Effect of Two Different Doses of Dexmedetomidine on Extubation Quality Score during Tracheal Extubation in Adult PatientsA Randomised Controlled Trial

Abstract

Introduction: Extubation of the trachea is the process of discontinuing the artificial airway when the need for ventilation and protection of the airway are absent. Extubation most of the time is associated with haemodynamic changes like hypertension, tachycardia and dysrhythmias. Extubation during lighter planes of anaesthesia can stimulate reflexes by laryngeal and tracheal irritation which may lead to laryngospasm and bronchospasm. Aim: To study the effect of two different doses of dexmedetomidine on extubation quality score during tracheal extubation in adult patients undergoing Ear, Nose and Throat (ENT) surgeries. Materials and Methods: The present study was a randomised controlled trial in which 120 patients with American Society of Anesthesiologists (ASA) grade I and II, aged 18-60 years, were randomised into two groups, D1 and D2, to receive dexmedetomidine 0.3 μg/kg and 0.5 μg/kg, respectively. The drug was infused over 10 minutes before skin closure. Extubation quality score was assessed on a 5-point scale and sedationagitation scale was recorded during tracheal extubation. Haemodynamic parameters (Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Blood Pressure (MBP), Oxygen Saturation (SpO2), Electrocardiography (ECG) were noted at two, five and ten minutes interval during endotracheal extubation, and after that every 10 minutes till one hour. Mann-Whitney U test was used for quantitative data and Chi-square test, Fisher’s-exact test were used for qualitative data. Results: Quality of extubation was better in D2 as compared to D1. There was no severe coughing in D2 as compared to D1 {0/60 (0) vs 4/60 (6.67%), p-value 0.027}. Lesser number had minimal coughing in group D2 as compared to D1 {9/60 (15%) vs 13/60 (21.67%), p-value 0.047}, 15/60 (25%) of patients were found sedated in group D2 and 5/60 (8.33%) were found sedated in group D1 (p-value 0.039). Patients in group D2 were more haemodynamically stable than D1 during extubation. Conclusion: Present study concluded that dexmedetomidine 0.5 μg/kg administered before tracheal extubation, had a better extubation quality score, better sedation–agitation scale and was more effective in maintaining the haemodynamic stability as compared to dexmedetomidine 0.3 μg/kg.

Keywords

• ear
• nose and throat surgery
• general anaesthesia with drug infusion
• sedation-agitation score