Extubation Response Research Articles

Efficacy of endotracheal tube cuff lignocaine in the prevention of postextubation cough in children undergoing elective surgeries - A randomised controlled trial.

Postextubation airway complications are more common in paediatric patients than in adults. Intravenous lignocaine effectively prevents extubation response; however, data on using intracuff lignocaine in microcuff endotracheal tubes is scarce. The primary aim of this study was to compare the incidence of postextubation cough between intracuff lignocaine and intracuff air in the paediatric population during tracheal extubation. This randomised controlled study was conducted in 120 paediatric patients aged 1 month to 12 years who were scheduled to undergo surgeries under general anaesthesia. They were randomised to Group C (intracuff air) and Group L (intracuff 2% lignocaine). After administering general anaesthesia, the airway was secured with an age-appropriate microcuff endotracheal tube. According to groups, the cuff was inflated with air or lignocaine to achieve a cuff pressure of 10 cm H2O. Incidences of cough, desaturation, laryngospasm, apnoea and haemodynamic changes were recorded after tracheal extubation. Categorical variables were compared using the Chi-square or Fisher's exact test, and continuous variables were compared using the Student's t-test or Mann-Whitney U test. Intergroup differences between the variables were analysed by a two-way repeated measure analysis of variance. The incidence of postextubation cough was significantly higher in Group C [17 (28.3%) (confidence interval {CI} = 17.4-41.4)] when compared to Group L [8 (13.3%) (CI = 5.9-24.6)], with P = 0.043. One patient in Group C had laryngospasm compared to none in Group L. In Group C, there was also a significant increase in heart rate at all time points (1-5 min after extubation) from the baseline, and this increase was also significantly higher when compared to Group L (P < 0.05). The incidence of postextubation cough was significantly lower with intracuff lignocaine compared to that with intracuff air in paediatric patients.

Comparison between dexmedetomidine and lidocaine for attenuation of cough response during tracheal extubation: A systematic review and meta-analysis.

Tracheal extubation often causes cardiovascular and airway responses, potentially resulting in hazardous consequences. It remains unknown whether dexmedetomidine or lidocaine is more effective for cough suppression. Hence, we conducted a systematic review and meta-analysis of randomised controlled trials to compare the effectiveness and safety of dexmedetomidine and lidocaine in reducing cough response after tracheal extubation in adult patients. A thorough search of electronic databases, including PubMed, Embase, Cochrane Library, and Web of Science, was conducted to identify relevant studies (from inception to 31 January 2023). Randomised controlled trials comparing intravenous (IV) dexmedetomidine versus IV lidocaine administration during emergence from anaesthesia to prevent tracheal extubation response in adult patients under general anaesthesia were included. The primary outcome was the incidence of post-extubation cough. Secondary outcomes included emergence time, extubation time, residual sedation, and incidences of bradycardia. Statistical analysis was conducted using RevMan software. The Cochrane risk of bias tool was used to evaluate the potential risk for bias. In total, seven studies with 450 participants were included. There was no statistically significant difference in the incidence of cough between dexmedetomidine and lidocaine groups [Risk Ratio = 0.76; 95% Confidence Interval: 0.46, 1.24]. Emergence and extubation times were not significantly different between the two groups. Meta-analysis revealed a higher incidence of bradycardia and residual sedation in dexmedetomidine compared to the lidocaine group. This meta-analysis found no difference in cough, emergence, and extubation time between dexmedetomidine and lidocaine after tracheal extubation. However, residual sedation and bradycardia were more significant in dexmedetomidine than in lidocaine.

