Comparison of dexmedetomidine and lignocaine on attenuation of airway and pressor responses during tracheal extubation

Abstract

Background: Haemodynamic stability and rapid emergence after general anaesthesia used in spinal surgery is a common practice, the goal of which is to permit early neurological motor and sensory examination. Extubation is almost always associated with hypertension, increased airway response and arrhythmias. We have compared the effects of the α-2 agonist Dexmedetomidine and Lignocaine given at the end of the procedure on attenuation of airway and pressor responses following tracheal extubation. This study is a randomised, placebo-controlled, double-blinded study. Materials and Methods: Sixty ASA I-III patients, aged 18-70 years, scheduled to undergo spinal surgery at the level of thoracic, lumbar or sacral region were randomly divided into three groups. Balanced general anaesthesia comprising standard procedures and drugs were used for monitoring, induction and maintenance. At the last skin suture, inhalation anaesthetic was discontinued. After turning the patient supine and return of spontaneous efforts, in Group D Dexmedetomidine 0.5 μg/kg, in Group L Lignocaine 1.5 mg/kg and in Group P normal saline (10 ml) were administered as bolus intravenously over 60 seconds. Systolic, diastolic and mean arterial pressures and heart rate were recorded before intravenous administration and also every minute for 3 minutes, at 5, 10 and 15 minutes post-extubation. Duration of emergence and extubation were noted and attenuation of airway response and quality of extubation was evaluated on cough grading. Results: Mean arterial pressures and heart rate were higher in Group L and Group P than in Group D but not statistically significant. The duration of emergence, extubation and recovery were comparable in all the groups (P > 0.05). Extubation Quality Scores was 1 in 80%, 2 in 20% in Group D; in Group L, the quality scores were 1 for 55%, 2 for 45% and I Group P 1 for 35%, 2 for 45% and 3 for 20% of the patients. The requirement of rescue analgesia was also less and after prolonged time in Group D than in Group L and Group P (P < 0.05). None of the patients in all three groups showed respiratory depression, allergic reactions, nausea, vomiting or shivering. There was occurrence of hypertension for the initial 3 minutes of administration of drug in 10 (50%) of patients in Group D (Dexmedetomidine) group. Conclusion: Without interfering in emergence and extubation times, attenuation of pressor response is comparable between Dexmedetomidine 0.5 μg/kg and Lignocaine 1.5 mg/kg but airway response is much better controlled allowing a smooth easy extubation providing a more comfortable recovery and early neurological examination following spinal surgeries.

Keywords

Airway responses - dexmedetomidine - haemodynamics - lignocaine - tracheal extubation

