English

Abstract

BACKGROUND: Tracheal extubation and emergence is associated with significant haemodynamic alterations and is poorly tolerated by patients with co-morbid conditions. We compared the efficacy of fentanyl and dexmedetomidine in mitigating haemodynamic stress response and assessed extubation quality in study groups. MATERIALS AND METHODS: One fifty patients of either sex, ASA grade I & II normotensive patients, aged 18-55 years undergoing elective surgeries under general anaesthesia were randomized into 3 equal groups. Anaesthetic technique was standardized. 10 minutes prior to extubation, patients in Group N, F and D received intravenous bolus infusion of 0.9% normal Saline, Fentanyl 1μg /kg and Dexmedetomidine 1μg /kg respectively over 10 minutes period. Heart Rate (HR), Systolic BP (SBP), Diastolic BP (DBP) and Mean Arterial Pressure (MAP) were noted at extubation, 2, 4, 6, 8, 10 min and at regular interval thereafter for a period of two hours. Extubation quality was evaluated on 5-point extubation quality scale ( scale 1 = no coughing, 2 = smooth extubation, minimal coughing (1 or 2 times), 3 = moderate coughing (3 or 4 times), 4 = severe coughing (5-10 times) and straining, 5 = poor extubation, very uncomfortable (laryngospasm and coughing >10 times)). Ramsay sedation score and Aldrete's recovery score were recorded. Any adverse events, use of rescue drugs and postoperative analgesics were noted. RESULTS: All the measured haemodynamic parameters were significantly elevated at extubation and at various points of observation in normal saline group than fentanyl and dexmedetomidine group (p=0.000). Tachycardia response was seen in 84% patients in group N, compared to 36% and 8% in group F & D respectively (p=0.000). Statistically significant hypertensive response was noticed in 43(86%) patients of group N, 9(18%) of group F and 3(6%) of group D (p=0.000). Duration of tachycardia and hypertensive response was significantly longer in control group. Three groups differed with regard to overall extubation quality (p<0.001). Groups D (1.50±0.58) and F (1.94±0.55) had lower scores compared to group N (2.68±0.47) implying smoother extubation. Use of rescue drugs to treat acute hypertensive response was more in group N (34%) than group F (2%) and group D (0%). Sedation and recovery scores were similar in all the three groups. CONCLUSION: Dexmedetomidine 1 µg/kg IV was most effective followed by fentanyl 1 µg/kg IV in attenuating haemodynamic stress responses during emergence with no clinically significant differences in sedation and recovery profile. Dexmedetomidine group had smoother and best extubation quality.