Table of Contents

2017 Month : October Volume : 4 Issue : 79 Page : 4650-4655

EFFECT OF DEXMEDETOMIDINE AND ESMOLOL ON EXTUBATION

Santhosh Govinda Rao1, Mathikere Boregowda Sudarshan2, Velagalaburrre Yalappa Srinivas3

1. Junior Resident, Department of Anaesthesiology, Mysore Medical College and Research Institute, Mysuru.
2. Assistant Professor, Department of Anaesthesiology, Mysore Medical College and Research Institute, Mysuru.
3. Professor, Department of Anaesthesiology, Mysore Medical College and Research Institute, Mysuru.

Corresponding Author:
Dr. Mathikere Boregowda Sudarshan,
Assistant Professor, Department of Anaesthesiology,
Mysore Medical College and Research Institute,
Irwin Road, Mysuru - 570001.
E-mail: drmbs1975@yahoo.com
DOI: 10.18410/jebmh/2017/930

ABSTRACT
BACKGROUND
Complications during extubation are 3 times more than the intubation. A clinical study compares the efficacy of dexmedetomidine with esmolol in attenuating extubation stress responses in patients undergoing procedures under general anaesthesia.

MATERIALS AND METHODS
After institutional ethical committee clearance and informed consent, 90 patients of either sex between 18-60 years belonging to ASA Class I posted for elective surgical procedure under general anaesthesia were enrolled in the study. The study population was randomly divided into three groups of 30 each. Group DX received dexmedetomidine 0.005 mg/kg, Group EX received esmolol 1.5 mg/kg and Group CX received saline placebo intravenously. Various parameters regarding haemodynamics were evaluated just before, during the process and immediately after extubation. Two time intervals- one between stopping of nitrous oxide to eye opening and the other between stopping of nitrous oxide to extubation were noted. Various side effects such as desaturation, bronchospasm, laryngospasm and post-extubation cough too were recorded simultaneously. A 5-point scale was used to rate quality of extubation and Ramsay sedation scale was used to rate sedation.

RESULTS
Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Mean Arterial Pressure (MAP) were increased in all the groups at extubation, but was statistically and clinically significant only in control group (p <0.001). Time to extubation and eye opening were prolonged in Group DX (p <0.001). Incidence of coughing was 10% in Group DX when compared to 23% and 26% in Group CX and group EX respectively, which was significant (p <0.001). Incidence of hypotension was 3 out of 30 in Group DX, 4 out of 30 in Group EX compared to none in Group CX, which was significant. Agitation was high in Group CX-30% and Group EX-26% than in group DX- p <0.001. The patients of dexmedetomidine group were more sedated for 30 minutes post extubation. Extubation quality was better in dexmedetomidine group.

CONCLUSION
Both the drugs attenuate haemodynamic response to extubation, whereas dexmedetomidine attenuates airway reflexed during emergence from general anaesthesia and facilitates smooth extubation without undue sedation.

KEYWORDS
Extubation, Dexmedetomidine, Esmolol, Haemodynamic Response.

How to cite this article

Rao SG, Sudarshan MB, Srinivas VY. Effect of dexmedetomidine and esmolol on extubation. J. Evid. Based Med. Healthc. 2017; 4(79), 4650-4655. DOI: 10.18410/jebmh/2017/930

BACKGROUND

Complications that occur during and after extubation are three times more common than that occurring during tracheal intubation and induction of anaesthesia.1Hypertension and tachycardia are well documented events during extubation. These haemodynamic reflexes reflect sympathoadrenal reflex stimulation (epipharyngeal and laryngopharyngeal stimulation) with concomitant increase in plasma levels of catecholamines and activation of α and β

adrenergic receptors. This increase in blood pressure and heart rate are transitory, variable and unpredictable.2 Respiratory complications associated with tracheal extubation are coughing and sore throat, laryngospasm, bronchospasm, which leads to hypoxaemia.3 These reflexes maybe attenuated by pharmacological interventions. This study compares the efficacy of dexmedetomidine with esmolol in attenuating post-extubation stress responses in patients undergoing procedures under general anaesthesia.