The Effect of Intracuff Low Dose Alkalinized Lidocaine With and Without Dexamethasone on Extubation Response: A Prospective, Double-Blind, Randomized Control Trial

Background: Intubation with a cuffed endotracheal tube is the gold standard for securing a definitive airway. Bucking over the tube during extubation can result in a potentially dangerous hemodynamic response. Tracheal tube cuff can be used as a reservoir for drugs to blunt this response. Lidocaine, a local anesthetic can achieve this by anesthetizing the airway. Dexamethasone has been known to potentiate the effect of lidocaine and has an intrinsic anti-inflammatory property. Methods: A prospective double-blind randomized control trial was conducted in a tertiary hospital for patients undergoing elective surgeries under general anesthesia requiring endotracheal intubation. Sixty patients were randomized equally into one of three groups. Cuff was inflated with saline (Group-S), 40 mg alkalinized lidocaine (Group-L), 40 mg alkalinized lidocaine with 8 mg dexamethasone (Group-LD). Heart rate, blood pressure and bucking were recorded during extubation, and post-operative sore throat were assessed. Results: All groups were comparable with regard to demographics, quantity of drug instilled in the cuff, duration of extubation and baseline hemodynamics. Group-L had the lowest incidence of hemodynamic changes during extubation, even lower than Group-LD. (p=0.020). Group-L and Group-LD had a lower incidence of bucking when compared to placebo (p&lt;0.001). Both Group-L and Group-LD revealed a lower grade of sore throat in the early post-operative period. Conclusion: Instilling endotracheal tube cuff with 40 mg alkalinized significantly blunts hemodynamic response and bucking during extubation, and sore throat in the early post-operative period compared to placebo. Addition of 8 mg dexamethasone does not improve hemodynamic extubation response.

Comparison of Normal Saline and Alkalinized 2% Lignocaine to Reduce Emergence Phenomenon and Post-Intubation Morbidities: A Prospective, Double-Blind, Randomized Study.

Endotracheal intubation for airway management in general anesthesia is associated with post-intubation morbidities due to tracheal mucosa injury caused by endotracheal tube (ETT) cuff. Nitrous oxide (N2O) diffuses into tracheal tube cuffs filled with air. The rate of diffusion of N2O through the membrane is proportional to its concentration gradient. High-volume low-pressure cuffs expand with only a slight increase in pressure until fully inflated. At this point, owing to the inelasticity of the material, the cuff pressure rises rapidly. This increased pressure can damage the tracheal mucosa. This phenomenon can be avoided, if we inflate the cuff with either a liquid or a gas mixture identical to the inspired gas and monitor the cuff pressure and volume at regular intervals. When lignocaine is used to inflate the ETT cuff, it diffuses to the underlying tracheal mucosa. Thus reducing local irritation and inflammation of the airway through its local anesthetic action. Alkalinization of lignocaine increases its rate of diffusion across the ETT cuff. It also reduces the dose of local anesthetic required to achieve the desired result. We sought to determine the benefits of filling the ETT cuff with alkalinized lignocaine 2% over normal saline, to prevent ETT-induced emergence phenomenon and reduce the incidence of post-intubation morbidities like sore throat, hoarseness, and nausea. This prospective, randomized, double-blind, and comparative study was done at a multispecialty hospital. A total of 120 individuals ofAmerican Society of Anesthesiologists (ASA) physical status 1 and 2, posted for surgery under general anesthesia, were randomly selected and divided into two groups: alkalinized 2% lignocaine group (group L) and normal saline group (group S). After induction of general anesthesia, the airway was secured with appropriate-sized ETT. The ETT cuff was inflated with either of the study media. Continuous cuff pressure monitoring was done to keep cuff pressure below 30 centimeters of water (cm of H2O), at all times. At extubation, the response was evaluated in terms of percentage change in heart rate (HR) and blood pressure from baseline, coughing, bucking, and restlessness. All the surgeries lasted more than two hours. Post-operatively, the patients were evaluated for sore throat and hoarseness, at regular intervals of up to 24 hours. ETT cuff pressure was initially less in group S, which rose to a significantly higher level at extubation, compared to group L (p <0.001). At extubation, there was a significant increase in HR and systolic blood pressure (SBP) from baseline, in group S than in group L (p <0.001 and p=0.001, respectively).The incidence of cough and restlessness was less in group L, compared to group S (p<0.001 and p=0.002, respectively). Mean extubation time and emergence time was more in group S than in group L (p<0.001). Post-operatively, the incidence and severity of sore throat were significantly higher in group S than in group L (p<0.001). Meanwhile, the incidence of hoarseness and nausea was comparable in the two groups. Continuous ETT cuff pressure monitoring helps to keep cuff pressure below tracheal mucosa capillary occlusion pressure. Filling the ETT cuff with alkalinized lignocaine further reduces extubation response and post-intubation morbidities.

