haemodynamic responses during tracheal extubation in patients undergoing craniotomies

“…18 Lawerence et al used single dose dexmedetomidine before study and observed reduced the need for anaesthetic and postoperative analgesia and attenuates cardiovascular response to intubation and extubation. 19 Our findings are well supported by Bindu B et al 20 Respiratory rate and SpO2 were comparable among all the 3 groups. Our findings are consistent with the study done by Aksu R et al 15 Present study observed insignificant difference in incidence of adverse effect between 2 groups.…”

Effect of Intravenous Dexmedetomidine on Haemodynamic and Recovery Response During Tracheal Extubation

“…Most workers used intravenous dexmedetomidine in the range of 0.5-1 mcg/kg body weight. However, Bindu b et al 21 used a dose 0.75 mcg/kg, same as our study.…”

“…14 To attenuate airway and pressor response during tracheal extubation, dexmedetomidine, a highly selective alpha-2 adrenoceptor agonist, has been studied as single dose, 15,16 at the time of extubation and as an anaesthetic adjuvant. 16,17,18,19,20,21 MATERIALS AND METHODS Place of study The present study was conducted in the Department of Anaesthesiology, Assam Medical College and Hospital, Dibrugarh for a period of one year.…”

Evaluation of Heamodynamic Responses upon Using Dexmedetomidine Infusion in Hypertensive Patients under General Anaesthesia

“…Dexmedetomidine offers the benefit of producing light sedation with minimal respiratory depression, in attenuating airway reflex responses to tracheal extubation and maintaining hemodynamic stability without prolonging recovery when used in the absence of other sedative or analgesic agents (1,7) .The anaestheticand analgesic-sparing effects of dexmedetomidine have been well documented in animal and human studies (12,13) . Dutta et al (16) reported that a dexmedetomidine plasma concentration of 0.66 ng/mL reduced the propofol dose required for sedation and induction of anaesthesia by 40% to 70%.…”

“…The reported incidence of hypotension and bradycardia in patients receiving dexmedeto-midine for sedation commonly exceeds 50 % (7) . Low dose infusion of 0.25-0.5 μg/kg/h results in a monophasic response of 10-15% fall in mean arterial blood pressure and HR (1,4,5,6,9,12) . A recent echocardiographic assessment of the cardiac function (9,11) of patients receiving dexmedetomidine infusion did not demonstrate an impairment in systolic or diastolic function but did find areduction in cardiac output because of a negative chronotropic effect of dexmedetomidine.…”