 

Aim of the Study

a) To study and compare intravenous dexmedetomidine 0.005 mg/kg given 600 seconds before vs. esmolol 1.5 mg/kg given 120 seconds before extubation on the extubation responses regarding variations in HR, SBP, DBP and MAP and airway reflexes, coughing, extubation quality, breath holding and saturation.

b)   To study complications like bradycardia, hypotension and sedation.

MATERIALS AND METHODS

Method of Collection of Data- Normal adult patients of either sex, aged between 18-60 years belonging to ASA class I, without any comorbid disease, admitted for all elective surgeries under general anaesthesia with prior ethical committee clearance.

90 patients were considered for the study. They were divided randomly into 3 groups of 30 each. Sealed envelopes were used to obscure the group and each time the patient was asked to pick one and hand it over to a senior anaesthesiologist who was not involved in the study. On opening the envelope, the above anaesthesiologist would recognise the group to which the patient belonged and he was asked to prepare the drug solution.

Group CX = Saline control group.

Group DX = Dexmedetomidine group (0.005 mg/kg).

Group EX = Esmolol group (1.5 mg/kg).

 

Patients were premedicated with Tab. Alprazolam 0.5 mg and Tab. Ranitidine hydrochloride 150 mg orally at bedtime and kept nil per orally 6 hours before surgery.

On arrival of the patient in the operating room, IV line will be obtained with 18G cannula and will be preloaded with ringer lactate 10 mL/kg body weight before administering anaesthesia. The patients were connected to multiparameter monitor, which records HR, noninvasive measurements of SBP, DBP, MAP, ETCO2 and continuous ECG monitoring and SPO2. The baseline SBP, DBP, MAP and HR were recorded (basal parameters). The cardiac rate and rhythm were also monitored from a continuous visual display of ECG from lead II.

All patients were premedicated with Inj. Midazolam 0.02 mg/kg bodyweight and Inj. Fentanyl 0.01 mg/kg bodyweight, Inj. Ramosetron 0.3 mg, Inj. Dexamethasone 8 mg IV. Then, patients were preoxygenated for 180 seconds. Patient was induced with Inj. Pentothal Sodium 5 mg/kg bodyweight. Endotracheal intubation was facilitated with 1.5 mg/kg IV suxamethonium 60 seconds prior to laryngoscopy and intubation. Laryngoscopy and intubation were performed and after confirmation of bilateral equal air entry and capnograph, the endotracheal tube was fixed.

Anaesthesia was maintained using 50% nitrous oxide and 50% of oxygen with 1% isoflurane. Once the patients came out from suxamethonium, further neuromuscular blockade was maintained with vecuronium 0.1 mg/kg bodyweight initially and 0.01 mg/kg increments as and when required.

At the beginning of skin suturing, isoflurane is discontinued and Group DX will receive dexmedetomidine 0.005 mg/kg bodyweight diluted in 10 mL normal saline as infusion over 10 minutes using an infusion pump, whereas Group CX and Group EX will receive 10 mL normal saline over 600 seconds. Nitrous oxide will be discontinued at the end of infusion.

At the end of surgery, HR, SBP and DBP recorded serve as baseline values. Patient is reversed using Inj. Neostigmine 0.05 mg/kg and Inj. Atropine 0.02 mg/kg IV. After 120 seconds of reversal, Group EX will receive esmolol 1.5 mg/kg IV diluted to 10 mL with normal saline and Group CX and Group DX will receive 10 mL normal saline.

Patients were extubated when subjective and objective criteria were fulfilled.

 

Parameters Evaluated-

  1. HR, SBP, DBP, MAP, SpO2 and TOF readings - basal, prior to drug or placebo infusion; 60, 120, 300, 420 and 600 seconds during infusion; following reversal administration; post extubation every 300 seconds for 900 seconds, thereafter every 900 seconds for next 2 hours.
  • Hypotension was defined as SBP ≤20% of baseline value.
  • Tachycardia was defined as HR >25% of baseline value.
  • Bradycardia was defined as HR <45 beats/minute.