Can low dose of intratracheal dexmedetomidine be used to attenuate peri-extubation cough? - A prospective, double-blinded, randomized clinical trial.

Peri-extubation cough is an undesirable event during extubation, prevention of which has been studied with multiple drugs, amongst which intravenous dexmedetomidine has emerged as one of the favourable drugs. Intratracheal route is attractive because of its ease of administration, provided it avoids the hypotension and bradycardia that occurs during intravenous bolus administration. There is a paucity of data exploring the utility, doses, and adverse effect of intratracheal dexmedetomidine. After obtaining ethical committee approval, 60 eligible, consenting adult patients undergoing surgery under general anesthesia in a tertiary teaching hospital were recruited and randomised into three groups-DEX0.3, DEX0.5, and NS. The plan of general anesthesia was standardized. Half an hour prior to extubation, study drug was instilled intratracheally-dexmedetomidine 0.3 mic/kg, 0.5 mic/kg, and NS in groups DEX0.3, DEX0.5, and NS, respectively. 4-point cough score was used to assess extubation response. Hemodynamic response and time to Ramsay sedation score 3 was also recorded. Majority of patients in DEX0.3 (60%) and DEX0.5 (85%) group had no cough (cough score 0), while majority of the patients in the NS group (70%) had either mild or moderate cough (cough score 1, 2). Kruskal Wallis test followed by post-hoc pairwise comparison showed statistically significant difference in 4-point cough score between GroupDEX0.3 and GroupNS (P < 0.001) and between GroupDEX0.5 and GroupNS (P = 0.038). DEX0.5 group, compared to DEX0.3 group, had significantly higher time from reversal to extubation (P < 0.001) and time to achieve Ramsay sedation score of 3 (P < 0.001). We conclude that both 0.3 mic/kg and 0.5 mic/kg of dexmedetomidine when given intratracheally are effective in preventing peri-extubation cough. Further, 0.3 mic/kg dexmedetomidine showed a better recovery profile compared to 0.5 mic/kg dexmedetomidine when administered intratracheally.

Comparison of intravenous lignocaine versus combination of lignocaine with diltiazem on attenuation of haemodynamic responses to tracheal extubation in patients undergoing abdominal surgeries under general anaesthesia: A randomized double blind interventi

Background: Tracheal intubation is frequently associated with cardiovascular stress response characterized by hypertension, tachycardia and increased serum concentration of catecholamines and similar phenomenon is also seen during extubation. During Endotracheal extubation increase in sympathoadrenergic activity is caused by epipharyngeal and laryngopharyngeal stimulation. Objective: The aim and objectives of this study are to compare the effect of combination of intravenous (i.v.) diltiazem 0.1 mg/kg and i.v lignocaine 1.0 mg/kg vs intravenous lignocaine alone to attenuate haemodynamic extubation responses and airway reflexes during extubation. Material and method: This study was undertaken with 72 patients belonging to the age group 20–60 years with physical status ASA Classes I and II of either sex. Group A received injection diltiazem 0.1 mg/kg and lignocaine 1 mg/kg. Group B received injection lignocaine 1 mg/kg with normal saline. In this study, the drug dosage was fixed based on the previous studies. Result: The baseline values of heart rate,systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were statistically comparable between the two groups. The heart rate, SBP, DBP, and MAP was significantly high in group A (lignocaine) as compared to group B (diltiazem with lignocaine) at extubation and till 1 min, 3 min, 5 min, and 10 min post extubation (pvalue &lt; 0.05). Conclusion: Combined diltiazem and lignocaine provides more effective prophylaxis than lignocaine alone for attenuating the cardiovascular responses to tracheal extubation

