Manasi Panat^1*, Pranali Shukla², Ramesh Talele³

¹Associate Professor, ²Junior Resident, ³Professor, Department of Anaesthesia, JMF'S ACPM Medical College, Dhule, Maharashtra, INDIA.

Email: mapanat7498@gmail.com

Table 1: General characteristics

The mean heart rate before extubation, during extubation and after extubation was calculated in both groups. The mean heart rate before extubation was comparable in Dexmedetomidine group and Lignocaine group, difference not significant statistically. The difference between mean heart rate during extubation, after extubation at 1, 3, 5, 10, 15, 20, 25, 30 minutes in dexmedetomidine group and lignocaine group was statistically significant.

Table 2: Heart rate

The mean systolic blood pressure before extubation was comparable in Dexmedetomidine group and Lignocaine group, difference not significant statistically. The difference between mean systolic blood pressure during extubation, after extubation at 1, 3, 5, 10, 15, 20, 25, 30 minutes in dexmedetomidine group and lignocaine group was statistically significant.

Table 3: Systolic Blood Pressure

The mean diastolic blood pressure before extubation was comparable in Dexmedetomidine group and Lignocaine group, difference not significant statistically. The difference between mean diastolic blood pressure during extubation, after extubation at 1, 3, 5, 10, 15, 20, 25, 30 minutes in dexmedetomidine group and lignocaine group was statistically significant.

Table 4: Diastolic Blood Pressure

The mean arterial blood pressure before extubation was comparable in Dexmedetomidine group and Lignocaine group, difference not significant statistically. The difference between mean arterial blood pressure during extubation, after extubation at 1, 3, 5, 10, 15, 20, 25, 30 minutes in dexmedetomidine group and lignocaine group was statistically significant.

Table 5: Mean arterial pressure

In Dexmedetomidine group, 12% of the patients had no cough during extubation, 72% of the patients had smooth extubation with minimal cough and 16% of the patients had moderate cough. In Lignocaine group, 22% of the patients had smooth extubation with minimal cough, 74 % of the patients had moderate cough during extubation and 4% of the patients had severe cough.

Table 6: Extubation Quality Score

In Dexmedetomidine group, 36% of the patients were calm, oriented and co-operative during extubation. 64% of the patients were drowsy but responding to commands. In Lignocaine group, 12% of the patients were apprehensive, restless or agitated. 82% of the patients were calm, oriented and co-operative during extubation. 6% of the patients were drowsy but responded to commands. Statistical analysis of the Emergence agitation score shows a P value of 0.001 which is significant statistically.

Table 7: Emergence Agitation Scale

In Dexmedetomidine group, 2% of the patients had vomiting during extubation and in Lignocaine group, 4% of the patients had vomiting. 11 patients in dexmedetomidine group had bradycardia (heart rate less than 60/minute) whereas 2 patients in the lignocaine group had bradycardia.

Table 8: Adverse events

DISCUSSION

During extubation of trachea, the cause of hemodynamic changes has multiple reasons such as pain at surgical site, anaesthesia emergence and irritation of trachea.⁶ Emergence from anaesthesia and extubation of trachea causes hemodynamic changes which is due to tracheal irritation and post-operative pain. Exaggerated responses to tracheal extubation can cause increased intracranial pressure, myocardial ischemia, arrhythmias, raised intraocular pressure.  Coughing and bucking in intubated patients occurs in 40% of patients on emergence from general anaesthesia.⁷ Coughing maybe harmful because it causes increases in blood pressure, heart rate, intrathoracic pressure, intraabdominal pressure, intracranial pressure and intraocular pressure. Thus coughing exacerbates pain, edema, venous bleeding, hematoma and bronchospasm. Cough at extubation increases morbidity risk after surgical procedures. Smooth emergence from general anaestheisia with minimal coughing is desirable.^8,9 These responses are well tolerated in healthy patients but maybe dangerous in patients with coronary artery disease, intracranial pathology and vascular anomalies. Many methods have been tried to attenuate the hemodynamic changes associated with extubation. Sharma et al.,¹⁰ found that heart rate increased during extubation in all three groups as compared to baseline values. The heart rate remained significantly high after 5 minutes of the drug administration in lignocaine group and placebo group, use of dexmedetomidine was associated with less increase in heart rate as compared to lignocaine group. In present study, heart rate variations between dexmedetomidine and lignocaine groups was statistically significant from the extubation time till the time the observations were recorded. Kotak et al.,¹¹ observed that bolus dose of dexmedetomidine 0.5 microgram/kg given before extubation caused a better control of systolic blood pressure after extubation as compared to esmolol 1mg/kg. In present study, better control of systolic blood pressure was seen with the use of dexmedetomidine as compared to that of lignocaine. R. Amutharani et al.,¹² observed that Dexmedetomidine group showed a lesser rise in diastolic blood pressure compared to fentanyl group from 5 minutes before extubation to 130 minutes after extubation which was statistically significant. In present study, the variations in diastolic blood pressure between Dexmedetomidine group and Lignocaine group were statistically significant from the time of extubation till the time the observations were done. Tung et al.,¹³ observed that all study medications- lignocaine (intravenous, intracuff, tracheal tube or topical applications), dexmedetomidine, remifentanil and fentanyl were better than placebo or no medication in reducing moderate to severe emergence cough, with dexmedetomidine ranked the most effective. Similar findings were noted in present study. Saidie, et al.,¹⁴ observed that dexmedetomidine reduced agitation in patients during extubation. Similar findings were noted in present study.

Limitations of present study were small sample size,and from single hospital. Multicentric larger studies with are required to validate the results.

CONCLUSION

From this prospective randomised comparative study, we can conclude that administration of Dexmedetomidine before tracheal extubation was more effective in maintaining the hemodynamic stability, facilitated smooth tracheal extubation and had a better quality of recovery as compared to Lignocaine.

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