 

Incidences of all these parameters were recorded in all the three groups.

The side effects of the study drug like hypotension, bradycardia and sedation were noted. Hypotension was treated using 3 mg increments of IV mephentermine and fluids. Bradycardia was treated using 0.6 mg of IV atropine.

 

  1. Extubation quality was rated using 5-point.4
    1. No coughing.
    2. Smooth extubation, minimal coughing.
    3. Moderate coughing (3 or 4 times).
    4. Severe coughing (5 to 10 times) and straining.
    5. Poor extubation, very uncomfortable (laryngospasm and coughing >10 times).

 

Number of coughs per patient was monitored for 900 seconds post extubation. Any laryngospasm, bronchospasm or desaturation was noted.

 

  1. Time to extubation and time to eye opening were recorded.
  2. Sedation was evaluated using Ramsay sedation scale.4
    1. Anxious, agitated, restless.
    2. Cooperative, oriented, tranquil.
    3. Responsive to verbal commands, drowsy.
    4. “Asleep”, responsive to light stimulation.
    5. Asleep, slow response to stimulation.
    6. No response to stimulation.

 

Statistics- Statistical significance (P) for the results obtained from the above study were analysed using-

  1. Descriptive statistics.
  2. t-test = Independent samples.
  3. t-test = Paired samples.
  4. Repeated measure ANOVA.
  5. Using SPSS for Windows (version 20.0).

 

RESULTS

 

 

Group CX

Group DX

Group EX

Total

Age Group (in years)

18 to 20

3 (10)

1 (3)

2 (7)

6 (7)

21 to 30

9 (30)

12 (40)

7 (23)

28 (30)

31 to 40

11 (37)

9 (30)

5 (17)

25 (28)

41 to 50

6 (20)

8 (27)

11 (36)

25 (28)

51 to 60

1 (3)

0 (0)

5 (17)

6 (7)

Total

30 (100)

30 (100)

30 (100)

90 (100)

Mean Age in Years

34.30 ± 9.24

33.87 ± 9.32

36.83 ± 9.51

35.24 ± 10.2

P value

0.1 (NS)

Table 1. Showing the Age Distribution

 

Figures in the parentheses indicate percentage; NS - Not significant.

 

Sex

Group CX

Group DX

Group EX

Total

No. of Patients

No. of Patients

No. of Patients

Male

15 (50)

14 (47)

13 (43)

42

Female

15 (50)

16 (53)

17 (57)

48

Total

30 (100)

30 (100)

30 (100)

90 (100)

p-value

0.689 (NS)

 

Table 2. Showing the Sex Distribution between Three Groups

 

Figures in the parentheses indicate percentage; NS - Not significant.

 

Body Weight (kg)

Group CX

Group DX

Group EX

No. of Patients

No. of Patients

No. of Patients

<40

1 (3)

1 (3)

0 (0)

41-50

9 (30)

7 (23)

8 (26)

51-60

16 (54)

13 (44)

11 (37)

61-70

4 (13)

8 (27)

8 (27)

71-80

0 (0)

1 (3)

3 (10)

Total

30 (100)

30 (100)

30 (100)

Mean body weight in kg ± SD

53.80 ± 7.41

56.83 ± 8.25

58.03 ± 8.93

p-value

0.19 (NS)

Table 3. Showing the Body Weight Distribution

 

Figures in the parentheses indicate percentage; NS - Not significant.

 

 

Duration of Surgery (minutes)

Group CX

68.33 ± 19.76

Group DX

70.12 ± 20.34

Group EX

67.33 ± 20.87

p-value

0.235 (NS)

Table 4. Showing the Mean Duration of Surgery

 

NS - Not significant.

