COMPARING TWO DOSES OF DEXMEDETOMIDINE TO ATTENUATE EXTUBATION RESPONSE IN ELECTIVE LAPAROSCOPIC ABDOMINAL SURGERY: A PROSPECTIVE RANDOMIZED DOUBLE-BLIND CONTROLLED TRIAL
Main Article Content
Keywords
Dexmedetomidine, extubation response, laparoscopic surgery, hemodynamic stability
Abstract
Background
Extubation during general anesthesia is associated with significant sympathetic stimulation, causing transient but potentially harmful hemodynamic and airway reflex responses. Dexmedetomidine, an α2-adrenoceptor agonist, is increasingly used to attenuate these stress responses, but the optimal dose for elective laparoscopic abdominal surgery remains under-investigated.
Objective
To compare the efficacy and safety of two intravenous dexmedetomidine doses 0.75 µg/kg and 0.5 µg/kg—in suppressing extubation-related hemodynamic and airway responses and sedation score in patients undergoing elective laparoscopic abdominal surgery.
Methods: In a prospective, double-blinded, randomized controlled trial, 74 ASA I-II adult patients (18–60 years) were assigned to receive either 0.75 µg/kg (Group A) or 0.5 µg/kg (Group B) of dexmedetomidine intravenous infusion over 10 minutes, 15 minutes prior to extubation. Hemodynamic parameters (heart rate, systolic/diastolic blood pressure, mean arterial pressure), oxygen saturation, extubation quality, and sedation scores were recorded pre-extubation and up to two hours post-extubation.
Results: The groups were comparable demographically. Group A demonstrated significantly better attenuation of heart rate and blood pressure responses post-extubation (p<0.001).
Smooth extubation without coughing (Extubation Quality Scale score 1) occurred in 59.5% of Group A versus 8.1% in Group B (p<0.01). Group A patients showed higher Ramsay Sedation Scores immediately post-extubation, indicating deeper but clinically safe sedation. Oxygen saturation remained above 98% with no respiratory compromise in either group. No episodes of bradycardia or hypotension requiring intervention occurred.
Conclusion: Dexmedetomidine at 0.75 µg/kg provides superior hemodynamic stability and smoother extubation compared to 0.5 µg/kg dose in elective laparoscopic abdominal surgery. This dose optimally balances efficacy and safety, making it preferable for clinical use.
References
2. Liu Z, et al. Optimal dexmedetomidine dose to suppress airway and cardiovascular responses to extubation. J Perioper Sci. 2023.
3. Turan G, Ozgultekin A, Turan C, Dincer E, Yuksel G. Advantageous effects of dexmedetomidine on haemodynamic and recovery responses during extubation for intracranial surgery. Eur J Anaesthesiol. 2008;25:816-820.
4. Jamal MK, Ahmad S, Ahmad F. A comparative study of three dexmedetomidine doses for extubation response. J Med Sci Clin Res. 2018;6(3):1521.
5. Bindu B, Pasupuleti S, Gowd UP, Gorre V, Murthy RR, Laxmi MB. To study the effect of dexmedetomidine on hemodynamic and recovery responses during tracheal extubation. J Anaesthesiol Clin Pharmacol. 2013;29:162-67.
6. Agarwal M, Malliwal A. Effect of dexmedetomidine on hemodynamic responses during tracheal extubation. Ind J Clin Anaesth. 2019;06:23-29.
7. Kotak N, Mamde R, Desai PM. Prospective randomised comparative trial of dexmedetomidine versus esmolol for attenuation of extubation response. Med J DY Patil Vidyapeeth. 2019;12:131-35.
8. Sharma A, Gupta M, Kapoor BB. Comparative evaluation of dexmedetomidine, fentanyl, magnesium sulphate and control group to attenuate pressor responses and airway reflexes to intubation during general anaesthesia. J K Sci. 2018;20:120-27.
9. Standring S, ed. Gray's Anatomy: The Anatomical Basis of Clinical Practice. 41st ed. London: Elsevier; 2016. p. 503-521, 688-698.
10. Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Cohen NH, Young WL. Miller's Anesthesia. 9th ed. Philadelphia: Elsevier; 2020. Chapter 56: Extubation and Emergence, p. 1495-1512.
11. Precedex (Dexmedetomidine) Package Insert. Abbott Park, IL: Abbott Laboratories; 2004.
12. Drummond JC, Dao AV, Roth DM, Cheng C, Atwater IB, Minokadeh A, et al. Effect of dexmedetomidine on cerebral blood flow velocity, cerebral metabolic rate and carbon dioxide response in normal humans. Anesthesiology. 2008;87:684-90.
13. Panzer O, Moitra V, Sladen RN. Pharmacology of sedative-analgesic agents: dexmedetomidine, remifentanil, ketamine, volatile anesthetics, and the role of peripheral mu antagonists. Critical care clinics. 2009;25(3):451-69.
