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

Abstract

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.

Effect of dexmedetomidine on hemodynamic and recovery responses during tracheal extubation

“…However, few other studies have also found similar results. 12,14 Similar study by Guler et al 15 had also emphasized that desaturation, bronchospasm respiratory depression, coughing, laryngospasm and undue sedation were not found in any of the two groups (Table 4).…”

“…Similar results were observed in other studies too. 1,[3][4][5]10,11 In a study done by Goel et al, 12 there was an equal prevalence in both groups. Lawrence et al 13 in his study noted that bradycardia occurred only during 1 st and 5 t h minute during extubation.…”

“…Our findings are consistent with other studies which proved that intravenous administration of dexmedetomidine stabilizes vascular hemodynamics, offers smooth extubation and a much more easy and comfortable recovery. [1][2][3][4][5][10][11][12] Anxiolytic and sedation effect of dexmedetomidine are due to the inhibition of sympathetic outflow and stimulation of parasympathetic division from the locus coeruleus in the brainstem. α2 A and α2 C receptor stimulation in locus coeruleus induces sedation.…”

“…Similar findings were observed in other studies too. 1,[3][4][5][10][11][12][13] Dexmedetomidine activates the imidazoline-preferring receptors, α2 adrenoceptors, or both in the nucleus tractus solitarus (ventrolateral part of medulla) lowers the heart rate. 1 Our study results have shown that dexmedetomidine group had significantly higher incidence of hypotension and bradycardia than the control group.…”