 

 

Group CX

Group DX

Group EX

P

Basal prior to infusion

84.93 ± 8.42

86.80 ± 13.10

87.63 ± 11.329

0.54

At 60 seconds

87.43 ± 8.30

86.97 ± 12.21

89.90 ± 11.22

0.61

At 180 seconds

99.77 ± 8.02

85.87 ± 11.80

95.30 ± 12.20

0.32

At 300 seconds

92.50 ± 10.67

81.97 ± 11.55

95.67 ± 10.56

0.05

At 420 seconds

95.63 ± 10.65

78.43 ± 10.86

94.61 ± 10.85

<0.001

At 600 seconds

96.83 ± 11.44

76.50 ± 11.55

96.61 ± 11.03

<0.001

At reversal

101.87 ± 9.70

78.67 ± 12.20

100.20 ± 12.63

<0.001

Drug 2

107.07 ± 10.22

81.63 ± 12.00

102.87 ± 11.96

<0.001

At extubation

112.47 ± 12.49

85.67 ± 12.55

96.83 ± 15.81

<0.001

Post extubation 60 seconds

110.77 ± 11.25

83.73 ± 12.46

94.87 ± 12.82

<0.001

Post extubation 180 seconds

103.63 ± 20.34

81.87 ± 12.28

90.73 ± 12.59

<0.001

Post extubation 300 seconds

103.70 ± 10.73

80.40 ± 13.47

84.77 ± 10.59

<0.001

Post extubation 420 seconds

100.77 ± 10.45

78.53 ± 13.37

81.30 ± 10.56

<0.001

Post extubation 600 seconds

96.00 ± 8.45

76.10 ± 13.72

82.10 ± 10.27

<0.001

Post extubation 900 seconds

92.07 ± 7.69

74.40 ± 13.32

84.03 ± 9.96

<0.001

Post extubation 1800 seconds

87.97 ± 8.41

73.87 ± 11.91

83.93 ± 8.95

0.001

Post extubation 3600 seconds

85.23 ± 7.95

75.97 ± 11.33

83.03 ± 8.36

0.016

Post extubation 5400 seconds

84.30 ± 8.86

77.87 ± 1.68

83.60 ± 7.76

0.4

Post extubation 7200 seconds

83.70 ± 8.98

80.70 ± 11.00

83.00 ± 6.72

0.56

Table 5. Showing the Intergroup Comparison of Mean Heart Rate (BPM) Changes between all the Groups

 

(p <0.01) - Highly significant (HS); (p <0.05) - Significant (S); (p >0.05) - Not significant.

 

 