Comparing different doses of dexmedetomidine in attenuating extubation response in chronic smokers undergoing total extraperitoneal laparoscopic inguinal hernia repair: a randomized prospective study

BackgroundDuring the process of emergence from general anesthesia, tracheal extubation is a very critical step. Tracheal extubation is not just a reversal of intubation, as during extubation we encounter a change of state from controlled conditions to an uncontrolled environment. We have aimed our study at evaluating the attenuating effect on the extubation response using three different doses of dexmedetomidine on patients who are smokers and undergoing total extraperitoneal laparoscopic inguinal hernia repair under general anesthesia. This randomized, controlled, triple-blinded study included 90 smokers aged between 40 and 60 years. These patients were randomized to receive dexmedetomidine 0.5 μg/kg (group A), 0.75 μg/kg (group B), and 1 μg/kg (group C) prepared as a 10 ml infusion started 10 min before patients were extubated. Extubation quality, hemodynamic changes, oxygen saturation, sedation, and postoperative complications were evaluated.ResultsThe extubation quality became better, sedation and incidence of bradycardia in the post-operative period increased with a higher dose of dexmedetomidine. Attenuation of hemodynamic parameters was observed after 4 min of starting infusion and during extubation in each group and was found to be significant (P < 0.001).ConclusionsIt was concluded that dexmedetomidine when used at a dose of 0.75 μg/kg provided excellent extubation conditions with stable hemodynamic parameters in chronic smokers with minimal sedation and no other adverse effects.

Research progress on prevention of tracheal extubation response during recovery from general anesthesia

Research progress on prevention of tracheal extubation response during recovery from general anesthesia

Comparative Evaluation of Dexmedetomidine and Magnesium Sulphate in Mitigating Pressor Response while Extubation in Patients undergoing Mastoidectomies

Background: Ear surgeries performed under general anaesthesia mandate smooth emergence after surgery to facilitate a good surgical outcome. We conducted this study with primary objective of comparing dexmedetomidine and magnesium sulfate (MgSO4) in attenuating extubation response after mastoid surgeries. The secondary outcome was to study the adverse effects if any.&#x0D; Methods: Sixty patients of ASA grade I and II, aged 18 -50 yrs were randomized into 2 groups of 30 each receiving either dexmedetomidine 0.5μg/kg or MgSO4 30 mg/kg respectively 10 minutes prior to completion of surgery. Efficacy of both drugs in attenuating cough reflex, PONV, shivering and fluctuations in haemodynamic response were recorded. Postoperative sedation was noted. Any laryngospasm, bronchospasm, hypotension, bradycardia, desaturation was also noted.&#x0D; Statistical analysis: The observations were recorded and analysed using statistics calculator SPSS 19.00 version. Student’s t test and χ2 (chi square) test were used to analyze quantitative and qualitative data respectively. P-value&lt;0.05 was considered statistically significant.&#x0D; Results: The variations in systolic, diastolic blood pressure and heart rate were significantly less with dexmedetomidine as compared to MgSO4 (p&lt;0.01). Incidence of coughing (p=0.002), PONV(p=0.002), was less with dexmedetomidine while shivering control was similar in both groups, the sedation was more with dexmedetomidine (p=0.004). Patients with dexmedetomidine infusion were more satisfied in terms of reduced nausea sensation, drowsiness.&#x0D; Conclusion: Dexmedetomidine provides a smoother recovery profile as compared to MgSO4 when administered prior to extubation improving the surgical outcome and patient satisfaction in patients undergoing mastoidectomies.

Superior laryngeal nerve block with in-line lignocaine nebulization for awake extubation response.

