Comparison Of Efficacy Between Dexmedetomidine And Lignocaine For Attenuation Of Extubation Responses

Abstract

Comparison of Efficacy between Dexmedetomidine and Lignocaine  for Attenuation of Extubation Responses

Introduction: Tracheal extubation is associated with haemodynamic changes due to reflex sympathetic discharge resulting in hypertension, tachycardia and arrhythmias. Extensive research has been done to attenuate hemodynamic responses to intubation, but a reliable technique for rapid and smooth extubation is still not fully evolved. The aim of this study was to compare the effect of single-dose dexmedetomidine and lignocaine on the attenuation of circulatory and airway response to endotracheal extubation.

Methods and Materials:  This observational comparative study was conducted on 60 patients in the age group of 18-65years posted for surgery under general anaesthesia. Inclusion criteria: Patients in ASA grade I or II, Hemodynamically stable patients with all routine investigations within normal limits, and duration of surgery less than 3hrs. Exclusion criteria: Pregnant Women, patients with heart diseases like congestive heart failure, coronary heart disease, any degree of heart block and cardiogenic shock, patients taking drugs like β-blockers, digoxin, α2-agonists, patient with pre-operative heart rate < 45 beats/minute, Patient with renal insufficiency and liver impairment, Patient with coagulopathy and psychiatric disorders, patient with known allergy to studied drugs and patients who required postoperative mechanical Ventilation. Clinical monitoring parameters included were non-invasive blood pressure measurement, heart rate, and oxygen saturation. Hemodynamics were recorded preoperatively (baseline), and intra-operatively (for every 15 mins), until the completion of surgery. Bolus doses of study drugs were given 10 minutes before extubation. Primary outcome namely the smoothness of extubation was noted by four-point scale 5 minutes after extubation. Secondary outcomes namely the level of sedation during suction and extubation assessed using observer assessment sedation score and airway response under direct laryngoscopy to suction noted by a five-point scale.

Results: Airway response for suctioning and extubation was better in dexmedetomidine group and it was also associated with better sedation score than lignocaine group.

Conclusion: Single dose of 0.75 μg/kg dexmedetomidine given 15 min before extubation provides smooth extubation when compared to lignocaine bolus.