Group CX

Group DX

Group EX

P

Basal prior to infusion

96.96 ± 9.40

93.04 ± 7.92

91.56 ± 5.56

0.22

At 60 seconds

100.44 ± 8.49

93.26 ± 7.60

91.76 ± 5.23

0.06

At 180 seconds

104.83 ± 7.95

92.09 ± 7.64

92.33 ± 4.28

0.01

At 300 seconds

108.27 ± 9.81

90.94 ± 9.70

93.90 ± 3.68

<0.001

At 420 seconds

110.28 ± 8.97

88.94 ± 7.36

94.98 ± 3.91

<0.001

At 600 seconds

110.00 ± 14.63

86.61 ± 6.90

98.85 ± 6.30

<0.001

At reversal

114.81 ± 12.19

89.60 ± 6.67

108.77 ± 8.90

<0.001

Drug 2

116.55 ± 12.20

91.95 ± 7.26

103.17 ± 12.25

<0.001

At extubation

122.67 ± 12.04

95.77 ± 9.32

95.14 ± 10.03

<0.001

Post extubation 60 seconds

120.22 ± 10.10

93.91 ± 8.21

87.33 ± 11.29

<0.001

Post extubation 180 seconds

116.16 ± 8.865

91.79 ± 7.52

83.72 ± 7.57

<0.001

Post extubation 300 seconds

111.82 ± 8.49

89.75 ± 7.84

85.90 ± 8.20

<0.001

Post extubation 420 seconds

110.28 ± 7.25

87.86 ± 7.31

86.71 ± 7.95

<0.001

Post extubation 600 seconds

109.71 ± 7.06

86.21 ± 7.13

87.38 ± 7.84

<0.001

Post extubation 900 seconds

107.77 ± 7.50

83.94 ± 6.06

89.39 ± 9.05

<0.001

Post extubation 1800 seconds

101.35 ± 7.24

84.08 ± 5.78

89.66 ± 5.80

<0.001

Post extubation 3600 seconds

97.65 ± 7.45

87.68 ± 6.77

90.38 ± 4.73

<0.001

Post extubation 5400 Seconds

96.07 ± 6.23

90.54 ± 6.26

92.05 ± 3.82

<0.001

Post extubation 7200 Seconds

95.31 ± 6.56

92.52 ± 5.74

92.27 ± 3.69

0.001

Table 6. Showing the Intergroup Comparison of Mean Arterial Pressure (mmHg) Changes between all Three Groups

 

 

Group CX

Group DX

Group EX

P

At extubation

1.59 ± 0.38

2.51 ± 0.53

1.45 ± 0.41

<0.001

Post extubation 300 seconds

1.97 ± 0.25

2.40 ± 0.32

1.78 ± 0.38

<0.001

Post extubation 600 seconds

1.90 ± 0.30

2.24 ± 0.38

1.90 ± 0.49

<0.001

Post extubation 900 seconds

2.01 ± 0.38

2.13 ± 0.19

1.96 ± 0.13

0.004

Post extubation 1800 seconds

2.02 ± 0.50

2.10 ± 0.20

2.01 ± 0.41

0.045

Post extubation 3600 seconds

2.00 ± 0.49

2.08 ± 0.41

2.00 ± 0.15

0.156

Post extubation 5400 seconds

2.00 ± 0.00

2.00 ± 0.00

2.00 ± 0.00

-

Post extubation 7200 seconds

2.00 ± 0.00

2.00 ± 0.00

2.00 ± 0.00

-

Table 7. Comparison of Ramsay Sedation Scale in Three Groups of Patients

 

 

Group CX

Group DX

Group EX

P

Time to extubation

15.58 ± 3.23

17.24 ± 2.89

15.8 ± 3.66

<0.001

Time to eye opening

13.84 ± 3.67

16.15 ± 3.12

14.23 ± 2.95

<0.001

Extubation quality 5 pt. scale

1.57 ± 0.81

1.03 ± 0.20

1.60 ± 0.70

<0.001

No. of bouts of cough per patient

1.08 ± 0.50

0.3 ± 0.18

1.00 ± 0.30

0.004

Table 8. Comparison of Extubation Parameters among Three Groups of Patient Studied

 

 

Group CX

Group DX

Group EX

Scale 1

18 (60)

27 (90)

20 (67)

Scale 2

6 (20)

3 (10)

5 (17)

Scale 3

4 (13)

0 (0)

4 (13)

Scale 4

2 (7)

0 (0)

1 (3)

Scale 5

0 (0)

0 (0)

0 (0)

Total

30 (100)

30 (100)

30 (100)

Inference

Lower score of extubation quality is significantly associated with study group with p=0.001

Table 9. Comparison of Extubation Quality Occurred in Three Groups

 

 

DISCUSSION

A study title, “Effect of Dexmedetomidine with Esmolol on Extubation” was undertaken to compare the effects of intravenous dexmedetomidine (0.005 mg/kg) and esmolol (1.5 mg/kg) given before extubation on haemodynamic responses to extubation and extubation characteristics.

This study was conducted to compare the effectiveness of intravenous esmolol (1.5 mg/kg), a selective beta-adrenergic blocker with dexmedetomidine (0.005 mg/kg), an alpha-2 adrenergic receptor agonist in attenuation of haemodynamic stress response and airway reflexes to endotracheal extubation.

