Effect of Dexmedetomidine on Haemodynamic and Recovery Responses During Tracheal Extubation: A Randomized Comparative Study

Abstract

This study was undertaken to evaluate the effect of a bolus dose of dexmedetomidine on haemodynamic, recovery responses and airway reflexes during extubation. MATERIAL AND METHODSSixty patients aged 20-45 yrs. of either sex of ASA grade I/II scheduled for elective general surgical, ENT, orthopaedics and gynaecological surgeries were studied after randomisation into two groups; 5 minutes before anticipated end of surgery, group A and B received either dexmedetomidine 0.5 µg/kg or placebo (Saline) respectively intravenously over 2 minutes. Anaesthesia technique was standardised for both groups. Heart rate, systolic, diastolic, mean arterial pressures were recorded at the start of a bolus drug injection and thereafter 1, 2 and 3 minutes after injection during extubation; at 1, 3, 5 minutes after extubation for 15 minutes. Quality of extubation was evaluated immediately after extubation based on cough using a 5-point rating score. Postoperative sedation was evaluated on a 6-point scale (Ramsay sedation scale). Side effects like laryngospasm, bronchospasm, respiratory depression, desaturation, vomiting, hypotension, bradycardia and undue sedation were noted. RESULTSHeart rate, systolic, diastolic, mean arterial pressure were significantly lower in study group. Extubation quality score in majority of cases was score 1 in study group and score 3 in control group. Sedation score in most of the cases was 3 in study group and 2 in control group. Bradycardia and hypotension were more in study group. Vomiting incidence was comparable in both the groups. CONCLUSIONOur study concludes that single dose of dexmedetomidine 0.5 µg/kg administered 5 minutes before extubation attenuates the haemodynamic and airway reflexes during emergence from anaesthesia without causing undue sedation. KEYWORDSDexmedetomidine, Haemodynamic Responses, Airway Reflexes, Extubation. HOW TO CITE THIS ARTICLE:Vankayalapati SD, Ramsali MV, Dumpala S, et al. Effect of dexmedetomidine on haemodynamic and recovery responses during tracheal extubation: a randomized comparative study.

Dexmedetomidine infusion during caesarean section under general anaesthesia: Evaluation of maternal awareness using BIS, maternal and neonatal outcomes

“…In addition, Sarada et al [34] found that single dose of DEX 0.5 μg/ kg given 5 min before extubation reduces the hemodynamic responses and airway reflexes during emergence from anaesthesia without causing excessive sedation.…”

Effect of Pharmacological Agents Administered for Attenuating the Extubation Response on the Quality of Extubation: A Systematic Review

“…Primary outcomes: The primary outcome was the quality of extubation. This was assessed by the presence or absence of cough at the time of extubation (graded from 1 to 5) [8], degree of sedation after extubation (Ramsay scale score of 1 and 2 meaning no sedation) [9][10], and the presence of laryngospasm/ bronchospasm at the time of extubation.…”

Effect of dexmedetomidine on hemodynamic and recovery responses during tracheal extubation

“…2 Weaning from anesthesia and ventilatory support can be linked with rise in plasma catecholamines, tachycardia and hypertension causing elevated myocardial contractility and systemic vascular resistance. 3 The carbon dioxide insufflations and pneumoperitoneum required in laparoscopic surgeries may lead to an increase in plasma renin activity, adrenaline, nor-adrenaline levels thereby resulting in increase in systemic and pulmonary vascular resistance, hypertension, tachycardia, and a compromised cardiac output. Further the reverse Trendelenburg position during surgery reduces venous return and hence further reduction in cardiac output.…”

“…Patients suffering from systemic diseases like coronary artery disease, diabetes, hypertension may or may not tolerate these hemodynamic responses. 3 Numerous drugs are being used to reduce these responses such as intravenous lignocaine, short-acting opioids such as fentanyl and remifentanyl, esmolol, labetalol, dexmedetomidine, diltiazem, verapamil, alfentanil, lidocaine, magnesium sulphate, propofol and intratracheal local anesthetic instillation. 3,5,6 Dexmedetomidine, a highly selective α2-adrenoreceptor agonist, induces sedation and analgesia without affecting the patients current respiratory condition.…”

“…3 Numerous drugs are being used to reduce these responses such as intravenous lignocaine, short-acting opioids such as fentanyl and remifentanyl, esmolol, labetalol, dexmedetomidine, diltiazem, verapamil, alfentanil, lidocaine, magnesium sulphate, propofol and intratracheal local anesthetic instillation. 3,5,6 Dexmedetomidine, a highly selective α2-adrenoreceptor agonist, induces sedation and analgesia without affecting the patients current respiratory condition. 2 It is eight times more potent than clonidine in suppressing catecholamine release in response to stress.…”