Comparison of dexmedetomidine and lignocaine on attenuation of airway and pressor responses during tracheal extubation

Abstract

Background: Haemodynamic stability and rapid emergence after general anaesthesia used in spinal surgery is a common practice, the goal of which is to permit early neurological motor and sensory examination. Extubation is almost always associated with hypertension, increased airway response and arrhythmias. We have compared the effects of the α-2 agonist Dexmedetomidine and Lignocaine given at the end of the procedure on attenuation of airway and pressor responses following tracheal extubation. This study is a randomised, placebo-controlled, double-blinded study. Materials and Methods: Sixty ASA I-III patients, aged 18-70 years, scheduled to undergo spinal surgery at the level of thoracic, lumbar or sacral region were randomly divided into three groups. Balanced general anaesthesia comprising standard procedures and drugs were used for monitoring, induction and maintenance. At the last skin suture, inhalation anaesthetic was discontinued. After turning the patient supine and return of spontaneous efforts, in Group D Dexmedetomidine 0.5 μg/kg, in Group L Lignocaine 1.5 mg/kg and in Group P normal saline (10 ml) were administered as bolus intravenously over 60 seconds. Systolic, diastolic and mean arterial pressures and heart rate were recorded before intravenous administration and also every minute for 3 minutes, at 5, 10 and 15 minutes post-extubation. Duration of emergence and extubation were noted and attenuation of airway response and quality of extubation was evaluated on cough grading. Results: Mean arterial pressures and heart rate were higher in Group L and Group P than in Group D but not statistically significant. The duration of emergence, extubation and recovery were comparable in all the groups (P > 0.05). Extubation Quality Scores was 1 in 80%, 2 in 20% in Group D; in Group L, the quality scores were 1 for 55%, 2 for 45% and I Group P 1 for 35%, 2 for 45% and 3 for 20% of the patients. The requirement of rescue analgesia was also less and after prolonged time in Group D than in Group L and Group P (P < 0.05). None of the patients in all three groups showed respiratory depression, allergic reactions, nausea, vomiting or shivering. There was occurrence of hypertension for the initial 3 minutes of administration of drug in 10 (50%) of patients in Group D (Dexmedetomidine) group. Conclusion: Without interfering in emergence and extubation times, attenuation of pressor response is comparable between Dexmedetomidine 0.5 μg/kg and Lignocaine 1.5 mg/kg but airway response is much better controlled allowing a smooth easy extubation providing a more comfortable recovery and early neurological examination following spinal surgeries.

Effect of Dexmedetomidine on Haemodynamic and Recovery Responses During Tracheal Extubation: A Randomized Comparative Study

“…This is in conjunction with the study done by Sharma VB. 14 Our study found insignificant difference in the incidence of vomiting between two groups.…”

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

“…4 Different drugs and methods have been used to prevent haemodynamic response during extubation such as local anaesthetics, calcium channel blockers and vasodilators. [5][6][7] Dexmedetomidine hydrochloride is a highly selective, specific and potent α2 adrenergic agonist (1620:1 2 to 1) drug which is S-enantiomer of medetomidine. 8 It decreases the sympathetic outflow and noradrenergic activity thereby decreasing blood pressure and heart rate.…”

Effect of Intravenous Dexmedetomidine on Haemodynamic and Recovery Response During Tracheal Extubation

“…29 In another study, dexmedetomidine was compared with lignocaine and normal saline in extubation and concluded that the use of dexmedetomidine was associated with less increase in HR as compared to lignocaine group, MAP was better controlled in the dexmedetomidine group than in lignocaine group and airway response was better controlled with the use of dexmedetomidine providing a smooth and easy tracheal extubation, thereby a more comfortable recovery and early neurological examination. 30 In another study, there was a significant decrease in MAP and HR in Dexmedetomidine group as compared to group Lignocaine and group Placebo (p<0.05) at all-time interval after extubation. Extubation quality score of the majority of patients was 1 in group DEX, 2 in group Lignocaine and 3 in group Placebo.…”