Esmolol hydrochloride is an ultra-short-acting, beta-one selective adrenergic receptor blocker with a distribution half-life of 120 seconds and an elimination half-life of 540 seconds. Esmolol appears quite suitable for use during a short-lived stress such as tracheal intubation and extubation.

Esmolol 1.0 mg/kg, 1.5 mg/kg and 2.0 mg/kg were used in patients before extubation in a study by Dyson et al,5 which showed that the increase in systolic blood pressure could be prevented with 1.5 mg/kg and 2.0 mg/kg esmolol, but 1 mg/kg esmolol was found to be ineffective. Since, distinct hypotension was observed with 2.0 mg/kg esmolol, 1.5 mg/kg esmolol was reported as the optimal dose for the prevention of haemodynamic response due to tracheal extubation.

In our study, we used esmolol 1.5 mg/kg slow bolus 120 seconds prior to extubation, which was effective in blunting haemodynamic response with no side effects.

Fuhrman TM et al6 (esmolol 0.5 mg/kg bolus followed by 0.3 mg/kg/min. infusion and alfentanil 5 mg/kg followed by saline infusion), Kovac et al7 (nicardipine 0.03 mg/kg IV versus esmolol 1.5 mg/kg IV) and Bostana et al8 (esmolol 1 mg/kg and lidocaine 1 mg/kg) all found esmolol was more effective than others in suppressing the response. Similar to our study here, all researchers have used ≥1 mg/kg esmolol in their studies, which have shown its efficiency over other drugs.

Dexmedetomidine is a highly selective α2 adrenoreceptor agonist (α12 - 1:1620). α2 agonists decrease the sympathetic outflow and noradrenergic activity thereby counteracting haemodynamic fluctuations occurring at the time of extubation. The selectivity is dose dependant at low-to-medium doses and on slow infusion, high levels of alpha-2 selectivity is observed, while high doses or rapid infusions of low doses are associated with both alpha-1 and alpha-2 activities.

Different doses of dexmedetomidine have been used to attenuate the stress response to emergence from general anaesthesia. Guler et al9 (0.5 µg/kg over 5 mins.), Aksu et al10 (0.5 µg/kg over 10 mins.), Jain et al11 (1 µg/kg over 10 mins.), Sriranga Rao et al12 (0.5 µg/kg over 10 mins.), Kwon Hui Seo et al13 (0.5 µg/kg, 0.7 µg/kg, 1 µg/kg), Bindu et al14 (0.7 µg/kg over 10 mins.) have used various doses of dexmedetomidine.

Dose 0.5 µg/kg and above have been found to be effective in attenuating stress response to extubation. Kwon Hui Seo et al13 conducted a study comparing the effectiveness of doses 0.5 µg/kg, 0.7 µg/kg, 1 µg/kg of dexmedetomidine and concluded that 0.5 µg/kg is effective in attenuating stress response and with minimal side effects.

Hence, we selected dose of 0.005 mg/kg dexmedetomidine, which is the dose effective with minimal side effects. We diluted the required dose of dexmedetomidine in 10 mL of normal saline and with the help of a syringe pump infused it intravenously over a period of 10 minutes. A brief increase in blood pressure and decrease in heart rate is noted initially whenever dexmedetomidine is administered as a single bolus dose. This early effect of dexmedetomidine can be attributed to its stimulation of peripheral alpha-2B receptors located in smooth muscles of blood vessels and this effect can be reduced by a slow infusion. Hence, we decided to administer this initial bolus dose of dexmedetomidine slowly over a period of 10 minutes intravenously.

From the pharmacokinetic profile, it is seen that the distribution half-life of intravenous dexmedetomidine is approximately 6 minutes. Jain et al,11 Sriranga Rao et al,12 and Bindu et al14 have administered dexmedetomidine 10 minutes before extubation. Hence, in the present study, dexmedetomidine was administered 10 minutes before extubation to prevent stress response to extubation.

