6. Single low dose dexmedetomidine for attenuation of hemodynamic responses and airway reflexes during extubation following spine surgery - A randomized controlled prospective study

Background: Smooth extubation, haemodynamic stability, rapid emergence from anaesthesia allow immediate neurological evaluation. We evaluated the efficacy of single low dose dexmedetomidine (0.25 mcg/kg) vs. normal saline for attenuation of hemodynamic responses and airway reflexes during extubation following spine surgery. Materials and Methods: Eighty ASA I and II patients, aged 18-65 years, undergoing spine surgery under anesthesia were randomly divided into two groups using computer generated table. The standard neuroanesthesia protocols and drugs were used for monitoring, induction and maintenance of anesthesia. After discontinuing sevoflurane, 5 minutes before end of surgery, patients in Group D received dexmedetomidine 0.25 mcg/kg and Group C received 20 ml normal saline intravenously over 5 minutes. With patient supine, extubation was done after reversal of neuromuscular blockade. Heart rate, oxygen saturation, Systolic and Diastolic Blood Pressure were recorded before administration of the drug and at 1, 3 and 5 minutes during drug administration, at completion of dressing, at the time of extubation, and at 1, 3, 5, 7 and 10 minutes after extubation. Attenuation of airway response and Extubation quality was rated using extubation quality scale. Adverse effects, Extubation and Emergence time were recorded. Results: All data measured and analyzed using standard statistical tests (student’s t-test, Chi-square, Fisher’s Exact Probability tests, Man- Whitney, Wilcoxon rank test). A ‘P’ value of ≤ 0.05 was taken as significant. The systolic, diastolic blood pressure and heart rate were higher in group C than in group D. The need for rescue medications (nitroglycerine for hypertension, esmolol for tachycardia) was higher in group C. Extubation quality scores were superior in group D than group C. Extubation time and Emergence time were comparable in both the groups. Conclusion: Dexmedetomidine in a single dose of 0.25 mcg/kg is safe and efficacious in attenuation of hemodynamic responses and airway reflexes during extubation following spine surgery without prolonging emergence and extubation times.

No conflict of interest has been declared by the author(s).