14. Dogru K, Arik T, Yildiz K, Bicer C, Madenoglu H, Boyaci A. The effectiveness of intramuscular dexmedetomidine on hemodynamic responses during tracheal intubation and anesthesia induction of hypertensive patients: a randomized, double- blind, placebo-controlled study. Current therapeutic research. 2007;68(5):292-302.
15. Fragen RJ, Fitzgerald PC. Effect of dexmedetomidine on the minimum alveolar concentration of sevoflurane in adults aged 55-70 years. Journal of Clinical Anesthesia. 1999;11:466-70.
16. Kanazi GE, Aouad MT, Jabbour-Khoury SI, Al-Jazzar MD, Alameddine MM, Al- Yaman R, et al. Effect of small dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta Anaesthesiol Scand. 2005;50:222-7.
17. Khan ZP, Munday IT, Jones RM, Thornton C, Mant TG, Amin D. Effects of dexmedetomidine on isoflurane requirement in healthy volunteers: 1 Pharmacodynamics and pharmacokinetic interactions. Br J Anaesth. 1999;83:372-80.
18. Talke P, Tayefeh F, Sessler DI, Noursalehi M, Richardson C. Dexmedetomidine does not alter the sweating threshold but comparably and linearly decreases the vasoconstriction and shivering thresholds. Anesthesiology. 1997;87:835-41.
19. Shehabi Y, Ruettimann U, Adamson H, Innes R, Ickeringill M. Dexmedetomidine infusion for more than 24 hours in critically ill patients: sedative and cardiovascular effects. Intensive Care Med. 2004;30:2188-96.
20. Aho M, Erkola O, Kallio A, Scheinin H, Korttila K. Comparison of dexmedetomidine and midazolam sedation and antagonism of dexmedetomidine with atipamezole. Journal of Clinical Anesthesia. 1993;5:194-203.
21. Ebert TJ, Hall JE, Barney JA, Uhrich TD, Colinco MD. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology. 2000;93:382- 94.
22. Mohamed Ali M, Sharma L, Patel D. Comparative study of two dexmedetomidine doses on extubation response. Saudi J Anaesth. 2021;15:89-95.
23. Bhardwaj V, Singha D, Pathania A, Chaudhary U, Chaudhary S. Comparing different doses of dexmedetomidine in attenuating extubation response in hypertensive patients undergoing laparoscopic cholecystectomy. Bali J Anaesthesiol. 2021;5:72-7.
24. Manickam V, Kumar P, Singh S, et al. Dose-dependent dexmedetomidine effects on extubation in cholecystectomy. Int J Surg Anesth. 2021;52:75-80.
25. Jain D, et al. Hemodynamic and coughing response to extubation: Dose-response evaluation of dexmedetomidine. Indian J Clin Anaesth. 2022;9(1):10-6.
26. Ayyanagouda B, Dhulkhed VK, Mudigere SS. Comparison of 0.5 µg/kg and 0.75 µg/kg dexmedetomidine in attenuating hemodynamic response during extubation. Indian J Anaesth. 2023;67:43-316.
27. Luthra A, Prabhakar H, Rath GP. Alleviating stress response to tracheal extubation in neurosurgical patients: A comparative study of two infusion doses of dexmedetomidine. J Neurosci Rural Pract. 2017;8:S49-56.
28. Singh R, et al. Comparison of dexmedetomidine 0.5 vs 1 mcg/kg for smooth extubation in neurosurgical cases. Asian J Neurosurg. 2020;15(2):332-8.
29. Ranjan A, Kumar M. Comparison of two different doses of dexmedetomidine in attenuation of haemodynamic response during endotracheal extubation. Int J Pharm Clin Res. 2024;16(6):2487-90.
30. Suresh R, Prakash S, Rao M, et al. Efficacy of dexmedetomidine 0.75 µg/kg for extubation hemodynamics. Ann Anesth Res. 2020;41(2):12-18.
31. Kotak S, Phalgune DS. Comparison of two dexmedetomidine doses in elective surgery. Indian J Anaesth Crit Care. 2022;8(3):145-150.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Komal Kishanrao Mutkhede
Junior Resident, Department of Anesthesiology, Government Medical College, Nagpur, Maharashtra, India.
Dr. Megha Tajne
Professor & HOD, Department of Anesthesiology, Government Medical College Nagpur, Maharashtra, India.
Dr Tanisha Uikey
Undergraduate Student, Datta Meghe Institute of Higher Education and Research, Nagpur, Maharashtra, India.
Dr Avishkar Gaikwad
Undergraduate Student, Datta Meghe Institute of Higher Education and Research Nagpur, Maharashtra, India.
Dr. Pratiksha Gosavi
Junior Resident, Department of Anesthesiology, Government Medical College Nagpur, Maharashtra, India.
Dr. Saikat Dhar
Junior Resident, Department of Anaesthesiology, Government Medical College Nagpur, Maharashtra, India.