In our study, we observed that HR did not show a significant rise compared to basal value from second minute of drug administration, during reversal, at extubation and any period post extubation in dexmedetomidine group. But, in control group, there was a significant rise in HR compared to basal value. In esmolol group, there was no increase in heart rate during extubation compared to pre-esmolol value. Incidence of tachycardia was 74% in control group, 3% in dexmedetomidine group and esmolol group. The rise in HR in control group was more persistent than study group.

This observation is in concurrence with the study done by Jain D et al,11 Sriranga Rao et al12 where the pulse rate in dexmedetomidine group remained below the pre-DEX values (baseline value) at all-time intervals following extubation.

In our study, both dexmedetomidine and esmolol were equally effective in controlling heart rate response to extubation in contrary to Vanish Priya et al15 who observed that dexmedetomidine to be effective than esmolol probably due to the lower esmolol dosage 0.5 mg/kg used in their study compared to 1.5 mg/kg used in ours.

Bradycardia was not observed in any of the patients. This finding is in concurrence with other studies, which did not observe statistically significant incidence of bradycardia.

SBP, DBP and MAP values were significantly lower in dexmedetomidine compared to baseline values at all times from the time of dexmedetomidine infusion to post extubation 30 minutes. This is in conjunction with the study conducted by Jain D et al11 in which study group patients received 1 µg/kg of dexmedetomidine and they did not observe any significant change (p<0.05) in the blood pressure in dexmedetomidine group throughout the study period. Similarly, the SBP, DBP and MAP values in esmolol group remained below the pre-drug values. On the contrary, systolic blood pressure rose significantly (p<0.05) in control group following extubation as observed in our study, which we achieved with 0.5 µg/kg of dexmedetomidine and 1.5 mg of esmolol.

In our study, none of the patients in dexmedetomidine group and esmolol group had hypertension as against 74% in control group.

This observation is in contradiction with the study done by Aksu R et al who observed significantly increased SBP at 1 and 5 minutes after extubation. Probably, this is due to infusion of dexmedetomidine over 5 minutes (Aksu et al).10

Sedation score was significant post extubation for 30 minutes in dexmedetomidine group compared with control group and esmolol group. After this period, sedation scores were comparable in all the three groups.

Agitation was observed in 9 patients in control group and 8 in esmolol group following extubation, whereas none were agitated in Group D. So, this finding concurs with the study done by Guler G et al16 who conducted a study on the effect of single-dose dexmedetomidine in reducing the agitation and providing smooth extubation after paediatric adenotonsillectomy. Guler G et al16 in their study on emergence agitation in children undergoing adenotonsillectomy observed that time to extubation and emergence were prolonged significantly when compared to control group with p<0.05 (5.03 ± 2.3 vs. 3.30 ± 1.3 minutes and 9.30 ± 2.9 vs. 7.20 ± 2.7 minutes, respectively). This observation is in agreement with our study conducted wherein time to extubation and eye opening (i.e., interval between cutoff of nitrous oxide to extubation and eye opening, respectively) were significantly prolonged in dexmedetomidine group when compared to control group and esmolol group (17.24 ± 2.89 vs. 15.58 ± 3.23, 15.8 ± 3.66 minutes and 16.15 ± 3.12 vs. 13.84 ± 3.67, 14.23 ± 2.95 minutes, respectively).

 

CONCLUSION

Inj. Dexmedetomidine 0.5 µg/kg bodyweight administered over 10 minutes and Inj. Esmolol 1.5 mg/kg bodyweight and administered over 1 minute before extubation attenuates haemodynamic responses to extubation, whereas dexmedetomidine also attenuates airway reflexes during emergence from general anaesthesia and facilitates smoother extubation without causing undue sedation.

Hence, dexmedetomidine is superior to esmolol in attenuating stress response to extubation without any adverse effects.

 

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[16]  Guler G, Akin A, Tosun Z, et al. Single-dose dexmedetomidine reduces agitation and provides smooth extubation after pediatric adenotonsillectomy. Pediatr Anesth 2005;15(9):762-766.

 

 

 

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