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
- To study the hemodynamic effects of dexmedetomidine on the patient during Extubation.
- To compare the quality of extubation of dexmedetomidine with respect to the patientsresponse.
- 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
