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Category: Volume 11 Issue 04 April 2023
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Title: To compare the effect of varying doses of dexmedetomidine on airway reflexes and hemodynamic responses during tracheal extubation in patients undergoing surgery under general anaesthesia

Authors: Dr N Periysamy Sakya, Dr K Gunasekara, Dr Ruba

 DOI: https://dx.doi.org/10.18535/jmscr/v11i4.07

Abstract

Background: Extubation of the trachea is the process of discontinuing the artificial airway when the necessities for its use like protection of the airway, ventilation, airway obstruction, and hypoxia were corrected.

It is one of the most uncomfortable states during general anaesthesia. It is a well known factor that, after tracheal extubation, there is an increase in arterial blood pressure and heart rate associated with an increase in plasma concentrations of both nor, adrenaline and adrenaline. It is almost always associated with hemodynamic parameter changes

Different techniques and drugs have been tried from time to time to attenuate the stress responses and airway responses during tracheal extubation. But none of the methods has been completely successful.

Many trials have been conducted to attenuate the hemodynamic and stress responses during tracheal extubation by using various drugs like inhalational agents, opioids, local anaesthetics, vasodilators, alpha blockers, beta blockers and calcium channel blockers.

Studies have been carried out using fentanyl, sevoflurane, Lignocaine, Propofol, magnesium sulphate, nitroglycerine, clonidine, esmolol, labetolol, metoprolol, verapamil, nicardipine, diltiazem, etc., either as a sole agent or in comparison with each other with this background.

This study was conceptualized to analyze the varying doses of dexmedetomidine on the hemodynamic and recovery profiles during endotracheal extubation.

Aim & Objectives

Aims of the Study: To compare the effect of varying doses of dexmedetomidine on airway reflexes and hemodynamic responses during tracheal extubation in patients undergoing surgery under general anaesthesia.

Objectives of the Study

  1. To study the hemodynamic effects of dexmedetomidine on the patient during Extubation.
  2. To compare the quality of extubation of dexmedetomidine with respect to the patientsresponse.
  3. To study the emergence - agitation response of the patient to dexmedetomidine during and following endotracheal

Methods: This is a prospective randomized comparative study of Dexmedetomidine group-D1 versus Dexmedetomidine group-D2 on the hemodynamic and recovery responses during tracheal extubation. This study was carried out in 60 patients belonging to ASA I & II, aged between 20 and 60 undergoing elective surgery. These 60 patients were allocated into two groups – group D1 for Dexmedetomidine group-D1 and group D2 for Dexmedetomidine group-D2 with 30 in each group.

Results: Patients in the dexmedetomidine group-D2 had a lesser increase in heart rate during and after extubation compared todexmedetomidinegroup-D1, which is statistically significant.  Patients in the dexmedetomidine group-D2 had a better control of systolic arterial pressure compared to dexmedetomidine group-D1 during and after extubation, which is statistically significant.

 Patients in the dexmedetomidine group-D2 are associated with a lesser rise in diastolic blood pressure during and after tracheal extubation compared to dexmedetomidine group-D1 which is statistically significant.
There is a statistically significant difference in the mean arterial pressure between Dexmedetomidine group-D2 and Dexmedetomidine group-D1. The dexmedetomidine group D2 is associated with a better control of the mean arterial pressure at the time of extubation and the period following extubation.

The Quality of Extubation was observed to be better with the Dexmedetomidine group-D2 as compared with the Dexmedetomidine group-D1 and is statistically significant.

Conclusion: To conclude, Dexmedetomidine Group-D2 (0.75μ/kg) administered before tracheal extubation, was more effective in maintaining the hemodynamic stability, facilitated smooth tracheal extubation and had a better quality of recovery compared to Dexmedetomidine Group-D1(0.5μ/kg).