• REFERENCES

• 1 Nishina K, Mikawa K, Maekawa N, Obara H. Attenuation of cardiovascular responses to tracheal extubation with diltiazem. Anesth Analg 1995; 80: 1217-22
• 2 Fuji Y, Saitoh Y, Takahashi S, Tayooka H. Combined diltiazem and lidocaine reduces cardiovascular responses to tracheal extubation and anesthesia emergence in hypertensive patients. Can J Anaesth 1999; 46: 952-6
• 3 Mikawa K, Nishina K, Maekawa N, Obara H. Attenuation of cardiovascular responses to tracheal extubation; Verapamil v/s Diltiazem. Anesth Analg 1996; 82: 1205-10
• 4 Cranfield KA, Bromley LM. Minimum alveolar concentration of desflurane for tracheal extubation in deeply anaesthetized, unpremedicated children. Br J Anaesth 1997; 78: 370-1
• 5 Miller KA, Harkin CP, Bailey PL. Postoperative tracheal extubation. Anesth Analg 1995; 80: 149-72
• 6 Nishina K, Mikawa K, Shiga M, Maekawa N, Obara H. Prostaglandin E1 attenuates the hypertensive response to tracheal extubation. Can J Anaesth 1996; 43: 678-83
• 7 Nishina K, Mikawa K, Maekawa N, Obara H. Fentanyl attenuates cardiovascular responses to tracheal extubation. Acta Anaesthesiol Scand 1995; 39: 85-9
• 8 Baraka A. Intravenous lidocaine controls extubation laryngospasm in children. Anesth Analg 1978; 57: 506-7
• 9 Jee D, Park SY. Lidocaine sprayed down the endotracheal tube attenuates the airway-circulatory reflexes by local anesthesia during emergence and extubation. Anesth Analg 2003; 96: 293-7
• 10 Minogue SC, Ralph J, Lampa MJ. Laryngotracheal topicalization with lidocaine before intubation decreases the incidence of coughing on emergence from general anaesthesia. Anesth Analg 2004; 99: 1253-7
• 11 Dyson A, Isaac PA, Penant JH, Giesecke AH, Lipton JM. Esmolol attenuates cardiovascular responses to extubation. Anesth Analg 1990; 71: 675-8
• 12 Muzzi DA, Black S, Losasso TJ, Cucchiara RF. Labetolol and esmolol in the control of hypertension after intracranial surgery. Anesth Analg 1990; 70: 68-71
• 13 Kovac AL, Masiongale A. Comparison of Nicardipine versus esmolol in attenuating the haemodynamic response to anesthesia emergence and extubation. J Cardiothorac Vasc Anesth 2007; 21: 45-50
• 14 Sadegi M, Firozian A, Ghafari MH, Eefehani F. Comparison in effect of intravenous alfentanil and lidocaine on airway-circulatory reflexes during extubation. Int J Pharmacol 2008; 4: 223-6
• 15 Turan G, Ozgultekin A, Turan C, Dincer E, Yuksel G. Advantageous effects of Dexmedetomidine on haemodynamic and recovery reponses during extubation for intracranial surgery. Eur J Anaesthesiol 2008; 25: 816-20
• 16 Guler G, Akin A, Tosun Z, Eskitascoglu E, Mizra A, Boyaci A. Single-dose dexmedetomidine attenuates airway and circulatory reflexes during extubation. Acta Anaesthesiol Scand 2005; 49: 1088-91
• 17 Lawrence CJ, De Lange S. Effects of a single pre-operative dexmedetomidine dose on isoflurane requirements and peri-operative haemodynamic stability. Anaesthesia 1997; 52: 736-44
• 18 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
• 19 Bekker AY, Basile J, Gold M, Riles T, Adelman M, Cuff G. et al. Dexmedetomidine for awake carotid endartectomy: Efficacy, hemodynamic profile, and side effects. J Neurosurg Anesthesiol 2004; 16: 126-35
• 20 Tanskanen PE, Kytta JV, Randell TT, Aantaa RE. Dexmedetomidine as an anaesthetic adjuvant in patients undergoing intracranial tumor surgery: A double blind, randomized and placebo-controlled study. Br J Anaesth 2006; 5: 658-65
• 21 Bloor BC, Ward DS, Belleville JP, Maze M. Effects of intravenous dexmedetomidine in humans: Part II-Hemodynamic changes. Anesthesiology 1992; 77: 1134-42
• 22 Khan ZP, Ferguson CN, Jones RM. Alpha-2 and imidazoline receptor agonists: Their pharmacology and therapeutic role. Anaesthesia 1999; 54: 146-65
• 23 Asai T, Koga K, Vaughan RS. Respiratory complications associated with tracheal intubation and extubation. Br J Anaesth 1998; 80: 767-75
• 24 Turan C, Turan G, Ozgultekin A, Dýncer E, Yuksel G. The effects of two different doses of dexmedetomidine on extubation: 9AP3-5. Eur J Anaesthesiol 2007; 24: 114
• 25 Arain SR, Ruehlow RM, Uhrich TD, Ebert TJ. The efficacy of dexmedetomidine versus morphine for postoperative analgesia after major in patient surgery. Anesth Analg 2004; 98: 153-8