Prospective Double Blind Randomised Controlled Study on Effect of Dexmedetomidine on Quality and Ease of Extubation.

Abstract

Introduction: Tracheal extubation much like laryngoscopy and intubation is associated with haemodynamic derangements. The objective of our study is to see the effect of Dexmedetomidine an alpha 2 agonist infusion 15 minutes prior to extubation on the haemodynamics and extubation process.

Objectives: To evaluate the effect of dexmedetomidine on haemodynamic and recovery responses during extubation and the quality of extubation.

Methods: Prospective double blinded randomized controlled study. Sample size was calculated based on findings of Barkha et al. using the formula for comparison of two means. Study conducted at tertiary teaching hospital January 2014 to June 2015, 60 indoor patients (30 in each group) of ASA grade I and II , 18-60 years of age , scheduled for elective surgery under general anaesthesia with tracheal intubation.Population was randomized into two groups by closed envelope technique. Patients in C group received 100 ml of 0.9% Normal saline and group D received 0.5 mcg/kg of Dexmedetomidine in 100 ml Normal Saline over 15 minutes about 15 minutes prior to anticipated end of surgery.Heart rate, systolic, diastolic and mean arterial pressures were recorded at the start of the infusion and there after at every 1, 5, 10 and 15 minutes. Residual neuromuscular blockade was reversed. Ones patient is fully awake, obeying oral commands, patient extubated  after thorough oral suctioning. Vitals noted at the time of reversal of neuromuscular bloackade and extubation and at 1,5, 10, 15 and 30 minutes post extubation. Any untoward event noted. Respiratory rates noted in both the groups following extubation.

Results: Heart rate and blood pressure were evidently lower in the dexmedetomidine group during and after extubation. Sedation score was 3 in group D and 2 in group C. Quality of extubation score of most patients in  dexmedetomidine group was 2 and 3 in placebo group. No side effects were seen in any of the patients.

Conclusions:Dexmedetomidine, 0.5mcg/kg given as an infusion 15 minutes prior to extubation, provides stable haemodynamics and smooth extubation.