A Randomised Comparative Study Between Dexmedetomidine and Fentanyl on Attenuating Stress Response and Airway Response to Tracheal Extubation

Abstract

BACKGROUND: Tracheal extubation and emergence is associated with significant hemodynamic alterations and is poorly tolerated by patients with comorbid conditions. We compared the efficacy of dexmedetomidine and fentanyl in mitigating hemodynamic stress response and assessed extubation quality in study groups. AIM: To study the efficacy of dexmedetomidine and fentanyl on the attenuation of hemodynamic responses and airway reflexes during extubation following surgery under general anaesthesia. OBJECTIVES :  Hemodynamic changes of dexmedetomidine and fentanyl.  Adverse effects of dexmedetomidine and fentanyl such as delayed arousal, respiratory depression, bradycardia, hypotension, vomiting.  Early postoperative complication like laryngospasm. METHODS: A Randomised comparative study was conducted in the department of Anesthesia at B.L.D.E. (DEEMED TO BE UNIVERSITY) Shri B. M. Patil Medical College Hospital and Research Centre, Vijayapura. Ethical Committee permission- Taken Informed written consent-Taken Total of 60 patients scheduled for various surgical procedures under general anaesthesia were allotted into two groups. Group D (Dexmedetomidine) Intravenous dexmedetomidine 0.4mcg/kg body weight diluted to 20 ml in normal saline is infused over 15 minutes prior to completion of surgery using infusion pump. DocuSign Envelope ID: 140F1505E3C7721--71EA14F1--44880BF0--996EF3C2--0F2D4F31CC3D939C7BD95A61 X Group F (Fentanyl) Intravenous fentanyl 0.5 mcg/kg body weight diluted to 20 ml in normal saline infused over 15 minutes prior to completion of surgery using infusion pump. Test used were Chi square test, unpaired t test and Anova test. Inclusion criteria  Age 18-60 years of age.  ASA grade I and II.  Mallampati grade I and II.  Patient’s giving valid and informed consent. Exclusion criteria  Patient’s suffering from cardiac and pulmonary disease.  Patient’s with anticipated difficult airway.  Pathology of oropharyngeal tract.  Patient’s on beta blockers, patients with conduction defects of the heart (heart blocks).  Pregnant women.  Morbidly obese (BMI>35kg/m2)  Patients with anticipated difficult airway. RESULTS : Statistically significant lesser increase in heart rate, systolic blood pressure, diastolic blood pressure and mean arterial blood pressure in the dexmedetomidine group than fentanyl group. Dexmedetomidine group had better extubation quality than the fentanyl group. Bradycardia in two cases observed with dexmedetomidine group than the fentanyl group but none required intervention. DocuSign Envelope ID: 140F1505E3C7721--71EA14F1--44880BF0--996EF3C2--0F2D4F31CC3D939C7BD95A61 XI CONCLUSION: Inj. Dexmedetomidine 0.4mcg/kg body weight in 20 ml normal saline administered 15 minutes before tracheal extubation was better compared to Inj. Fentanyl 0.5 mcg/kg body weight in 20 ml normal saline in attenuating airway and hemodynamic reflexes to a greater extent allowing smooth and easy tracheal extubation , thereby providing comfortable recovery. Hence, dexmedetomidine infusion can be a safer alternative to fentanyl infusion for attenuating stress response.