Advantageous effects of dexmedetomidine on haemodynamic and recovery responses during extubation for intracranial surgery

Background: Dexmedetomidine an α2 agonist reduces heart rate and blood pressure due to sympatholytic activity. The aim of this study was to evaluate the effect of dexmedetomidine on haemodynamic response during endotracheal extubation in patients undergoing craniotomies for intracranial space occupying lesion (ICSOL).Methods: Sixty patients of ASA grade I and II, age 18-50 years scheduled for craniotomy for nonvascular ICSOL were selected after randomization into 2 groups with 30 patients in each group. Group D and C received an IV infusion of dexmedetomidine 0.5 mg/kg and normal saline 100 ml respectively over 10 min at the time of skin closure in a double-blind manner. Heart rate, systolic and diastolic blood pressure were recorded just before drug administration, 3 and 5 minutes after drug administration, during extubation and at 3, 5, 10 and 15 minutes after extubation. Respiratory rate and oxygen saturation were analyzed at 3, 5, 10 and15 minutes after extubation. Any laryngospasm, bronchospasm, desaturation, respiratory depression, vomiting, hypotension and bradycardia was noted.Results: Heart rate, systolic and diastolic blood pressure increased during emergence time in both groups (p<0.05) but this increase was more significant in control group than group D. SBP and heart rate were significantly lower in group D from 3 minutes after drug administration to 15 minutes after extubation. DBP was lower in group D during extubation till 15 minutes after extubation (p<0.01). No significant differences were observed in the respect of adverse events between the groups.Conclusions: Intravenous dexmedetomidine 0.5 mg/kg before extubation is attenuates haemodynamic response during endotracheal extubation in craniotomies.

Section: Discussionmentioning

confidence: 98%

“…This correlate with study done by Guler G et al and Turan G et al as they found no significant difference between the dexmedetomidine group and control group in respect to complications. 16,17 …”

Section: Discussionmentioning

confidence: 99%

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

Goyal

Bandil²,

Bansal

2017

“…Intravenous or sublingual NTG has been used for attenuating hypertensive response during laryngoscopy, tracheal intubation and also for controlling hypertension during extubation while studying efficacy of other drugs. [4][5][6][7][8][9] NTG sublingual spray is a simple, easy to use formulation mainly aimed for treatment of acute anginal episodes. It is also marketed to treat acute hypertensive crisis and also to treat diabetic neuropathic pain with local application.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of sublingual nitroglycerine spray in attenuation of hemodynamics to tracheal extubation

Tagalpallewar¹,

Ambare²,

Agrawal³

et al. 2017

Background: The present study was undertaken to evaluate efficacy of nitroglycerine (NTG) spray for attenuating haemodynamic response to tracheal extubation in normotensive and hypertensive patients.Methods: The study enrolling total 120 ASA I and II patients, (60 normotensive and 60 hypertensive) who had undergone elective surgery under general endotracheal anaesthesia. Both these types of patients were randomly subdivided into two groups of 30 patients each -50% receiving NTG spray and 50% not receiving NTG spray.Results: There was significant increase in heart rate in all four groups after NTG spray. During extubation this increased in heart rate was not statistically significant in group A (Normotensive with NTG) but was significant in group C (hypertensive with NTG) when compared with control groups. Similarly, during extubation there was significant rise in systolic, diastolic and mean arterial blood pressure were noted in all four groups and with use of NTG spray the increase could be significantly attenuated in NTG groups. Increase in heart rate along with reduction in blood pressure seen after NTG spray did not produce significant increase in RPP as compared to hypertensive and normotensive patients who did not receive the NTG spray.Conclusions: Sublingually administered nitroglycerin spray in a dose of 0.8 mg prior to extubation is an effective, practical, easy and relatively safe method in attenuate haemodynamic response to tracheal extubation.

“…Dexmedetomidine in doses of 0.3μg/kg, 0.4μg/kg, 0.5μg/kg, 0.6μg/kg, 0.8μg/kg and 1μg/kg have been studied by various authors to find the effective and safe dose but with conflicting results. [10][11][12] For the present study, two different doses of dexmedetomidine infusion (0.3μg/kg/h and 0.6μg/kg/h) were chosen, to be given after loading dose of dexmedetomidine (1μg/kg) which was administered slowly over 10 minutes. Rapid administration of initial loading dose of dexmedetomidine was avoided to prevent the transient increase in blood pressure and reflex decrease in heart rate.…”

Section: Discussionmentioning

confidence: 99%

Clinical efficacy of dexmedetomidine in two different doses to attenuate the hemodynamic changes during laparoscopic cholecystectomy

Masoori¹,

Gupta²,

Agarwal³

et al. 2018

Background: Laryngoscopy and laparoscopy lead to predictable hemodynamic changes. Dexmedetomidine is selective 2 agonist with dose dependent sedation, sympatholysis and analgesia, hence could provide stable hemodynamics during laparoscopic surgeries. The present study was aimed to compare the clinical efficacy of dexmedetomidine infusion in two different doses to attenuate the hemodynamic variations during laparoscopic cholecystectomy.Methods: Total 60 adult patients of ASA physical status I and II of both gender, scheduled for elective laparoscopic cholecystectomy, were randomly allocated into two groups of 30 patients. All patients were infused with loading dose of dexmedetomidine (1µg/kg) before induction. Patients of Group 1 received maintenance infusion of dexmedetomidine in doses of 0.3µg/kg/h and patients of Group 2 received maintenance infusion of dexmedetomidine in doses of 0.6µg/kg/h, continued till the end of surgery. Heart rate and blood pressure were recorded preoperatively, after dexmedetomidine administration, after induction, intubation, after creation of pneumoperitoneum and postoperatively. Intraoperative changes in heart rate and blood pressure were noted as primary variables and dexmedetomidine related side effects were noted as secondary outcomes, for statistical analysis.Results: The hemodynamic responses were attenuated in patients of both groups after laryngoscopy, intubation and creation of pneumoperitoneum but patients of Group 2 (0.6µg/kg/h) showed more stability in hemodynamics. The difference between the group was statistically significant (p value=0.001). No any evident complication or side effects occurred.Conclusions: Dexmedetomidine infusion was effective for attenuating the hemodynamic changes due to laryngoscopy and laparoscopy but were better with maintenance infusion of dexmedetomidine in dose of 0.6µg/kg/h.