EFFECT OF DEXMEDETOMIDINE AND ESMOLOL ON EXTUBATION

BACKGROUND \nComplications during extubation are 3 times more than the intubation. A clinical study compares the efficacy of dexmedetomidine \nwith esmolol in attenuating extubation stress responses in patients undergoing procedures under general anaesthesia. \nMATERIALS AND METHODS \nAfter institutional ethical committee clearance and informed consent, 90 patients of either sex between 18-60 years belonging \nto ASA Class I posted for elective surgical procedure under general anaesthesia were enrolled in the study. The study population \nwas randomly divided into three groups of 30 each. Group DX received dexmedetomidine 0.005 mg/kg, Group EX received \nesmolol 1.5 mg/kg and Group CX received saline placebo intravenously. Various parameters regarding haemodynamics were \nevaluated just before, during the process and immediately after extubation. Two time intervals- one between stopping of nitrous \noxide to eye opening and the other between stopping of nitrous oxide to extubation were noted. Various side effects such as \ndesaturation, bronchospasm, laryngospasm and post-extubation cough too were recorded simultaneously. A 5-point scale was \nused to rate quality of extubation and Ramsay sedation scale was used to rate sedation. \nRESULTS \nHeart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Mean Arterial Pressure (MAP) were increased \nin all the groups at extubation, but was statistically and clinically significant only in control group (p <0.001). Time to extubation \nand eye opening were prolonged in Group DX (p <0.001). Incidence of coughing was 10% in Group DX when compared to 23% \nand 26% in Group CX and group EX respectively, which was significant (p <0.001). Incidence of hypotension was 3 out of 30 \nin Group DX, 4 out of 30 in Group EX compared to none in Group CX, which was significant. Agitation was high in Group CX- \n30% and Group EX-26% than in group DX- p <0.001. The patients of dexmedetomidine group were more sedated for 30 \nminutes post extubation. Extubation quality was better in dexmedetomidine group. \nCONCLUSION \nBoth the drugs attenuate haemodynamic response to extubation, whereas dexmedetomidine attenuates airway reflexed during \nemergence from general anaesthesia and facilitates smooth extubation without undue sedation. \n