Abstract

Endotracheal intubation is marked by sympathetic stimulation and increase in catecholamine concentration in susceptible individuals. Tracheal extubation can also be associated with detrimental airway and hemodynamic responses. Many drugs are used to attenuate the intubation response. Dexmedetomidine has been shown to be effective in maintaining hemodynamic stability during intubation and extubation without prolonging recovery. Fentanyl has been reported to reduce the prevalence of coughing during and after extubation. Magnesium sulphate decreases the hemodynamic response to airway management, with proven effectiveness. This study evaluated the efficacy and safety of dexmedetomidine, fentanyl and magnesium sulphate to find out safe anaesthetic technique so that pressor response changes and airway reflexes at the time of extubation are not harmful to the patient. Materials and Methods: This prospective, randomized study was conducted on 100 patients in the Government Medical College and Associated Hospitals, Jammu. The patients enrolled were those undergoing elective surgical procedures under endotracheal anaesthesia, of ASA Grade-I, within the age group of l8-65 years, of either sex. Pulse rate, blood pressure, electrocardiogram and oxygen saturation were recorded during preinduction, just before extubation, and l, 2, 3, 5 and 10 minutes after extubation. Mean arterial pressure at those intervals was calculated. Any laryngospasm, tracheal collapse, laryngeal edema, vocal cord paralysis, pulmonary edema and laryngeal incompetence bronchospasm, or desaturation was recorded. The time for requirement of first analgesic dose post-operatively was noted.The data so collected was analyzed, compared and subjected to statistical analysis. Results: There was statistically significant rise in mean heart-rate 1 and 2 minutes after extubation in all the groups (p<0.05) except in dexmedetomidine group. Mean heart rate decreased to non-significant levels in magnesium sulphate and fentanyl groups at 3 minutes, whereas it remained significant in the control group upto 5 minutes. Before extubation and after extubation, mean SBP, mean DBP and mean ABP shot up significantly in the control group. Conclusion: Dexmedetomidine is more effective as compared to magnesium sulphate and fentanyl in attenuating the rise in heart rate and blood pressure after extubation. There are no adverse effects seen in patients treated with dexmedetomidine.

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