Background and Aims:Tracheal extubation is associated with various undesirable hemodynamic and airway responses. Various drugs are used effectively to curb these responses. But these drugs have limitations and produce side effects. Hence, the study was planned to assess the effects of superior laryngeal nerve block with inline lignocaine nebulization on awake extubation responses to suggest an alternative. The aim of this study was to assess the effect of bilateral superior laryngeal nerve block with inline lignocaine nebulization on awake extubation responses.Material and Methods:A study was conducted in 35 patients aged 18-60 years, posted for surgery less than 3 h under general anesthesia. The hemodynamic responses like heart rate, arterial blood pressure, and mean arterial pressure were recorded preoperatively and at 1, 5, and 10 min postextubation. Undesirable respiratory responses like bucking, severity of sore throat, and cough response were also assessed. Repeated measures analysis of variance followed by the Tukey HSD test was used to find the significance of hemodynamic parameters. Qualitative data were expressed as percentages.Results:Decrease in Systolic Blood Pressure, Diastolic Blood Pressure and Mean Arterial Pressure was statistically significant at 5 mins (T2) and 10 mins (T3) postextubation as compared to baseline (T0). No cough was observed postextubation in 80% patients while 20% had mild Grade 1 cough.Conclusion:Superior laryngeal nerve block with in-line lignocaine nebulization for awake extubation is effective in curbing the haemodynamic and respiratory responses of extubation.

Effect of Different Concentrations of Esmolol on Perioperative Hemodynamics and Analgesia in Patients Undergoing Colectomy: A Prospective, Randomized Controlled Study.

PurposeThe aim of this study was to investigate the efficacy of esmolol on intraoperative hemodynamic and perioperative analgesic management.MethodsTotally, 125 patients undergoing colectomy were randomly divided into three groups. Group S (saline group) was administered 0.75 mL/kg/h of normal saline for 5 min before anesthesia induction and maintenance of 0.25 mL/kg/h; Group E1 and Group E2 were administered 0.5 mg/kg and 1.0 mg/kg esmolol for 5 min before anesthesia induction, and maintained of 0.5 mg/kg/h and 2.0 mg/kg/h, respectively. Several parameters including indexes of hemodynamics variation (primary outcome), intra- and postoperative analgesic usage, and pain score were measured.ResultsGroup E1 and Group E2 had significantly lower intubation response than Group S (P = 0.007, P = 0.001), and extubation response of Group E2 was significantly lower than Group S (P = 0.007). The opioid consumption in Group E1 and Group E2 was significantly lower than in Group S intraoperatively (P = 0.020 and 0.007). The incidence of postoperative adverse reactions among the three groups was not statistically significant (P = 0.368 and 0.772).ConclusionEsmolol 0.5 mg/kg and 1.0 mg/kg infusion before intubation both can effectively inhibit the intubation response, while only maintenance with 2.0 mg/kg/h of esmolol can reduce the incidence of extubation response. At the same time, esmolol can decrease intraoperative opioid requirement without increasing the risk of adverse reactions.Trial RegistrationChiCTR1900024538 and the date of registration was July 15, 2019 at http://www.chictr.org.cn.

Dexmedetomidine versus Lignocaine for extubation in patients undergoing craniotomies

Use of lignocaine and dexmedetomidine in terms of causing hemodymaic variation, sedation and pain management remains a question. Hence this was conducted to compare a bolus dose of dexmedetomidine 0.5mcg/kg/hr to a normal dose of 1.5mg/kg preservative free 2% lignocaine for extubation in patients undergoing craniotomies.This randomized controlled trial was conducted in the department of Anesthesiology at Sri Ramachandra Medical College and Research Institute, Chennai from January 2013 to June 2014. Patients aged between 18-60 years belongs to ASA class I and class II undergoing surgeries were included in the study. A total of fifty cases were included. Statistical analysis was done using SPSS version 17.Hemodynamic parameters showed significant attenuation of hemodynamic response during extubation when compared to lignocaine group and when the same were analyzed within the groups, the attenuation of extubation response was both clinically and statistically significant in both groups. Extubation and emergence time were similar in both the groups. Sedation and pain scores in dexmedetomidine group were low compared to lignocaine group. Single dose of dexmedetomidine given 10 minutes before extubation significantly attenuated the hemodynamic and airway response following extubation as compared to lignocaine given before reversal in patients undergoing craniotomy for intracranial space occupying lesions.

