A comparative study of the effect of dexmedetomidine and lignocaine on hemodynamic responses and recovery following tracheal extubation in patients undergoing intracranial surgery

Abstract

Background: Recovery from general anesthesia and extubation is a period of intense physiological stress for patients. The most feared complications after intracranial surgery are development of an intracranial hematoma and major cerebral edema. Both may result in cerebral hypoperfusion and brain injury. Thus, the anesthetic emergence of a neurosurgical patient should include maintenance of stable respiratory and cardiovascular parameters. Minimal reaction to the endotracheal tube removal prevents sympathetic stimulation and increases in venous pressure. In our study, we compared dexmedetomidine HCl, lignocaine HCl and placebo to blunt stress response and providing a smooth transition from extubation phase. Methods: 75 ASA Grade I and II patients aged 18-60 years scheduled for elective intracranial surgery for intracranial space occupying lesions were randomly divided into three groups of 25 each. Balanced general anesthesia was given. Inhalation anesthetic was discontinued and after return of spontaneous respiration patient in Group D received injection dexmedetomidine 0.5 µg/kg intravenous (IV), Group X received injection lignocaine 1.5 mg/kg IV and Group P received 10 ml normal saline IV over 60 sec. Heart rate (HR), mean arterial pressure (MAP), quality of extubation were measured at 1, 3, 5, 10, 15 mins interval after extubation. Emergence time and extubation time were noted and quality of extubation was evaluated on cough grading. Results: There was a significant decrease in MAPs and HR in Group D as compared to Group L and Group P (p<0.05) at all-time interval after extubation. Extubation quality score of the majority of patients was 1 in Group D, 2 in Group X, and 3 in Group P (p<0.001). The duration of emergence and extubation were comparable in all three groups. Sedation score of the most patient was 3 (44%) in Group D and 2 (56%) in Group X. Six patients in Group D and 1 patient in Group X had bradycardia. Conclusion: Single bolus dose of IV dexmedetomidine HCl 0.5 mg/kg given before tracheal extubation effectively attenuates hemodynamic response to extubation as compared to 1.5 mg/kg lignocaine HCl.