Comparison of the effect of intravenous dexmedetomidine and lignocaine spray instilled into the endotracheal tube on extubation response in patients undergoing spine surgery

Abstract

Background: In spine surgery rapid emergence and extubation with haemodynamic stability is crucial for early neurological examination. Here, we have studied the effect of α2 agonist – dexmedetomidine intravenous (IV) and lignocaine spray instilled into the endotracheal tube at the end of the procedure to attenuate the extubation responses. Methods: A total of 45 patients undergoing spine surgery were randomly allocated in three groups. After the return of spontaneous respiration, Group-D: Dexmedetomidine 0.3 mcg/kg IV, Group-L: 10% lignocaine spray 1.5 mg/kg through endotracheal route and Group-P: Normal saline IV given over 60 s. Haemodynamic responses (systolic blood pressure, diastolic blood pressure, mean arterial pressure [MAP], heart rate [HR] and SpO2) were recorded before and after administration of drugs and also duration of emergence, extubation, quality of extubation and post-operative sedation level were evaluated. Results: The increase in MAP and HR during extubation was significantly less in Group-D than Group-L and Group-P, 2 min after administration of the respective drugs (P < 0.05). There were no significant differences in the grade of a cough after extubation and post-operative sedation level. Conclusion: Dexmedetomidine (0.3 mcg/kg) attenuates haemodynamic response better than lignocaine spray (1.5 mg/kg) during emergence and extubation. It also provides smooth extubation and easy recovery without any post-operative sedative effect.

Efficacy of dexmedetomidine in attenuating hemodynamic and airway responses during extubation: a randomized double-blind study

“…Dexmedetomidine induced reduction of heart rate and blood pressure is mainly dose dependent. Dutta D. et al 15 observed no incidence of bradycardia and hypotension in their study with the use of dexmedetomidine 0.3 mcg/kg. In their study they have premedicated all the patients with Glycopyrrolate 0.2mg.…”

Effect of Pharmacological Agents Administered for Attenuating the Extubation Response on the Quality of Extubation: A Systematic Review

“…Dexmedetomidine 0.1 ug/kg resulted in a higher degree of sedation as compared to verapamil 0.3 ug/kg [5], but patients who received verapamil were anxious, agitated, and restless. The results were equivocal in studies that compared dexmedetomidine with lidocaine [24,26]. Dexmedetomidine in a dose of 0.3 and 0.5 ug/kg as compared to lidocaine did not show a significant difference in sedation [24,26].…”

“…The results were equivocal in studies that compared dexmedetomidine with lidocaine [24,26]. Dexmedetomidine in a dose of 0.3 and 0.5 ug/kg as compared to lidocaine did not show a significant difference in sedation [24,26]. Two studies compared dexmedetomidine with opioids [3,23].…”

“…The hemodynamic response was reported as blood pressure (BP) and heart rate (HR) change in all trials but the manner of reporting was different among studies. Nine studies documented a change in systolic blood pressure (SBP), diastolic blood pressure (DBP), and HR [2][3]7,[12][13][14][15][16][17] while 12 studies documented the changes in mean arterial pressure (MAP) and HR only [5][6][18][19][20][21][22][23][24][25][26][27]. Three studies documented changes in MAP in addition to SBP, DBP, and HR [28][29][30].…”

“…Three studies documented changes in MAP in addition to SBP, DBP, and HR [28][29][30]. A saline control group was used in 18 studies [2,[6][7][12][13][14][15][16][17][18][19][21][22][24][25][26][29][30]. In four studies, no placebo was used in the control against the study drug [3,20,[27][28].…”