To Evaluate and Compare the Effectiveness of Iv Dexmedetomidine and Iv Lidocaine on Attenuation of Haemodynamic Responses and Airway Reflexes During Extubation

Abstract

BACKGROUND Endotracheal intubation is an integral part of the modern anaesthesia techniques for major surgical procedures. Extubation are associated with various cardiovascular and airway responses leading to tachycardia, hypertension, arrhythmias, myocardial ischemia, coughing, agitation, bronchospasm etc., Many techniques and drugs have been proposed to attenuate airway and cardiovascular responses. This study intends to compare the effect of Dexmedetomidine & Lidocaine on haemodynamic responses and airway reflexes during tracheal extubation. MATERIALS AND METHODS After getting Ethical Committee clearance and written informed consent, double blinded randomised clinical trial study was conducted. 100 patients of ASA grade 1 & 2 aged between 16 to 60 years of either gender undergoing surgery under general anaesthesia were randomized into 2 groups with 50 each. Group D received Dexmedetomidine 0.75 mcg/kg and Group L received Lidocaine 1.5 mg/kg, both diluted to 10ml and given intravenously over 1min. Pulse rate, systolic, mean and diastolic blood pressure was recorded at the time of administration of the drug, at 1min, 3min, 5min after administering the drug and at extubation. Also, post extubation at 1min, 3min, 5min, 10min, 15min, 20min, 25min and 30min, it was recorded. Extubation quality was rated using extubation quality using 5-point scale. Sedation level was evaluated using Ramsay Sedation Scale. Any incidence of cough, laryngospasm, bronchospasm or desaturation was observed. Time at which the rescue analgesia was required post extubation was recorded. RESULTS The quality of extubation in group D was significantly better than group L (p<0.05). The sedation level was significantly higher in Group D as compared to Group L (p<0.01). The Time gap between the end of the surgery and the time of requirement of first dose of rescue analgesic was significantly higher in group D than in group L. MAP values showed a significant difference between the two groups (p<0.001) at various time intervals. The incidence of hypotension was noted during the study period was statistically significant. CONCLUSION Single bolus 0.75 mcg/kg dose of dexmedetomidine is an effective method to attenuate the haemodynamic response to endotracheal extubation in patients undergoing surgery under General anaesthesia and decreased the complications associated with extubation.

Evaluation of the efficacy of single dose of 0.6mcg/kg of iv dexmedetomidine for the attenuation of sympathoadrenal response to extubation

“…This is probably because suppression of sympathetic outflow centrally by dexmedetomidine. 10 In the study conducted by Rath A et al 11 the mean heart rate was increased by 3bpm compared to baseline in dexmedetomidine group at extubation and the mean arterial pressure was increased by 3bpm in Dexmedetomidine group compared to baseline. This is probably because of change in dosage and timing of administration of the drug.…”

To study the effect of iv dexmedetomidine versus iv labetalol for the suppression of sympathoadrenal response to extubation

“…These changes may lead to hazardous consequences in vulnerable patients. 8 Dexmedetomidine is an alpha-2 adrenergic agonist with unique effects such as sympatholysis, titratable sedation without causing severe respiratory depression and analgesia. It also reduces the dosage of opioids required.…”