Comparing Different Doses of Dexmedetomidine in Attenuating Extubation Response in Hypertensive Patients Undergoing Laparoscopic Cholecystectomy

Abstract Background: Tracheal extubation is always linked with hypertension, tachycardia, and high-plasma catecholamine levels. These hemodynamic fluctuations are seen more often in hypertensive patients than in normotensives. The present study evaluates the effects of three different doses of dexmedetomidine in hypertensive patients relative to each other in attenuating extubation response. Patients and Methods: In this randomized, controlled, triple-blinded study, 105 controlled hypertensive patients of either sex on antihypertensive drugs in the age group of 30–70 years, scheduled for laparoscopic cholecystectomy were included. They were randomized into Groups A, B, and C receiving 0.5 μg/kg, 0.75 μg/kg, and 1 μg/kg of dexmedetomidine 10 ml infusion 10 min before extubation. Hemodynamic parameters in form of pulse rate, systolic and diastolic blood pressure, mean arterial pressure (MAP), oxygen saturation, and bispectral index (BIS) were noted. Extubation time, quality, and sedation were evaluated. Any side effects in form of postoperative nausea, vomiting, and bradycardia were noted. Results: There was significant attenuation of rise in heart rate, systolic, diastolic, and MAPs after 4 min of starting infusion between the three groups. At extubation, the values of hemodynamic parameters and BIS were significant between the three groups (P &lt; 0.001). While the quality of extubation improved and the sedation scores increased with the increase in the dose of dexmedetomidine, the incidence of bradycardia was more with dose of 1 μg/kg as compared to 0.75 μg/kg and 0.5 μg/kg. Conclusion: It was found that 0.75 μg/kg was the optimal dose for extubation as it facilitated smooth extubation and maintained hemodynamic stability in patients without causing undue sedation.

Management of a Patient with Pheochromocytoma Posted for Right Adrenalectomy

Introduction: Patients posted for adrenalectomy with pheochromocytoma pose major challenge to anaesthesiologist as there may be excess catecholamine release during its removal that leads to severe hypertension and arrythmias intra operatively. Case presentation: Here we discuss anaesthetic management of 27 year old female with right supra renal mass posted for right adrenalectomy. She came with complaints of abdominal pain and weight gain for which hormonal evaluation and CECT abdomen done and was diagnosed with pheochromocytoma of right adrenal gland. As patient was obese and venous accesibility was difficult central venous catheterisation was done prior to surgery. Case was done under combined epidural with general anaesthesia. Conclusion: In patients with pheochromocytoma posted for adrenalectomy, pre operative hormonal evaluation, intra operative and post operative hemodynamic stability are important. Intra operative and post operative tachycardia, hypertension prevented by smooth induction, minimise the intubation and extubation response and use of other adrenergic blockade drugs during and after surgery. Effective post operative pain management is necessary.

Comparison of IV magnesium sulphate and IV esmolol in attenuating hemodynamic extubation response after general anesthesia

Tracheal extubation is associated with a 10–30% increase in arterial pressure and heart rate that could be detrimental in patients with hypertension, ischemic heart disease, and cerebrovascular disease. A reliable technique for rapid &amp; smooth extubation with stable hemodynamics is still not fully evolved. To compare the effect of intravenous magnesium sulphate and esmolol for attenuating hemodynamic response to extubation after general anesthesia.Prospective, randomized, double blind study conducted at tertiary care hospital.Sixty adult subjects undergoing major surgery were randomly divided into 2 groups. Group M received magnesium sulphate 40 mg/kg &amp; Group E received esmolol 0.6 mg/kg IV infusion over 5 minutes before extubation. Heart rate, systolic &amp; diastolic blood pressure, mean arterial pressure, rate pressure product, pain score &amp; sedation score were compared from extubation till 15 minutes after extubation. Students ‘t’ test used for continuous variables &amp; Chi Square test for categorical data.21.82% fall in heart rate was observed in group M with a plateau at 10 -15 minutes compared to 37.07% in group E with a peak at 15 minutes (p=0.0150). Fall in Systolic blood pressure was 18.86% in group M &amp; 21.15% in group E (p=0.4298). Rate pressure product was significantly lower in group E (50.40%) than group M (36.66%). Postoperative pain score was significantly less in group M compared to group E (p&amp;#60;0.0001). Magnesium sulphate provides better hemodynamic stability with postoperative analgesia compared to esmolol when used for attenuating hemodynamic response to extubation.