Keywords: Extubation, Dexmedetomidine

References

  1. Shabeel Aboobacker C ,Shamjith Kunikkakath, Melbin Baby , Salman Mohammed Kutty Effect of dexmedetomidine on hemodynamic and recovery responses during tracheal Extubation - Indian Journal of Clinical Anaesthesia Volume : 8, 2021 , 310-315
  2. Bindu B, Gowd UP, Gorre V, Murthy RR, Laxmi MB, Pasupuleti S. Double blind, Randomized, controlled trial to study the effect of dexmedetomidine on hemodynamic and recovery responses during tracheal extubation. J Anaesthesiol Clin Pharmacol. 2013;29(2):162– 7. doi:10.4103/0970-9185.111665.
  3. Vankayalapati SD, Ramsali MV, Dumpala S, Pasupuleti S. Effect of dexmedetomidine on haemodynamic and recovery responses during tracheal extubation: a randomized comparative study. J Evol Med Dent Sci. 2016;5(46):2880–3. doi:10.14260/jemds/2016/671.
  4. Rani P, Kumar VRH, Ravishankar M, Sivashanmugam T, Sripriya R, Trilogasundary M. Rapid and reliable smooth extubation – Comparison of fentanyl with dexmedetomidine: A randomized, double-blind clinical trial. Anesth Essays Res. 2016;10(3):597–601. doi:10.4103/0259-1162.186605.101
  5. Kim DJ, Kim SH, So KY, Jung KT: Effects of dexmedetomidine on smooth emergence from anaesthesia in elderly patients undergoing orthopaedic surgery. BMC Anesthesiol. 2015, 15:139. 10.1186/s12871-015-0127-4
  6. Devi Vankayalapati S, Ramsali V M, Dumpala S, Pasupuleti S: Effect of dexmedetomidine on haemodynamic and recovery responses during tracheal extubation: a randomized comparative study. J Evol Med Dent Sci. 2016, 5:2880-2883. 10.14260/jemds/2016/671
  7. Antony D , Davies C.V., Thomas M.K., Shenoy U , Mahesh V , Puthumana K.J. The effect of two different doses of dexmedetomidine to attenuate cardiovascular and airway responses to tracheal Extubation: a double-blind randomized controlled trial – IJMRR-2016
  8. Guler G, Akin A, Tosun Z, Eskitascoglu E, Mizrak A, Boyaci A. Single-dose dexmedetomidine attenuates airway and circulatory reflexes during extubation. Acta anaesthesiologica scandinavica. 2005 Sep 1;49(8):1088-91.
  9. Jain D, Khan R, Maroof M. Effect of dexmeditomidine on stress response to extubation. Internet J Anaesthesiol 2008;21:21-2.
  10. Kothari D, Tandon N, Singh M, Kumar A. Attenuation of circulatory and airway responses to endotracheal extubation in craniotomies for intracerebral space occupying lesions: Dexmedetomidine versus lignocaine. Anesth Essays Res 2014;8:78-82.
  11. Sharma VB, Prabhakar H, Rath GP, Bithal PK. Comparison of dexmedetomidine and lignocaine on attenuation of airway and pressor responses during tracheal extubation. J Neuroanaesth Crit Care 2014;1:50-5
  12. Aksu R, Akin A, Biçer C, Esmaoglu A, Tosun Z, Boyaci A. Comparison of the effects of dexmedetomidine versus fentanyl on airway reflexes and hemodynamic responses to tracheal extubation during rhinoplasty: A double-blind, randomized, controlled study. Curr 102 Ther Res Clin Exp 2009;70:209-20
  13. Fan Q, Hu C, Ye M, Shen X. Dexmedetomidine for tracheal extubation in deeply anesthetized adult patients after otologic surgery: Comparison with remifentanil. BMC Anesthesiol(2015;15:106).
  14. Bindu B, Pasupuleti S, Gowd UP, Gorre V, Murthy RR, Laxmi MB. Double blind, randomized, controlled trial to study the effect of dexmedetomidine on hemodynamic and recovery responses during tracheal extubation. J Anaesthesiol Clin Pharmacol 2013;29:162-7.
  15. Nishina K, Mikawa K, Maekawa N, Obara H. Fentanyl attenuates cardiovascular responses to tracheal extubation. Acta AnaesthesiolScand1995;39:85‑9.
  16. Venn R M, Bradsha C J et al. Preliminary UK experience of Dexmedetomidine, a novel agent for postoperative sedation in the Intensive care unit. Anaesthesia 1999; 54: 1136-42.
  17. Tobias JD. Dexmedetomidine: applications in pediatric critical care and pediatric anesthesiology. Pediatr Crit Care Med 2007; 8: 115-31.
  18. Venn RM, Grounds RN. Comparison between dexmedetomidine and propofol for sedation in the intensive care unit: Patient and clinician perceptions. Br J Anaesth 2001;87: 684
  19. Effect of dexmedetomidine and midazolam on respiration and circulation functions in patients undergoing open heart surgery under acupuncture-assisted general anesthesia].Tang W, Wang J, Fu GQ, Yuan L. Zhen Ci Yan Jiu. 2014 Jun;39(3):216-21
  20. Asai T, Koga K, Vaughan RS. Respiratory complications associated with tracheal intubation and extubation. Br J Anaesthesia 1998; 80: 767–75 103.

Corresponding Author

Dr N Periysamy Sakya

Assistant Professor, Department of Anaesthesiology, KAPV Govt Medical College Tiruchirappalli