BACKGROUND: Tracheal extubation is associated with significant hemodynamic alterations and poorly tolerated by patients with co-morbid conditions. We compared the efficacy of dexmedetomidine1μg /kg and low combination dose of dexmedetomidine .5μg /kg plus Lidocaine1mg/kg in softening hemodynamic stress response and assessed extubation quality in study groups.
MATERIALS AND METHODS: The number of the patients in our study one hundred and fifty of either sex, ASA grade I &II patients, aged 20-50 years undergoing elective abdominal surgeries under general anesthesia randomized into three equal groups. Anesthetic technique was standardized. Before extubation by 10 minutes, patients in Group N, D, and DL received intravenous bolus infusion of 0.9% normal Saline, dexmedetomidine 1μg /kg and Dexmedetomidine .5 μg /kg, respectively over 10 minutes period. Before complete extubation by 90 seconds, in the three groups by syringe ten cc volumes and at time of extubation patients in Group N and D received intravenous bolus infusion of 0.9% normal Saline but, in Group DL received Lidocaine 1mg/kg then extubation completed. Heart rate (HR), Diastolic BP (DBP), Systolic BP (SBP), and Mean Arterial Pressure (MAP) were noted at baseline, at the reverse, extubation, 2, 4, 6, 8, 10 min and at the regular interval after that for two hours. Extubation quality was assessed by extubation quality scale. Ramsay sedation score and Aldrete’s recovery score also recorded and any adverse events noted.
RESULTS: All the measured hemodynamic parameters significantly elevated at extubation and various points of observation in the normal saline group than dexmedetomidine and dexmedetomidine plus Lidocaine group (p=0.001). Tachycardia response was seen in 41(82%) patients in group N, compared to 18(36%) and 20(40%) in group D & DL respectively (p=0.001). The statistically significant hypertensive response noticed in 40(80%) patients of group N, 9(18%) of group D and 12(24%) of group DL (p=0.001). Duration of tachycardia and the hypertensive response was significantly longer in the control group. The three groups differed about overall extubation quality in Groups D (1.93±0.57) and DL (1.51±0.57) had lower scores compared to group N (2.67±0.48) implying smoother extubation (p