Comparison of intravenous dexmedetomidine and intravenous fentanyl to attenuate the hemodynamic stress response to tracheal extubation

Abstract

Introduction: Endotracheal extubation can be associated with hypertension, tachycardia, arrhythmias, myocardial ischemia and raised intracranial pressures due to sympathetic stimulation. Aim: To compare the efficacy of dexmedetomidine, fentanyl and placebo in decreasing stress response to tracheal extubation in elective general surgery patients. Materials and Methods: 180 patients of either sex, ASA grade I -II normotensive, aged 18-65 years undergoing elective general surgeries of 60-180 minutes duration under general anaesthesia were randomized into 3 groups. Anaesthetic technique was standardized. Patients in Group N, F and D received an IV infusion of 100 ml of 0.9% normal saline, fentanyl 1?g/kg and dexmedetomidine 0.5?g/kg respectively 10 minutes before extubation for a period of 10 minutes. HR, SBP, DBP, MAP and SPO2 were recorded before, during and after extubation. Results: Statistically significant lesser increase in HR, SBP, DBP, MAP were noted after extubation in the dexmedetomidine group than the fentanyl group. Dexmedetomidine group had better extubation quality than the fentanyl group. Ramsay sedation and Aldrete scores were similar in all 3 groups. Hypotension and bradycardia were more with dexmedetomidine group than the fentanyl group but none required intervention. Conclusion: Dexmedetomidine 0.5?g/kg infusion administered 10 minutes before tracheal extubation was better compared to fentanyl 1?g/kg infusion in attenuating the hemodynamic stress response with comparable adverse effects. Hence, dexmedetomidine infusion can be a safer alternative to fentanyl infusion for attenuating extubation stress response. Keywords: Dexmedetomidine, Fentanyl, Extubation, Hemodynamic response.