A comparison among different doses of dexmedetomidine in attenuating extubation response in patients undergoing open cholecystectomy

A comparison among different doses of dexmedetomidine in attenuating extubation response in patients undergoing open cholecystectomy

20. Effect of Airway Nebulization with Ropivacaine on Intubation and Extubation Responses in Patients Undergoing Surgery under General Anesthesia: A Randomized Double-blinded Controlled Study

20. Effect of Airway Nebulization with Ropivacaine on Intubation and Extubation Responses in Patients Undergoing Surgery under General Anesthesia: A Randomized Double-blinded Controlled Study

Effect of Pharmacological Agents Administered for Attenuating the Extubation Response on the Quality of Extubation: A Systematic Review.

BackgroundSeveral drugs have been tried to obtund the hemodynamic extubation response but all have variable side effects that may affect the quality of short-term recovery.ObjectiveOur primary objective was to evaluate the effect of pharmacological agents, such as dexmedetomidine, local anesthetics, and so on, administered for attenuating the extubation response on the quality of extubation, as judged by the presence or absence of cough, sedation, and laryngospasm/bronchospasm in adult patients who had undergone general anesthesia. A secondary objective was to evaluate the effect of these drugs on other immediate post-extubation complications such as respiratory depression, desaturation, bradycardia, hypotension, and nausea and vomiting (PONV).MethodsThis is a systematic review of (randomized controlled trials) RCTs with meta-analysis. The Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for RCTs on the effect of pharmacological agents on both the hemodynamic extubation response as well as the quality of extubation.ResultsFourteen out of 24 included studies were subjected to a meta-analysis. The risk of cough was less likely in the intervention group as compared to control groups (OR 0.26, 95% CI 0.15 to 0.46, p<0.00001, I2=35%). Sedation, hypotension (OR= 10.47; 95% CI: 1.86, 58.80, p=0.008, I2=0%), and bradycardia (OR= 6.57; 95% CI: 2.09, 20.64, p=0.001, I2=0%) were reported with dexmedetomidine. Only one study reported laryngospasm with dexmedetomidine and two studies with opioids.ConclusionDexmedetomidine 0.4 to 0.5 ug/kg was associated with smooth extubation, minimal coughing, no laryngospasm/ bronchospasm, and with stable hemodynamics, without causing respiratory depression, PONV, and desaturation. However, in higher doses (more than 0.5 ug/kg), it caused bradycardia, hypotension, and sedation. Other pharmacological agents, such as local anesthetics, calcium channel blockers, and opioids, did not attenuate cough associated with extubation.

Prospective randomized comparative trial of dexmedetomidine versus esmolol for attenuation of extubation response

Background and Aims: General anesthesia is known to elicit stress response during endotracheal intubation, but the equally important period of extubation is usually not addressed. The aim was to compare dexmedetomidine and esmolol for attenuation of extubation response. Materials and Methods: In this prospective randomized double-blind trial, 100 American Society of Anesthesiologists I/II patients between 18 and 60 years of age undergoing abdominal and lower-limb surgeries were randomly allocated into two groups (n = 50 each). Patients in Group D received dexmedetomidine (0.5 μg/kg intravenous [IV] bolus) over 10 min and in Group E received esmolol (1 mg/kg bolus IV) before extubation. Hemodynamic parameters, namely, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP), were compared at baseline, 10 min before extubation, at extubation, and at 1, 3, 5, 10, and 15 min thereafter. Data were expressed as mean ± standard deviation and analyzed using Student's unpaired t-test and Chi-square test. P

Dexmedetomidine versus Esmolol to attenuate the extubation response following surgeries under general anaesthesia - A comparative study

Dexmedetomidine versus Esmolol to attenuate the extubation response following surgeries under general anaesthesia - A comparative study