Background and Aim: Dexmedetomidine is a α₂ agonist with sedative, sympatholytic and analgesic properties and hence, it can be a very useful drug in anaesthesia to blunt the stress response to extubation, the smooth emergence of anaesthesia. We aimed primarily to evaluate the effects of three doses of dexmedetomidine  on haemodynamic response to extubation in patients undergoing elective general surgery. The secondary aims were to observe the effects on extubation quality, sedation levels and occurrence of adverse effects.

Methods: 90 patients of the American Society of Anaesthesiologists(ASA) physical grades I and II were randomly allocated into three groups. Group A patients  0.5mcg/kg, Group B 0.75mcg/kg  and Group C 1.0 mcg/kg  dexmedetomidine infusion, starting 15 minutes before extubation. Parameters noted were pulse rate, mean arterial pressure, oxygen saturation, post-operative sedation,coughing on extubation and any adverse effect .

Results: The three doses of dexmedetomidine were able to maintain  hemodynamic stability on tracheal extubation. But significant changes in hemodynamic parameters were noted in group A  at 3 and 15 minutes post extubation (P <0.05). The post extubation haemodynamically stability was statistically better in  group A and group B as  compared  with group C (P<0.05). Time for extubation and eye opening was prolonged in Group C (P <0.001). The Incidence of hypotension and bradycardia  were noted  in group C (6.66% and 3.33%) but was transient. Incidence of coughing was lower in Group B  (P <0.05). Patients in group C  were more sedated for 30 minutesutes post extubation. No significant side effects were noted.

Conclusion: Dexmedetomidine 0.5 µg/kg,0.75 µg/kg and 1.0 µg/kg  given before 15 minutes of extubation attenuates hemodynamic reflexes during emergence from anesthesia without causing undue sedation, but higher dose1.0 µg/kg  were associated with more post extubation sedation and some undesirable adverse affect hypotension and bradycardia.

Keywords: Dexmedetomidine, general anesthesia, extubation, hemodynamic responses, quality of extubation.

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Sarfaraz Ahmad

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