COMPARISON OF DEXMEDETOMIDINE AND LIGNOCAINE ON ATTENUATION OF PRESSOR RESPONSES DURING TRACHEAL EXTUBATION
DOI:
https://doi.org/10.22159/ajpcr.2022.v15i12.45888Keywords:
Dexmedetomidine, Extubation, Hemodynamic changes, LignocaineAbstract
Objectives: The aim of the study was to evaluate and observe the effects of single bolus intravenous dose of Dexmedetomidine with Lignocaine on the hemodynamic changes and pressor responses during tracheal extubation in patients undergoing elective surgery under general anesthesia.
Methods: This prospective and observational study was conducted in anesthesia department of tertiary care teaching hospital of Gujarat. Group A received single bolus dose of Dexmedetomidine 0.5μg/kg IV (diluted in 10 ml normal saline) over 10 min after completion of surgery and Group B received single bolus dose of Lignocaine 1.5 mg/kg IV (diluted in 10ml normal saline) over 60 s before extubation. Hemodynamic parameters were recorded before administration of drug (baseline), at extubation and post-extubation in both groups. Extubation quality was evaluated using a five-point scale. Complications were also compared in both the groups.
Results: Heart rate was 89.67±7.19 beats/minute in Group A at the time of extubation and in Group B, it was 115±6.88 beats/min which was found highly significant (p<0.0001). Mean systolic blood pressure (SBP) in Group A was 130.55±9.4 mmHg at the time of extubation and in Group B, it was 142±9.58 mmHg which was highly significant (p<0.0001). Mean diastolic blood pressure (DBP) in Group A was 85.76±3.26 mmHg at the time of extubation and in Group B, it was 99.1±2.86 mmHg which was highly significant (p<0.0001). Statistical significant difference was also observed between both the groups for heart rate, SBP, and DBP from extubation to 60 min post-extubation (p<0.05).
Conclusions: This study concluded that single bolus dose of intravenous Dexmedetomidine was more effective in maintaining hemodynamic stability and attenuating airway reflex responses as compared to lignocaine.
Downloads
References
Bindu B, Pasupuleti S, Gowd UP, Gorre V, Murthy RR, Laxmi MB. A double blind, randomized, controlled trial to study the effect of dexmedetomidine on hemodynamic and recovery responses during tracheal extubation. J Anaesthesiol Clin Pharmacol 2013;29:162-7. doi: 10.4103/0970-9185.111665, PMID 23878434
Lowrie A, Johnston PL, Fell D, Robinson SL. Cardiovascular and plasma catecholamine responses at tracheal extubation. Br J Anaesth 1992;68:261-3. doi: 10.1093/bja/68.3.261, PMID 1547048
Nishina K, Mikawa K, Shiga M, Maekawa N, Obara H. Prostaglandin E1 attenuates the hypertensive response to tracheal extubation. Can J Anaesth 1996;43:678-83. doi: 10.1007/BF03017950, PMID 8807172
Asai T, Koga K, Vaughan RS. Respiratory complications associated with tracheal intubation and extubation. Br J Anaesth 1998;80:767-75. doi: 10.1093/bja/80.6.767, PMID 9771306
Chelly JE. Regional anesthesia and the difficult airway. In: Hagberg CA, editor. Airway Management: Principles and Practice. 2nd ed. St. Louis: Mosby; 2007.
Fujii Y, Saitoh Y, Takahashi S, Toyooka H. Combined diltiazem and lidocaine reduces cardiovascular responses to tracheal extubation and anesthesia emergence in hypertensive patients. Can J Anesth 1999;46:952-6. doi: 10.1007/BF03013130
Miller RD. Miller’s Anaesthesia. 6th ed. United Kingdom: Elsevier, Churchill Livingstone; 2005. p. 1647.
Lahiri S, Das S, Basu SR. Intraoperative lignocaine infusion achieving earlier discharge criteria among laparoscopic cholecystectomy patients. Saudi J Laparosc 2018;3:16-20. doi: 10.4103/SJL.SJL_9_17
Shabnum T, Ali Z, Naqash IA, Mir AH, Azhar K, Zahoor SA, et al. Effects of lignocaine administered intravenously or intratracheally on airway and hemodynamic responses during emergence and extubation in patients undergoing elective craniotomies in supine position. Anesth Essays Res 2017;11:216-22. doi: 10.4103/0259-1162.200239, PMID 28298788
Aksu R, Akin A, Biçer C, Esmaoğlu A, Tosun Z, Boyaci A. Comparison of the effects of dexmedetomidine versus fentanyl on airway reflexes and hemodynamic responses to tracheal extubation during rhinoplasty: A double-blind, randomized, controlled study. Curr Ther Res Clin Exp 2009;70:209-20. doi: 10.1016/j.curtheres.2009.06.003, PMID 24683231
Jamal MK, Ahmad S, Ahmad F. A comparative study of effects of three different doses of dexmedetomidine on extubation. JMSCR 2018;8:12-9.
Babu KC, Rajan S, Sandhya SV, Raj R, Paul J, Kumar L. Effectiveness and safety of extubation before reversal of neuromuscular blockade versus traditional technique in providing smooth extubation. Anesth Essays Res 2021;15:133-7. doi: 10.4103/aer.aer_78_21, PMID 34667360
Braunwald E. Control of myocardial oxygen consumption: physiologic and clinical considerations. Am J Cardiol 1971;27:416-32. doi: 10.1016/0002-9149(71)90439-5, PMID 4396726
Kothari D, Tandon N, Singh M, Kumar A. Attenuation of circulatory and airway responses to endotracheal extubation in craniotomies for intracerebral space occupying lesions: Dexmedetomidine versus lignocaine. Anesth Essays Res 2014;8:78-82. doi: 10.4103/0259- 1162.128916, PMID 25886109
Gosai ND, Jansari AH, Solanki RN, Patel DP, Prajapati DN, Patel BM. A comparative study of the effect of dexmedetomidine and lignocaine on hemodynamic responses and recovery following tracheal extubation in patients undergoing intracranial surgery. Int J Basic Clin Pharmacol 2015;4:371-5. doi: 10.5455/2319-2003.ijbcp20150442
Sebastian R, Harshavardhan K. Comparison of two different doses of dexmedetomidine in decreasing the extubation response. Int J Sci Res 2019;8:380-3.
Jain D, Khan R, Maroof M. Effect of dexmedetomidine on stress response to extubation. Internet J Anesthesiol 2009;2009:1.
Rao S, Somasekharam P, Dinesh K, Ravi M. Effect of bolus dose of dexmedetomidine on hemodynamicresponses and airway reflexes during tracheal extubation. World J Pharm Pharm Sci 2015;4:731-40.
Meitei AJ, Singh PL, Singh HS, Singh HT, Devi AN, Debbarma B, et al. Effect of dexmedetomidine on airway reflexes and haemodynamic responses to tracheal extubation. Int J Health Sci Res 2015;5:66-73.
Antony D, Davies CV, Thomas MK, Shenoy U, Mahesh V, Puthumana KJ. The effect of two different doses of dexmedetomidine to attenuate cardiovascular and airway responses to tracheal extubation: A double blind randomized controlled trial. Int J Med Res Rev 2016;4:1392-403.
Published
How to Cite
Issue
Section
Copyright (c) 2022 Jayshri Prajapati, Maitri Patel
This work is licensed under a Creative Commons Attribution 4.0 International License.
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.